Guest603994

Additionally, you incorrectly mentioned earlier that it depends on what the FNP’s attending can do - this is not correct for the APRN scope: ”APRN scope is not determined by the setting in which the APRN practices. The focus is on what it is the APRN is doing – what care are they providing and what care are they managing, and, for what population including level of acuity.“ They go on to state you must be certified in the area you are practicing. THIS IS DIFFERENT THAN THE SOP FOR AN MD. You’re obviously giving incorrect information when you share your opinion, so again, the nurse who has further questions should ask their BON and not someone who claims to be a physician online who also said they prefer hiring PAs over NPs ?

Keep in mind I work with argumentative, irrational people every day - your laughing emojis don’t faze me, but if you read my post, you could see I wrote, “grab an SSRI and a referral.” I collaborate with FNPs often and I can tell you that many are not aware of their scope, so this is definitely not just an issue here. It’s something like a quarter of BON investigations are due to scope creep, as the AMA calls it, where NPs are going outside of their SOP. This is exactly the case when you blur the lines here and say sure go ahead and treat as you see fit until they’re unstable, THEN send them to a specialist. That’s silly. And I can tell you, they don’t need to be going inpatient in order to go to the ER to ensure safety. I’m not sure why you continue to say that - if they’re unstable, an FNP does not treat and you send them to the ER if they can’t safely wait for a referral. The ER doc consults psych and treats accordingly so they can stabilize until they see psych. Heres a great example that only happened last week: PCP refused to give propranolol to a pt c/o situation anxiety D/t SBP in the 90s. They gave a couple pills of low dose benzo instead. Pt fell in the middle of the night and had a head lac that resulted in multiple other costly interventions. They saw psych and psych immediately prescribed propranolol because they met criteria. This happens often where PCP is acting outside of their SOP and/or not collaborating on “stable anxiety” and making poor medication choices based on their experience, rather than referring, or better yet, consulting. It’s not rocket science, but FNP school isn’t medical school, so why even compare the two? And if it’s “not rocket science” and “just a list of criteria,” then why are psych providers dealing with this same ridiculous situation all day every day? A lot of incredibly insulting things are being said about the PMHNP profession as a whole here, I’m just shocked at how poorly you think of fellow NPs Just because you don’t like PMHNP schools, it doesn’t mean they don’t get tons of OJT or CEUs specific to their specialty every single day once employed. An FNP has a very generalized scope where they need to know enough about a lot and are not required to know the many nuances of psychiatry. Why should they? Plus, you don’t need to guess what the criteria is for FNP school related to psychiatry - I listed it above and it says nothing about bipolar FYI so good luck to the FNP who gets called to the stand there.

First off, “stable” means you’re not changing anything. You continue to prescribe the medication they’re already being prescribed, likely by psych. If they’re stable and saying depressed, you refer and likely they’ll get an appointment before any medication you think to try will kick in. But if you want to try something relatively low on the side effect scale and you’re confident in your abilities, how do you know it’s not bipolar II you’re treating? How do you know you didn’t send them into full blown mania? So from what you’re trying to argue, FNPs have been tested and educated while in school for bipolar d/o on screening, diagnosing, and medication management? It’s not emergent for an FNP to treat schizophrenia or bipolar or even anxiety and depression - because if it were, it means they’re unstable and you send them to the ER. If they’ve had symptoms for 5 years with no treatment, why does the FNP insist on treating rather than having them wait for a referral? If it’s anxiety or depression, grab an SSRI and a referral, but why are we even talking about anything beyond this? Same point you just made with derm - it’s not an emergency, so stay in your lane. Which was exactly my point - it’s not necessary in the moment, and even if I’m trained and confident to do it, it’s not my scope, so WHY in the world would I do it? Im not sure why you guys are having such a hard time with this and now you’re insulting the PMHNP profession which is childish. I could give very specific information on the awful things I’ve seen FNPs do in the 20 years of my career, but insult an entire profession won’t make my point more credible. Despite having no formal training in the area, even though it says you must be trained in school and then tested on the subject in your certifying boards in the documents I provided, you INSIST it’s still your scope because it doesn’t share minimum here. That’s a scary thing and it makes sense why when I get a patient from PC I’m constantly changing the mess they made. You’re doing far more harm, including many MDs and DOs who claim to have experience in the area. This was a link that didn’t share earlier from the BON - notice “Has the nurse completed the necessary education to safely perform the activity, intervention or role?” Followed by, “Is there documented evidence of the nurse’s current competence (knowledge, skills, abilities, and NO judgments) to safely perform the activity, intervention or role?” “Would a reasonable and prudent nurse perform the activity, intervention or role in this setting?” Because these are the questions you get asked in a court of law and if it’s no to any of the 3, you’re guilty for practicing outside of your scope. If you cannot furnish a PMHNP certificate and you get called into court, it’s your license and at the very minimum your insurance rates just went up. Again, this is bad advice and it’s your license, people. https://boards.bsd.dli.mt.gov/_docs/nur/sp_model.pdf

FYI from my state board: ”APRN scope is not determined by the setting in which the APRN practices. The focus is on what it is the APRN is doing – what care are they providing and what care are they managing, and, for what population including level of acuity. In short, an APRN-CNP may engage in mental health care consistent with the competencies validated by the national certification they obtained and maintain. The national certifying examination is the determining factor as to the APRN’s role and the population focus for whom APRNs are formally educated to provide care/medical management. APRN licensure by the Board is based on the applicant having passed a national certification examination by an approved national certifying body, in a particular role (certified nurse practitioner/CNP; certified nurse specialist/CNS; certified nurse midwife/CNM; or certified registered nurse anesthetist/CRNA) and in one of several different population foci (Family, Adult-Gerontology Acute Care, Adult-Gerontology Primary Care, Pediatric Acute Care, Pediatric Primary Care, Women’s Health, Psychiatric/Mental Health, etc.). An APRN may manage the care of those patients and conditions for which their formal education has prepared them, as evidenced by their national certification. It can be helpful to look at the test plan for the APRN’s national certification as the APRN’s practice should align with the competencies validated by the national certification.” They go on to state, “Managing more complex or severe mental health issues such as psychosis would require PMH certification, for example. Again, the APRN would look to the national certification they obtained and maintain, as certification validates their training, education and competencies regarding the types of conditions they can manage.” That would be the last document I uploaded here. So to answer the OP’s question, it doesn’t matter the practice setting or what someone’s “opinion” is that FNPs should be treating, it’s what you’re trained and ultimately certified to do - and anything outside of stable anxiety, depression, and some states ADHD is outside of scope for anyone other than a psychiatric nurse practitioner.

I agree. It’s frustrating to hear that an FNP *has* to do something because of rural setting or lack of providers or appointments or whatever. Telepsych makes accessing a psych provider so much easier. There is a reason your malpractice insurance will drop you if they get wind an FNP is treating beyond their scope, and this is a great example of that as well as why the AMA is going after NPs for scope creep. Don’t get your scope from an MD who will drop you for a PA (much like the physician in this thread said they would). They don’t know the scope difference between a PA and NP and don’t realize we’re working with our license and certification and NOT theirs. Protect your license. Protect your patients. Get your scope from your state board.

Again - don’t get advice about your license and scope from someone online. Go to your state BON. When they sent this to me a gazillion years ago, it was the same as it is now. If your competencies only show you can screen for something, you will not be defended in court when you treat beyond it. This isn’t some turf war or whatever was mentioned before, this is your license so be smart about it. Good luck.

This should be something we all know and defend - patient safety and your license should be paramount and going off of the “opinion” of some rando poster who claims to be a physician and an FNP is completely ridiculous. Diagnosing and treating anything other than anxiety and depression IS against a FNP’s scope - how is anyone even arguing this? Makes sense why so many are being sued right now because this is awful advice. Refer to attached screenshot - scope is left to the certifying bodies and this is what your BON will send you. Your insurance will not defend an FNP if you diagnose and treat beyond stable anxiety and depression (meaning you’re only carrying over medications they’re already stable on) and some states, ADHD. It’s your license and if you want to treat patients and risk your future based on what someone online says with zero proof, cool. And why in the world would a physician still be licensed as an FNP and then argue about what their physician “scope” is? That’s not the question here. If you scroll down and see what the FNP vs PMHNP scope is, it’ll be very clear. https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/Competencies/CompilationPopFocusComps2013.pdf

Again, not sure why a physician is on a nursing board arguing about what an APRN’s SOP is, but here’s more information on the subject. https://www.npjournal.org/article/S1555-4155(18)31013-4/fulltext?fbclid=IwAR1lpvIShUmGJmqt9KNl8ZE2fH5K4-x7PsyjqhyN6JmAueH8YASRXq4wdSs

You are arguing with the state BON SOP. Write a letter with your disagreements. However, you’re giving bad advice telling a FNP to put herself in a position where their license is at stake. Turf has zero to do with it.

I’m going to disagree. It is outside of an FNP’s scope to treat psychiatric disorders outside of stable anxiety and depression. Period. Please refer to the Ohio.gov article I shared. There is also an ongoing APNA thread currently discussing this as many PMHNPs are being asked to testify through the BON as to what their training and scope is against FNP colleagues who diagnosed and treated psychiatric disorders. If you do not have the training in school, which FNPs do not, you should not be providing this care. Please refer to your state BON for further clarification, but with all due respect, a general physician should not be giving their opinion on the matter or on this thread. As you said, you don’t even have a scope.

Again, why does a physician’s opinion have anything to do with this question? It is 100% outside of the FNP’s scope to diagnose and treat beyond STABLE anxiety and depression. I was speaking to the FNP’s scope as I’m aware of what a physician’s is. Adding a general medicine physician’s opinion, experience, or training is a moot point here which is why I brought up derm. It really has nothing to do with this conversation.

1. Why is a physician on Allnurses? 2. Why is a physician giving their opinion on a nurse practitioner’s SOP? As you said, general medicine training is far different. Additionally, I wouldn’t get a PMHNP started on how many times they’ve had to change the mess their PCP started them on. I still challenge the ongoing training any provider has outside of psych in order to monitor the psychiatric aspect of this drug.

Did you train on the use of lamictal in FNP school? What are you starting the lamictal for? Are you diagnosing something outside of stable depression and anxiety? If so, that’s outside of an FNP’s scope, rural or not. That’s like me saying I did a biopsy because it would take forever for them to see derm. I’ve done biopsies and sutures in the Army but it’s 100% out of my psych NP scope. Just because you can do it and bill for it doesn’t make it within your SOP and absolutely makes you liable.

I could be wrong, but I don’t know of a single state that expands on an FNP’s scope beyond STABLE anxiety and depression with or without a collaborator. Even in states we aren’t fully autonomous, psych NPs need a psychiatrist as a collaborator. Going outside of your scope is a sure fire way to get a BON investigation and opens you up to liability. There’s a reason you refer and I don’t know of a single FNP program that teaches therapy. “FNPs can diagnose and treat patients with uncomplicated mental illness, such as depression and anxiety, within their scope of practice (SOP). However, FNPs should be aware of areas that fall outside of their SOP, such as diagnosing and treating patients with complicated or severe mental illnesses or exceeding prescribing authority for psychiatric medications. Any breach of their SOP could lead to civil liability and disciplinary actions.” https://nursing.ohio.gov/wp-content/uploads/2019/09/UpcomingBoardMaterials_FNP-Scope-of-Practice_8.0.pdf?highlight=license verification

Hey Elizabeth - I just read your FB post that you’re transferring out of our cohort. So so sorry it’s been such a pain for you. Fingers crossed your next experience is much more positive!