psych HH with no psych experience

[lsvalliant]

I just accepted a position to do home psych evals for an agency per diem. I only have medical experience, but I always wanted to get into psych so why not. Someone recently told me though that there is a special certification that goes along with being a HH psych nurse in order to recieve compensation from medicare. Is that true? Im starting to wonder why they hired me.. Also, since this is a new area for me does anyone have any advice on doing evals.. thankx.

[Davey Do]

Isvalliant:

I'm going to base my answer on the premise that it's been years (1996) since I've worked in Home Health. According to Medicare Gudelines at that time, a Nurse supervising an At Home Mental Health Program needed to have only two years Psychiatric Nursing experience. Any licensed RN could make the Skilled Visits.

Skilled Psychiatric Nursing visits usually entailed VS monitoring, Patient Status Check, Medication compliance/teaching/setup and/or decanoate injections.

Good luck to you.

Dave

[Whispera, MSN, RN]

I think your agency should have a form for you to use to do evals. If they don't, then maybe you could develop one. I see you have two years of nursing experience. If you still have such things, and I think you might since you're not that far away from school in time, locate the assessment papers you did in nursing school when you were in your clinical rotation. These would help you refresh your memory about what's involved in a psych eval. Do you still have your psych textbook?

[lsvalliant]

Do you still have your psych textbook?

no, but i just ordered one online to help me refresh:) I was thinking the medicare cert was maybe if you wanted to bill them directly. Does that sound about right?

[Whispera, MSN, RN]

I'm a psych CNS. In order for either me or my agencies to bill Medicare, Medicaid, or any insurance companies for my services (I saw patients as their primary psychiatric care provider), I had to be a certified advanced practice nurse in psychiatry. There were quite a few other requirements too. Otherwise Medicare wouldn't pay for what I did. I don' t know how that fits in with an RN doing home visits. Maybe your agency can answer for you?

[lsvalliant]

I just want to make sure this job sounds kosher. Since I am technically considered an RN independent contractor in this case, I dont want to get screwed out of payments if I dont have the proper certification. What would be even worse is to get in trouble with Medicare.

[rn/writer, RN]

My guess is that you are not ordering anything. You're carrying out someone else's orders and acting on their behalf, the same way a nurse in a hospital or clinic setting would. You wouldn't be billing. Your agency would. And they would do so under the name of the person who ordered the care.

That is just a guess, however. You really should check this out with your HH agency.

They should be able to provide you with some kind of framework for your evaluations, whether it be training, forms or both. Please, ask them for more information.

Shadowing another nurse would probably be helpful.

I wish you the best.

[GoSteelers]

i loved psych home health but i left for more money. It is not unsafe - but most patients are very noncompliant - beware of the borderline personalities....

[Whispera, MSN, RN]

You're to be considered an "RN independent contractor"---does that mean you will be paid directly by Medicare and/or the client or insurance companies? THAT does not sound good to me. Also, if you're an independent contractor, I would think that means you are not covered by any malpractice insurance the agency carries. So, you'd need to be sure to get your own.

[Guest717236]

Check with the agency about what resources you have available to you.

Is there another nurse or social worker available to go with you if the client is not on their medication, or a potential to act out.

It is not easy walking in by yourself if a situation may escalate.

So just make sure you know what the plans are if a client is potentially dangerous, sometimes they are mixing alcohol or drugs -legal or illegal with prescribed psych meds which changes the mental status/presentation.

A DSM V book will be helpful for you ,( you may already have one.)

You will want to ask what MSE (mental status examination) format

your local hospital/crisis team/state hospital uses.

(Sorry, don't want to deviate from the original question, but please make sure you are safe as you go on your rounds.)

[Carlyjo]

You must have 2 years of acute psychiatric nursing experience and be approved by Palmetto per Medicare guidelines to do psychiatric home health nursing. Your agency would be out of compliance with Medicare otherwise. Other nurses are not allowed to make visits unless it's for a medical reason or he/she is also a psychiatric nurse approved by Palmetto. We had a psych program at my former HH agency. It was very hard for the agency to get approval for psychiatric nurses from Palmetto. Our psych nurses had many years of psych experience and still found the job a challenge. The agency had so many referrals for the program that they were constantly trying to find nurses with the proper credentials. I would see the psych patients on occasion for medical needs and all I could think was how much patience the psych nurses must have. Many patients were highly demanding, hard to schedule appointments with, caused frequent missed visits, and very non-compliant. For example, patients with CHF would stop taking their Lasix because they " just don't want to be on medication anymore."

[elkpark]

I realize people have different opinions about this kind of issue, but, as a long-time psych nurse and someone who has often worked with nurses from other backgrounds new to psych in inpatient settings where they had plenty of support and guidance (and they struggle more than enough in that situation), I feel strongly that a nurse with no psychiatric experience doing psych home health is a really bad idea, and an indication of an employer that doesn't really care a) what quality of care it's providing to its clients, and b) doesn't care what happens to its employees. I'm fully aware that times are hard and jobs are hard to find, but, IMO, this is just asking for serious trouble.