Psych NPs and Sleep Clinics

[apocatastasis]

So, I'm a new psych NP, and there's a posting at one of the major hospitals here for a job at a sleep center. I have a pretty strong interest in sleep disorders and want to apply. But I'm curious, have any of you have worked in such a setting, and, if so, what credentials did/do you or your co-workers had/have?

The job posting says that the position requires an ARNP license, but it doesn't specify a board certification. The posting does note that their MDs (who, of course, have wider scopes of practice than NPs) have varied certifications in psychiatry, neurology, or pulmonology. I think that evaluating, diagnosing, and managing most sleep disorders (e.g. ordering sleep studies, teasing out mood disorders, substance abuse and dependence, primary hypersomnia, narcolepsy) are within the scope of practice of a psych NP. I did have several hours of seminar on these topics-- significantly more than what the FNPs at my school got. Management of central and obstructive sleep apneas would have to be referred to a pulmonologist or primary care, because those issues are not my scope.

Of course, if I decide to pursue the position, I will also ask the Board their opinion. I'm looking for as many opinions as I can get!

[zenman]

Let me sleep on it!

[Psychcns]

Read your state BON carefully before you call or write them. Some states are quite rigid. Some leave decisions like this up to you. You have some good arguments for sleep disorders being within your scope.

[BlueDevil,DNP, DNP, RN]

"Management of central and obstructive sleep apneas would have to be referred to a pulmonologist or primary care, because those issues are not my scope."

I would anticipate that this last sentence would represent a problem for you. I don't know how it works anywhere else, but when I refer patients to the sleep center, the FNP that they see over there takes over every aspect of that issue. It would not be very efficient or helpful to send them back out again for treatment. Perhaps there is something you could do to become qualified to be able to treat OSA, because I think you would be expected to as part of the job.

I'll be honest, if my patients were coming out of a sleep center with a diagnosis but no treatment due to this kind of issue, I'd stop referring there and go with one of the competitors.

[apocatastasis]

I did see that there were pulmonologists on staff at the center, so it may be possible to refer within the facility.* I'd have to talk to them during the interview and also to get clarification from the nursing board on whether or not I could order a CPAP as a psych NP.*

I am comfortable prescribing adjunctive psych medications for ancillary issues related to OSA, such as modafinil for fatigue.* I'm not intimidated by OSA coming from an ICU/ER RN background, I just can't make that diagnosis (which would probably be done during the actual sleep study anyway).* But what exactly in my scope of practice is somewhat of a gray area.* I wonder how/if psychiatrists and neurologists handle the issue, e.g. if they also refer to on staff pulmonology.

Thanks for your advice, BlueDevil and psychcns!

[apocatastasis]

Iiiiii... Don't know why there are stars in my above post, but they're cute and can stay.

[harmonizer]

I know a psychiatrist that is doing sleep medicine and make extra money doing that.

I would like Psych NP to be able to do the same thing now or in the future..

The problem we have is that some schools requires only minimum level of medical components of psych NP while some schools demand a lot more. In the future, they have to come up with the way to combine FNP/PMHNP into one, or requiring FNP as a pre-req for PMHNP (too extreme). Or they have to make it easier for me to go back and get FNP.

What we have to do is to increase and "require" the medical clinical hours/ components in Psych NP curriculum..

Right now.. there is no definite standard depending on school other than regular pharm and health assessment.

My school requires ~200 hr of medical/ambulatory clinical hours regardless of specialties.

[Psychcns]

When the Psych NP came along in the late 1990's there was a lot of talk about it being a combined primary care/ psych specialty. The NP could do physical exams and then do a mental status, at least that was the talk... It evolved into what I was trained to do as a Psych CNS ( diagnostic assessment and med mgt) without the therapy.

[apocatastasis]

We had a mix of (non-psych) primary care, therapy, and med management clinic hours. A third of my psychiatric clinical hours were in therapy. We can do physical examinations as necessary, but we are technically supposed to refer and not diagnose non-mental health conditions.

[Psychcns]

Sounds like a good educational background to me for working in a sleep lab. Let us know how it goes with the board.