[NP-Clinical] psych/counseling

Fri May 11 09:50:10 PDT 2007

I'm due to get my premium statement this month, and I'll let you know if the price went up in NY!

Stephanie

----- Original Message -----
From: debcfnp at aol.com
Date: Friday, May 11, 2007 11:33 am
Subject: Re: [NP-Clinical] psych/counseling
To: np-clinical at nurse.net

> 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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> > >NP-Clinical at nurse.net
> > >http://lists.nurse.net/mailman/listinfo/np-clinical
> > >
> > > 
> > >
> > 
> > 
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