PMHNP and telepsych

Nigel9 · Nov 15, 2018

bumpity bump bump

Thanksforthedonuts, MSN, APRN · May 18, 2019

This is a great question, I'm surprised no one has answered it!

I don't have an answer but I'll be watching for one.

Nigel9 · May 18, 2019

For what it's worth, and I'm sorry but I don't remember the actual legal references right now, but aside from needing to be licensed where the client is, coding presents as a problem (especially with Medicare/aid, which represents the bulk of clients), and also there is an issue with initial assessments. I believe initial assessments need to be done in person.

myoglobin, ASN, BSN, MSN · May 19, 2019

It depends upon the employer. For example my SO is licensed in Arizona (and Florida), but lives in Florida. All of her patients are in Arizona. She works from home, but on occasion (such as when the hurricanes hit last year and knocked out our electricity) she worked from a hotel room. As long as she has her computer, integrated camera, and reasonably high speed internet (plus access to a fax/copier at least once per day) she is good to go. Now some employers/agencies (perhaps such as the one you work for) require their telepsych. providers to be onsite. Also, many telepsych. jobs require one to two years of experience. That said my wife got her job straight out of school.

Nigel9 · May 19, 2019

That sounds appropriate. But does she do initial assessments along with initial prescriptions over tele/internet? And if you guys took a trip out of the US, I do not believe she would be able to work, at the very least not something that would allow her to code for M/M patients.

But what has been her experience with this?

myoglobin, ASN, BSN, MSN · May 19, 2019

Yes she does initial assessments and all prescriptions are electronic. In the past she has also done inpatient (again over the internet). I'm pretty sure that she must be within the United States. I'm not sure if USVI, American Samoa, Guam and other territories would work for federal law (mainly this is a Medicare/Medicaid issue I believe). Of course the job isn't easy. It's 20 minute medical management and 40 minute evals. Then again the place where I'm doing my PMHNP clinicals (brick in mortar in Florida) is 15 minute appointments. Plus, she believes that there is slightly less of a tendency to "stay and talk" which is a major issue when you are dealing with 15 minute appointments, because it is more "transactional" and less personable. In the final analysis she still finds the job stressful. Then again she's not with me anymore in a trauma ICU lifting 400 pound patients by herself, getting hit, and driving 70 minutes each way to work. Her workday is M-F 11AM to 8PM (9PM to 5PM Arizona time). She also doesn't have to deal with attractive drug reps. bringing her food all day and inviting her to fancy dinners so they can push their latest $2,000 dollar per month antipsychoic or antidepressant. I know at my clinical site we probably lose no less than 30 minutes per day to drug reps and they are always pushing us to go to fancy dinners (and since I practice intermittent fasting along with a ketogenic diet there is essentially nothing for me to eat, even if I had the time or energy after working and studying which I do not). She also benefit in that she can type about 80 words per minute, as an OCD personality, and has essentially memorized everything ever written by Stahl, Saddock, and Maudley with regard to psychotherapeutic medications (she also utilizes UpToDate, and Epocrates heavily).

flipkid1287 · Apr 23, 2020

I am also a Psych Nurse and about to start my PMHNP online program next month. My job also entails a doctor who does tele-psych in SJBH.

Where are you currently going to school?

The tele-psych doctors are no PMHNP's. They are MD's.