Psych/FNP Scope -Need Your Help!

  1. Hi all -



    As some of you will know, I'm a psychiatric NP with full practice authority in Connecticut.

    I have been approached by a friend about working p/t at one of those new trendy IV vitamin/hydration "therapy" places (actually this would be concierge). This certainly isn't my calling in life, but I can't say I'm not a little interested.

    I thought this would definitely be out of my scope, but some of my friends (a paramedic, an FNP, my biller), think perhaps not.

    How do I ago about determining, concretely, if I can do this (would be standard IV fluid limited to NS and LR, some IV B-vitamins, and meds limited to Zofran and Toradol)? Most people doubt that my state's BON will have given specifics on this. I tried the ANA's website - some vague statements and no contact email/number.

    I can see this maaaybe being okay b/c I have prescribed fluids and I think once zofran/toradol to an occasional in-patient psych patient. (Plus, can PMHNP's prescribe IV ketamine?)

    Does it matter that this position wouldn't actually be "treating" any medical (or psychiatric!) problem (okay-aside from hangover-level dehydration)? Yes I need to have competencies with inserting and running IVs, knowing about extravasation etc, (have that covered as an RN)..... what about knowledge of fluid and acid-base balance? I have that, having been a SICU RN, but I haven't received NP-level education on the subject. Do you FNP's have specific lectures/classes on it?


    Thanks for any thoughts/suggestions/insight!
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  2. Visit NHGN profile page

    About NHGN

    Joined: Feb '08; Posts: 79; Likes: 47
    from CT , US

    7 Comments

  3. by   Jules A
    Prior to getting my FNP I didn't initiate or make dosage adjustments on any prescription meds that were not psych oriented. Have you checked with your BON? That is the place to get confirmation, in writing, that this is within your scope.
  4. by   NHGN
    Jules - there's nothing on their website. I spent 30 mins on hold on the phone only to get disconnected - I'll try again tomorrow!
    A few experienced colleagues have thought that the BON won't have information on this. Still others said refer to my hospital policy- but there is no hospital and the "company" at this point is one person.
    I did talk with somebody from the ANA over email since many other professional groups refer to them for scope of practice limits, but they referred me back to the BON too. So I'll make that phone call again tomorrow.
  5. by   djmatte
    As noted, the bon would be the best bet. If you are prescribing anything outside of the psych scope, you are likely outside your scope. If there is another provider prescribing treatment though and you are only working as an infusion type job, your RN should cover you in this capacity.
  6. by   BostonFNP
    Are those medications within your experience and training (and could you make a reasonable defense of this)? If so, then unless the BON specifically addressed it, I'd think you'd be ok.
  7. by   NHGN
    Boston -
    Well...I've prescribed them once or twice while under physician collaboration. But there is no way I could prove this (ie it's documented in two patients' charts from ~2 years ago).
    Another experienced NP advised "You can prescribed those, there is no restriction. People will all tell you to stay in your scope but with additional training and add this to your liability insurance, that will be sufficient."
    I will talk to the BON. I expect them to be vague and not have anything if I ask for documentation.
  8. by   Jules A
    Quote from NHGN
    Boston -
    Well...I've prescribed them once or twice while under physician collaboration. But there is no way I could prove this (ie it's documented in two patients' charts from ~2 years ago).
    Another experienced NP advised "You can prescribed those, there is no restriction. People will all tell you to stay in your scope but with additional training and add this to your liability insurance, that will be sufficient."
    I will talk to the BON. I expect them to be vague and not have anything if I ask for documentation.
    There is no way I'd take this on the authority of a colleague(s) especially because this is stepping outside of your formal training and expected practice. The one time I needed clarification of something I emailed the board and got the answer in writing.
  9. by   BostonFNP
    Quote from Jules A
    There is no way I'd take this on the authority of a colleague(s) especially because this is stepping outside of your formal training and expected practice. The one time I needed clarification of something I emailed the board and got the answer in writing.
    After re-reading the OP regarding IV infusions, I agree with Jules, I wouldn't want to touch this. This is an invasive and off-label treatment of potentially anaphylactogenic compounds. Even Toradol has some significant adverse reactions especially with chronic use (which if you do take this on I would make sure your are intimately familiar with). This just seems like too big of a risk compared to the reward.

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