For new or prospective Psych NPs

[Oldmahubbard]

I had been in practice as a Psych NP for several years when a 17 year old male was referred by his mother, also a patient. He had no previous known diagnoses of any kind, to include ADHD, but he was apparently making very poor progress in life.

His parents complained about him, because he was sassy and disrespectful. That part didn't concern me too much, as it seemed normal. But he also did not express interest in dating, driving a car, or getting a job. There was noevidence of substance abuse. However, his engagement with me with fair to poor, and most of the information was secondhand from his parents.

I didn't have much to offer, and over several months, I began to suspect borderline intellectual functioning, or pedophila, because he hung out with 13 year olds.

The parents kept complaining about him, but he was never arrested or anything along those lines. His mother claimed his IQ had been tested, and was quite high, ie 140, contrary to his grades, and my impression.

Finally, the situation came to a head, and I was pressured into offering depakote as a mood stabilizer. I emphasize the patient was never hospitalized, and was always calm, if somewhat sullen, in my office. The parents complained bitterly that he had "mood swings".

The patient started on the drug after I informed the mother that labs would be required. A co-pay was needed. This was somewhat of an issue, because they had a large family, and a limited income.

Several weeks went by, and no labs came in. I called to inform his mother that there would be no refills without lab work.

She called back to beg me for another chance. She said her son was a changed person on depakote, a night and day difference, and that she would somehow scrape up the funds for the labs.

She did, and the depakote level was zero.

I had several years of inpatient experience under my belt when this happened.

I offer this as an experience to people who think they can do online Psych NP without extensive inpatient experience.

[NurseCard, ADN]

Totally not understanding this post.

I would like to understand it.

[CharleeFoxtrot, BSN, RN]

Totally not understanding this post.

I would like to understand it.

What NurseCard said.

[Davey Do]

Totally not understanding this post.

I would like to understand it.

Yeah, because it was an interesting read!

She called back to beg me for another chance. She said her son was a changed person on depakote, a night and day difference, and that she would somehow scrape up the funds for the labs.

She did, and the depakote level was zero.

[KatieMI, BSN, MSN, RN]

I've seen it happening, and not only with psych meds. Just yesterday I had one A, Ox4 who swore that the "new pill" I ordered made him all new and great, his blood glucose got so much better, his diabetic leg pain way down... all that was brought up by changing of the same med, same dose Brand A (little and white) to Generic B (big and dark green). Or a lady who was darn sure that she feels great and gets "all her blood back" thanks to Levaquin (both it and Venofer packed in the same brown packs, but iron runs "just" 30 min and Levaquin for 2 hours.).

Placebo effect. Sometimes it works really better than the real stuff. And when we have two "believers" plus a hefty dose of "broken phone effect", results can be truly spectacular.

[dream'n, BSN, RN]

Shows how manipulative teens may be, or rather how gullible these parents are. Hope the kid has been flushing them and not saving them up for a suicide attempt. I also hope you've already notified the parents to search the kids room.

[Sour Lemon]

Shows how manipulative teens may be or rather how gullible these parents are. Hope the kid has been flushing them and not saving them up for a suicide attempt. I also hope you've already notified the parents to search the kids room.[/quote']

Now I'm really confused. I thought the mother was taking them herself?

[cleback]

How would have going to an online school prevented one from ordering a med level? Not that I agree with online schools but curious how you came to your last statement.

[pixierose, BSN, RN]

Just reread the OP again and ... I'm still confused.

What situation came to a head? Why even prescribe the med if you weren't getting very far with therapy? And what does this have to do with online schooling?

And I second the pp who suggested telling the parents to search the room.

[Davey Do]

I'm still confused.

What situation came to a head? Why even prescribe the med if you weren't getting very far with therapy? And what does this have to do with online schooling?

I believe I can help you with your confusion, pixierose:

What is on second. Why plays left field.

Hope this helps.

Davey (Who's on first?) Do

[NurseCard, ADN]

All I understand was that the son was not really taking the med.

That's it.

[DTWriter]

I think this post's purpose is to warn against nurses becoming psych NPs without extensive inpatient experience. If so - OP, you did not connect this NP experience to something that happened during your inpatient experience that helped guide your decision making with this NP experience.

Though, don't get me wrong - totally agree that a nurse should get patient experience prior to becoming a NP.