B52Bomber

Agreed. Although, I'm not sure if you were referring to me using a "denigrating tone" but in fact I was not if you refer back to my post. I did not say or insinuate the term should apply to PAs and not NPs. I said I commonly see 'physician extenders' being applied to PAs but it delineates the knowledge and skills they've developed by making it sound as if they are only working based on the opinions/treatments of the physician (does not mean I support the term being applied to them). I definately do not believe the term should be applied to NPs because physicians and nurse practitioners are separate entities practicing similar yet different approaches to care.

Yes, yes it is. My intention was to create a title that would intrigue others to read my commentary hence why you're here and responded. :)

No problem, I love your responses it makes me think/see the bigger picture about diffferences in care and opinions of other providers. As for rate... considering it's Detroit, it pays the bills but my retirement investments won't show much growth LOL. Its over 90K which compared to my colleagues is great. I always strived to seek out my own clinicals and preceptors (usually were MDs because of their expertise) which definately helped me obtain great experience and job opportunities. Other students seemed to expect rotations handed to them and then complained how much they hated them. I actually enjoyed most of my program because I supplemented my education with certificates or trainings such as a SANE program but I would have never gotten that offered by my program.

Less than a year, but I'm in a private practice position with 2 psychiatrists and an NP (who is also a psychologist and prefers psychotherapy over med management). We also have 4 therapists. Mind you our clinic is specialized in alternative medicine and many of our clients are referred to us for our use of neurotransmitter testing and other therapies not commonly offered elsewhere. Because of this, many of our patients seek out our services while continuing to see their original therapist so I do end up coordinating and developing their plan of care on deeper assessment of their needs. I see anywhere from 7-12 patients a day depending on what kind of visit. We actually offer 1hr for initial visit and 30min for follow-up.

I should've stated "don't solely provide." In psychiatry I'm not specifically concerned with WHAT their diagnosis is or WHAT medications I choose to use for treatment, rather HOW will the patient access them and WHO will be there to assist them through their treatment? I'm not solely concerned with the what's in treatment but the "ADLs" of their life being met admist their circumstances within their life that placed them where they are. Our care is multifactoral and at times I feel like I'm more focused on everything but simply their diagnosis because how can you treat if there's no access, support, negativity, or unmotivation to be treated?

I should've stated "don't solely provide." In psychiatry I'm not specifically concerned with WHAT their diagnosis is or WHAT medications I choose to use for treatment, rather HOW will the patient access them and WHO will be there to assist them through their treatment? I'm not solely concerned with the what's in treatment but the "ADLs" of their life being met admist their circumstances within their life that placed them where they are. Our care is multifactoral and at times I feel like I'm more focused on everything but simply their diagnosis because how can you treat if there's no access, support, negativity, or unmotivation to be treated?

Well NPs don't provide medical care anyway so that's a good thing :-P but yes these programs really promote the end product but don't tell you how difficult it is to get there (financially and not well instructed clinically or in lecture). I honestly felt lost at times and was able to successfully complete my capstone project without any assistance which was supposed to be provided. Ugh

Most programs allow this to happen to show their large cohorts and acceptance/graduation from the program to boost their recognition and reputation. As far as those who wish to use 'Dr.' in all actuality they have earned it. I don't prefer to use it because it does not determine my ability to provide care. But realistically if someone were to obtain a DMA (doctor of musical arts) then he can use Dr. as well to exhibit is expertise in that area. It is what it is.

I was nervous too! My first nursing job was in a neurotrauma ICU with only student nurse experience in cardiac cath and telemetry. I can tell you it takes time, it was exciting to me so I would ask other nurses to complete some of their tasks while they watched so I could demonstrate it correctly. My first time I passed my NG tube meds and forgot I left the feeding tube clamped and when I finished and started running the pump, 5 minutes later I heard POWWW and walked in to find my patient and their family members covered in Glucerna! Luckily the family thought it was funny and had no idea what even happened. I'd say I felt the most comfortable after a year (including knowledge and preparation of emergent invasive and non-invasive procedures) which made the MDs happy haha! Always determine what needs to be done and prepare what you need to get it done. It's very complex but intriguing and exciting!

I have yet to be in any circumstance using psychotherapy haha! So far I've been in PHP, outpatient and private practice settings primarily managing medications including alternative medicine but the closest I've used to any kind of counseling/psychotherapy is plain ol therapeutic communication and some motivational interviewing. A PMHNP I worked with in my practice was actually a psychologist as well and used psychotherapy and would typically conduct our neuropsychological testing.

Oddly enough I've received more negative feedback from other NPs, CNSs, and RNs for obtaining my DNP degree at 27 years old than I have from other colleagues (I.e physicians, psychologists, PT/OT and PAs). I've been passionate in psych nursing since my BSN program. I decided to get my minor in psychology and was then accepted into the DNP program before even graduating with my BSN. My first nursing job was Neuro ICU, then I briefly worked as a SANE nurse and then I worked in various psychiatric settings (including emergency psych). I do only have 5 years of nursing experience but personally I feel as though my passion and interest really pushed me to learn more and more. What are your thoughts on young RNs who have pursued or are pursuing graduate degrees with little experience? Is age just a number? Or is it an important factor in advanced nursing?

First off that company he researched for would payoff docs just to prescribe their meds (but I'm sure if NPs did he wouldn't be complaining about us being unnecessary to the health care world because we wouldve kept him employed). Also that company held important study information from the public regarding a cholesterol medication - seems rather unethical? On on another note, he has no idea what he's talking about in relation to the socio-economical needs for NPs and the fiscal gains associated with NPs providing care especially in areas lacking providers... which is probably why he only landed an A&P instructor position to teach NURSES who are needed and gainfully employed. Lastly, he's a doctor/scientist with an interest in research and creating data that could be applied in the clinical arena. With many physicians leaving primary care/outpatient settings and clinics, who will be there to translate that evidence into practice? I'm a DNP prepared nurse and I'm 27 and I've had a number of physicians and practices reaching out to employ me for the need of a PMHNP. We will always be needed!

I'm curious to know what the direct orders would be for them or the inmates? (You don't have to specify) but in the Wayne County jails in Detroit they have health administrators that refer to the medical directors regarding any implementation of treatment or development of guidelines and such. I know specifically in the mental health department that the administrator oversees social workers, other psychologists, general psychiatry residents and clerical staff. Also they report to and collaborate with the lead psychiatrist or medical director. I have not heard of nurses taking orders from custody officers, rather they should be assisting the medical/nursing staff with inmate assessments and implementing care if needed to make sure care is provided when and how it's needed. Most times I've heard of nurses providing education and guidance to the officers regarding safe and effective care.

I think it's ridiculous. I'm curious to find out where it even originated. Once again physicians want to emphasize the fact they are "supervising" when really in the majority of my experiences they were barely collaborating. When I think back to working neuroICU during the dreaded month of July and having my 3 years of experience, I innocently taught new residents simple hands on patient care techniques. And the nerve to call us midlevel. But in all honesty in the psych world I've never had any issues with psychiatrists we've worked very well together. My FNP and ACNP friends have differing views.

The advocacy of advanced nursing education and clinical expertise is a main driver for your acceptance into a DNP program. Being able to acknowledge, address and affect healthcare and further the nursing profession is a vision of accepting students who will excel in the program. I was still in my BSN program when I applied, interviewed and was accepted into my BSN to DNP program with a specialty in psych-mental health. Majority of the questions asked were how I think I could make a difference or practice change that would benefit various levels including patients, facilities, communities while addressing health policy, using leadership and acknowledging health disparities. Plus I was the only psych-mental health DNP student in my program cohort hehe.

I worked in an emergency psychiatric crisis center at a level 1 trauma center and not one patient or scenario was similar, including our frequent fliers. Our clientele included anyone from the pleasantly confused elderly woman to older individuals who were in prison for +20 years after committing vicious crimes and trying to reaclimate themselves. Never a dull moment, especially in triage where they're brought in by PD or EMS right off the streets requiring emergent care. I really learned to be creative working with my patients and after 2 years, I was the only nurse on that unit that was never injured or attacked by a patient. I've also worked PHP programs with children and adolescents and it just wasn't as exciting or satisfying.

Numerous positions posted in Michigan (and elsewhere) titled "Mid Level provider" and "physician extender." First of all, who would actually be confident and proud to post a position looking for a mid level provider? After earning a DNP and gaining experience in various areas, of you would like an advanced practitioner, then yes I would consider it. Advertising that you need and employ mid level providers sounds to consumers as if they're "going to get what's provided and from this clinician that's only MID level care." Who's considered the low level providers? Second, I'm not a physician extender, I'm a nurse. I'm not extending any physician practices. I practice nursing and I'm extending my skills and knowledge to treat you. Now I'm assuming that phrase may be commonly applied to physician assistants, which still delineates the knowledge and skills they're applying to treat patients because they are extending their attending's practices. Any thoughts??

I currently work psych home care and I'm consulted to do psych evals on various patients (primarily geriatric patients) for possible depression, increased agitation or other behavioral issues and even to determine if they have dementia. At first, it was enjoyable, but lately it's become relatively routine and I often feel ineffective, exhausted of resources, and negativistic due to the progression of the dementia disease process. Some patients are stable and progress slower over time, while others I've admitted to hospice weeks after opening them to homecare. Also, at this stage in their lives many have POAs making their medication and mental health decisions and because of psychotropic risks/side effects many families refuse to use any meds for behavioral management and then you unfortunately watch while the patient is agitated, sometimes verbally/physically aggressive, and eventually refuses or stops participating in ADLs including eating. Overall, geropsych is not my area of interest and I don't feel there is much room to grow or learn (other than addressing other medical co-morbidities as well) but for now they need the help and there's not many willing to advocate for them! Hopefully you have a more valuable experience!

Well first off, your DNP will be a practice change project (quality improvement) not research based, you're going to use already published literature and data in your area. My first nursing job was in a Neuro ICU and my DNP specialty area was psych-mental health and I figured how can I overlap the two and address an important issue?? *DING* it came to me at 3am when I was asleep but I ended up implementing a depression screening protocol among post-stroke patients in the outpatient setting. I pretty much had a neurologist use the screening tool, see the results and effectiveness and then assess their comfort with using the tool. Overall, positive results - more than half of the people screened were positive for depression, the provider thought it was easy to implement and it's never done so I made a practice change!

Well, to be more specific I have an interest in neuropsych (disorders associated with TBI, neurodegeneration, neuroimmunology, etc) rather than treating S/p neurosurgery (craniectomies, endovascular, spinal). My clinical inquiry project for my DNP degree was "implementing and evaluating a depression screening protocol among post-stroke patients in the outpatient setting." Interestingly enough we don't focus on the psych consequences of neurotrauma or disorders.

Do I wish I was a physician? - Nope Have I considered that in the past? - Yea I was accepted into graduate school for my DNP before I even finished my BSN! I knew I wanted to obtain "advanced" clinical experience and education related to NURSING. In my opinion I chose nursing because: - Physicians CURE (try to) the disease process. Nurses CARE for the patient's symptoms/behaviors/thoughts/emotions in relation to the disease process. - Physicians make clinical judgements based on physical assessment and observation of the patient's condition and develop treatment based on the numerical data from past research. Nurses make clinical judgements based on assessment of what we see, what the patient is telling us, and intuition from previous experiences - which ultimately guide or priority of care - Physicians do find the associated treatment and implement it based on lines of treatment and recommendations, BUT nurses make sure that the treatment is feasible, realistic, and agreeable to the patients wants, needs, and cultural/spiritual views. - Physicians determine that the patient is appropriate for discharge back into the community based on clinical outcomes/improvement. Nurses however determine if patients are ready to return based on their home conditions, available resources and their knowledge of disease self-management techniques - which will all advertently affect whether or not the patient will be compliant. Lastly, physicians understand the disease processes inside and out and can diagnose the patient based on biological, chemical and pathophysiological mechanisms.... But nurses can assess and understand the patient's disease processes based on bio/psycho/social perspectives. Nursing is so unique, flexible, challenging, interesting, amusing, even fought and heart breaking but everything I do I do for the well being of my whole patient - body, mind, -!: soul.

Hello, So this may be a simple question... or maybe not! I recently obtained my DNP degree with a focus in psych-mental health nursing - taking my PMHNP boards soon!! My first 3 years of RN experience were in a Neurotrauma ICU and I'm still fond of the neurological/neurosurgical environment. As many of you know our fellow MD/DO's are board certified in neurology and psychiatry. I wonder if this could apply to PMHNPs who have experience in acute care/outpatient neurology yet wish to practice without being an ACNP or FNP? Thanks!