[NP-Clinical] psych/counseling
debcfnp at aol.com
debcfnp at aol.com
Fri May 11 08:30:33 PDT 2007
I'm a little late in this discussion but Dena you took the words out of my head!! I think I paid 1210 last year!
Debbie
Stephanie--
Not sure where you practice but it's been a long time since I lived in any state where one could still get malpractice from NSO for $650/yr!!
Dena Galler
stephanie2u at optonline.net wrote:
I will echo Julie here. The fact that your co-workers would be lovely people to work with is one thing and your responsibilities are a separate issue. I'm very cautious in general, but for what it's worth these are my comments:
1) I am not comfortable writing a prescription for a diagnosis someone else has made. Ultimately the diagnosis being correct now becomes my responsibility, since I've taken over its treatment.
2) If I were the patient, I think I would deserve to be treated by someone who was trained and experienced and not an amateur. Without training and experience, the both the counseling and the drug treatment could be harmful or just unhelpful, which is just as bad in some ways.
3) As a provider, I would not venture into territory where I have no experience. I like to learn new things as much as the next person, but it's better done under the supervision of an expert, who can make sure I'm on the right track, for the sake of patient safety.
3) Malpractice insurance runs about $650 from NSO for fulltime FNPs, and family practice does encompass some mental health prescribing, but if the worst happened--say, some student committed suicide & their family came after you--your lawyer would have a hard time defending you since you couldn't point to any formal training in psychiatry. The chances of any problem are so minimal it hardly seems worth mentioning, but bad things do happen to good people now & then.
Good luck in making your decision,
Stephanie Walker, RN, FNP
----- Original Message -----
From: Julie
Date: Friday, April 27, 2007 3:00 pm
Subject: Re: [NP-Clinical] psych/counseling
To: NP Clinical
> Hi Lisa,
> I am a FNP (for ten years) who went back and got my PMHNP
> (psychiatric
> mental health nurse practitioner) and have been doing psych full
> time
> for three years. I would be somewhat hesitant about doing that
> job as a
> FNP. I had also done a lot of psych as a FNP, I had worked in a
> large
> county jail and seen a lot of depression in family practice but
> I really
> had no idea how specialized psych is and how little I really
> knew until
> I went though my psych NP program and more importantly when I
> did my
> clinicals and started working as a psych NP in a clinic.
> Without my
> precepting psychiatrist who then became my boss and supervising
> physician I would not have known and understood nearly what I do
> now.
> One thing I have learned is that bipolar disorder is very
> commonly
> misdiagnosed as plain depression. The age that bipolar is most
> commonly
> evident and diagnosed is in the 20's, the college years,
> although we are
> picking it up earlier now. I see SO many people that have been
> misdiagnosed and prescribing these people antidepressants can
> lead to
> potentially fatal results because it can cause increased
> aggitation,
> mania, anger etc. sometimes leading to suicide. I think you are
> taking
> a risk working in a specialty without the credentialling and if
> something went wrong it wouldnt look good in court. Psych is a
> risky
> area because of suicide (and rarely homicide). We all know all
> the
> issues right now with black box warning on antidepressants, etc.
> If you
> dont have a psychiatrist there to directly supervise you then i
> think
> you are at risk. Also I dont know what state you are in or the
> regulations there but there can be issues with a family practice
> doctor
> supervising someone working in a specialty. I would at the very
> least
> make sure your supervising MD is a psychiatrist but I am not
> sure they
> can supervise someone outside of their specialty.
>
> I work with very experienced therapists and I can tell you that
> they are
> NOT reliable as far as diagnosis at all. They really seem to
> misdiagnose, practically everyone they see seems to have either
> plain
> depression or PTSD. Most therapists/counselors are not exactly
> pro
> medication either. I dont recommend that you rely on them at
> all for
> diagnosing patients or any other recommendations as far as
> medication
> either for that matter. This is a fairly common belief in
> psychiatry
> among providers vs. therapists that we are quite different and
> often at
> odds.
>
> College students can be infamous for drug seeking and stimulant
> and
> benzo abuse is widespread. I would NOT prescribe any controlled
> drugs
> to this population at all. I have therapist who think I should
> prescribe these drugs to more people than I do and they dont
> understand
> the high diversion rate and abuse potential. There are a lot of
> complicated issues that I had no idea of until I go in the
> program I was
> in and worked very closely with a great psychiatrist.
>
> Having said all that I know there is a shortage of providers in
> psychiatry. As far as books go, I dont think this is an area
> you can
> really learn from books. The medications are so specialized and
> often
> it takes a combination of medications for successful treatment.
> I didnt
> learn any of that in my as far as the classroom work, I learned
> all that
> from the psychiatrist I did clinicals with and it took a lot of
> time and
> observation and there is no way I could be doing well at what I
> am
> without it. In addition, most family practice doctors and
> internal
> medicine doctors wont even treat many mental illnesses now
> (including in
> many cases depression) because of the risk and the specialized
> medications that have just an entire host of potential side
> effects and
> drug interactions. That is saying something.
>
> Best wishes,
> Julie Worley, FNP, PMHNP
>
>
> Lisa Meyer wrote:
>
> > Lists:
> >
> > I have been approached with a part time job offer that I am
> > considering and am looking for some advice. I am an FNP
> currently
> > working ER/Walk-In. The new opportunity is at our university
> > counseling center. The current NP (who is WH/Adult health) is
> leaving
> > the position due to her partner's job. The position is mainly
> > prescribing. All of the students she sees have already been
> evaluated
> > by one of the counselors and are interested in medication
> initiation.
> > She sees back all of the med refills and assesses compliance,
> side
> > effects, efficacy, etc. She says she mostly sees depression
> and
> > anxiety--very rarely bipolars or stable schizophrenics.
> >
> > I am very interested in the position because I really enjoy
> working
> > with college students, and have been interested in trying
> something
> > different (have always worked urgent/emergency care). In the
> ED where
> > I work though, NP's and PA's generally don't "do" psych
> diagnosing or
> > prescribing. My one concern is that I have little specific
> training
> > in psych (other than what I got in my FNP and undergrad
> program). The
> > outgoing NP assures me that she didn't either, and that you
> learn a
> > lot from the counselors and the psychiatrist that is available
> to us.
> > We also have a collaborating MD at the health center if
> needed.
> >
> > Is there anyone on the list who works in a similar setting and
> would
> > be willing to give me some advice? If I did decide to pursue
> this,
> > can anyone recommend any texts, handbooks, or courses that
> could bring
> > me up to speed on psych prescribing? The outgoing NP has
> written some
> > nice guidelines/protocols for the position as well, but I
> would still
> > want to seriously "hit the books" first.
> >
> > The position does not offer malpractice, so for the first
> time, I
> > would be looking at buying my own. Does anyone have any
> advice
> > regarding this, and does the type/amount needed differ for a
> part time
> > (12 hours) position such as this? The outgoing NP gushes
> about how
> > much she loves this job and the co-workers, which is, I guess,
> a
> > positive thing...
> >
> > Thanks!
> >
> > Lisa
> >
> >----------------------------------------------------------------
> --------
> >
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> >
> >
> >
>
>
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