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New Grad FNP offer

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NorthBeach is a APRN and specializes in FNP.

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I am a new grad FNP and I received an offer to work in a private psychiatric clinic treating mood disorders, anxiety, PTSD, and ADHD for most part. The practice does not manage clients with schizophrenia. The clinic is staffed with a psychiatrist on site available for consultation. The psychiatrist is willing to provide training to a new grad FNP. I was hoping to get feedback on whether I would be practicing out of scope as an FNP. The clinic does not provide malpractice insurance. Is that typical for private practice or psychiatry?

Thanks in advance.

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MikeFNPC is a MSN and specializes in FNP.

215 Posts; 5,818 Profile Views

I'm in primary care and manage all of the above without any concern.  If my pt's don't respond to my treatment, I refer.  It really doesn't matter about he malpractice insurance, you need your own anyway.  Maybe others working in psych can chime in with more accurate information.  Good luck and congratulations, NP is amazing, I love it.  

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2 Followers; 153 Posts; 3,380 Profile Views

You will get a mix bag of responses regarding this. I am an FNP who works in both an outpatient psych private practice (my main bread and butter job) as well as a family practice (side hustle).

I will say that prior to working psych, I did work full time in primary care, and had some experience diagnosing and treating common mental health conditions (mainly depression and anxiety).

I do all the follow up appts, and the psychiatrist, who I consult with for any questions I have, does all the initial intake. In this way, I am similarly doing the level of care I did in primary care - assessment and medication management. I obviously do way more mental health care than I did (and do) in primary care. Again, should I have any questions regarding more complex mood disorders (i.e. bipolar disorder), I consult. 

If they are acute and/or complex (schizophrenia) , I refer them to the psychiatrist. 

It may be a challenge for you if it's your first job out of grad school. Personally, I think it's best to work in primary care as an FNP to get a general understanding of the health issues you've learned in school and clinicals before going into specialty. However, psych (the more common and general mental disorders) won't be completely foreign based on your training. If your employers training is thorough, and your an inquisitive learner, you should do well.

If you decide to stay in psych, I'd recommend going back to school and getting your psych cert. It's what I plan to do so that I can confidently do more within this speciality. 

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adammRN has 10 years experience as a BSN and specializes in pmhnp 2020.

235 Posts; 4,989 Profile Views

On 11/4/2019 at 9:23 PM, ToFNPandBeyond said:

You will get a mix bag of responses regarding this.

(mainly depression and anxiety).

In my DNP cohort, we have FNP and PMHNP students and have talked about this. Look into your local policy and state board. If it is light psych stuff, such as anxiety or mild depression, you can try to treat it. Any more then that and you should be referring. This is in Texas at least, a red NP state. Not sure how much that type of thing changes by state. 

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myoglobin has 11 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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I think it is a "borderline" situation.  There is an attorney/NP out of Ohio who has a podcast called The NP Dude which touches upon this issue in several podcasts (it is free on Apple Podcasts).  You could "strengthen" your situation by joining a The Psychiatric Institute, and The Carlat Report, and the Psychotherapy and Pharmacology Podcast (with Dr. Puder out of Loma Linda) each offers the opportunity for CE credits (at a price).  If you did this combo you could at least make a reasonable argument (to any board) that you had received additional education. The real issue tends to be insurance panels that are moving towards requiring the PMHNP certification, but it may be that your "group" has enough pull to overcome this.  There will be purist however, who argue that nothing short of a post masters will cut the mustard.  In any case if you plan on staying in Psych long term you will likely earn the best compensation if you go back (at least part time) for the PMHNP certification.  

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FullGlass has 1 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

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FNPs and AGPCNPs should have received education and training in treating simple mental health conditions such as depression, anxiety, insomnia.  The majority of treatment of mild cases of these issues is provided by primary care providers.  More complex cases of these illnesses, as well as illnesses like schizophrenia, should be treated by a mental healthcare provider.  

I would advise checking the regulations for your state.  In California, the state does not require a PMHNP to treat mental illness.  There are organizations that hire PCPs and provide in-house training to treat mental illness, as there is an acute shortage of mental healthcare providers in our state.  However, some insurance organizations require that the facility only employ PMHNPs.  

I am an AGPCNP and will be starting an outpatient behavioral health NP position in Dec.  However, this organization has an in-house training program, along with support from a consulting psychiatrist.  I am also applying for a post-master's PMHNP certificate and plan to start a program in Fall 2020.  

If you really want to do mental health, go for it, but as others have suggested, please get a PMHNP.

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