FNP working in Psych??

Trauma Columnist · Oct 15, 2015

I'm in IL also and would go with what ISAPN and the IDPFR site say.

However, I would also consult an administrative law lawyer as to scope of practice from a malpractice standpoint but with that said, I am extremely cautious about practicing outside my scope of practice.

elkpark · Oct 15, 2015

I find it helpful to reframe these kinds of questions. If it were you presenting to a psychiatric practice, seeking help for your own psychiatric concerns, would you be satisfied being seen by an FNP, or would you be expecting to be seen by a trained, board-certified psychiatric clinician?

sailornurse · Oct 17, 2015

As a FNP who started covering for H&P on new admits & urgent care consults at a local inpatient psychiatric acute care hospital, I have to caution you that as FNPs we are are not prepared in the role of Psych NPs. While one of your preceptors is dual certified, take her lead and and get that education & certification as a psych NP. Your experience as a student NP where under supervision of an experience psych NP. IMO, you are not ready as a new NP to properly evaluate & prescribe meds for paranoid schizophrenia, mania, severe depression with suicidal ideations, dysthymia, anhedonia, substance abuse, etc etc. I am an experienced NP, have 38+ years nursing experience, including ER and I would advise you seriously re-consider this job offer. Transitioning from RN to NP the learning curve is approx 2 years. 4 years RN experience ( and you don't say what type of psychiatric unit you have been working on), IMO is not enough for you to take a new NP job in a psychiatric practice when your NP education is FNP. Since you asked, I have to be blunt. As I review the charts, I am amazed at the variety and amount of psychotropics, anti-depressants, anxiety meds, mood disorder medications that are prescribed. Since you state you plan to pursue the Psych NP education, you should do that and get the certification before accepting a position in a strictly psychiatric practice.

"I am a new grad FNP and I have a job offer with a private psychiatry practice in Illinois. I have over 4 years experience working as an RN in a inpatient acute psychiatric hospital. One of my preceptors were dually certified in family practice and psychiatry so I have seen/managed many psych patients in the outpatient setting and I am very familiar with psychotropic medications and managing complex psychiatric disorders ."

alexb45 · Oct 30, 2015

I have been a Family Nurse Practitioner for almost ten years now, and have been working with a plastic/cosmetic surgery group. My training as an FNP did not prepare me for this role as there were no surgical rotations in my program. I had previous OR experience as an RN and was fortunate that one of the surgeons were willing to hire and train me as a new NP for their practice. Yes, there definitely was a learning curve in the first year or two but I think your success depends on the willingness of your physician to train you in your given field.

I see a dermatologist who is an FNP, yet there isn't a Board Certified Dermatologic Nurse Practitioner, and I couldn't be happier with the care I receive. I have another colleague who works with an interventional radiology group, and from my understanding there is no certification for that specialty either, yet she provides excellent care. Most typical family nurse practitioner programs offer little to no training in most of the specialties that NPs work in, yet they all have positive patient outcomes. I can go on and on.

IMO IF the psychiatrist you will be working with will provide you the necessary training and not throw you out there on your own right away, I say go for it. A lot of the knowledge you will obtain will be from on the job training. Depending on your state if you will be collaborating with your physician, I am almost 100% certain that the physician will not put their license at risk by allowing you to practice without supervision until they are certain you are comfortable and competent to provide excellent and safe care for your patients.

In my years working with a variety of other medical professionals, I have found that PAs don't seem to have this issue among their profession. From my understanding, their training encompasses all aspects of medicine plus they are required to do rotations through most specialties. Yes, PAs have specialty certifications they can obtain however they don't have "turf wars" between specialties as most Nurse Practitioners do. If there is a board certification in your speciality I absolutely encourage you to go for it. IMO as advanced practice nurses we are doing ourselves a disservice by having these "turf wars" between specialties, by telling each other "we cant do this or that." I understand the training for the FNP may be limited in its scope, however this may signal a change on how all nurse practitioners are trained/educated. As healthcare changes we also have to change and work together as a profession.

Jules A, MSN · Oct 30, 2015

If there is a board certification in your speciality I absolutely encourage you to go for it. IMO as advanced practice nurses we are doing ourselves a disservice by having these "turf wars" between specialties, by telling each other "we cant do this or that." I understand the training for the FNP may be limited in its scope, however this may signal a change on how all nurse practitioners are trained/educated. As healthcare changes we also have to change and work together as a profession.

This is not a turf war it is a requirement of the board of nursing in my state. Although you feel comfortable receiving care from someone who isn't board certified in their specialty I do not.

There is a psychNP program for a reason and therefore it is imo lacking in judgement for a FNP to feel they are adequately educated to practice solely in this specialty. FWIW I put my money where my mouth is and invested the time and money to obtain my FNP post masters so I can initiate somatic medications for my patients why should I not expect FNPs to do the same if they want to practice in the areas where there are specialty certifications available?

sauce · Oct 30, 2015

well just yesterday i had to do a craniotomy while attempting to redose this actively suicidal patients haldol.... all while attempting to place a new heart in a 25 year old male with genetic cardiomyopathy which was also complicated by his active rejection of transplanted liver and kidneys. Good thing my FNP cert gave me a third arm, not sure they would have all survived if i didn't have it.

I thought fnp= master of all trades, jack of none.

Jules A, MSN · Oct 30, 2015

well just yesterday i had to do a craniotomy while attempting to redose this actively suicidal patients haldol.... all while attempting to place a new heart in a 25 year old male with genetic cardiomyopathy which was also complicated by his active rejection of transplanted liver and kidneys. Good thing my FNP cert gave me a third arm, not sure they would have all survived if i didn't have it.

Lol, because if you didn't do it all who would? And what? No hand holding, hugging, spending extra time on something totally unrelated to the craniotomy like taking vitals, answering call bells, phones and re-filing the physician's charts? What kind of a sorry excuse for a nurse are you? :whistling:

sauce · Oct 30, 2015

yeah it was a tough day. I'm just glad i saved my elixir of chuck norris sweat so i could make it through

PG2018 · Oct 30, 2015

If it weren't for the butt pounding Total Gym, there'd be no Norris diaphoresis from which to concoct your elixir.

Thank you, Total Gym. You changed a life!

alexb45 · Oct 30, 2015

If you are in a state that has full independent/unrestricted autonomy to practice as an NP, then yes it makes perfect sense for that state's BON to make it a requirement for NPs to have a specific board certification. In that case I would feel a little uncomfortable seeing an NP with a different board certification. If it's a state that does not offer full autonomy then I'm comfortable with seeing an NP working in collaboration with a psychiatrist, dermatologist, endocrinologist etc. because I know those NPs have the resources, job training and backing of their collaborative physician. I'm not at all saying those individuals should not pursue their respective certifications, I completely agree that they should invest the time and money in that field if they plan to stay with it.

sauce · Oct 30, 2015

If it weren't for the butt pounding Total Gym, there'd be no Norris diaphoresis from which to concoct your elixir.
Thank you, Total Gym. You changed a life!

Total gym doesn't make chuck norris diaphoresis, chuck makes total gym diaphoresis. but he did sweat a little bit after taking his daily swim in the plasma of the sun, hence where my sample came from.