Challenging specialities - page 2

As someone was telling me why they thought being a psychiatric NP was was one of the most.Challenging specialities (mentally at least). It got me thinking what about your specialty do you find... Read More

  1. by   WKShadowRN
    Quote from Jules A
    Whaaaat??? I took care of lots of crazy people in ICU!! You mean you can't just take a few classes as a post masters and automatically recognize and treat EPS? or distinguish between psychosis, delirium, trauma or malingering? I'll be fine, my borderline patient with substance abuse issues is really only suffering from ADHD so I'm going to add a stimulant to the benzodiazepines she's getting for the most severest anxiety on the planet and oh yeah btw that 10 year old threatening Mom with a knife is definitely Bipolar and needs Lithium for sure. Said tongue in cheek however I have seen every single one of the above scenarios at the hands of an under prepared NP.
    /sits in corner, rocking, hands clapped over her ears, sing ,"LA LA LA I can't hear you." Yeah. So not my Forte. I'm glad for those who can do that.
  2. by   Aromatic
    heard pain medicine is tough. esp since the DEA is making people cut back people's narcotics.

    How would you like to have the conversation: "Sorry sir/maam I know you have been on foxy roxy 30s for 15 years for your back pain, but I have to cut your down to the LowTabs."
    Get yelled at, or tears, or whatever for 15 minutes.
    " and also, about your alprazolam...."

    rinse and repeat 30 times per day


















    Ill pass
  3. by   Jules A
    Quote from Aromatic
    heard pain medicine is tough. esp since the DEA is making people cut back people's narcotics.

    How would you like to have the conversation: "Sorry sir/maam I know you have been on foxy roxy 30s for 15 years for your back pain, but I have to cut your down to the LowTabs."
    Get yelled at, or tears, or whatever for 15 minutes.
    " and also, about your alprazolam...."

    rinse and repeat 30 times per day

    Ill pass
    Unfortunately yeah we do it all the time in psych. Easiest to start by asking about their baseline pain score, which is always high even on the handfuls of pills so many are prescribed, discuss the cons of being dependent on medication that doesn't seem to be working, then on to attempting to educate that opiates have not been shown per research to be effective for chronic pain.....and as you guessed there are usually tears, threats and insults. Meh just part of the job and in my opinion those of us without the stones to insist on judicious prescribing are taking the cowardly way out or are just after the $$ and look I'm all about making as much $$ as I can however I will not do it at the expense of my patients well being.
  4. by   PG2018
    Quote from Aromatic
    psych patients. psych is hard enough, and psych always has other physical comorbis that goes with it. Not saying psych isnt a physical problem since we learn day by day it is, but you know what I mean.

    If you want a challenge hop on the non-compliance bus
    It's really astounding how psych patients can be in treatment for a diagnosis for a decade(s), perceive that they're better, stop meds, and relapse.
  5. by   PG2018
    Quote from Aromatic
    heard pain medicine is tough. esp since the DEA is making people cut back people's narcotics.

    How would you like to have the conversation: "Sorry sir/maam I know you have been on foxy roxy 30s for 15 years for your back pain, but I have to cut your down to the LowTabs."
    Get yelled at, or tears, or whatever for 15 minutes.
    " and also, about your alprazolam...."

    rinse and repeat 30 times per day


















    Ill pass
    There is not enough money to make pain medicine at all appealing.
  6. by   PG2018
    Quote from Jules A
    Unfortunately yeah we do it all the time in psych. Easiest to start by asking about their baseline pain score, which is always high even on the handfuls of pills so many are prescribed, discuss the cons of being dependent on medication that doesn't seem to be working, then on to attempting to educate that opiates have not been shown per research to be effective for chronic pain.....and as you guessed there are usually tears, threats and insults. Meh just part of the job and in my opinion those of us without the stones to insist on judicious prescribing are taking the cowardly way out or are just after the $$ and look I'm all about making as much $$ as I can however I will not do it at the expense of my patients well being.
    You prescribe opes?
  7. by   Jules A
    Quote from PsychGuy
    You prescribe opes?
    On rare occasion inpatient. I'll verify continue or taper, never OP.
  8. by   Jules A
    Quote from PsychGuy
    There is not enough money to make pain medicine at all appealing.
    Agreed. That Suboxone is coming our way has me considering it although I'd need to find a clinic with a similar philosophy as I object to what I see coming out of the MAT clinics in my area. Short term absolutely but I believe there are very few who are unable to achieve sobriety long term using a combo of initial MAT with later Abstinence. Just my opinion but that "we" are putting young people and especially adolescents who's brains aren't even fully formed on Methadone and Subs with the plan that this is an indefinite treatment with minimal, if any, therapy and 12 step requirements is disgraceful imo.
  9. by   PG2018
    I don't know. Like I may have said before, I've hung a sign in my office that says "no benzos." I'm so sick of being begged for meds, and I haven't even been in the business for any length of time. New people are not getting them anymore for any reason, and those I inherited on them or placed on them are either being tapered or maintained based on the level of crap I'm going to have to deal with to taper and discontinue. I'm seizing opportunities such as termed insurances and hospitalizations, during which they typically can't obtain benzos, and not continuing them after. I've got one patient I'm managing neuropathy and anxiety with Lyrica, and so when that loses efficacy that's done with. It's not a benzo I know, but less controls the better, IMO. Need I mention at least 40% of my practice are on stimulants? I'm being asked for medical MJ which I don't even recognize as a treatment option.


    Facepalm
  10. by   Jules A
    Quote from PsychGuy
    Need I mention at least 40% of my practice are on stimulants?
    I have exactly 2 adult patients, on stimulants, and I inherited them both on the meds. They work, haven't ever "lost their prescription" or had their car broken into "with the brand new bottle inside" etc. I can't decide which class medication I despise more benzos or stimulants and the providers who hand this stuff out like candy often together until it becomes problematic and they suddenly need a psych specialist evaluation disgust me.
  11. by   PG2018
    Quote from Jules A
    I have exactly 2 adult patients, on stimulants, and I inherited them both on the meds. They work, haven't ever "lost their prescription" or had their car broken into "with the brand new bottle inside" etc. I can't decide which class medication I despise more benzos or stimulants and the providers who hand this stuff out like candy often together until it becomes problematic and they suddenly need a psych specialist evaluation disgust me.
    2/3 of my practice is Peds . No stims, no revenue
  12. by   Jules A
    Quote from PsychGuy
    2/3 of my practice is Peds . No stims, no revenue
    Yeah peds is a whole different story.

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