[NPInfo] Back to Stephanie re: Psych NPs

Fri Sep 7 04:24:12 PDT 2007

Dear Stephanie:

In order to be eligible for certification by the ANCC as a Psych NP, you 
have take the same core curriculum in graduate school as the other NPs, 
including advanced physical assessment, pathophysiology, etc. It is fairly 
easy for a FNP to get a post-masters certificate as a Psych NP, or to just 
take the required psychopharmacology and psychotherapy courses, to fulfill 
the ANCC requirements to take the psych NP certification exam.

I have worked with some awesome psychiatrists. They are good at making 
differential diagnoses between brain disorders and mental disorders. Some of 
them are good addictionologists. I have been a preceptor for our local 
medical school's forensic psychiatry fellowship program. The fellows who 
trained in my jail tended to be adept at identifying malingering (in 
patients faking a mental disorder) while still demonstrating professionalism 
and compassion. Psychiatrists can perform ECT, and I have never known a 
Psych NP who does that.

Psychiatrists, unlike NPs, generally don't touch patients. One of my 
fellows, when asked by our administrator for his CPR card last year, 
shouted, "I'm a psychiatrist - I'm not going to be doing CPR!" I had to take 
him aside and gently remind him that ALL staff are required to have a 
current CPR card, even the maintenance man and the kitchen manager.

I think Psych NPs are more likely to provide hands-on care and assessment. I 
have sometimes worked in primary care, and I like to keep my primary care 
skills current in order to be more marketable. As a Psych NP, I occasionally 
treat stuff like rashes, achy joints, and I might occasionally adjust 
someone's does of Synthroid or seizure medication.

Our state Medicaid program reimburses ONLY psychiatrists for inpatient 
mental health care. They have a great deal of difficulty recruiting 
psychiatrists for our local crisis stabilization unit at the community 
mental health center. I would dearly love to be a provider in that facility, 
but they can't find a way to get paid for an NP's services. I think that 
sucks, but what can I do?

Best Regards,

Shelby Havens, ARNP

>From: np at c-zone.net
>Reply-To: NP Info <npinfo at nurse.net>
>To: "NP Info" <npinfo at nurse.net>
>Subject: Re: RE: [NPInfo] My Reply........To Shelby and others- 
>Psychiatrists & Psych NPs Date: Thu, 6 Sep 2007 21:53:04 -0700 (PDT)
>
>In California, at least, there are very,very few Psychiatric & Mental
>Health NPs at all. Most Psych NPs have previously practiced as WHCNP, or
>FNP, or ANP, etc. for a number of years before becoming interested in &
>pursuing Psychiatric NP training/certificate. Most (ie.80%+)seem to be
>FNPs who study up on their own, take a number of courses over a period of
>a few years, do some lengthy OJT stints & then just sort of self-declare
>that they are now Psychiatric NPs - nothing wrong with that at all here in
>CA (kind of the way parents in West Virginia are rumored to teach their
>kids to swim- show them how to move their arms and kick their little legs
>& then throw them head first into the river- most make it, some don't).
>That being said, what distinguishes Psych NPs from Psychiatrists often is
>that the NP has probably had many more years of general/family practice
>medical experience under her belt than the Psychiatrist! Haven't you heard
>some psychiatrists joke that "I'm not a real Doctor, I'm a Psychiatrist, I
>don't practice medicine?" That's certainly not technically correct but it
>does seem to be the way many feel about their role and the discomfort they
>may feel about reaching too much beyond their self-limited scope of
>practice.
>
> > I just posted saying that NPs are not necessarily cost efficient, but I 
>do
> > think Shelby is right. I am not in psychiatry, but in the past,
> > psychiatrists would refer their patients to the primary care provider 
>(who
> > was me sometimes) if they thought the patient might have a medical
> > problem, or to clear them medically for some drug. I have often 
>wondered:
> > if they're not practicing as medical practitioners, what distinguishes
> > them from psychiatric nurse practitioners, as far as knowledge base?
> >
> > Stephanie
> >
> > ----- Original Message -----
> > From: Shelby Havens
> > Date: Wednesday, September 5, 2007 11:08 am
> > Subject: RE: [NPInfo] My Reply........To Shelby and others
> > To: npinfo at nurse.net
> >
> >>
> >> Dena wrote:
> >>
> >> "Oh, dear, you've used a VERY bad example by bringing up
> >> chiropractors!! Do
> >> you think they worry about MDs' position in the food chain?? You
> >> betcha!!You think WE need to worry about MD's position in the
> >> food chain?? You
> >> betcha!! And to think otherwise is VERY unwise."
> >>
> >> *****************
> >>
> >> Dear Dena:
> >>
> >> Thanks for bringing that up! The grass is not always greener in
> >> the other
> >> health-related professions! I think we should focus on re-
> >> defining our role
> >> in relation to physicians. For instance, I simply relegated my
> >> MD to the
> >> role of "consultant", essentially. He collaborates with me on
> >> complex cases.
> >> As far as the jail is concerned, I'm much more cost effective
> >> and equally
> >> clinically skilled.
> >>
> >> Another thing that "works" for me is my choice of practice
> >> settings. Most
> >> MD's don't want to work in jails and prisons. Since autonomy is
> >> important
> >> for my job satisfaction, jails and prisons are ideal practice
> >> sites because
> >> there simply aren't enough MD's around to look over my shoulder.
> >> If you want
> >> to take care of mentally ill patients in Florida, most of them
> >> are either in
> >> jail or prison. So I have a corner on the market as a
> >> psychiatric ARNP with
> >> prescriptive authority.
> >>
> >> Whatever we do, we have to make it a "win-win-win" situation for
> >> NP's &
> >> PA's, physicians, and patients. I have no idea how to accomplish
> >> that, quite
> >> frankly. But we have to find a way to peacefully co-exist within
> >> the power
> >> structure that we've got.
> >>
> >> Cheers,
> >>
> >> Shelby Havens, ARNP
> >>
> >> _________________________________________________________________
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> >>
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