Psych Meds

Trauma Columnist · Jul 5, 2012

Please don't take this wrong but it sounds like you really shouldn't be managing these issues with your comfort level. Maybe some instructions from your collaborating MD? I prescribe for nephrology pts and delve little into psych med for this very reason. I do Rx with ativan/ SSRIs and ensure that the meds my pts are on renally dosed meds.

zenman · Jul 5, 2012

Ditto what traumaRUs said. There's a reason this is a speciality. I admitted a patient last week who was on Prozac started by her FNP. Problem was the patient had undiagnosed Bipolar Disorder. At least the FNP told her to go to the hospital. I stopped the Prozac and started her on Lamictal. Her life should be much better soon and she should quit buying things like a new Harley Davidson that she can't even ride.

Things to consider are: Past history of response. Family history of response. Patient preference. Other Medical Issues.My Best Guess at What Will Help the Target Symptoms. My Best Guess at the Side Effect Profile, for better or for worse. The Patient's Financial Concerns.

NPinWCH · Jul 6, 2012

Please don't take this wrong but it sounds like you really shouldn't be managing these issues with your comfort level. Maybe some instructions from your collaborating MD?

I totally agree with the collaborating MD idea, but I also totally get where the OP is coming from. If I had a resource to send my psych patients to then I wouldn't have to treat them beyond my comfort zone, which I very often do. Sure, I can can throw some Prozac at depression, but like that FNP in zenman's comment, I too may miss that Bipolar. (Yes, I have some experience with it now, but it still can be missed if you don't have much history on the patient and only 15 min to make a dx).

My most recent example: I have a pt with schizophrenia who currently has no psychiatrist because his retired and no one is accepting new medicaid patients within a 3 hour drive. So, now I'm suddenly responsible for trying to find him care. I was the one who found him care initially and that was only because I had him hospitalized (for the third time) due to suicidal ideation and delusions. He's on medications I've never heard of and I've had to try to figure out how to dose and if I'm even allowed to prescribe.

As for my collaborating MD and my complicated cases, he's about as lost as I am. He shrugs and says, "Well, do your best. I trust you."

zenman · Jul 6, 2012

Are you in a location I might want to move to, lol? PM me if you'd like.

myelin · Jul 7, 2012

hmm. I keep hearing about the desperate need for psych providers and then at the same time I hear other people say that the market for psych NP isn't that great. It's pretty confusing. Is the need in rural areas? Or is it more like urban underserved populations?

I'm wondering how the ACA will affect psych, since it includes parity and insurance will be required to cover mental health. This should bring in more patients, right? Also, I think a read a stat that said that a large percentage of psychiatrists are 55+ and will be retiring soon, which means there should be an even greater need for psych providers, right? hmm. This might be the wrong thread for these questions, sorry for being off-topic!

harmonizer · Jul 8, 2012

hmm. I keep hearing about the desperate need for psych providers and then at the same time I hear other people say that the market for psych NP isn't that great. It's pretty confusing. Is the need in rural areas? Or is it more like urban underserved populations?

Yes. There is definite need in rural for PMHNP, and same for FNP. However, do you want to move there? Not me. There's demand is in certain areas of the country and rural "for now". There will be demand as long as the schools does not increase enrollment. I feel that it is not as easy to get a job as a 2 years ago as a new grad compared to people I know b/c of increased supply r/t more schools?. But regardless of the demand, PMHNP is much less mobile (I think) b/c very limited of places they can practice. And sadly, in those rural/non-rural areas where psychiatrists or facilities can't find psych NP, they sometimes use FNPs and PAs (in some states only. of course not in independent practice states). I know that some tasks can be learned on the jobs but there is legal issue if something goes wrong. Here, collaborative psychiatrists must sign the paper certifying the person meet educational & training requirement for the delegated job on the collaborative agreement form. Many PAs has 1-2 week of psych rotation during school and FNP has no psych rotation and no psych courses. And there are already the routes (DNP/post-master's for psych, there is a few psych fellowships program for PA) where both professions can get properly trained and specialized. Personally, I think hiring FNPs and PAs destroy the purpose of the specialized education/training.

NPinWCH · Jul 9, 2012

As for where I am, it's rural Ohio, not too rural. I'm within 1 hour of Columbus and Cincinnati. The problem is there are still too few psych providers even in the city and when we do get one, they quickly get overwhelmed and leave. Also, IF they accept them, they quickly fill their quota of medicare/medicaid patients, which is the majority of the patients I have problems placing. The waiting lists are 6-8 months for an intake visit.

Do you want to live here? Problably not.

Psychcns · Jul 9, 2012

I would do locums..

The rural clinic, lack of psych providers is similar to my current locums job. I find it doable and satisfying in 2-3 month blocks of time. The NP I am replacing quit because of high workload issues.

myelin · Jul 10, 2012

Interesting... so it sounds like psych NPs can get overwhelmed with too much workload since their services are so desperately needed? Still, at least there are jobs. Oh, and yes, I am willing to go anywhere in the US where I can qualify for loan repayment. I have no mortgage, no kids, etc. I'm looking to pay down my loans as quickly as I can, once I graduate.

harmonizer · Jul 10, 2012

Still, at least there are jobs. Oh, and yes, I am willing to go anywhere in the US where I can qualify for loan repayment. I have no mortgage, no kids, etc. I'm looking to pay down my loans as quickly as I can, once I graduate.

You may rethink that again about being willing to move to the rural area for jobs when you graduate:) Being a single person, living in a rural area can be miserable and restrictive unless you can afford to drive back and forth the city and find a place to stay in the city once in a while (and get pay enough to that). Most of the time people would rather compete for jobs in the city with limited openings.

I don't mind doing locums but being stuck in rural area somewhere for years with contract.. no...

newnp2012 · Jul 22, 2012

It saddens me that as far as we have come we still like to make the ones less experianced wonder what the hell it is we are doing. I appreciate the intro "please don't take this the wrong way"..

If I truly had someone or somewhere to refer my psych pts to don't you think I'm smart enough to do so.

shame on me for thinking I could come into a peer posting and seek advice. this is why NP's will never have the respect of our profession..we can't even respect each other enough!