Psych nurse practitioners and psychotherapy?

[Healthmed101]

Do psychiatric nurse practitioners who want to practice psychotherapy have to get additional training and complete 2000 hours of clinical experience under a licensed psychotherapist just like an LPC or LCSW has to do?

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[pamac]

Psychiatric nurse practitioners cost quite a bit more than an LPC or LCSW. To have them practicing in the realm of what an LPC or LCSW performs would be a significant waste of resources. A large part (if not the largest part) of an NP's value is due to their prescriptive authority. That's where you will see them utilized. That value is also why you see psychologists in many places trying to get limited prescriptive authority... it will boost their income and relevance.

 

[Healthmed101]

Psychiatric nurse practitioners cost quite a bit more than an LPC or LCSW. To have them practicing in the realm of what an LPC or LCSW performs would be a significant waste of resources. A large part (if not the largest part) of an NP's value is due to their prescriptive authority. That's where you will see them utilized. That value is also why you see psychologists in many places trying to get limited prescriptive authority... it will boost their income and relevance.

But to get this training, how many additional hours of certification do they need after graduation?

Also, are u for or against psychologist rx rights?

 

[AnnoyedByFreud]

Do psychiatric nurse practitioners who want to practice psychotherapy have to get additional training and complete 2000 hours of clinical experience under a licensed psychotherapist just like an LPC or LCSW has to do?

No. Once a psych NP is licensed, they are licensed. All the training hours are included during schooling.

 

[pamac]

But to get this training, how many additional hours of certification do they need after graduation?

Also, are u for or against psychologist rx rights?

The psychologists that can take advantage of being able to prescribe supposedly have additional pharmacological training, and have a very limited pallet of meds to work with. I guesse that one of the reservations that immediately comes to mind is that those limitations that they work under might cause them to miss out on additional medication options that could be beneficial. It's like the saying "when you are a hammer, everything starts to look like a nail".... When you only can prescribe a handful of meds, you only see solutions that involve those meds.

Not all nurses have a tight grasp of medications or pharmacology, but most of us have a healthy respect for things like side effects and interactions. Even on a psyche unit, medical emergencies occur due to psyche meds (many, if not most psyche meds have significant physical effects beyond just the ones associated with the thought process). Recently, a nurse peer of mine stumbled into a really obscure drug interaction involving an antipsychotic that ended up being life threatening, but we were able to save the patient's life based on our nursing skills, and my peer's quick thinking and observation. Not every NP these days has much experience as an RN, but most do, and it is really far from the norm to have it be otherwise. I would think that even though it might be convenient for psychologists to have some ability to secure some medications for patients to take the edge off, so to speak, I can't help but think that there are headaches that would come with that opportunity that would cause it to be more of a burden than it would be worth, given the responsibility. Patients with significant comorbidities are more the norm now. I actually see way more situations where psychologists shouldn't be testing the waters that I don't think it's worth it for the handful of times when a patient presents with just one issue that can be dealt with using a mild medication... It's like the stars would have to align for that to happen, and if they didn't align, should they really be messing around with meds?

 

[Jules A]

Not every NP these days has much experience as an RN, but most do, and it is really far from the norm to have it be otherwise.

Your friend's insight and experience is an excellent example of why RN experience is both necessary and in the past was considered a palatable bridge for the lack of clinically relevant graduate education NPs receive. Unfortunately a majority of SONs have decided it is in their financial interest to retain their undergrad students and encourage them to stay aka pay through grad school with absolutely no requirement to ever have worked as a nurse prior to prescribing despite the lax pharmacology requirements in NP programs. That the AMA isn't all over this continues to surprise me. I have grave concerns about not only the large numbers of grads they are cranking out but also the quality although I'm sure there will be an abundance of "nursing research" to support wonderful and even superior outcomes to Docs. Bottom line is its all fun and games until someone loses an eye.

 

[Healthmed101]

The psychologists that can take advantage of being able to prescribe supposedly have additional pharmacological training, and have a very limited pallet of meds to work with. I guesse that one of the reservations that immediately comes to mind is that those limitations that they work under might cause them to miss out on additional medication options that could be beneficial. It's like the saying "when you are a hammer, everything starts to look like a nail".... When you only can prescribe a handful of meds, you only see solutions that involve those meds.

Not all nurses have a tight grasp of medications or pharmacology, but most of us have a healthy respect for things like side effects and interactions. Even on a psyche unit, medical emergencies occur due to psyche meds (many, if not most psyche meds have significant physical effects beyond just the ones associated with the thought process). Recently, a nurse peer of mine stumbled into a really obscure drug interaction involving an antipsychotic that ended up being life threatening, but we were able to save the patient's life based on our nursing skills, and my peer's quick thinking and observation. Not every NP these days has much experience as an RN, but most do, and it is really far from the norm to have it be otherwise. I would think that even though it might be convenient for psychologists to have some ability to secure some medications for patients to take the edge off, so to speak, I can't help but think that there are headaches that would come with that opportunity that would cause it to be more of a burden than it would be worth, given the responsibility. Patients with significant comorbidities are more the norm now. I actually see way more situations where psychologists shouldn't be testing the waters that I don't think it's worth it for the handful of times when a patient presents with just one issue that can be dealt with using a mild medication... It's like the stars would have to align for that to happen, and if they didn't align, should they really be messing around with meds?

But they are trained to look for differential diagnostics and comorbid medical conditions that can complicate or present with a patient. Their 2.5 year additional postdoctoral masters in psychopharmacology includes all that.

 

[pamac]

Your friend's insight and experience is an excellent example of why RN experience is both necessary and in the past was considered a palatable bridge for the lack of clinically relevant graduate education NPs receive. Unfortunately a majority of SONs have decided it is in their financial interest to retain their undergrad students and encourage them to stay aka pay through grad school with absolutely no requirement to ever have worked as a nurse prior to prescribing despite the lax pharmacology requirements in NP programs. That the AMA isn't all over this continues to surprise me. I have grave concerns about not only the large numbers of grads they are cranking out but also the quality although I'm sure there will be an abundance of "nursing research" to support wonderful and even superior outcomes to Docs. Bottom line is its all fun and games until someone loses an eye.

Nobody has ever shown me that a majority, or even a healthy minority, of NP's being churned out are of the direct entry flavor. I personally know of no RN's around me that went on to NP school without hitting the floor as a nurse for at least a few years. That's just my own observation, but I would think that I would have run into at least a couple folks doing that if it was any kind of major trend. Conversely, I can't even count how many PA's and PA students I know who had minimal or no worthwhile healthcare experience prior to PA school. Just because some NP schools will allow it doesn't mean that in practice, direct entry is very common. But it seems like every conversation on here reverts to people insisting that PA's all have decent healthcare experience, and NP's are all direct entry noobs. Its just not the case from what I've seen, but I realize that's subjective. Are you actually seeing a lot of direct entry style NP's out there? Personally, if that were happening around me, I think I'd be upset too... I just haven't seen it. If another region of the country is completely different than mine, I'd be interested in why that's the case.

My experience in my BSN program was enlightening to see how the nursing world is focused heavily on advancing the profession. It may look like programs are setting up their own pipeline to make cash, but I saw a different process at play in my school. I had a 2 credit class that was solely based on preparing a portfolio to apply to a graduate program (nothing specific as to NP or some other nursing masters degree... could have even been an MBA or MHA). The final project was a dry run application to a graduate program, complete with filling out an entire application to the program of choice. The only thing left to do was pay the fee and push the button to submit. It didn't even have to be my program's NP track, and the one I chose was a different school. So the BSN faculty was very interested in advocating for nurses to go on with their education, wherever that may take them. They didn't even talk at all about what my school offered as far as graduate school options. What I saw was not so much an effort to feed their own immediate application pools, but to feed the profession as a whole.

One of my last classes had to do with promoting the profession directly, with a big part of that being advocating for NP's to be fully integrated into the healthcare system as independent providers. Having kept abreast of the midlevel provider landscape as a bystander for years, even I was surprised at how unsubtle all of it was. Nursing is really set up to thrive as a bureaucracy, and the ACA plays right into that, complete with consolidation of healthcare entities into bigger entities. I don't think its a good thing, but I think its happening right in front of us. Nurses want to own the care coordination process and be a fixture, and they want to do so at the expense of anyone else that would challenge them... it didn't matter if it was another modality of care like RT or radiological science techs... they want all interdisciplinary care to be coordinated through an RN. Everyone downplays the DNP for not offering more robust clinical education, but it has always been about getting a seat in board rooms, not getting ahead in exam rooms. They are doing everything they set out to do. In all honesty, that's not my thing. Management doesn't appeal to me at all... I'm interested in being a provider. I'm fine with some of the advancement NP's enjoy. I can't say that I am all aboard with the rest of the nursing agenda, but if you think that the AMA is the organization that will come to the rescue, think again. The AMA becomes more and more of a pipe organ for advancing centralized care each year, and politically, they are in lockstep with a lot of the goals of the ANA. They aren't there to maintain market share, they are there to show up with white coats to photo ops at the White House and push for socialized medicine.

 

[pamac]

But they are trained to look for differential diagnostics and comorbid medical conditions that can complicate or present with a patient. Their 2.5 year additional postdoctoral masters in psychopharmacology includes all that.

Mmmmm.... sure.

The profession is certainly out there making the case for them to become prescribers so they can wield all those differential diagnosis skills you mentioned. See how much psychotherapy those guys do after they discover what they can bill for med management. My guess is that patients that previously would have had a decent amount of time on the couch will ultimately be transitioned to being stacked into 15 minute appointments that focus on tweaking their medications. But maybe I'm just looking at psychologists who want to perscribe with the same kind of hesitancy that some physicians look towards PA's and NP's with.

 

[Jules A]

Nobody has ever shown me that a majority, or even a healthy minority, of NP's being churned out are of the direct entry flavor. I personally know of no RN's around me that went on to NP school without hitting the floor as a nurse for at least a few years. That's just my own observation, but I would think that I would have run into at least a couple folks doing that if it was any kind of major trend. Conversely, I can't even count how many PA's and PA students I know who had minimal or no worthwhile healthcare experience prior to PA school. Just because some NP schools will allow it doesn't mean that in practice, direct entry is very common. But it seems like every conversation on here reverts to people insisting that PA's all have decent healthcare experience, and NP's are all direct entry noobs. Its just not the case from what I've seen, but I realize that's subjective. Are you actually seeing a lot of direct entry style NP's out there? Personally, if that were happening around me, I think I'd be upset too... I just haven't seen it. If another region of the country is completely different than mine, I'd be interested in why that's the case.

My experience in my BSN program was enlightening to see how the nursing world is focused heavily on advancing the profession. It may look like programs are setting up their own pipeline to make cash, but I saw a different process at play in my school. I had a 2 credit class that was solely based on preparing a portfolio to apply to a graduate program (nothing specific as to NP or some other nursing masters degree... could have even been an MBA or MHA). The final project was a dry run application to a graduate program, complete with filling out an entire application to the program of choice. The only thing left to do was pay the fee and push the button to submit. It didn't even have to be my program's NP track, and the one I chose was a different school. So the BSN faculty was very interested in advocating for nurses to go on with their education, wherever that may take them. They didn't even talk at all about what my school offered as far as graduate school options. What I saw was not so much an effort to feed their own immediate application pools, but to feed the profession as a whole.

One of my last classes had to do with promoting the profession directly, with a big part of that being advocating for NP's to be fully integrated into the healthcare system as independent providers. Having kept abreast of the midlevel provider landscape as a bystander for years, even I was surprised at how unsubtle all of it was. Nursing is really set up to thrive as a bureaucracy, and the ACA plays right into that, complete with consolidation of healthcare entities into bigger entities. I don't think its a good thing, but I think its happening right in front of us. Nurses want to own the care coordination process and be a fixture, and they want to do so at the expense of anyone else that would challenge them... it didn't matter if it was another modality of care like RT or radiological science techs... they want all interdisciplinary care to be coordinated through an RN. Everyone downplays the DNP for not offering more robust clinical education, but it has always been about getting a seat in board rooms, not getting ahead in exam rooms. They are doing everything they set out to do. In all honesty, that's not my thing. Management doesn't appeal to me at all... I'm interested in being a provider. I'm fine with some of the advancement NP's enjoy. I can't say that I am all aboard with the rest of the nursing agenda, but if you think that the AMA is the organization that will come to the rescue, think again. The AMA becomes more and more of a pipe organ for advancing centralized care each year, and politically, they are in lockstep with a lot of the goals of the ANA. They aren't there to maintain market share, they are there to show up with white coats to photo ops at the White House and push for socialized medicine.

I absolutely can't believe undergraduate students were required to pay for a course on graduate education and that in any way that would be to advance the nursing profession rather than pad the university's pockets. Your point about wanting a seat at the table with the DNP is a good one, although unfortunate that they don't see the need to produce better clinicians as a priority which I do believe would earn credibility among physician colleagues but in any event my opinion is I don't think that by simply adding more nursing research requirements and calling themselves "doctor" they are going to garner additional respect.

In any event my guess is you will begin seeing direct NPs in your area in upcoming years especially with all the online programs. In my area this actually includes Johns Hopkins. Bless UPenn for requiring work experience in some of their MSN programs. Google "direct entry nurse practitioner programs" resulted in 194,000 results so there is likely more than a few in that list who are producing NPs who haven't ever worked as a nurse and with all the soft nursing courses such as the you describe above that is concerning to me.

 

[762513]

I absolutely can't believe undergraduate students were required to pay for a course on graduate education and that in any way that would be to advance the nursing profession rather than pad the university's pockets. Your point about wanting a seat at the table with the DNP is a good one, although unfortunate that they don't see the need to produce better clinicians as a priority which I do believe would earn credibility among physician colleagues but in any event my opinion is I don't think that by simply adding more nursing research requirements and calling themselves "doctor" they are going to garner additional respect.

In any event my guess is you will begin seeing direct NPs in your area in upcoming years especially with all the online programs. In my area this actually includes Johns Hopkins. Bless UPenn for requiring work experience in some of their MSN programs. Google "direct entry nurse practitioner programs" resulted in 194,000 results so there is likely more than a few in that list who are producing NPs who haven't ever worked as a nurse and with all the soft nursing courses such as the you describe above that is concerning to me.

You're right, I can't believe that either, because it's not what he said. It was a class designed to promote graduate prepared studies in nursing; one of the goals of the ANA is to double the number of doctoral prepared nurses by 2020. This will provide more faculty for nursing schools to attempt to close the nursing shortage that is looming and it gives nurses the chance to be policy makers and have a bit more control over their own profession. Any other group of people who made this move would be commended, but people like you seem to become triggered instead.

Putting the words "Doctor" and "research" in quotations shows you seem to have disrespect for the nursing profession. Physicians don't own the title Doctor, yet made a very successful power play. This is them defining their profession, and much respect to them for that decision. Doctors of nursing shouldn't use the title Doctor at the bedside, but they are still doctors.

Nurses are doing hard hitting quantitative research all over the country. My professor did a post doc in molecular biology and has moved on to the CDC.

Your triggers are showing.

 

[Makati2008]

You're right, I can't believe that either, because it's not what he said. It was a class designed to promote graduate prepared studies in nursing; one of the goals of the ANA is to double the number of doctoral prepared nurses by 2020. This will provide more faculty for nursing schools to attempt to close the nursing shortage that is looming and it gives nurses the chance to be policy makers and have a bit more control over their own profession. Any other group of people who made this move would be commended, but people like you seem to become triggered instead.

Putting the words "Doctor" and "research" in quotations shows you seem to have disrespect for the nursing profession. Physicians don't own the title Doctor, yet made a very successful power play. This is them defining their profession, and much respect to them for that decision. Doctors of nursing shouldn't use the title Doctor at the bedside, but they are still doctors.

Nurses are doing hard hitting qualitative research all over the country. My professor did a post doc in molecular biology and has moved on to the CDC.

Your triggers are showing.

Wish you could tell your colleagues that here on my current rotation. They call themselves Doctor daily here.


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[762513]

Wish you could tell your colleagues that here on my current rotation. They call themselves Doctor daily here.


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They are foolish.

 

[Makati2008]

They are foolish.

I would not say foolish just misguided. They are very intelligent and nice


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[pamac]

You're right, I can't believe that either, because it's not what he said. It was a class designed to promote graduate prepared studies in nursing; one of the goals of the ANA is to double the number of doctoral prepared nurses by 2020. This will provide more faculty for nursing schools to attempt to close the nursing shortage that is looming and it gives nurses the chance to be policy makers and have a bit more control over their own profession.

That's how I saw that course too. It wasn't a feeder class to drum up business for my particular school per se, although maybe a couple of folks pursued that. They have a finite number of seats and easily meet their space constraints each term without any pressure of the sort that was suggested. In my course we all were aware of where everyone was applying, and none of them were gunning to go back to that institution as grad students. My particular class was fairly small that term, so it was a small sample.

 

[pamac]

Wish you could tell your colleagues that here on my current rotation. They call themselves Doctor daily here.


Sent from my iPhone using SDN mobile app

Anyone doing that would lose me pretty quick. I like to know who I am talking to. To muddy up the waters for the sake of making some kind of statement is where I get off the train, and its always been that way for me. I can't see any benefit in a DNP insisting on being called "doctor" at the expense of clarity for patients and staff. No time for that. Save pulling out "Doctor so-and-so" for office hours when you teach as an adjunct at a nursing school. Anything more sets you up for some appropriately awkward interactions with patients, physicians, and staff. I wouldn't enjoy the apprehension that would come from using the title, waiting to get called out on it. Some folks seem to be missing the part of their psyche that is self aware in that regard.

 

[762513]

Anyone doing that would lose me pretty quick. I like to know who I am talking to. To muddy up the waters for the sake of making some kind of statement is where I get off the train, and its always been that way for me. I can't see any benefit in a DNP insisting on being called "doctor" at the expense of clarity for patients and staff. No time for that. Save pulling out "Doctor so-and-so" for office hours when you teach as an adjunct at a nursing school. Anything more sets you up for some appropriately awkward interactions with patients, physicians, and staff. I wouldn't enjoy the apprehension that would come from using the title, waiting to get called out on it. Some folks seem to be missing the part of their psyche that is self aware in that regard.

Agree. Call me whatever you want, what matters is how well my patients do under my care.

 

[NYCGuy86]

I felt my BSN time was an amalgamation of research-philosophy-health education, I.e. the health you took in ninth grade.

That sounds horrible. Fortunately, not all are like that. I know mine wasn't.

 

[762513]

Does the Nepalese doctor who trained in Australia with a BMMS call himself doctor? I find that confusing.

We're used to "dr." Anyone can be a doctor. Why does if matter? Makes Mrs/miss/ms a sight easier.

More appropriate:
Physician Smith
Nurse Practitioner Wesson
Optometrist Jones
___ Therapist Brown
Psychologist Green
Pastor White
(School) Superintendent Black

There remains confusion over what a DNP is a doctor "of".

Nursing practice is distinct from nursing discipline.

When I'm done with school it is appropriate to use the title if in a teaching or administrative position.

Interestingly, though, many of my DNP instructors don't want to be called Doctor. They want us to consider each other peers.

 

[hamstergang]

That's absurdly long.

Not even a little. It takes time to learn medicine properly.

 

[hamstergang]

I disagree. They're not becoming medical practitioners. They'll be in a collaborative role anyway. Suspected stomatic problems and atypical presentations can be punted so the physician can get a little extra money.

They'd be prescribing medications but they wouldn't be medical practitioners? I don't think we'll be able to agree on this subject.