Spaciousness

Great story. You used the terms "Task" as opposed to "thought" orientation. I like the term "process." Process, process, process! It's another way of referring to "critical Thinking." What comes to mind is a book written by a physician called, "The Check List Manifesto" by Atul Gawande--an excellent book about process or critical thinking. One of his points is that healthcare, medicine, and associated technology has become so complex with so much new information and level of complexity that no one can stay on top of it all. In order to eliminate (or at least significantly reduce) error, all of us should engage in the process of the checklist--even with tasks that we think we have mastered. For example, even if you have worked with the same patient for 12 hour shifts, 3 days in a row you still ask them to state their full name and check what they tell you against their wrist band and the room # (and associated name) and another source as part of the "right patient" portion of the "5 rights." Even if you check the bar code on their wrist band against the Computer on Wheels (COW). Some things may seem very very obvious, so much so, that we throw the check list out and go right into the task (e.g. "I obviously know who this patient is and I know what drug they take at this time so I am going to skip the process of asking him or her to tell me their name and check their band and instead I can go right into the task of giving the med"). Whether you are a pilot prior to take off, or a surgeon get ready to cut, or a nurse about to give a med, ALWAYS go through your check list no matter how obvious things may (or may not) seem. We shouldn't worry about other's possible judgment of us for engaging in this process.

Dear Nurse Beth, I am go glad that you took the initiative (and perhaps risk) to share your experience. I feel gratitude knowing that your share will help other's who may have pre-determined ideas about the so called "here-after." My awareness of these accounts has helped me better accept the passing of loved ones because I feel more secure in the knowledge that there is more to "this life" than meets the eye. While we may not always perceive it based on temporal situations and circumstances in this life, the Universe is a place of Love and connectedness. We can participate in this Love and connectedness anytime. God Bless You and Yours...

I have heard in class that lab monitoring can be a major pain. I don't know what the solution is, other than some kind of visiting nurse (RN; LPN) doing home visits or something. It looks like the specialty of mental health clearly can has its own unique set of challenges. On the other hand, I know people that work in primary care and in other specialties beside psych that are unhappy with poor patient initiative and follow-through. Thanks for the feedback.

As with any specialty area, I agree that the provider (be it a PA; MD; NP; DO; etc.) needs to have experience and training in the area. I believe that there is a great need for this service given the dismal results (based on what my preceptor told me) of recovery without the help of Suboxone. AND it is important that the provider not only be knowledgable, but have a passion for the work and compassion for these patients along with having excellent boundaries and some streetwise discernment--anything less will not help anyone.

Thanks Verne for finding that information! Your efforts and skill with tracking down the information are greatly appreciated!!! I am going to try and contact my State Board to see what they say.

Thanks for your response. I always appreciate your posts PsychGuy. I suspect that the information that NPs can offer Suboxone TX is not accurate. As a PMHNP student I am curious about your comment. Where are you absorbing the clozapine patients from (do you work in an agency or government system that sees a lot of people with severe and persistent mental illness?)? When you refer to special meds are you talking about meds that need close lab monitoring? What do you find aversive about working with folks on these kinds of meds? If you care to share that would be great. Thanks.

I am in the clinical portion of a PMHNP program. My preceptor is a psychiatrist who provides Suboxone therapy. My understanding as of last year is that NPs are not allowed to become certified to provide Suboxone treatment. I am aware that there was proposed legislation in 2015 to allow NPs to provide Suboxone therapy; "U.S. Senators Edward Markey of Massachusetts and Rand Paul of Kentucky would increase the first-year cap from 30 patients to 100, and would allow nurse practitioners and physician assistants to prescribe buprenorphine." I understand that the cap on a provider's case load of Suboxone patients has been increased, but I do not know if NPs are allowed to offer this service. I was told that NPs can now prescribe Suboxone, but I cannot find anything to corroborate this. Any feedback would be appreciated. Thanks

Hello Atomic Woman, I haven't been back to this site for awhile. Thanks for responding to my question. Your response is similar to the conclusion that I came to after giving it some thought. With Gratitude.

PsychGuy, Your comments are much appreciated. BTW, I note that you respond to a variety of people's questions/concerns in a very positive, upbeat, and informative manner--kudos to you! Patients in mental health (well, actually all patients in any area of healthcare) really need exposure to people with your energy and values. And, as a profession, we really need to be out there building each other up!

Thanks jer_sd, DNP,NP, CNS for helping to separate out and clarify the issue.

"we're so limited to a singular niche." Thanks PsychGuy , appreciate your feedback. Your comment about the "singular niche" I see as being a real problems with the NP sphere. I believe that our training and professional structure should be such that regardless of specialty (an I see family medicine as a specialty), we have a base level of competence from which we can build, but some things should be a given (whether a psych NP or one specializing in cardiac, we should be counted on to be able to understand and treat some of the more common presentations showing up in a primary care office (be it a bacterial sinusitis or mild to moderate depression) without having to get board certification under the medical specialty that these disorders fall under.

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Thanks for taking the time to respond to my query. To give it some context, I attended a grand rounds workshop sponsored in part my the local medical college and attended by a prominent member of the board of nursing in my state who is also an PMHNP and by 2 NPs who were trained as PNPs but now did psych after doing some training and continuing ed with psychiatrists. I was told that with my background, I would be within in my scope of practice to prescribe psychotropics just as the PNPs who were presenting their work at the grand-rounds. I would not presume to know how to do the work of a PMHNP as an FNP unless I received some additional training. Also, as an FNP, I would not want to get into treating serious mental illness such as thought disorders or unstable rapid cycling bi-polar; I would without a doubt refer that out. The gist of my question is that if a family doc or PA can prescribe the occasional anti-depressant or anxiolytic in primary care and get reimbursed for their services, than why not an FNP?

I am looking for some feedback/direction. I am a clinical psychologist in an FNP program. I chose the FNP track BTW because as an RN I did mostly psych and got "type-casted" there, i.e. couldn't get into other areas (e.g Med-surg,; ED) later on. I want my scope to go beyond psych assessment and prescribing psychotropics. That said, I learned that in my state, that non -PMHNP can work exclusively in psych if they have background to show familiarity (e.g. worked as a psych RN; in my case being a psychologist) with psych. In other words they are not considered to be working outside of their scope of practice. So far for me, Great. Now I learn that some insurance companies will not cover non-PMHNPs that provide psych services. So....finally my question/comment; Would this be something that a national NP organization could lobby and sue over? I mean if an internal med doc or a family doc (or an PA working in primary care practice) can prescribe psychotropics and get Ins. coverage, then why should FNPs be treated differently if they are " within their scope"-- even if they are not board certified as a PMHNP? On this note, I can't help but notice that PAs get hired into, and operate in just about any specialty without having to have the kind of background that is often required of FNPs that want to work in a specialty. As a profession, are we getting short-changed by our training and organizational hierarchy? In short if a PA or family/internal medicine doc can do it (i.e. psyc services) and get reimbursed, then why are FNPs settling for less?

I would like to "piggy back" off of ernurse2013's question. Most of my nursing experience has been in psych. I eventually went on to get a graduate degree in psychology and I haven't worked as a nurse since 2010. I want to get back into nursing but not psych (I still plan to use my psych degree--either to do out patient private practice, or to supplement my NP--I am in an FNP program now, and I am debating going into psychiatry, or trauma, or if possible, both). I have a strong interest in the ED and would like to work as an ED nurse and possibly as an NP in an ED setting in the future. My last job involved working with geriatric patients that had concurrent psych and medical issues (unlike some psych units, we did not keep people out who needed medical management) so I got a little exposure to medical nursing (e.g IVs; hanging blood; NG tubes; dressing changes, colostomy bags, etc.). Anyway, it seems like the EDs all want people with previous experience (with the exception that one that I am aware of, occasionally takes GNs or has a "nurse interns."). I have been turned down. I have asked about shadowing and was told, "we don't do that anymore." I offered to work for free during an extended training period-no luck. No one seems interested in training me. I was looking at doing an RN refresher program and I would hope that they could provide clinical experience in an ED, but that might be doubtful--esp. since I have never worked in one in the past. So..how the heck do people get into the ED???? It seems like a brick wall, but obviously, some people have scaled it. Maybe they know someone? Any feedback would be appreciated!

Dear VivaLasViejas, I read your reply yesterday (August 2nd) and it has been "hanging-out" in my head. It really resonated for me personally, because I have personally found that I can always come up with good reasons why a job isn't right. What I have noticed however is that I keep doing this and that while my "reasons" may be true, the real issue has to do with me. The terms that you used, "restlessness" and "dissatisfaction" really ring true. I wish that I would have come to this kind of awakening earlier in life, yet at the same time, I still struggle with restlessness and dissatisfaction. There have been many things that have helped me to deal with this, e.g., history (just looking back over my life and seeing many job changes, relationship changes, moves, etc.), therapy, my faith (christian), as well as the support of good friends and using mindfulness meditation and aspects of Buddhist psychology (even though I identify as christian); such as the recognition that part of dealing with life is accepting the fact that dissatisfaction (dukkha) is an inherent part of life (this is one aspect of "The First Noble Truth" attributed to the historical Buddha). This does not mean of course that people should take abuse, or that nurses shouldn't organize, just that wise action comes from seeing the big picture in a sober and discerning way and not from emotionally reacting to "causes and conditions" (another common piece of Buddhist terminology). Also sometimes (as others have noted in this thread, but not using these words) we have to "lose the battle to win the war." If we are too busy reacting and moving around we may miss out on either a better opportunity when it shows up at the right time or on the fact that the situation that we are in has changed. Just my "2 cents" to thank you for your comment as well as feedback for Kasandra and anyone else reading the thread who can relate. Peace.

The bottom line is that you are already being charged for people that don't have insurance through "cost shifting." Will this prevent costs from rising? Who Knows. As far as helping you. If you are fortunate enough to have health insurance coverage (whether it is adequate enough when you really need it is another story), than nothing much changes EXCEPT the insurance company won't be able to boot you out if (without reimbursing you the money that you and your employer paid in) if you get really sick. If you decide to strike out on your own and be an entrepreneur, you will be able to buy your own policy without worrying that you will be excluded because of a pre-exisiting condition.

Thanks Zenman. Spaciousness.

Hello All, I am new to this site. I have my BSN and my doctorate in clinical psychology. I am looking at pursuing a nurse practitioner degree (increase my knowledge on medications and physiology as well as treat with psychotropics) but I do not want to limit my future job options. When I graduated with my BSN, I went right into psych and eventually regretted it--I got burnt out. I wished I had taken the early advice of getting some med-surg experience first (because straight psych nursing got old for me). I eventually got a little med surg type RN work experience by working on a geriatric unit that had psych patients with medical nursing needs (e.g. IVs, dressing changes, hanging blood,etc.). I enjoyed doing more medical type nursing. Anyway, I was thinking of pursuing either an Adult Nurse Practitioner degree and then getting post-graduate certification in psych.or Family Nurse Practitioner with post-graduate certification in psych. rather than going into a straight PMHNP program. That way, I will not limit myself to working in psych only. I see what the NPs do on the inpatient unit at the hospital where I work. I want to be able to work in as an NP inpatient or outpatient (maybe even E.R.) as well as do psych NP work to keep my options open. Would the FNP with post-master's certification in psych be the best?