Unhappy and stressed as NP- seeking advice.

Oldmahubbard · Jul 20, 2019

I have been an NP for 15 years and love it, but I do feel the weight of the responsibility at times. Your post was actually reassuring to me, because I feel some NPs are overconfident and too casual in their approach.

I am in Psych, and I had someone die early in my career directly from the effects of a med I had prescribed. It was a fluke reaction and nothing ever came of it, but it convinced me all the more that this is very serious business.

There was a time earlier in my career when I took an SSRI for anxiety. It helped. Just a thought.

It sounds like the MDs you work with are decent. But in Urgent Care, a symptom that seems innocuous can actually be the sign of something serious. That should be worrisome. How do the MD's handle it? Or your NP co-workers?

I found it helpful to research psychiatric malpractice cases. Google, in other words. It was reassuring. There weren't that many, and the mistakes were things I could easily avoid.

It was probably helpful in the end that I was involved in a malpractice suit. Me and the other 75 people who were listed in the chart. Nothing ever came of it, and the only person who got into any trouble was an RN who documented something she didn't do on camera.

It might be helpful to know exactly what are the expectations when a pt comes in with something vague, maybe diffuse abd pain. I know when I have been to urgent care, I always get a paper that says to come back if things don't improve in 24-48 hours.

Those are my thoughts. I am now in LTC with a relaxed pace. That might be an option to consider as well.

AnnieNP, MSN, NP · Jul 20, 2019

I have also been in practice for over 10 years, and I still worry. Is that sinus headache really a brain tumor? That did happen to me early on. After treating for a sinus infection with no improvement I ordered a cat scan (denied by insurance) . I then referred to Ophthalmology and neurology. Six weeks later after the Neurologist fought for the CAT scan it was finally approved. Turned out to be benign and operable.

Now, I still worry every time I treat someone with a headache. I stay up to date on treatment guidelines and never hesitate to refer to a specialist when needed.

Angeljho, MSN, NP · Jul 20, 2019

I'm in psych, but at times I also feel the pressure of being fully responsible for someone's care and making clinical decisions. If I'm unsure about anything, I go to the MDs or more experienced NPs for guidance. I'm still under a year since I started practicing, so I'm still learning.

I will say this.. most of the stress I endure comes from things like constant prior authorizations or ridiculous bureaucratic busywork that just seems to suck up my time.

MikeFNPC, MSN · Jul 20, 2019

A level of "worry" is normal. I use it to keep me on my toes. Adverse reactions can happen with any treatment. What helps me is to inform every patient that there are always additional measures for whatever I'm treating and to call, return to clinic, or ER if necessary. Knowing that the pt has been made aware of what to do if the plan of care is not effective helps me sleep at night.

As stated previously, if you think you need something to help yourself, definitely seek it. I hope you find peace and support.

hm0225 · Jul 21, 2019

Thanks for the advice thus far. It is reassuring to know i'm not alone. I'm not an anxious person in other areas of my life and I know a large portion of my worrying has to do with my confidence level in my job. I always give patients a list of red flags and direct them to the ED for new or worsening symptoms, otherwise recommend follow up with PCP. I think I tend to put too much pressure on myself to be perfect when in reality, you just do your best and trust the patient to follow instructions. I'd rather not take an SSRI/SNRI just to feel less stressed in my job. Thank you all for your advice and knowing that i'm not alone.

Workitinurfava, BSN, RN · Jul 23, 2019

I am thinking of becoming a psych NP. I am a psych RN. Can one of you nurses that is a psych nurse do a day in the life of a Psych NP? I would really appreciate it.

Workitinurfava, BSN, RN · Jul 23, 2019

1 hour ago, Workitinurfava said:
I am thinking of becoming a psych NP. I am a psych RN. Can one of you nurses that is a psych NP do a day in the life of a Psych NP? I would really appreciate it.

Oldmahubbard · Jul 23, 2019

It will depend to some degree on where you work, but generally you will be expected to see and independently manage 15-25 patients a day.

In 15 years, I have had a few jobs. In private practice, it will be a lot of fairly high functioning people. I had a handful of very mixed up professionals. All the usual problems, including drug and alcohol abuse.

In a Community Mental Health Clinic, the people will generally be somewhat lower socioeconomic class. You'll see your fair share of schizophrenia, intellectual disability, personality disorders, and every other damn thing under the sun, with a large side of poverty served along with it.

In a Forensic hospital, the patient contact will be somewhat less. You'll be figuring out what to do with a boat load of malingerers, and how to treat the unwilling psychotic. A lot of meetings, a lot of collaborating with other professionals. I appeared in court many times as an expert witness for the state.

In my state, a court order is needed to treat people over their objection unless they are an acute danger to themselves or others.

I saw a number of dramatic recoveries with long term injectable antipsychotics by court order.

In my state, the long term psych beds have all disappeared. So nursing homes in certain areas have a significant chronically mentally ill population. This is what I do now.

Outside of forensics, the expectation is independent management of the usual diseases. You might have a physician available for consult, but not every day, and certainly not for every patient.

Knowing that, I worked in the field while I went to school for 4-5 years. I basically went home every night and worked up the cases I saw all day.

The atual coursework was mostly a lot of bull feces. Sad to say.

But when the time came, the rx pad didn't terrify me. I was extensively self prepared.

ToFNPandBeyond · Jul 24, 2019

Agree with Oldmanhubbard,

I work in psych private practice and most of my patients are high functioning. Most common diagnoses are MDD and anxiety, followed by bipolar and ADHD. Like in many specialties, you start to see patterns in sxs, which helps with diagnosing and treating common illnesses. Minority of my patients are schizophrenic. I care for those who have commercial insurance and about 60 percent who have Medicare. I state this fact because it matters when you start prescribing meds that either require a PA or meds that are newer on the market. It can be a pain trying to get meds approved for use when someone has government insurance unfortunately...

I really like outpatient psych. I feel I've found a niche that I'm good at and comfortable with. I know myself to know I could never do inpatient psych, child psych or community health psych...not built for it. But outpatient private practice psych where majority of ppl are motivated to get well, and I'm not drowning myself in the work, I'm all for!

bryanleo9 · Jul 26, 2019

When the job is effecting you outside out work it's time to change things up. You are not alone, keep an open mind and you will find a job that doesn't consume you outside of work.

Forest2 · Jul 31, 2019

Hindsight, what-if's, and rethinking can drive a person crazy. So many diseases and ailments have common denominator symptoms. Just do what you feel is right and prudent, make sure these patients take some accountability for their own health too. We can't force medication down them, or make them otherwise do what they should do. But, we can make sure we give them good directions and document it. I am sure there are some less stressful NP jobs out there. A rural clinic servicing a geriatric population might be one of them.