I've searched this site high and low and found some posts on psychiatric NPs but nothing recent. I'm just wondering if psych NPs have a high level of job satisfaction and what are the hours typically like? Do you get to incorporate therapeutic communication a lot in your practice? Also, if anyone has attended Vanderbilts program.. did you enjoy it? did you feel they adequately prepared you for practice.. such as for prescribing meds?
60% of mental heath care is provided by primary care providers. As an AGPCP NP, I did receive formal education in psychiatric care. I'm just reporting the California regulation. Therefore, there would be no reason for a lawyer to "be all over" this, as I am working in an out patient clinic. In addition, I am not aware of any primary care providers being sued for prescribing out patients antidepressants and so forth.
A formal education is psych care is pretty broad of a statement. Getting a few lectures over psychiatry does not promote someone to uber nurse psychiatrist status. If one considers psych to be mostly just handing out SSRI and handling kids on ADHD, and benzo pumping on everybody who gets a shiver of nervousness occasionally you are not correct. If it is a rural clinic, there probably is not much of a choice of where people should go. Which means the patient with Schizo comes knocking at your door with "I keep hearing things all over the place and nothing freaking works" story.
. If it is a rural clinic, there probably is not much of a choice of where people should go. Which means the patient with Schizo comes knocking at your door with "I keep hearing things all over the place and nothing freaking works" story.
Dont get sued.
Agreed and think there is a difference with a FNP or AGNP pushing the limits out of necessity in rural PCP clinics while their patients seek psychiatric appointments either on the long waiting lists or telepsych. That is far different than a FNP or AGNP deciding they are competent to practice solely in psych after a few courses in their generalist program.
I appreciate your concern. Malpractice is always a possibility, no matter what. In the area where I will be practicing, there are communities that are literally 2 to 4 hours away from any healthcare facility, and many of these people are poor and have no transportation. They don't even have a primary care provider! So, the practice is a combination of in-person outpatient care and telemedicine. The clinic does send providers to meet in-person with the remote population regularly as well. We do not handle overly complicated or acute cases; we refer those. The clinic has the equivalent of an NP residency program for new grads. They are given one on one teaching for a minimum of three months, along with study assignments (homework). You are not allowed to work alone with patients until your instructor deems you safe and if you don't get to that point, you are let go. That hasn't happened yet and most people take 3 to 6 months before they are allowed to work independently with patients. So, at 40 hours per week times 12 weeks that is 480 to 960 hours of intense clinical training along with academic assignments. Sorry if I did not make that clear previously. Let's compare that to a post-master's psych certificate, which is about 500 hours of clinical. So I am confident I will be fine, but I do appreciate everyone's concern. And I will also be starting a post-master's psych certificate program within the next year.
California always does things their own way. Many employers require the PMHNP certification, but it is not a state requirement. There are 3 ways to become an NP in California. In fact, one does not need to pass a national cert exam to become an NP in California, if an MD will sign off on the candidate NP's skills. This is all on the California Board of Nursing website. You are entitled to your opinion, but you present no evidence to back up your assertions, other than anecdotes.
If you graduated from an out-of-state school you have be certified.
Am I understanding correctly that you are saying California doesn't require the accepted standard of NP board certification in psychiatry to practice solely in psych? If so in my opinion that is disgraceful and a grave disservice to that vulnerable population.
Dear old Cali doesn't require board certification for anyone, unless you graduated out-of-state. That being said, you're employer would probably want it, if you are a new hire or within a certain period of time. Your license arrives as soon as all your paperwork is processed. If you are moving to California, but did not graduate from a California school, start studying.
You may be too young to remember that just the other day, NPs weren't even required to have a bachelors degree. I'm not kidding, I promise. More education is great, but we can't lose our minds if every state does not operate the same. Also, although California is one of the most regulated states, and has an economy that can swallow all others whole, the most vulnerable tend to be on MediCal, which reimbuses the least of all the states. So sad, but so true. Close supervision is probably more important than certification. Certification means you know the basics. You are not anywhere near the level of a psychiatrist, even with specialty training. It takes time and training. Disgraceful and grave disservice are strong words. How much training do you need to refill meds on a stable patient? Many people who go to psychiatry go there because their primary MD does not want to deal with ADHD, mild depression or anxiety. They are not complicated. Unstable, complicated patients can be left to the MD or certified NP. Is that an ok compromise? Or perhaps you or someone else can post a study showing the difference in care provided in this area. That would be quite interesting.
I understand where you're coming from, although I think it is too early to go that route. I would rather we start with specialty certification in internal medicine, OB/GYN, neurology and cardiology.
I appreciate your concern. Malpractice is always a possibility, no matter what. In the area where I will be practicing, there are communities that are literally 2 to 4 hours away from any healthcare facility, and many of these people are poor and have no transportation. They don't even have a primary care provider! So, the practice is a combination of in-person outpatient care and telemedicine. The clinic does send providers to meet in-person with the remote population regularly as well. We do not handle overly complicated or acute cases; we refer those. The clinic has the equivalent of an NP residency program for new grads. They are given one on one teaching for a minimum of three months, along with study assignments (homework). You are not allowed to work alone with patients until your instructor deems you safe and if you don't get to that point, you are let go. That hasn't happened yet and most people take 3 to 6 months before they are allowed to work independently with patients. So, at 40 hours per week times 12 weeks that is 480 to 960 hours of intense clinical training along with academic assignments. Sorry if I did not make that clear previously. Let's compare that to a post-master's psych certificate, which is about 500 hours of clinical. So I am confident I will be fine, but I do appreciate everyone's concern. And I will also be starting a post-master's psych certificate program within the next year.
Good for you. I think you will be able to gain a deep understanding of what you're already doing and maybe make some practice changes of your own. "Personalize it," as my preceptors have told me in the past. Nowadays, it's all about the evidence.
Thank you for the clarification. I do have to laugh about you saying I may be too young to remember - I am 56! That is interesting that NPs didn't have to even have a BSN in earlier times. Wow!
I'm shocked that APRNs would argue that what is covered in a PMHNP program is not necessary to treat psychiatric patients. One would have little knowledge concerning the caveats covered in prescribing had they not attended a psych program. Specialized knowledge yields a higher accuracy of care. Case in point, if you think you are treating all depression and anxiety, you are mistaken as there are other disorders that may be worsened by such treatment. And children have even more prescribing considerations. In addition, PMHNP programs educate on appropriate therapy techniques, something a practitioner would be remiss in not knowing the field she is working in for full EBP, either by the practitioner or with appropriate referrals to other specialized therapists. Quality is what is at stake. I would never claim to give quality primary care or geriatric care. Why would any APRN not defer to her profession's specialty tracks of education to direct the type of population she cares for?
I have an MSN in Adult and Geriatric Primary Care and was hired by an outpatient mental health clinic. In California there is no Psych NP license. This clinic is in a rural area so they were more flexible and provide 6 months of training. The schedule is four 10 hour days and they are very strict about no overtime and no oncall. I only do medication management, but there is a definitely a lot of therapeutic communication. The trend now is for NPs, PAs, and MDs to focus on med management and for psychologists to do psychotherapy. This is more cost effective due to the higher billing rates of NPs versus psychologists. However, depending on the state you are in, you may be able to set up your own practice and offer psychotherapy as well.
As I have pointed out in other posts I almost always bill for both supportive therapy as well as medication management. My appointments are usually 90 minute intakes and 30 minute medical management appointments. All of my patients are currently online but after Ryan H goes back in to effect I will spend one week in Washington state per month to see clients that are on schedule II medications (they must be seen in person on the initial visit and best practice is to see them at least once per year in person).
I'm shocked that APRNs would argue that what is covered in a PMHNP program is not necessary to treat psychiatric patients.
You guys digging up almost a 3 year old thread btw... But this could be said of nearly any program ; including pre-reqs for med school. But yes, you risk liability when you go outside your scope, so if you didn't learn to do something in school or clinic and more so are not comfortable treating something, you should refer the care to a specialist. That goes for PCPs as well.
Clinical disciplines learn the most from practice. You will always have patients that are the exception not the rule. I think that is a BIG problem with the MD programs. You spend so much time in books you forget you are dealing with people, and good clinical care is dynamic and patient centered. Some people will be the exception even to results from systematic reviews...
You guys digging up almost a 3 year old thread btw... But this could be said of nearly any program ; including pre-reqs for med school. But yes, you risk liability when you go outside your scope, so if you didn't learn to do something in school or clinic and more so are not comfortable treating something, you should refer the care to a specialist. That goes for PCPs as well.
Clinical disciplines learn the most from practice. You will always have patients that are the exception not the rule. I think that is a BIG problem with the MD programs. You spend so much time in books you forget you are dealing with people, and good clinical care is dynamic and patient centered. Some people will be the exception even to results from systematic reviews...
I think California is unusual in this respect and psychiatry. To my knowledge it is the only state that does not require ANCC board cert. to practice as a PMHNP. I would be curious as to what percentage of NP's that routinely prescribe psychotropic medications there have this. This is especially curious given that in every other way California is perhaps the most difficult state to obtain licensure in both with regard to RN and APRN levels. I had investigated getting licensed there, but they actually wanted the syllabus from my Pyschopharm class from USI rather than just my transcripts which caused me to bail on the process. Also, I'm a big fan of "digging up old threads". That's one of the things that bugs me about some sites like Trip Advisor. I will find something interesting about a rare topic like a secluded beach in Kauai and it will be "closed to further comments or questions" and this is very frustrating.
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Most physicians are wise enough to not practice outside of his or her scope. For an APRN to do so is asking for a lawyer thomping.