Non-psych nurses as CRNP-PMH

[Jules A, MSN]

Why does it seem there is a ton of money and pathetically short bridge programs from FNP to PHM? Has anyone ever thought of recruiting our own? Why aren't there programs focused on funding undergraduate nurses with the invaluable psychiatric experience and dedication to competently care for our patients?

I just heard the argument that a FNP with poor prescribing skills for psych meds is better than no one prescribing. WTH? That sounds like crap to me and if true I resent that this is the bar they are setting for our mental health patients. Are these programs aimed at trying to get a warm body in to prescribe psych medications? If so, that sounds like an example of the stigmatization that runs rampant in mental health. Interestingly enough these "integrated health clinics" that are trying to combine medical, psychiatry and dentistry which I think is a great idea don't seem to have any FNPs who are taking the free fast track program to start drilling teeth. Dentistry is a separate specialty and I contend that mental health is also. As someone who has seen the damage that can be done especially in the areas of addictions, anxiety, psychosis and pediatrics when non-psych prescribers take a stab at it I am sad and frustrated by this trend.

If I'm going to complain I suppose I should offer my thoughts for improvement. :) How about special consideration for admissions to PMH-NP programs, financial resources in the form of grants for service and fast track programs for psych nurses who have the background, talent and dedication to mental health service. It would seem that this would likely result in better patient outcomes.

[PMHNP-1]

I hadn't really thought about the fast track programs much, because the reverse is true, too: PMHNPs going for the FNP or other specialty, via the post-MSN cert programs.

The only classes that post-grad cert programs include are the specialty classes, because the student already has taken all the general stuff for the first cert area.

I haven't seen FNPs who got the PMHNP certs added on, who weren't good at the psych part - most went for the psych because it was their interest. But I have seen something even worse: FNPs working AS PMHNPs without ANY psych experience, no certification, nothing. Totally out of scope, and liable, too. Way to lose a license and one's home.

[Jules A, MSN]

I hadn't really thought about the fast track programs much, because the reverse is true, too: PMHNPs going for the FNP or other specialty, via the post-MSN cert programs.

The only classes that post-grad cert programs include are the specialty classes, because the student already has taken all the general stuff for the first cert area.

I haven't seen FNPs who got the PMHNP certs added on, who weren't good at the psych part - most went for the psych because it was their interest. But I have seen something even worse: FNPs working AS PMHNPs without ANY psych experience, no certification, nothing. Totally out of scope, and liable, too. Way to lose a license and one's home.

I have also seen FNPs who were specializing in psych before having their license either revoked or threatened and it can definitely can go both ways but psych-NP pays so much more that I'm seeing more our way rather than the other route. In my experience the NPs I see without psych experience tend to have the overflowing benzo bottle for c/o anxiety which I especially love for those concurrently abusing alcohol with history of OD, polypharmacy including antipsychotic medications for borderline patients who say they have auditory hallucinations with no indication of psychosis whatsoever and more likely trauma history or another secondary gain. My most favorite of all the numerous young children

[Jules A, MSN]

Interesting and sad that there was such little interest in this topic. If we don't step up as a specialty and take ownership in the future of mental health our beloved patients will continue to receive substandard care at the hands of inexperienced providers. Bummer.

[elkpark]

Interesting and sad that there was such little interest in this topic. If we don't step up as a specialty and take ownership in the future of mental health our beloved patients will continue to receive substandard care at the hands of inexperienced providers. Bummer.

I completely agree. I've been kvetching for decades that if we, the psychiatric community, were out there treating people's COPD, diabetes, heart disease, gout, etc., the rest of the medical community would be after us in an angry mob with torches and pitchforks -- but everybody thinks s/he's competent to treat psychiatric disorders ...

There's a reason it's a specialty.

I think that the "quick 'n dirty" bridge programs exist, though, because there is such a huge shortage of psychiatric providers in so many areas, and, with the higher salaries (as you note), lots of people who aren't making much are thinking psych NP is a quick, easy way to big bucks.

[Jules A, MSN]

It breaks my heart to see the results of poor diagnosing and prescribing by well meaning but incompetent prescribers. Kids who report AH when in fact its trauma related and are put on antipsychotics, adults with substance abuse being given stimulants and benzos, Grandmom being given benzos, patients being started on the latest/greatest antidepressant meds because they have free samples-until the samples run out and the patient can't afford the pricey meds when good old $4 Walmart Zoloft would have been fine. I could go on and on. The part that makes me the saddest is that there are a million really competent psych RNs who would be amazing at this and for whatever reason aren't being targeted by these patchwork programs or don't see it within themselves to consider increasing their scope of practice.

[Whispera, MSN, RN]

The graduate school I attended discontinued its psychiatric nursing specialty program the year after I graduated. There were ony 3 in the specialty when I was in it, and none signed up for the next semester.

Where I used to teach, the undergraduate school is going to move all it's psych content into the other courses. The administrator in charge actually said she felt anyone could teach psych nursing.

Psych nursing isn't valued, and it makes me furious.

[EatYourVeggies]

Maybe it is just me but I strongly feel one needs to be an RN working in Psychiatry before one becomes a Psychiatric Nurse Practitioner. Experience in the field is really necessary because school really does not teach you everything and I do feel bad for patients as there are not enough psychiatric providers and too many incompetent ones. There also needs to be more competent psych nursing instructors, not anyone can teach psych nursing there are too many individuals who oversimplify mental health and are ignorant on the subject.

[snoozyd, NP]

I'm one of the direct-entry NP applicants AllNurses seems to hate. But the reasons cited in this thread are exactly why I'm going straight for advanced practice. I've worked on an inpatient psych unit for psychotic disorders (studied psych undergrad), and seen the development of the same conditions in a few of my own friends. Nowadays I work in cardiac research participant follow-up and I'm constantly shocked at how MDs and RNs at our clinical site treat people with psychiatric issues. They oversimplify their condition and, worst of all from my perspective, enroll people who really aren't capable of processing what the study entails. Most of the time when I bring this issue up, they make as if performing heart surgery is proof they can understand anything so I have no right to question their understanding of psychiatry. Obviously not everyone pulls this - but if the majority of the docs and nurses in the study feel that way, nothing will change.

[Jules A, MSN]

I'm one of the direct-entry NP applicants AllNurses seems to hate.

I don't think anyone hates the applicants but may be just the programs? :) Speaking only for myself I'm just are frustrated with people who have no experience in the field who think they can go through school and be safe to prescribe medications without knowing the real life outcomes for presentations they haven't ever seen. It sounds as if you have some experience in the psychiatry but I'd still encourage you to consider working on an inpatient acute unit as a RN before you go on to become a prescriber.

[snoozyd, NP]

I don't think anyone hates the applicants but may be just the programs? :) Speaking only for myself I'm just are frustrated with people who have no experience in the field who think they can go through school and be safe to prescribe medications without knowing the real life outcomes for presentations they haven't ever seen. It sounds as if you have some experience in the psychiatry but I'd still encourage you to consider working on an inpatient acute unit as a RN before you go on to become a prescriber.

I definitely get that. Most programs I've applied to indicate their students work on units at least through the master's portion. Some stay on as RNs and ease into an NP role - I've known folks that did this. If I stay local I'll probably return to my patient care position per diem and eventually an RN role at the same hospital.

But you're right, there are programs that don't emphasize this option are doing a disservice to their students as well as their future patients.

[Barnstormin' PMHNP]

I agree with everyone, JulesA you make many valid points. In my PMHNP program we starts with 5 full time students, only 2 of us have had direct psychiatric experience, and now we have bloated to 10, from FNP students hopping over because Patho scared the you know what out of them. I agree, it is ridiculous to allow people in the program that have not had psych experience, they sound like Pollyanna when discussing psych. When RN's apply for the FNP program you HAVE to have 2 years RN acute care experience.

I have spoken to many psych nurses over the past couple of years and all of them without exception did not want the responsibility or to have to put the time in to advance their learning. The psych techs are a different matter, they are all BSN psych majors are pursuing fast track RN to become PMHNP's.