Is a FNP working for a Psychiatrist legal ??

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Hello all. I am a brand spankin new FNP . Just got AANP certified two weeks ago and graduated this past May. Here is my thoughts. I live in Mississippi.. the jobs for new grads are scarce. Most places want you to have 1 year experience. The pay in Mississippi is also fair compared to other states. I am willing to relocate. I applied to a facility in Texas, not knowing it was a psych facility. The psychiatrist wants to set up an interview. I did not think it was OK for FNPs to work under a psychiatrist. However, this psychiatrist who is also the owner, says its ok, and that he gives a very good orientation to his employees. He also said that he is an instructor and that he teaches students. He also said that his friend who is also a psychiatrist has FNPs working for him too. I have researched and see that it is possible , but what is the red tape to this??? IS this 100% legal with no fraud involved? I know that as FNPs we can work in Women's Health, Peds, and just about any other setting, but how about Psych?? I know that we cover a small amount of Psych in our program, and learn the basics of ADHD, depression, anxiety, but is that enough to work under a psychiatrist if he is willing to offer a solid training and orientation? I do not want to get into any trouble being a new naive NP. Any advice is welcome.

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Specializes in Internal Medicine.

Depends on what he specifically wants you to do. Texas is pretty vague about its rules in regards to specialization. You technically learned about psych in school and can treat all patient populations. A psychiatrist is an MD and nothing prevents you from working with him.

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Specializes in Critical Care/Coronary Care Unit,.

As a FNP, you are fully capable of working for a psychiatrist as long as he is a licensed MD. The only thing is you may have to take a certificate course for therapeutic counseling...beyond that you're good.

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Specializes in Surgery.

I think it's fine too. You could always check with your BON but if you're an FNP then you're qualified to take of patients across the age spectrum, assuming he will train you as needed for this role..

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Specializes in Psychiatric Nursing.

Get some psych CME's- there is a new DSM-the DSM 5, there is new medicare billing documentation the last couple of years- your doc may be on top of all this.

Massachusetts General Hospital Academy has free courses and they are very good. I also like the Carlat Report, there is an adult and child version. A great way to keep up. I think the best way to learn psych is 1:1 supervision and if Texas allows this, Great!! Just make sure you like psych..

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Specializes in Adult Internal Medicine.

I actually differ with the other posters, burbs am not intimately familiar with the APN scope terminology in your state. Your best bet, in all honesty, is call the BON/BOM and ask them.

I know in my state APNs are permitted to practice to the extent of their education and training. You would need to be very confident you could defend your education and training in psychiatry in a clue of law.

Always err on the side of caution as your license and career is a big investment to risk.

Sent from my iPhone.

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Psych isn't something you can just 'pick up' by reading a few articles here and there and having someone train you on the fly. It's a whole different medical specialty. I would tread really carefully. If anything goes wrong the first thing a lawyer is going to want to know is why you think you can practice psychiatry when your training is in primary care. As a pmhnp in my state I will be able (technically) to practice primary care if I want. Now is that appropriate or ethical for me to do? Absolutely not.

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Specializes in Internal Medicine.

Like myelin said, Psych is a different ballgame, and although being an FNP and working in specialty settings is allowed, it really depends on what your role is and whether or not you are going to be initially diagnosing psych patients.

After doing a little digging, the Texas BON in regards to psych states:

The use of DSM-IV diagnoses by a Registered Nurse recognized by the Board as an Advanced Practice Registered Nurse in the role and specialty of either a Clinical Nurse Specialist (CNS) in Psychiatric/Mental Health Nursing or as a Psychiatric/Mental Health Nurse Practitioner is authorized provided he/she is acting within the scope of his/her advanced practice role and specialty and that the diagnoses utilized are appropriate for the individual APRN's advanced education, experience, and scope of practice. APRNs must also utilize protocols or other written authorization when providing medical aspects of care in compliance with Rule 221"Advanced Practice Nurses." When patient problems are identified that are outside the CNS'/NP's scope of practice or expertise, a referral to the appropriate medical provider is indicated.

http://www.bne.state.tx.us/practice_bon_position_statements2013.asp#15.12

Since this specifically mentions Psych NP's/CNS's but no other APRN, I would imagine it's implied that as an FNP you cannot make a DSM diagnosis. To add more confusion, here is what the Texas BON says about adding skills/patient care activities to your role as an APRN:

Adding New Procedures and/or Patient Care ActivitiesWhen adding a new procedure or patient care activity, the advanced practice registered nurse should maintain documentation of additional education and competency. An advanced practice registered nurse may add new procedures or patient care activities to his/her individual scope of practice by using the following suggestions:

  • Identify the benefit for a new patient care activity, taking into consideration consumer demand, standards for safe practice, and interest of the advanced practice registered nurse.
  • Ensure that state or federal statutes and regulations do not constrain the advanced practice registered nurse from incorporating the activity into practice.
  • Identify established professional standards, if available, supporting the performance of the new activity.
  • Establish goals and methods for learning that encompass knowledge and skills acquisition through which competence is attained.
  • Demonstrate competent performance of the procedure/activity.
  • Maintain records that reflect the acquisition and maintenance of competency.

The Texas Board of Nursing recognizes that individual scopes of practice will vary and that what is within the individual scope of practice for one advanced practice registered nurse may not be within the individual scope of practice for another advanced practice registered nurse authorized to practice in the same role and specialty. However, it is important to keep in mind that the Board holds each advanced practice registered nurse accountable for knowing and practicing within his/her professional and individual scope of practice.

Again, it's really going to depend on what he wants you to do. I have a friend working for a psychiatrist, but he acts as a primary care provider to those patients and the psychiatrist handles the psych evaluations. Get in writing what your role is going to be and shoot it over to the Texas BON. They reply quickly.

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Specializes in Internal Medicine.

Here's another relevant Q/A regarding what the OP is inquiring about straight from the Texas BON. Again, pretty vague, but they do tell you if in doubt to contact them. The answer portion is through the link to the Texas BON (it wouldn't paste the whole answer).

I am licensed to practice in a particular population focus area. I want to expand my scope of practice to include a second population focus area. (Examples of this situation include but are not limited to: adult health expanding to include pediatrics, family practice expanding to include care of patients with complex psychiatric pathologies, and primary care expanding to include acute/critical care). Can I do this by completing continuing nursing education activities specific to the population focus and working with another advanced practice registered nurse licensed in that population focus or a physician?

Texas Board of Nursing - APRN Practice FAQ

population focus from the BON. When incorporating a new patient care activity or procedure into one's individual scope of practice, the board expects the advanced practice registered nurse to verify that the activity or procedure is consistent with the professional scope of practice for the licensed role and population focus and permitted by laws and regulations in effect at the time. For example, a women's health nurse practitioner or nurse-midwife who wishes to incorporate performance of colposcopies in his/her practice may do so without obtaining an additional licensure to practice from the BON because this activity is consistent with the professional scope of practice for those roles.If the activity is not consistent with the professional scope of practice for the licensed role and population focus, additional formal education and authorization from the BON in the second role and/or population focus is required. For example, an advanced practice registered nurse who is licensed to practice in gerontological nursing wishes to provide advanced practice nursing care to all adult patients. In order to do so, he/she must complete education that will prepare him/her in an advanced practice role and population focus that encompasses advanced practice registered nursing care of adults of all ages. Rule 221.4© requires that this additional education meet the curricular requirements outlined in Rule 221.3

population focus from the BON. When incorporating a new patient care activity or procedure into one's individual scope of practice, the board expects the advanced practice registered nurse to verify that the activity or procedure is consistent with the professional scope of practice for the licensed role and population focus and permitted by laws and regulations in effect at the time. For example, a women's health nurse practitioner or nurse-midwife who wishes to incorporate performance of colposcopies in his/her practice may do so without obtaining an additional licensure to practice from the BON because this activity is consistent with the professional scope of practice for those roles.If the activity is not consistent with the professional scope of practice for the licensed role and population focus, additional formal education and authorization from the BON in the second role and/or population focus is required. For example, an advanced practice registered nurse who is licensed to practice in gerontological nursing wishes to provide advanced practice nursing care to all adult patients. In order to do so, he/she must complete education that will prepare him/her in an advanced practice role and population focus that encompasses advanced practice registered nursing care of adults of all ages. Rule 221.4© requires that this additional education meet the curricular requirements outlined in Rule 221.3

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Specializes in Emergency.

If you have interest in treating psych, maybe a post masters in PMHNP would be in order? Quite possibly you could offer to treat the primary care issues during the time your getting your post masters.

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A friend of mine got a job working in an inpatient psych unit fresh out of school. She is also a FNP. As long as your supervising (or collaborating) physician agrees to take you under his wing, it is ok for you to practice in psychiatry. You can get your certification in the area as well.

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Specializes in Adult Internal Medicine.
As long as your supervising (or collaborating) physician agrees to take you under his wing, it is ok for you to practice in psychiatry.

FYI this is not true, legally or ethically.

Sent from my iPhone.

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