New PMHNP

[Bea Bea, MSN, NP]

Hello,

I am a new PMHNP. Will be starting in September. I'm nervous about prescribing, dealing with insurance companies, etc. I've been a nurse for 6 years, but I'm still feeling nervous about it all. Any tips or suggestions?

[ToFNPandBeyond]

What about prescribing, insurance, etc are you nervous about?

[Bea Bea, MSN, NP]

Just being new to it all. I know it sounds super general, but it's the truth

[Oldmahubbard]

It would be helpful to know what type of position you have accepted. The case mix is going to be somewhat different in private practice, as opposed to a Community Mental Health Center or inpatient.

Perhaps you could talk to someone who already works there and learn more about the population. Then target your preparations to those conditions.

Private practice will be mostly anxiety and depression. Community Health will be absolutely everything, plus poverty. Inpatient will be major mental illness. Forensics is psychosis and malingering, haha.

[AnnieNP, MSN, NP]

When I started practicing (primary care) I took the top 5 diagnosis that the practice billed and learned everything I could about them. Good luck to you.

[umbdude, MSN, APRN]

1 hour ago, AnnieNP said:

When I started practicing (primary care) I took the top 5 diagnosis that the practice billed and learned everything I could about them. Good luck to you.

I love this idea!

[cayenne06, MSN, CNM]

I wish schools better prepared their students for the red tape of health care- billing, the credentialing process, dealing with insurance. It is very daunting.

Your employer should facilitate getting you on board with insurance companies and teach you how to bill. They are highly motivated to do this for obvious reasons. Mine made it as straightforward as they possibly could. I wouldn't stress about this.

With prescribing. Just be cautious and meticulous about allergies and drug interactions, and the 5 rights- don't forget to ask about supplements and OTC.

I strongly recommend always ordering your meds in the room with the patient. I often turn my computer towards them and review the RX together. I ALWAYS do one more verification of allergies/meds. Err on the side of asking a colleague if you aren't sure. Be mindful when taking telephone or pharmacy requests for refills- its easy to go on autopilot there. Check the chart. I've seen patients get auto refills for like 3 years without an office visit. And when you make a mistake (because you will), learn from it, and acknowedge it.

Don't forget your friendly pharmacist- they they LOOOOVE getting a consult and know a crazy amount. They've saved my butt more than once.

[Oldmahubbard]

Know your state laws and figure out your own philosophy on controlled substances. It will evolve, but you have to start somewhere

[marigoldey]

HI Bea Bea, can you give us an update on how you are doing and in what setting you're having your first PMHNP experience?

[DrCOVID, DNP]

Lol... you're program didn't prepare you for these types of patients I presume ??

[MissMemphis05]

Hello,

Congratulations on your new position. Can you give me any tips on how you reviewed for the ANCC certification? Have you heard of the Lantern Review? Thank you in advance.

[myoglobin, ASN, BSN, MSN]

I don't believe any program can fully prepare you for the multifaceted experience of actual practice. There is nothing short of "dealing with plethora of patient issues/situations". The same was true with nursing school, going into ICU from day one (after nursing school) was a completely different experience. Also, when I went to medical/surgical/PCU it was radically different again. Even changing hospitals (as an RN) can be an ordeal. The same is true with the PMHNP experience. Here are some decent resources that may help:

1. Subscribe to UpToDate. It is about $60.00 per month and you get some of the best evidence based protocols for a plethora of psychiatric diagnoses.

2. Subscribe to The Pyschopharmacology and Psychiatry podcast by the Psychiatric Institute. You can get detailed protocols and they have a $350.00 dollar per year option that not only gets you lots of CE's, but the ability of psychiatrists to respond to detailed (actual) case scenarios with the latest evidence based medicine.

3. Subscribe to The Carlat Report, The Carlat child and adolescent report, and the Carlat substance abuse report (each are about $70.00/year) and give you CE's and non evidence based opinion from an institution that doesn't accept funding from pharmaceutical companies.

4. Subscribe to the Psychiatry & Psychopharmacology Podcast with Dr. David Puder of Loma Linda. He offers an wonderful/ deep, evidence based perspective regarding a plethora of psychiatric issues. He also offers paid CE's as well.

5. Buy the premium Epocrates application. It will offer very good information about medication protocols, compatibility, labs, and even which drugs specific insurance companies will pay for.

6. Start your own "personal resource library" that has the best RCT's and meta-analysis by disease category. Thus, if the subject comes to depression you should be able to discuss Cipriani's study published in The Lancet last year that compared 21 antidepressants and how this built upon the STAR*D trials.

7. Beware pharmaceutical rep's who will hawk open label trials that are sometimes funded by the companies purporting the benefits of their latest (and often expensive) medications. Always, compare the data of these trials to high quality RCT's.