FNP in a psychiatric office?

Jules A, MSN · Aug 7, 2015

In Virginia you can be an FNP and work in Psych. Lots of Psych offices with ads for hiring FNPs.

NP if it is cool with your BON. However I wouldn't take the word of employers because they could care less if you are practicing outside your scope.

Have you gotten actual confirmation from the VA board of nursing about this practice?

traumanightsRN, NP · Aug 7, 2015

NP of it is cool with your BON. However I wouldn't take the word of employers because they could care less if you are practicing outside your scope.

I completely understand what your saying and the OP definitely needs to check with their BON. But in Virginia an FNP is allowed to work in acute care, psych, primary care, women's health, etc.

harmonizer · Aug 7, 2015

Bottom line---This topic came up so many times. It really depends on the BON of each state. Unfortunately, in some states, there is no specific clause limiting advanced nursing practice in within certified specialty, which would allow FNP to work in psych setting. I am personally against this. I understand people said that you can learn med management from experience and so on. But this is not just meds. Psych visit also involves diagnosing and assessing and good history taking. Some clinic allows 30 min follow-up appointment and you can do and bill some supportive therapy, which includes the concepts learned from psych experiences and psych theories, not included in FNP curriculum.

It looks bad for the profession to allow members to practice in an area without verified standard education. You do not see family physician treat complicated psychiatric issues and bill for it but in nursing we can (in some states). If this is the case, why are we specializing for? We can just all do FNP. However, nothing can be done since there are no clear rules. Please call the BON and read the rules-- that's it. But another thing to consider.. I heard the rumor that some insurance companies may require board certification for credentialing..

elkpark · Aug 7, 2015

Totally apart from the BON questions, what about what clients expect and deserve?? People who are presenting at psychiatric offices are there because they want and expect to be seen by psychiatric specialists. If I went to a psychiatric practice, there is no way I would find it acceptable to be seen by an FNP. It's one thing when people go their PCP's office and c/o sxs of depression or anxiety -- they have chosen to present at a generalist's office with these complaints. But people go to a specialist because they are looking for a specialist, not a generalist passing her/himself off as a specialist.

traumanightsRN, NP · Aug 7, 2015

Totally apart from the BON questions, what about what clients expect and deserve?? People who are presenting at psychiatric offices are there because they want and expect to be seen by psychiatric specialists. If I went to a psychiatric practice, there is no way I would find it acceptable to be seen by an FNP. It's one thing when people go their PCP's office and c/o sxs of depression or anxiety -- they have chosen to present at a generalist's office with these complaints. But people go to a specialist because they are looking for a specialist, not a generalist passing her/himself off as a specialist.

I definitely agree with this. A patient goes to a specialist to see a specialist. I believe in the future all regulators of NPs will require specialty certification to work in X specialty. It's better and safer for the patient and justifies our education and training. It's better for our profession in my humble opinion.

Whispera, MSN, RN · Aug 7, 2015

It bothers me SO much that a psychiatrist's office wants to hire a generalist NP! Besides all everyone wrote above, there's a huge learning curve in any new NP job. The patients you will see in your early months may not get what they need to get from you. I think it's an accident waiting to happen as well.

I second, also, that some insurance companies require certification in the specialty in which you work, whether your state allows you to do the work or not.

I wonder if the office manager is acting on the doctors' thoughts or if he just doesn't understand the difference between a FNP an a psych NP??

Dranger · Aug 7, 2015

Should and allowed are two totally different things. Just because the BON is loosey goosey on restricting practice to specific specialties in some states doesn't mean it's a good thing. As many on here have echoed, the mantra that FNPs can do everything should and will fall by the wayside.

There are specialties for a reason as there are physician residencies for a reason. You don't see an OB or family med doc waltz into an ICU to start bronching, intubating or titrating vents even though they have vastly more generalized training than the average NP even before residency. I don't understand why some NPs are so resistant when physicians got this memo decades ago.

You get a PMHNP degree you go into psych,

FNP you go into primary care across the lifespan

ACNP you treat inpatient and specialty clinic adults

PNP-AC you treat kids in a hospital setting

CRNA you give the gas

CNM you delivery babies and provide some GYN care

The list goes on....

Off the top of my head I can think of at least 7 NP specialties not including CNM and CRNA. Do they exist just for fun and no purpose?

Jules A, MSN · Aug 7, 2015

I don't think some psychiatrists understand that there is a psych-NP designation, cause nursing is so straight forward, rofl. So when they hear from FNPs that "we can do anything" they figure what the heck. Other types of employers could care less if you aren't practicing within your scope and will throw you under a bus in a hot second.

As a psychNP of course I find it offensive that those with inadequate education and experience in psych are smug enough to feel they can do a decent job sorting through the subtleties of this most vulnerable population. I see the damage they do with their incompetent prescribing on my inpatient acute unit. I also enough respect for your field to get my FNP certificate so I can legally prescribe basic somatic meds but trust me you won't find me attempting to work in an ED despite my extensive clinical experience and love of that specialty. Knowing what we don't know as both a new grad or experienced professional is priceless, imo.

bethymaester · Aug 7, 2015

Okay, so I'm seeing a lot of concern over a FNP handling psych cases, which is my concern and why I was wondering if it would be common to have a different role in mind for a FNP in a psych clinic. I don't know, but I feel like with only psychologists, counselors, a PHM-NP, and a physician one day per week, maybe they want someone to do physical exams or something like that? Handle straightforward cases a FNP would see in primary care like some ADD/ADHD, etc.?

Whispera, MSN, RN · Aug 7, 2015

I think you need a written job description so you'll know what would be expected. I have FNP friends who work in psychiatrist's offices and inpatient. They do physicals and handle medical problems so the psychiatrist doesn't have to do it. at their beginnings, however, they were expected to prescribe psych meds too. That stopped. One more thing, considering areas of expertise...psychiatrists aren't necessarily well-versed in medical issues, just as a family practice doc isn't expert in psych. If your state, or the insurance companies require a doc to collaborate with you, and even if not, who will you turn to in a sticky medical situation?

PG2018 · Aug 7, 2015

In my state, there are FNPs working in outpatient psychiatry. It's not in violation of any regulations. What I submit, from experience, is that they can do less. They never do psych evals. They do med checks, and depending on the insurance, they may not be reimbursed at the same rates a PMHNP would be.

However, you'd be great to have around because we could throw the folks that have a thyroid disorder, dyslipidemia, hyperglycemia, obesity, epilepsy, migraines, etc. in your direction. Many of those are caused by our psychotropics. The latter two are frequent in our population.

Jules A, MSN · Aug 7, 2015

I think you need a written job description so you'll know what would be expected. I have FNP friends who work in psychiatrist's offices and inpatient. They do physicals and handle medical problems so the psychiatrist doesn't have to do it. at their beginnings, however, they were expected to prescribe psych meds too. That stopped. One more thing, considering areas of expertise...psychiatrists aren't necessarily well-versed in medical issues, just as a family practice doc isn't expert in psych. If your state, or the insurance companies require a doc to collaborate with you, and even if not, who will you turn to in a sticky medical situation?

Interesting and they were probably smart for declining to continue. I can't imagine why a psychiatrist, unless at a state funded all purpose clinic, would want FNPs for physical exams? How would that billing even work if their PCP is billing for them also? If they don't have a PCP they need one.

Imvho if a patient's garden variety ADHD or uncomplicated depression can be handled on 1 medication its appropriate for a FNP to do it although ideally I'm not sure if they are astute in the role and value that therapy will provide. Do FNPs know when to require therapy? Slogging along with inadequate coping skills in hopes that a pill will fix everything is rather counterproductive. I'd also advise treading lightly in taking on anxiety because instead of trialing SSSRI most PCPs go right to freaking Xanax which usually results in a train wreck that the "mental health specialist" now needs to correct.

My outpatients have or are required to get a PCP who I collaborate with when needed. If they don't have a PCP we can refer them to one but under no circumstances are we taking on the PCP role in a solely psychiatric clinic.