FNP working in Psych??

Mookiepsychnp · Nov 10, 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.

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!

alexb45 · Nov 19, 2015

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 psychiatryâ€ 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.â€

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 tierâ€ 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. :)

Dudenurse73 · Nov 19, 2015

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.

Mookiepsychnp · Nov 19, 2015

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.