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.
Now remember when you did the actual mental health course! how much did you learn? alot to treat and safe a patients life.
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.
It make more sense for FNP to work with mental patients but the reverse does not make sense.
Maybe things are different in Texas with regard to LIPs?? As for school I didn't have a mental health course in my FNP program. There were blurbs throughout a few of the classes but nothing psych specific and definitely no real diagnosis on mental health.
I'm not sure how other practices are but both inpatient and outpatient as a Psych-NP right from the start they expected me to practice independently hence the title LIP. I was literally shown how to use the electronic medical record and started seeing patients. Although there have been patients I have consulted with a psychiatrist after the fact it is unrealistic to expect the opportunity will be available consistently when you are in the room with a patient. Will there really be a Doc who is free to assist you in the 20 minutes you have to see your patient? It has also been my experience that we don't just refer back or trade patients. Other professionals would likely be reluctant to "take over" your patient if you are in over your head and at what point does that become malpractice?
I would disagree that a FNP can do psych but the reverse doesn't make sense. Personally I don't think anyone should practice out of their specialty however there are algorithms of best practice with medical conditions like HTN, asthma etc. Where are those for psych?
I am an Adult Np and I too was recruited by a psychiatrist to work for an ACT (Assertive Community Treatment) team that treats adults with persistent mental health issues in the community (in their homes). My job will be medication management. I have an extensive psych background and am ANCC certified as a Psychiatric Mental Health RN. On my application when I applied to the BON it asked the specialties that I planned on practicing in...I listed Psych and Adult Health and was approved..again the guidelines are so vague. Now reading this, I am confused...
I am an Adult Np and I too was recruited by a psychiatrist to work for an ACT (Assertive Community Treatment) team that treats adults with persistent mental health issues in the community (in their homes). My job will be medication management. I have an extensive psych background and am ANCC certified as a Psychiatric Mental Health RN. On my application when I applied to the BON it asked the specialties that I planned on practicing in...I listed Psych and Adult Health and was approved..again the guidelines are so vague. Now reading this, I am confused...
I would suggest contracting the BON and specifically describing your plans. I know of a FNP who lost her job and her license was threatened for practicing psych with a FNP in Maryland. Medicare and Medicaid would likely be all over this when it comes to reimbursement also.
I definitely would not do it because its not an area I am trained in as a FNP. Just like I should not manage ICU patients either, because I'm not an Acute Care NP. My ICU experience as a RN would not hold up in court. Nothing wrong with treating medical problems, but once it goes beyond your training as a NP, you should stop. The clue here is, what was your training in NP school. Get the post masters in Psych if at all possible. But you would be at a disadvantage to yourself and your patients. Your BON and your protocols should never conflict.
There is a Psych Residency in Minnesota that accepts FNP's and I'm guessing once you are done you can treat psych patients without the PMHNP certification,?
I was enrolled in my AGNP program and the amount of information we had on psych issues and prescribing was a joke. I dropped that program and enrolled in a PMHNP.
It really depends on the program, but for the most part I don't think most FNP/AGNP programs provide the education to be a safe provider who could defend their license in court if necessary.
I don't see how someone trained in primary care could suddenly jump into the psyc world and effectively treat patients with severe mental illnesses. Too me, psychiatric patients are as complicated as they come in health care. Unless someone was able to study independently and pass the specialty certification exam for psych, I think more than on the job training is necessary.
Jules A, MSN
8,864 Posts
Maybe things are different in Texas with regard to LIPs?? As for school I didn't have a mental health course in my FNP program. There were blurbs throughout a few of the classes but nothing psych specific and definitely no real diagnosis on mental health.
I'm not sure how other practices are but both inpatient and outpatient as a Psych-NP right from the start they expected me to practice independently hence the title LIP. I was literally shown how to use the electronic medical record and started seeing patients. Although there have been patients I have consulted with a psychiatrist after the fact it is unrealistic to expect the opportunity will be available consistently when you are in the room with a patient. Will there really be a Doc who is free to assist you in the 20 minutes you have to see your patient? It has also been my experience that we don't just refer back or trade patients. Other professionals would likely be reluctant to "take over" your patient if you are in over your head and at what point does that become malpractice?
I would disagree that a FNP can do psych but the reverse doesn't make sense. Personally I don't think anyone should practice out of their specialty however there are algorithms of best practice with medical conditions like HTN, asthma etc. Where are those for psych?