lucianne

Sssshhhh! Don't let the secret out...

The original poster is referring to Kentucky and HB 282 seeks to remove the collaborative practice agreement for non-scheduled drugs, not controlled substances. Those will still require a collaborative agreement. At least in Kentucky, the essence of the collaborative agreement is that an MD promises to be available to consult with the collaborating NP should the need arise. There is no supervision, no chart or prescription review, no requirement to even contact one another. It is a pretty meaningless document and some NPs have reported that their collaborating physicians are requiring large monthly fees or percentages of gross income to essentially give permission for an NP to practice.

First of all, psych NPs DON'T throw meds at people. They prescribe appropriate medications for disorders that cannot be treated by therapy alone, for people who are not good candidates for therapy, or for whom therapy is not available. If you pursue an FNP, you can certainly prescribe psych meds but will most not likely have the training to handle complicated patients and if you are working in an underserved area you will most definitely encounter those patients and will be pressured to prescribe for them because mental health care is even less available in rural areas than primary care. You will not be qualified to provide psychotherapy as an FNP. There is no way to predict if you will be able to provide psychotherapy as a psych NP, it depends on where you work and who you work for. If you are working for a community mental health agency, you will probably not be doing much therapy because therapists are more available than NPs and can be paid less. However, even when I was working for community mental health, I did manage to provide a certain amount of therapy for my patients during their med checks (that was because I treated children and adolescents and was able to get 30 minute instead of 15 minute appointments). A lot of FNPs return to school to get post-masters' psych/mental health certification.

That isn't a universal practice. One of the places I did my clinicals was a community mental health clinic and they were thrilled to have someone who was willing to see children (and I ended up working there after graduation). Of course, I had to have my preceptor in the room so they could bill, but she would often do other work while I was doing an evaluation or follow-up. If you want to get family psych certification, you will have to get the pediatric experience somewhere. You could see if one of the child psychiatrists will precept you. Your preceptors do not all have to be NPs and that would give you the exposure.

There is a national shortage of psychiatrists and the demand for psych NPs is high in many areas. If your local schools have closed admissions for PMHNPs, it may be because they don't have the faculty to teach the courses or the preceptors for clinicals--hence, high demand. Only 2 psych NPs applied for the job I have now. I precept and know that all of the most recent graduate from the local university have found jobs. As for what psych NPs do, search previous posts here and on the NP page and you should be able to find several responses.

You may not think sex is important to mental health and that it is a luxury and not a need, but I strongly disagree and I can guarantee you that a significant number of your patients (and colleagues) will disagree as well. If you are not discussing sexual matters with your patients (unless they are children), then you are not fully addressing their health and well-being. I feel my patients need to be comfortable enough to come to me and say that they've stopped taking their meds because they cannot participate in sex or have no desire to do so when they take them. If they aren't comfortable enough with me to let me know they have had an erection for 4 hours, then it becomes a very significant health issue. If a marriage is suffering because one of the partners has very low libido, then it most certainly is a mental health issue. If someone is engaging in high risk sexual behavior related to their bipolar disorder or impulsivity, then it needs to be addressed in an open, non-judgmental manner.

I've had one other patient who took lithium and had trouble with nocturnal incontinence. He had a host of other issues besides bipolar disorder so I never felt that the incontinence was entirely due to medication. It also wasn't constant and seemed to flare up only at certain times. I don't know if that helps any. You said you've posted on incontinence forums, how about bipolar/mood disorder forums?

I've never been an occupational therapist, so I have no idea how it would compare to being a psych NP. I love being a psych NP, probably get paid more than an OT, have flexibility and autonomy, and get lots of respect from colleagues and patients. I'm lucky that I have the option to provide psychotherapy as well as medication management in my current position and in my private practice as well. I like having a mix of patients I only see for medication follow-up and those I see for therapy as well.

I've never had anyone get belligerent about being "analyzed" or diagnosed, but some people have been a little uncomfortable when they find out I'm a psych NP. If they say anything that suggests they are uncomfortable, I smile and tell them I only diagnose people when I am being paid to do so. (I also tell this to people who want to tell me about a friend or family member and have me give them a diagnosis).

A psych NP student that I precepted last semester has had 3 job offers so far and she certainly doesn't have any inside track anywhere. She has been working with a recruiter, but even other members of her graduating class who aren't are doing well finding jobs. South Dakota may not have many opportunities, but other areas of the country certainly do and you may be able to find a position that will pay off your student loans if you are willing to relocate and to work with an underserved population. My first job working for someone else (did a few months of private practice before I had to get something more reliable) was at one of my clinical sites. They didn't even have a job posted, I just called one day after I'd been out of school for a few months and asked if they could use me. The clinical director said "How soon can you start and how much do you want?"

Anise, in my opinion there should be a growing demand for nurses who are willing to work geropsych. However, you should realize that there is a great deal of "other" nursing involved in working with all psychiatric patients, but especially the geriatric population and you must be willing to do that as well. You state that you have "no business trying to do anything else related to nursing." If it is fear that you won't be competent that is holding you back--we all feel that way when we start nursing school and again when we start working. You will have to deal the physical problems of your patients as well as the psychological ones.

In the U.S. you must complete a general nursing degree covering all areas of nursing. I believe other countries may do things differently.

From Merriam-Webster Online dictionary: Hygiene 1: a science of the establishment and maintenance of health 2: conditions or practices (as of cleanliness) conducive to health. So while "hygiene" may encompass cleanliness it is not limited to it.

Madglee--there isn't a certification for child/adolescent PMHNPs, only family PMHNPs and adult PMHNPs. The advantage to the family PMHNP is that you can treat all ages. Unless someone was adamant they didn't want to treat children or adolescents, I think the family PMHNP is the best choice. I went to school with someone who was an adult PMHNP and returned to get her clinical hours for the family PMHNP certification. All she had to do was take 2 semesters of clinical class.

I just laugh. If they don't want to be treated by NPs, then fine with me. I've got PLENTY of patients and most of my patients really, really like me. I've had patients who have requested transfers from a psychiatrist to me. A few patients have preferred to see one of the psychiatrists--I'm not offended. People have many options for their health care: physicians, chiropractors, naturopaths, herbalists, nurse practitioners, physician's assistants, acupuncturists, reiki practitioners, curanderas, etc. Some types of health care providers are more mainstream than others and some people feel more comfortable with alternative approaches. Physicians are not the only health care providers and never have been. I like to think of nurse practitioners as having "hybrid vigor." I'm sure the anti-NP crowd would have another word for it though.