Jump to content

FNP working in Psych??

Posted
by FNPAPN FNPAPN (New) New

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 . According to the Illinois board or nursing and the Illinois Society of Advanced Practice Nurses, there is no restriction for me to work in this speciality and they stated that "it is within my scope of practice". However from other threads I have read, there may be issues with insurance billing and other potential pitfalls. I know this may be a gray area since there is a psychiatric NP certification available, which I will be pursuing. As a new grad NP I would hate to put myself in a position where I could jeopardize my license. Any advice would be greatly appreciated.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

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.

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

Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care. Has 39 years experience.

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 ."

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

Specializes in Family Nurse Practitioner.

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?

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

Specializes in Family Nurse Practitioner.

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:

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

Specializes in Outpatient Psychiatry.

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!

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.

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.

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.

This issue really has absolutely nothing to do with "turf wars" but it is all about scope of practice and malpractice. If you are a FNP you are still practicing within your scope of practice if a cardiologist or dermatologist decides to give you advanced training and you decide to work in that specialty. If you however decide to take a position working with a psychiatrist and treating mental health disorders as a FNP you are practicing outside your scope of practice which leaves you vulnerable for lawsuits. I am certified as an Adult psych np and I had a private practice try to convince me to see children stating that the psychiatrist could supervise me and I could take CMEs in child psychiatry. Well I contacted my malpractice provider and they informed me that if I practice outside of my scope which is adults only, they would not represent me if I were to find myself involved in a lawsuit. Providers need to recognize that even if an organization or physician tells you it is alright for you to provide services that you may not be sure falls within your scope of practice, it is your responsibility to find out if you are really protected. I'm sure when we start seeing posts about people being caught up working outside their scope because such and such said it was alright or they prefer that specialty, this will become less of an issue. As the NP field grows so will the lawsuits!

If you are a FNP you are still practicing within your scope of practice if a cardiologist or dermatologist decides to give you advanced training and you decide to work in that specialty.

It has been awhile since I finished my program, but I'm certain that FNP programs cover training and coursework that's built in the curriculum for psychiatry, just like there is for cardiology, dermatology, etc., you get the point. From what I recall the psychiatry portion was more in depth than Dermatology. So how is it any different for an FNP that will get Advanced training in psychiatry” be out of their scope of practice if they decide to work in that specialty? I mean it was included in the curriculum just like the other specialties you mentioned that would be in their scope.”

As far as malpractice, out of curiosity I called my malpractice provider and asked about scope of practice/potential lawsuits in regards to this topic. They stated there is not a restriction for an FNP to practice in psychiatry, only thing that changes if I want to add it on my policy is that I'm considered on another tier” and my rate goes up a few dollars a year. I didn't ask if that extended to the pediatric population, as the inquiry was only quoted for general psychiatry coverage. I'm just going to say that ANY provider, no matter what the specialty is, IF you are not comfortable in managing your patient's care, medications etc., then don't try to be a hero, use common sense, be safe, protect your license, (avoid lawsuits) and refer that patient to the MD. That's why they are paid the big bucks. :)

I think what is important to remember is the training. As PMHNPs we understand (though I cannot find the source) the average patient referred to a mental health clinician has failed two previous medications trials. If FNPs were trained well enough to practice as a psychiatric clinician there would be no need to train PMHNPs. I do not doubt the primary care psychiatry is taught in FNP school, but that is the extent of the education. There are FNPs who provide great psychiatry services, but a "rotation" does not prepare you to be a competent provider. Ultimately, everyone will be concerned about your liability. I could care less about your liability, but I am concerned about your improper diagnosis leading to delayed or inappropriate treatment of your patient. You can always learn on the job, but your education will then be through a biased knowledge bank. Severe mental illness should be left to professionals. I can promise you won't find me walking into the ER treating NSTEMIs, PEs, surgical emergencies, or DKA. This is coming from a guy with 4 years of experience at a level I trauma center. Not a turf war, but respect your knowledge and the knowledge of others.

Alexb45 Correct me if wrong, but there isn't a specialty certification for cardiology or dermatology so if you as an FNP who are trained as generalist works in either, you are not out of scope of practice. Psychiatry is a specialty that requires extensive training and knowledge in the field and you are board certified for psychiatry only. I don't know what state you are from but where I live the majority of employers would never offer non psych certified a position so it's a mute issue here. If your malpractice insurance is willing to fight a lawsuit for you practicing out of your scope I'm amazed but I know I have to practice within my scope and will not put my license at risk. I'm surprised this was not covered by most NP programs that a topic like this even exists.

Edited by Mookiepsychnp