Psychiatric NP's on consult service?

zenman · Oct 17, 2012

Has anyone ever heard of PMHNP's working on a psych. consult service in a hospital? I currently work as an RN case manager in a hospital w/an MD-run consult service. The service is mainly made up of fellows and residents-in-training. They are referred by the attending MD's on the medical floors and see pts. all over the hospitals (ex's being pt's on medical floor or ICU post over-dose, pts on burn unit who set themselves on fire, pt on ortho unit who broke his leg jumping out of a building, elderly man w/CRF & worsening depression/SI).
I would love to do this kind of work, but I have no interest in going to medical school to be a psychiatrist!! Do NP's ever get these kind of jobs?? What hospital psych NP jobs are you aware of?
In my hospital there is an PMHNP in the ED who assess pts & prescribes, & several "psych CNS's" (they are experienced nurses who got the degree way before PMHNP existed) who consult to medical floors on behavioral management issues (vs. diagnosis/prescribing). There are no NP's on the inpt psych floor.
Thanks!!

Until I took my current job a few weeks ago I was working in a hospital doing inpatient, outpatient, and lot's of consults on every floor, including ED, ICU, CCU, Peds, OB-GYN rehab, ortho, etc.

ivyleaf · Oct 17, 2012

Are you in the SF area? Have you seen other positions like this, and if so, in what area of the country?

I work in the Boston MA area and haven't yet seen NP's in this role, but it's exactly what I want to do!! I have worked in psych for 5 yrs inpt and in the community, and am now the RN CM for the inpt. consult service and do discharge planning for the pts.

Did you do rotations similar to this when you were in school for PMHNP?

Thanks for answering my questions!!!

zenman · Oct 17, 2012

No, I was in Santa Fe. I did a couple consults while doing clinicals in Okinawa. However, I have a lot of critical care and mdd/surg experience which helps greatly.

PsychiatricNP · Oct 17, 2012

In the hospital system that I work in, we have a consult liaison team who provides psychiatric services to the entire health system (emergency department, medical floors, etc.) The team is comprised of mostly clinical social workers, a couple of clinical mental health counselors and a couple of RNs. I am the only the PMHNP on the team (and worked on the team as an RN and a clinical social worker prior to finishing my PMHNP program). There are three psychiatrists that we consult with telephonically, but the consult liaison is the one on the "front line." Our psychiatrists never see patients face-to-face (other than on the inpatient psych unit), but we instead serve as the liaison between the psychiatrist and the medical providers. I also sometimes work on inpatient psych unit as well. There are a wide range of possibilities for the PMHNP or specialized RN in the consult role.

ivyleaf · Oct 17, 2012

Interesting!! Where do you work, and where did you train, if you don't mind me asking?

In our hospital, the consult-liaison team is comprised only of psychiatrists (attendings, residents, fellows) & the RN case manager (me); it serves a dual purpose as an academic/training program for MDs. The psychiatrists all see the pts and follow them until they are dc'd or transferred to a psych unit; my role has freedom to decide which pts to meet with-- I mainly do bed searches and precerts. Do you provide diagnosis/assessment and medication recommendations?

I am curious to hear where you work, as I wonder if in different settings (smaller hospitals, rural settings) NP's have more power/autonomy.

ivyleaf · Feb 23, 2013

Just wanted to bring this thread alive.. would like to hear more about hospitals who use NPs as part of their inpatient medical consult service. I am an RN cas manager on a psych consult service @ a large New England teaching hospital, but they do not have RNs on the service; it is just attending MDs, residents, and fellows.

I would also like to know of any PMHNP programs that include a clinical rotation on an inpatient consult service. A lot of the pts we see on the consult service here are so complex (geriatric, many medical comorbidities, etc) that I would want to feel confident that I knew all the medical rule-outs/interactions in order to practice safely.

Has anyone ever done ANP & PMHNP to achieve this?

PsychiatricNP · Feb 23, 2013

Hi ivyleaf - Im sorry that I neglected to come back to this post and reply. I work in a private, for-profit health system. We do not have residents or fellows in the system, so there are more opportunities/needs for other disciplines to participate on the CL team. My role is to consult on psychiatrically complex and co-mobid patients and make recommendations as to treatment (medications, therapy, etc.) and disposition. Should the patient require an inpatient psychiatric admission, the case management department facilities this. I did recently learn that the large academic teaching hospital in my area is using a PMHNP as a consult liaison in the medical emergency department, so there appears to be growing use of the PMHNP in this role.

In terms of training; in my PMHNP program I was able to arrange my own clinical rotations and should I have opted to pursue a placement with a CL service, I would have been able to. I am not aware of any colleagues who have chosen a placement on a CL service while in their PMHNP program. I agree that it is essential to have a very solid foundation on both the physical/medical and psychiatric presentations you will encounter on the CL service. The job is a challenge. I have considered pursuing an FNP down the road to broaden my abilities, but I am currently pursuing a DNP and the FNP doesn't fit into the big picture for me right now.

Hopefully others might be able to share their experience with the CL functions to give you a better idea of PMHNPs on the service.