FNP working in mental health

delphiniumRN · Jul 28, 2010

Actually I will get my Psych Np next year and the only caveat I have to you is to know what you are dealing with when doing psych. For instance in IM a family M.D. wont touch someone with severe depression with psychotic features, Mania that is not well controlled and chronic Anxiety/OCD issues.

If you decide to go into the psych field which your FNP does not restrict, remember that if you were to go into a court of law to defend yourself you would have to prove that your training was adequate to handle this type of patient.

For example as a psych NP there is no law that I can not treat a Bacterial Brochial infection, however if I have no adequate training in that field and that patient ends up sicker s/p my treatment and it is due to my lack of knowledge in that field, and they decide to sue me for neglicence. Judicially I may be at fault.

You would also in some states need a Psychiatrist to contract a collaborating agreement with you.

marineRN · Jul 28, 2010

Thanks for the reply. I will finish my FNP in 2012. I have a couple of friends who are opening (this month) a 90 day treatment facility which I am helping with. The medical director is a prominent psychiatrist. The goal is eventually to open a couple more for different populations in the upcoming years. Anyways, I was looking at going back to get PMHNP postgrad certificate but all it would consist of is clinical hours and preceptorship. So essentially I would be paying for OJT, which I would already be able to get from the Psychiatrist. It doesnt make sense to me. Thanks again for the reply.

-MarineRN

delphiniumRN · Jul 28, 2010

interesting that all they require is hours, my school also requires 16 credits of didactics minimum depending on post specialization. Good Luck, there is definately a need for people willing to work with the mentally ill.

MERCEDES674, MSN, RN · Jul 28, 2010

Thanks for the reply. I will finish my FNP in 2012. I have a couple of friends who are opening (this month) a 90 day treatment facility which I am helping with. The medical director is a prominent psychiatrist. The goal is eventually to open a couple more for different populations in the upcoming years. Anyways, I was looking at going back to get PMHNP postgrad certificate but all it would consist of is clinical hours and preceptorship. So essentially I would be paying for OJT, which I would already be able to get from the Psychiatrist. It doesnt make sense to me. Thanks again for the reply.
-MarineRN

What school is that?

marineRN · Jul 29, 2010

There are several. U of Va is one, but if you google "post msn PMHNP certificate" there are many that essentially contain the core classes (that I already have from FNP) then some assortment of clinicals/practicum/preceptorship.

elipscombs · Jul 29, 2010

It seems you are right...FNP could do mental health

zenman · Jul 29, 2010

interesting that all they require is hours, my school also requires 16 credits of didactics minimum depending on post specialization. Good Luck, there is definately a need for people willing to work with the mentally ill.

I had attended a Psych CNS program and when I did a post-masters psych NP, I had to take 19 more credits plus 260 more hours of clinical. Glad I did!

marineRN · Jul 29, 2010

I do not personally understand why anyone would want to go through the CNS without doing the NP. It appears to be essentially the same classes without the clinical hours, but then your job opportunities are limited.

zenman · Jul 30, 2010

Okay.....I already know what the reaction of PMHNPs will be. But after looking at the scope of practice of an FNP there is nothing banning FNPs from working in a mental health setting only vice versa. Anyone know for sure?
MarineRN

You might consider also that while it might be within the "scope of practice," it might not be legal, which trumps scope anytime.

core0 · Jul 30, 2010

Okay.....I already know what the reaction of PMHNPs will be. But after looking at the scope of practice of an FNP there is nothing banning FNPs from working in a mental health setting only vice versa. Anyone know for sure?
MarineRN

You can look at this answer from Carolyn Buppert in Medscape:

Log In Problems

Also take a look at this article by Tracy Klein.

Log In Problems

The bottom line is that its going to be state by state. Some states adhere strictly to their scope of practice documentation and some do not. If you are practicing at the fringes of your scope you have to understand that that scope can be limited at any time (as happened in Maryland).

The other issue is liability. There have been a number of attempts to skirt medical malpractice limitations by claiming that the NP was outside their scope of practice which moves the standard to negligence which doesn't have limits.

Depending on the state an FNP can probably do psych. The real question is, is it a good idea?

David Carpenter, PA-C

allnurses Guide · Jul 31, 2010

I'm an FNP who has been "forced" (for lack of a better term) into doing much more psych than I bargained for. This is due to lack of resources for a community with non-existent psych services. I am not thrilled about it, not entirely comfortable with it, and wouldn't do it if these patients had somewhere else to go. I think it's fine for an FNP to manage straight forward depression and anxiety, but more complex needs really should be managed by someone who has more specialized psych training than an FNP receives. I'm ok legally by my state's scope of practice rules, but I think a good chunk of my patients would be better served by a PMH NP. Fortunately, my administration has seen the light and we have one starting next month!!! All of the adult providers (MDs included), will be sending him patients in droves. Bottom line-if you want to do psych exclusively, go for the PMH NP specialty. I think it's better for both patients and providers.