seckmann1

I found this to be helpful from http://www.medscape.org/viewarticle/506277_7 "Is it within the scope for an FNP to diagnose and treat uncomplicated mental health conditions like depression, anxiety, and ADHD?The answer is yes, in the context of primary care, and at the level of competency and skill expected for the FNP standard of practice. The context of primary care means that you are seeing this patient for health needs and the depression or anxiety is clearly diagnosed to be situational, acute, and/or potentially responsive to medications. The competency and skill preparing the FNP for practice does not include differential diagnosis of complexities such as unipolar vs bipolar depression, or anxiety related to underlying psychiatric conditions as an example. If you are prescribing medications for a condition that you cannot clearly diagnose (or support the established diagnosis with documentation), treat, follow, and monitor to a level or stabilization and beyond, you are practicing outside of your scope. Atypical or off-label prescribing for a mental health condition would be considered a subspecialty role requiring greater expertise and competencies. Most practice acts provide for time-limited stabilization of a patient or continuation of psychiatric medications that a patient has been taking for a diagnosed condition. Initiating diagnosis of a complex condition that has consequences for schooling, job, and military records, such as ADHD, is out of the scope of training and competency for the typically educated FNP. Collaboratively arriving at a diagnosis and treatment plan with a mental health provider trained and licensed to diagnose mental health conditions may be one possibility for initial diagnosis and for periodic management. There have been several licensing disciplinary cases related to both FNPs treating mental health conditions and PMHNPs treating primary care conditions. In the case of the FNPs, many were not licensed or clinically trained to differentially diagnose beyond the very basic self-limited mental health conditions, yet had prescribed medications such as antipsychotics or had mistakenly given selective serotonin reuptake inhibitors to patients with mood disorders who they thought had simple self-limited depression. Lack of access to mental health providers (or primary providers) may be an issue, but it does not change the requirement to get your patient to the most appropriate provider to coordinate their care. For the PMHNP, coordinating or initiating treatment for primary care conditions without the knowledge of a primary care provider can be a significant area of risk to the patient and to your license."

I did consult with a lawyer and he stated that it would be practicing outside of the scope of a family nurse practitioner to do psyc evals. Just for anyone wanting to know! I was told by the company several times that it was okay, but just had to listen to my gut and get legal advice.

I spoke with the company and informed them that I would be practicing outside of my scope if I did any psyc evals, but that the lines are a bit blurred regarding patient care. So, the next question is to those FNP's working under a psychiatrist, what are your job roles or functions? Are you mainly doing H&P's for new patients and maintaining medication management for the psyc meds already prescribed by your collaborating? I am a FNP-BC, with a BS in psychology, mental health therapy background and also as an RN worked in outpatient Psyc. I took the FNP route to have a broader scope, but I am going to pursue the post masters certificate in psychiatry. This company will pay for that, but in the mean time, I still don't want to practice out of my scope. Any advice? I am trying to find a lawyer versed in this so any IL recommendations on that would be great too.

I have a degree in psychology too, with experience as a mental health therapist. I don't, however, have training in psychiatry as a nurse practitioner. I think you're all right that it's a bit risky even if the BON gives the ok.

Sorry, I meant the pmhNP. I have a job offer paying VERY well, but I need to do at least one psyc eval a week. I called my state board of nursing and they said, "you can work for them, but not as them." I said, what does that mean? If I'm in a family practice doctor's office, I'm working as a NP, I'm not working as a doctor. So to me, that answer didn't make sense. I can work for a psychiatrist, but not as one??? I was told to call back later when their computers were up and running. So, I guess I'm just wondering if there's any FNP's out there who currently work in this area or do psyc evals currently? Or is this too risky of a position to take?

I have been in talks with a great company to work under a MD psychiatrist at an addictions/mental health facility. I cannot seem to get an answer from the BON on this. I need to know if it's okay for an FNP to work there and do psyc evals or do I have to be a PNP? Thanks for any tips or advice!