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.
Boston is right. You're state board of nursing is who determines what is and isn't okay. Just because a physician is willing to take you in DOES NOT make it legitimate.
I can't see myself as a PMHNP (currently in grad school) accepting a position as a FNP. If the physician is using you only in the FNP role then yes. The clinical and educational preparation for the two different roles is completely different after you get past the basic classes. I would be concerned about working for a psychiatrist who feels this is acceptable.
Boston is right. You're state board of nursing is who determines what is and isn't okay. Just because a physician is willing to take you in DOES NOT make it legitimate.
In the state of Maryland it is my understanding that you can NOT practice as a PMH-NP with only a FNP. Like others have said you need to check with the BON not the person who is trying to recruit you.
Thanks for all all the responses. Its is very vague what APRNs can and can not do.. What about the NPs who are doing surgery with the surgeons? I know one NP who does as much as cutting open the skull for her nerousurgeon. This is not included in the educational preparation of FNPs. The lines are so blurred .. Its like a double standard..
You're right about the lines being blurred. Even state nursing boards paint a pretty vague picture. I would argue an APRN specializing in acute care would be perfectly fine assisting in surgery, but when you're an FNP I have a hard time seeing where they could defend that skill, let alone working in the OR.
Thanks for all all the responses. Its is very vague what APRN can and can not do.. What about the NPs who are doing surgery with the surgeons? I know one NP who does as much as cutting open the skull for her nerousurgeon. This is not included in the educational preparation of FNPs. The lines are so blurred .. Its like a double standard..
I'm starting a job as a Surgical NP that includes assisting in the OR and post-op for all of the patients on the surgical service which of course includes ICU patients. I'm an FNP. In MA you must have an RNFA to assist. Before this I was a OR RN for the past 10 years. My question though, was could I care for ICU acute care patients as an FNP. My BON is also vague as to this question. I contacted an old professor who had a friend at the BON. Long story short-I can work with these patients as long as I'm trained properly by the MD.
I'd suggest you reach out to your BON and see if you can get a clear answer before proceeding.
I would not take the psych job; you really would be practicing outside your scope of practice and training. The quotations from the Texas BON regulations make that pretty clear. Just think what would happen the first time you were supposed to diagnose and treat someone with schizophrenia or any other complex psych Dx you haven't been trained in. It doesn't matter that the doc says it is OK; the only thing that matters is what the BON says is OK. Beyond that, if you got sued, any lawyer worth his or her salt would pounce on the fact that you had not been trained in psych/mental health. Think if it were turned around: what if you were a psych NP and an endocrinologist wanted to hire you to diagnose and treat his diabetic patients? Or a cardiologist wanted to hire you to treat heart failure patients? Would that seem reasonable? No. Same thing holds for an FNP or ANP working in a psychiatric setting. Just too dangerous for the health of your NP license.
It may depend on what your role will be at the facility. I currently work in a psych hospital as an FNP, but strictly as a primary care provider, caring for chronic issues such as diabetes or acute illnesses or injuries. Our service is separate from the psych service, so I don't deal with diagnosing or treating psychiatric conditions.
BostonFNP is correct! It depends on definition from BON AND any authorizing medical board.
I will not comment on whether it is ethical. It is legal in some states but not legal in others, depending on the wordings of the board of nursing. In most states, BONs limit NP to work within specialty they are certified in. In Arizona, Texas, and Iowa, I know for sure that only PMHNP can practice in psych. In some states, since there is no statue of limitation, it is legal.
I read your question and went over all the answers. I am in the same situation as you. Just graduated May 2014. I am also an FNP.I have worked as a RN in a psych facility for about 2 years before graduating as a FNP.I have a psychiatrist willing to hire me to work for him with an attractive pay.However, I went back and forth with the texas board of nursing but all I got were vague responses.
I pondered about the situation and concluded that the only problem will be if you are called in court to answer an error. Mind you this can happen with any specialty: WHNP, FNP, Pediatrics or Mental health nurse practitioner.
FNP's You were trained in school on mental health. You assessed patients and came up with differential diagnoses.Remember when you did hypothyroidism, hyperthyroidism, remember your differential diagnoses remember how this was linked to bipolar disorder, anxiety disorder, depression, remember when you did women's health, think about the mental disorders you came across and how patient care was planned. Now remember when you did the actual mental health course! how much did you learn? alot to treat and safe a patients life. You have to trust your knowledge! you have several resources to check for side effects like drug and drug interactions or food and drug interactions which is the main concern when caring for mental health patients; even the Psych MD's use these resources, plus you have a psych MD right by you to help guide you. Now do you mean you will not be able to assesses and treat if a depressed patient comes to your practice? it can be medical practice, you will meet a lot of these type of patients, or a patient with schizoaffective disorder presenting with psychosis and hallucinations are you going to refer this patient to a psychiatrist without performing an intervention? No!
NP's what are you all talking about. FNP's can treat psych patients, you will refer the patient but what can you do now to prevent a situation. What will you say in court if you send this patient home with a referral to a psychiatrist and the patient while waiting for the appointment commits suicide or hurt some one? the Judge will ask you: as an FNP you should have treated the patient with one of the common medications for depression or for schizophrenia while awaiting his appointment.
The same model applies when working in the clinic with the psych MD. You can follow up the less complex cases and refer complex scenarios back to him.
I am interested to know what you decided on, because I am working with this Psyc MD, inpatient and he will be my supervising physician for the medical clinic I am about to open. There are law suits every where what ever specialty, all we have to do is o be prudent with what ever we do with our patients, don't let any one discourage you on you plans. It make more sense for FNP to work with mental patients but the reverse does not make sense. The Texas board of nursing will never tell you not to see psych patients, they are not straight with their responses. For all the times I tried, all I got were very vague answers living you cold and dry to make the decision by your self, why the did we do FNP and mental health as part of the course of study if we are not allowed to diagnose and care of psych patients under the supervision of a Pych MD, why should psych MD's be allowed to be a supervising physician for FNP's if we are not allowed to work with them. Sum it up! doe'n't make sense.
Abashed I ended up accepting a job offer with a pediatrician. I was so apprehensive about doing psych. I am considering doing a post master psych course to eventually have more options as I would also like to open a dual clinic in the future.
Riburn3, BSN, MSN, APRN, NP
3 Articles; 554 Posts
Boston is right. You're state board of nursing is who determines what is and isn't okay. Just because a physician is willing to take you in DOES NOT make it legitimate.