[NPInfo] Back to Stephanie re: Psych NPs

Fri Sep 7 05:42:58 PDT 2007

You may want to contact Denise Robinson at Northern Kentucky Univ. regarding 
their on-line program in Psych-Mental Health.
deniserobinson at NKU.edu.
Pat M
----- Original Message ----- 
From: "Shelby Havens" <shelbyhavens at hotmail.com>
To: <npinfo at nurse.net>
Sent: Friday, September 07, 2007 6:24 AM
Subject: [NPInfo] Back to Stephanie re: Psych NPs


> 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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