NP Scope of Practice - alternative medicine?

[MegRyanGirl]

I am trying to figure out what the scope of practice is for NPs in terms of various alternative medicine modalities (i.e. aromatherapy, acupuncture, prescribing Chinese herbs, prescribing vitamins, Reiki, Guided Imagery, meditation, etc). I would like some input from you all as I am having a hard time finding this information.

I did some research online and it appears to me that you need a separate certification to do accupuncutre. Even an MD seems to need a separate certification. Am I right in this?

Does one need a certificate to practice aromatherapy? Or does being an NP allow you to give aromatherapy recommendations without the certificate? Same question for the herbs and vitamins.

I am especially curious about the legal requirements for prescribing Chinese herbs and whether an NP can do it.

Any information is appreciated

[Joebird21]

Just realized I said some of the same exact things you did lol

[zenman]

Just realized I said some of the same exact things you did lol

Well, that makes 2 people who seem to be confused!

[elkpark]

I would recommend checking with the BON before starting rxing any alternative therapies; you don't want to end up inadvertantly getting your license in trouble.

[Joebird21]

Which part am I confused about?

[zenman]

Which part am I confused about?

Just as i thought….

[cayenne06, MSN, CNM]

Just as i thought….

????

I am not confused. Maybe my opinion differs from yours but that doesn't mean I haven't thought about this issue and arrived to my conclusions based on the available evidence.

[Psychcns]

I have interest and skills in "alternative therapies." They are part of who I am as a practitioner and a person. When I work as an psychiatric APRN I practice advanced psychiatric nursing, not reiki, not yoga, not Breathwork, not tai Chi. Over the years I have seen alternative practices like meditation , mindfulness influence mainstream practice and I do incorporate these sometimes. But I am busy enough diagnosing prescribing and documenting within my own mainstream practice (and being effective) without bringing in other practices at this time, anyway.

[zenman]

I'd caution anyone interested in "alternative" medicine to do their research before recommending or performing these types of remedies. Some are relatively harmless and have potential for good (aromatherapy, for example), but much of what is called "alternative/complementary/integrated medicine are, at best, an unethical waste of a patients money, and at worst, can cause harm.

When you say this you must also include, The same goes for modern Western medicine.”

80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials.

-Dr. John Ioannidis

Lies, Damned Lies, and Medical Science - The Atlantic

PLOS Medicine: Why Most Published Research Findings Are False

Bias and error are rampant in medical literature

There are some elements of "alternative medicine" that are fact based, and these are readily adopted by mainstream medicine-stress reduction, exercise, and a balanced diet come to mind.

Stress reduction, exercise and a balanced diet are not alternative medicine.” However, more focus is being made by the medical establishment on nutrition as physicians used to have very little nutrition training other than order this diet for this condition.” Dr. Herbert Bensen did take meditation practices when had been around forever and re-named it the relaxation response” to make it acceptable to Western medicine.

I think those of us in health care have a responsibility to critically examine the evidence and steer our patients towards therapies that work.

True, but consider many modalities have hundreds or thousands of years of field research behind them. If a certain modality doesn't work throughout the years, customers die off or don't come back. We do the same type of research after clinical trials and this is where we start seeing what happens with real” patients. There are also some types of healing practices that you just can't study and I'll quote a research scientist if you don't believe me.

[zenman]

I have interest and skills in "alternative therapies." They are part of who I am as a practitioner and a person. When I work as an psychiatric APRN I practice advanced psychiatric nursing, not reiki, not yoga, not Breathwork, not tai Chi. Over the years I have seen alternative practices like meditation, mindfulness influence mainstream practice and I do incorporate these sometimes. But I am busy enough diagnosing prescribing and documenting within my own mainstream practice (and being effective) without bringing in other practices at this time, anyway.

I'm glad you're effective as we need you to come over and stop veterans from killing themselves. In psych we barely know how the brain works, how our meds work, why they work, they cause side effects, sometimes are barely better than placebo, etc, etc….

Luckily, more military posts are bringing in Qigong, Tai chi, and mindfulness-based practices.

[cayenne06, MSN, CNM]

I read this very interesting article that explained why most "alternative" modalities tend to be harmless. The effective treatments are incorporated into mainstream medicine, and the stuff that kills you is usually abandoned for obvious reasons. I wish I could find that article, it described it so much better than I could!

It is true that much of western medicine is found to be ineffective as we gather more data- that is because medicine is a SCIENCE, and is driven by the scientific method. That is how it is supposed to work. That is hardly an argument against allopathic medicine!

[Psychcns]

Cayenne6-- good post. (Zenman good post also--always)

There was a recent article in the NY times about NNT. The number needed to treat. For example aspirin is often given prophylactically to keep blood from clotting. They said something about the NNT being 2000 meaning that if 2000 people are given ASA one will be helped. What a concept. No wonder a lot of meds don't work the first time.

Re: psych. I see it as we are treating the brain as a way of treating the mind. Placebo effect, the therapeutic relationship, the prescribers experience and decision making skills are as important as the medicine and the theoretical mechanisms of action in the brain.

Re: evidence based medicine . I have been reading about how EBM is about treating populations. This is not the same as treating individuals. What works for a population may not work for an individual. Lots of grey areas..

[cayenne06, MSN, CNM]

Re: evidence based medicine . I have been reading about how EBM is about treating populations. This is not the same as treating individuals. What works for a population may not work for an individual. Lots of grey areas..

SUCH an important point.