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Hi all, I posted in another forum without much success, perhaps I'm looking in the wrong place.
Is there a forum or group specific to NP's who specialize in psychiatry? I am considering a master's degree in this area but instead of jumping into school like I did for the A.A.S. program, I'd really like to get a feel from NP's who actively work in the field .
I'll keep this post short for now, perhaps I can be directed to the correct place.
Thank you.
@Jules. I came into psychiatry as a CNS when therapy was dominant and meds were secondary. This was early 90's. I learned psychiatry, first as a therapist-actually I learned therapy on the job with weekly supervision in the 80's. I got my CNS in 90's and eventually began prescribing.
I don't know how the role is developing, I do locum tenens and I see some trends. I like having a therapy foundation. Primary care APRN's should not do psychiatry. It is too specialized and too easy to miss bipolar, addiction, suicide, etc. But when the Psych NP began displacing the psych CNS in the late 90's, there was a lot of thinking about how the psych NP could do it all- first the physical, then the mental status. Therapy has to be the foundation of psychiatric nursing practice, not the physical exam. There is probably a comprehensive article somewhere about the psych np role.
@Jules. I came into psychiatry as a CNS when therapy was dominant and meds were secondary. This was early 90's. I learned psychiatry, first as a therapist-actually I learned therapy on the job with weekly supervision in the 80's. I got my CNS in 90's and eventually began prescribing..
I attended a dual psych CNS and NP program so my education was also heavy in therapy. Although it isn't my main focus I have found the therapy skills very useful. There are so many nuances that can be missed or misdiagnosed and treated with hard core psych medications incorrectly that I feel it is crucial psychNPs have a solid background in mental health.
I am in primary care and do little psych beyond anxiety and depression (although refractory cases are always referred out). The problem around here is that my patients have an incredibly hard time finding a provider -- NP or not -- who isn't booked-up months in advance and who takes their insurance. I had a patient I suspected was/is bipolar, and it took her 3 months to get an appointment with a psych NP. Nope, I don't practice in the sticks. It's a suburb of a large city. The trend around here has been for psychiatrists to stop taking any insurance and then charging ridiculous $$$ for what amounts to medication management. And forget finding anyone who accepts Medicaid, although I suspect that that problem isn't unique to my area.Primary care APRN's should not do psychiatry.
The issues with access to psych care have me seriously considering getting a post-master's in psych. I figure my primary care skills would serve me pretty well, too.
All of this is to say that while I agree primary care NPs should not do psych (and risk a lot by doing it if it is outside the scope of their training and certification), many of us are in a bind with patients who desperately need help and can't get it.
The problem is, all of you are right. I am in a big central city area with way too many hospital systems and way too few psych providers. We have patients told the next new patient psych appointment is 4 months out. I had a patient come in last week with a bag full of nearly empty bottles of psych meds, and well-controlled bipolar disorder, stating "my psychiatrist up and quit suddenly...I need my PCP to prescribe these for me so I won't end up inpatient psych for a third time, I'm in a good place now."
I work in a primary care clinic that is in some ways an "FQHC lookalike" but without psych services. There is such a huge need...I am tempted to enroll in the PMHNP program here to help fill that vastly underserved need, but my psych experience is limited (my care coordination and T2DM roles involve me with majority psych patients though) just to try to help with this complex issue.
So you see how this is a conundrum. NPs want to help, people are asking for help, and often there is nobody else.
I guess you have to figure out your comfort level. It is one thing to prescribe refills to prevent a hospitalization . It is another thing to do a new evaluation. Your BON or your malpractice insurance may have guidelines about how much psych is within your scope and if you would need psychiatric supervision.
Jules A, MSN
8,864 Posts
Possibly but where is the supervision going to come from? I have never received what I would call any type of orientation as a NP. I definitely see psych services being offered in primary care offices but believe they will need separate providers. The primary care providers, at least the physicians, will have no parts of doing specialized psychiatry. Now the bleeding heart NPs might be another story. I can't count the times I have heard of NPs going outside their scope "because if I don't do it no one will".