I HATE Nurse Practitioners

[Angeljho]

So the director of psychiatry and some senior psychiatrists at my hospital are in a funk. It appears surrounding hospitals are offering incentives (increased salary and other benefits) to attract psychiatrists to their institutions - and its working. So far, we have lost four psychiatrists in the past five months to nearby hospitals that are offering those incentives. Those facilities also hire FNPs and PMHNPs whereas my hospital doesn't. Clearly there is no way for my hospital to match the benefits of the other competitive institutions and there is a huge shortage of psychiatrists in the area. So... I suggested that we start hiring NPs.

Bad move.

I never seen so much hatred from health professionals. One of the senior psychiatrists actually shouted at me for coming up with "a stupid idea." He then proceeded to tell me how many years of schooling and training he's had out of some need to compare himself to a PMHNP. What really bothered me is that the director said, "I HATE Nurse Practitioners" as if that was a good enough reason for not hiring them in our facility. What they think is what they think; I can't change that. But would I be overstepping boundaries if I drew up a presentation at our next meeting to outline the benefits of hiring NPs? The chief director of psychiatry will be present at the next meeting and I really think its worth a mention.

[anh06005, MSN, APRN, NP]

We are professionals! I have disagreements with docs (and other NPs/PAs) all the time regarding all sorts of things and I never hesitate to challenge them on it, but I never do so disrespectfully as we all have the same goal we just have a different approach.

I don't doubt professionalism in most in person disagreements but sometimes I get in this site just got some good ole entertainment.

Kudos to you two

[greygooseuria]

I wish my disagreements were civil. They usually go something like "Attending A, I think your patient Patty P is septic due to her low BP, elevated white count, diaphoresis, etc. I've ordered blood cultures, a CBC, CMP and a UA C&S."

"No, absolutely not, just elevate her feet to raise her BP." *ACTUAL CONVERSATION I HAVE HAD* (and they hadn't seen the patient in 2 weeks)

[Jules A, MSN]

II would also say my mid-level colleagues are under supported by their advising docs who physically remote from where they practice and may infrequently see or never see their high complexity patients.

It varies from state to state but fwiw I do not have an "advising physician". I have an attestation agreement with a psychiatrist I worked with for years as a nurse and also trained under during NP school who is available for discussion but I practice independently. Some states are working on doing away with the attestation agreement because as in my case I could call this psychiatrist and a couple of others any time with or without the attestation agreement so I'm not sure it is really warranted. In addition to carrying my own patient load I also have admitting privileges at 2 hospitals.

What I will say with regard to psych-NPs is that, again anecdotally, I have found some to be more conservative with regard to prescribing psych medication than psychiatrists and when dealing with children I don't think that is necessarily a bad thing. I hit hard with the adults who I treat on the locked inpatient acute unit but tend to be a bit more conservative with the kids, in particular the under 12 crowd. No need to crawl up my dress about my peer reviewed sources I'm just throwing out my anecdotal experience with patient's medication regimens that I have been privy to during inpatient hospitalizations or who come to me as new patients from other providers.

[MollyJ]

Jules, I like the APRN's and PA's I work with just fine. They are nice people. They do help people. But my school building has some really complex kids with ODD tendencies along with ASD and these kids need coordinated team approaches that include a skilled psychiatrist and in my area, that is just hard to come by. And I think that depending on who mentors whom, people can arise to great levels but these patients are in a psychiatric care dessert and the mid-levels while doing their best I think would love to know that they had somewhere to turn--to talk to, to have the patient seen with them--though I certainly cannot speak for them.

[MollyJ]

BostonFNP, I am not trying to get into a fight here. Surely, everyone has a patient they say about, "They needed someone; I decided it was someone smarter than me." This just looks more like APRN's and PA's left holding the bag than anything else to me.

And surely you understand that 4 years of medical school plus a residency in psych and specialization in child psych might count for something, even though I know that you DO help a lot of people and I am glad for that as are they.

[Jules A, MSN]

Jules, I like the APRN's and PA's I work with just fine. They are nice people. They do help people. But my school building has some really complex kids with ODD tendencies along with ASD and these kids need coordinated team approaches that include a skilled psychiatrist and in my area, that is just hard to come by. And I think that depending on who mentors whom, people can arise to great levels but these patients are in a psychiatric care dessert and the mid-levels while doing their best I think would love to know that they had somewhere to turn--to talk to, to have the patient seen with them--though I certainly cannot speak for them.

Neuropsych is tough for any provider imo and I would agree that if your NPs don't have extensive experience with that population they should consult with psychiatrists as needed. As a RN I worked for a specialty hospital with a large PDD, ASD and intrauterine exposure population of pediatrics and adolescents so I feel more comfortable with these diagnoses than some with no experience might however these patients can be very challenging. You are correct that if someone isn't well versed in their care it is doing them a disservice if they don't request assistance as needed. Do keep in mind however that remarkable improvements even with the best care can be few and far between.

[Jules A, MSN]

This just looks more like APRN's and PA's left holding the bag than anything else to me.

They should have the professional contacts and the appropriate insight to call for assistance as needed. I have 9 psychiatrists' cell number in my phone as well as a couple of sharp NPs who I can contact. If they don't realize they are floundering and need assistance which I have also seen that is a whole different topic.

I would like to add that I have seen more than a few psychiatrists who are horrible prescribers also so while I agree that their education is far superior to NPs I believe the individual, their innate insight and clinical background makes a big difference in the quality of any provider's prescribing.

[Missy89]

Why should anyone consider not doing NP because MDs hate them?? It's that mentality of nurses that doesn't help the profession at all!

[Missy89]

I would let it go. You won't be able to change their minds. This is why I would never do NP. Nurses so really think twice before going NP. Alot of MD's have that opinion. Right or wrong. It's hard to work with someone that doesn't even see your degree as legit.

Why would I not become an NP just because SOME MDs hate us?? 10 years from now I don't see any MDs even doing primary care.

[BostonFNP, APRN]

BostonFNP, I am not trying to get into a fight here.

And surely you understand that 4 years of medical school plus a residency in psych and specialization in child psych might count for something, even though I know that you DO help a lot of people and I am glad for that as are they.

No one is trying to start a fight! This is just a discussion, and important one.

Absolute medical school and residency count for something. Most often a bigger pay check! In all seriousness:

Try for a moment to forget the "common sense"'and take a scientific approach: if patient outcomes are the same then does it matter if a provider has 1 year of school or 100?

Sent from my iPhone.

[Missy89]

No one is trying to start a fight! This is just a discussion, and important one.

Absolute medical school and residency count for something. Most often a bigger pay check! In all seriousness:

Try for a moment to forget the "common sense"'and take a scientific approach: if patient outcomes are the same then does it matter if a provider has 1 year of school or 100?

Sent from my iPhone.

EXACTLY! Please school her...

[BostonFNP, APRN]

EXACTLY! Please school her...

No "schooling" just an open discussion!

Sent from my iPhone.