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Psychologist NP's

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by Doctor Eliza, Mar 14, 2012.

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  1. Doctor Eliza

    Doctor Eliza

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    I am a licensed psychologist and I am beginning to contemplate returning to school to become a nurse practitioner so that I can rx meds. My ultimate goal is to be in practice doing a mix of med management and therapy.

    I know that there are at least 2 people on this board who are going this route. Can you offer any advice? Where to research this more? So far, I just know that my local university has an accredited direct entry NP program.

    Any ideas and experiences are much appreciated!!
    Dr. E
  2. AnnoyedByFreud

    AnnoyedByFreud

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    Hi Doctor Eliza,

    It's psychiatric NP. I am going this route, although I am not a psychologist (I opted not to pursue this field after a few years of working in research). I will be entering a DE program this summer. Most programs are around 3 years, although some are shorter. You do about one year of RN training and then two years where you specialize and earn your MSN.

    The first thing to do would be to look into prereqs for the specific program(s) you're interested in. Nursing is not uniform, unfortunately, and prereqs for each of the programs can differ slightly. You will most likely have to take anatomy/physiology 1&2 and microbiology, among other classes. Make sure you do very well in these classes (it shouldn't be too hard), because these programs are typically very competitive, although not as competitive as a funded PhD in clinical psychology.

    Are your GRE scores out of date? If you haven't taken the GRE in the past five years, the program may require that you take it again. Some programs waive the GRE for people who already have advanced degrees, so hopefully that will be the case for you.

    I think the most important thing for getting into these programs is making sure you have a cogent, coherent narrative for why you want to become a nurse and a NP, specifically for your specialty. Make sure you know what nursing is on the RN level and NP level, since for the first year you're training will be purely RN training. I basically said that I was all about the biopsychosocial model, and they loved that. You want to be able to speak intelligently about the field and its future to prove you know what you're getting into. Volunteering around nurses (on a hospital floor, for example) can really help the adcoms see that you understand nursing, although I feel like I would have been accepted without my hospital volunteer experience, tbh. Also, if you want maximum career opportunities, go for a family PMHNP program, so you can work with anyone.
    Last edited: Mar 14, 2012
  3. Doctor Eliza

    Doctor Eliza

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    Yes, perhaps it would have been a better choice for my subject line to be "psychologist/NP" or "psychologists who are also NP's" It was a poor/misleading choice of words. All this by way of saying--I'm not a stupid as I sound!! :laugh: I tried to change it after you pointed that out, but they don't let you change subject lines.

    Now i just sound neurotic!

    Thanks for taking the time to respond with your valuable info!

    Best,
    Dr. E
  4. 4410

    4410

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    I've known psychologists who are getting their ANP license, but I believe they cannot use both their psychologist license and ANP license under the same title or same practice due to different regulatory boards for each license. You cannot see a cient for therapy for one hour and then put on your ANP hat and see them for thirty minutes and prescribe medications. Also, you have to be supervised by a MD or a DO. I've heard of psychologist who are in independent practice doing assessment and therapy and they use their ANP seperately working for another agency under the supervision of an MD/DO. I think you would get in trouble having your own independent practice as a psychologist and then having the ANP credentials with the same clients. If you live in Louisiana or New Mexico you can achieve a two year postdoctoral MA clinical psychopharmacology degree and prescibe psychopharmacology medication under your psychology license. There is a thread above that has a long duration over psychopharmacology that you may have interest in reviewing.
    Last edited: Mar 17, 2012
  5. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    All of these are speculations (since your always too freakin lazy to look anything up) are COMPLETELY false.
  6. AnnoyedByFreud

    AnnoyedByFreud

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    Actually, there is a practicing clinical psychologist and psych NP on this forum... and it seems like they're able to incorporate both "hats" into their practice just fine. Also, NPs have independent practice (no MD/DO supervision) in many states.
  7. AcronymAllergy

    AcronymAllergy Neuropsychology Fellow Moderator

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    I've never heard of this being an issue, and it's never been raised by the psychologist/NPs on this board (although they can of course feel free to chime in and correct me). The only situations I could see it being a problem in are those related to multiple roles being in play (e.g., your role as a psychologist is one related only to providing an independent assessment), in which case prescribing, as with any other type of treatment, could represent an ethical transgression.
  8. 4410

    4410

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    Psychologist and ANP are licensed under different boards. If you hold both license when are you a psychologist and when are you an ANP, which board are you working under? Can you be a Psychologist and an ANP and practice and bill under both licenses with the same client at the same billiable hour? Most mental health agencies have ANP prescribing medications. Many of these ANP have psychology training or social work training but they cannot bill for these services. They work under their ANP license and are supervised by a MD/DO. Unless you live in Louisiana or New Mexico you are not able to prescribe psychopharmacological medications under your psychology license. ANP are able to practice under supervision from and MD/DO in all the States. DOD, IHS, and Teritory of Guam have provisions for psychologist to prescribe psychopharmacological medications without supervision from an MD/DO.

    If a psychologist in these other States is prescribing medicaitons under the ANP license,it is under the supervision of an MD/DO. ANP license does not allow for psychological evaluation or therapy so you will be in violation of your ANP license if you are billing for evaluations/therapy under this license while doing independent practice. ANP who work in medical facilities may have some therapy provisions while practicing under the umbrella of the medical facility, but ANP are not allowed to provide therapy services in an Independent practice.

    These are the questions that must be asked when a psychologists decides to pursue ANP credentials. When are you a psychologist and when are you an ANP? If complaints are filed against you regarding ethical violations, which board investigates these complaints?

    There are psychologists who have completed the postdoctoral clinical psychopharmacology two-year training and completed 100 patient preceptorship and passed the PEP. However, they cannot prescribe medications in their State due to no legislation allowing for prescription privileges. They are eligible to consult with PCP, Famility practitoners and with other medical providers under their psychologists license but they cannot precribe medications under their psychology license. They often have a assessment interview with the referral from the medical provider and do a consult with the medical provider with recommendations for interventions (psychotherapy and medication) but the MD/DO prescribes the medications. They bill insurance for this assessment under their psychology license.

    Psychologists are licensed under a psychology board and ANP are licensed under a medical board. Some ANP have recieved training at the doctoral level under a nursing program at the PhD level. However, the majority are licensed at the masters level and they cannot use the tiltle Dr. Psychologist are licensed at the doctoral level and may use the title Dr. However, if they are also an ANP and using their ANP credential they may not be called Dr. or use the title Dr. as this is a violation of ANP guidelines. MD/DO are opposed to ANP with the Dr. degree using the title Dr. because a Dr. degree is not required for ANP credential and they are supervised by a DO/MD and essentially working under the DO/MD credentials. ANP are seeking independent practice but most or all states require supervision of a number of their clinical cases and to have a working relationship with a DO/MD under their supervision.

    You have heard of Dr. Laura? Well she has a PhD in physiology from Columbia University and a MS in Marriage and Family Therapy. Well, is it not an ethical violation for her to use Dr. Laura title on her radio show concerning marriage and family issues since her PhD is in physiology? Yes it is, but she has a disclaimer that her show is not intended to be therapy or a replacement for therapy and that it is entertainment, so she is allowed to use the title Dr. Laura. If she had a independent practice as a LMFT she would not be allowed to use the title Dr. Laura. This would be a violation. If you are an ANP at the MS level and a psychologist at the PhD level when using your ANP credential it would be a ethical violation to use the title Dr. unless you have the PhD in Nursing. Medical boards are not necessarily in agreement that the PhD in Nursing should be allowed to use the title Dr. while under the supervision of a MD/DO but they should use the title ANP without the Dr. designation.
    Last edited: Mar 17, 2012
  9. AnnoyedByFreud

    AnnoyedByFreud

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    This is utterly untrue. I live in an independent practice state and know several PMHNPs who have independent practices and both prescribe meds with no physician supervision and provide (and are reimbursed for) psychotherapy.

    I don't really see what the whole title/Dr. thing has to do with the conversation. I, for one, think the DNP as entry to advanced practice nursing is ridiculous.
    futurepsych0 likes this.
  10. 4410

    4410

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    Nurse practitioners may have independent practice in some States but they still must have supervision of 15-30 percent of their cases by an MD/DO. Nurse practitioners are in the process of adopting legislation to have the supervision by MD/DO to be time limited for so many years and then they are truely not being supervised by and MD/DO.

    They may have their own independent office without an MD/OD on staff or in the office but they still must be supervised by an MD/DO for so many cases. They may be doing psychotherapy but not billing it as psychotherapy but billing it under their ANP license under a medical code similar to MD/DO psychiatrist.
  11. AnnoyedByFreud

    AnnoyedByFreud

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    Once again, what you're posting isn't true. You can look up the nursing practice acts yourself. In these independent practice states (like Oregon, Washington, Arizona, and New Mexico), NPs have no physician supervision requirement. None. They can choose to collaborate with a physician or other providers, but it is not required of them. And they do bill for therapy. At least in my state PMHNPs do.

    Further reading: http://www.acnpweb.org/i4a/pages/index.cfm?pageid=3465

    "NPs are authorized to practice across the nation and have prescriptive privileges, of varying degrees, in 49 states. Nurse practitioners perform services as authorized by a state's nurse practice act. These nurse practice acts vary state-to-state, with some states having independent practice for NPs (not requiring any physician involvement), some with collaborative agreement required with a physician."
  12. 4410

    4410

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    I believe you are getting your terms confused. They may have an independent practice. Yes this is true, but they have to be supervised by an MD/DO for so many cases. Normally, the first two years they are supervised for all of their cases and then it is 15 to 30 percent after that. A person can still engage in independent practice while being supervised for 15 to 30 percent of their cases. It is common for a ANP to have a collaborative relationship by a physician and in some cases the physician has to be onsite for 10% of the time. There is nothing listed in the regulations about doing psychotherapy but there is a designation for counseling. Counseling and psychotherapy are not the same and if they bill for psychotherapy they are in violation of their ethics board.



    "The AAFP position is that the term "nurse practitioner" should be reserved for those who undergo specific training programs following attainment of a Registered Nurse (R.N.) license. Following licensure as an R.N., the nurse desiring to function as a nurse practitioner should be certified rather than licensed as a nurse practitioner.

    The nurse practitioner should not function as an independent health practitioner. The AAFP position is that the nurse practitioner should only function in an integrated practice arrangement under the direction and responsible supervision of a practicing, licensed physician. In no instance may duties be delegated to a nurse practitioner for which the supervising physician does not have the appropriate training, experience and demonstrated competence.

    The AAFP position is that the training programs preparing nurse practitioners, like the training for all other health care providers, should be constantly monitored to assure the quality of training provided and that the number of graduates reflects demonstrated needs.

    The AAFP supports the concept of patient and third-party payment for services of nurse practitioners only where services are provided in an integrated practice arrangement. (1984) (2009 CoD)"



    Again, the question that begs to be answered is license that you practice under and conflicts with the rules/regulations of each of these licenses. Plus, an ANP cannot use the designation of Dr. unless they have a PhD in Practical Nursing.
    Last edited: Mar 17, 2012
  13. AnnoyedByFreud

    AnnoyedByFreud

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    I feel like I'm running out of ways to explain this to you. There is no supervision requirement for NPs in independent practice states. The link I provided includes a chart that breaks down scope of practice and whether or not physician supervision is required by state. Feel free to peruse it.

    What you quoted is the AAFP's position on the issue, not what the law says. Of course family physicians are against NP independent practice... that has nothing to do with the nursing practice acts and the law. Nurses do not operate under the BOM, they operate under the board of nursing.

    Also, the doctor/title stuff depends on the state, as well. What that has to do with the issue at hand (level of physician supervision) is beyond me.

    Here is an easy breakdown: www.texaspolicy.com/pdf/2007-11-PB34-nursepratitioner-mks.pdf

    "Nine states and the District of Columbia permit fully independent practice and pre- scriptive authority for nurse practitioners. In these states, nurse practitioners may establish their own clinics that operate within a scope of practice dictated by their training and licensure. These states have no provisions for physician collaboration or oversight, though they do not prohibit such arrangements."
    Last edited: Mar 17, 2012
  14. 4410

    4410

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    Yes, I get it!!! However, even the States with Full Independent Practice require some sort of collaborative relationship with a physician for so many years before this collaboration is no longer required. NP are trying to mandate full independent licensure nationwide at this point in time. There are similarities here with masters level trained mental health professionals and doctoral level trained mental health professioners. I work in Texas where NP are supervised by MD/DO for so many cases. Most NP work in hospital settings or clinic settings where they are supervised by a MD/DO.

    The whole issue of licensed psychologist using ANP credential to prescribe medication is different than a non licensed psychologist using ANP credentials. Can a psychologist see patients with the ANP MS degree and ethically refer to themselves as Dr. Smith, clinical psychologist and I recommend medications of Prozac 20 mg 1 in the am. I will see you in two weeks and let me know if you are having any side effect or other concerns if they come up before I see you in two weeks. No they must refer to themselves as Ms. Smith, ANP.
  15. AcronymAllergy

    AcronymAllergy Neuropsychology Fellow Moderator

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    If it came down to it, for billing purposes, I would imagine you could schedule two appointments back-to-back for each patient. The typical 45-50 minute therapy session, and then an additional 10-15 minutes at the end or beginning for medication management. Given that you're licensed in both capacities, I don't see providing (or billing for) these services to be an issue.

    But again, one of the practicing psychology/NPs on this board can feel free to fill us in on how they handle the administrative aspects of their practice.
  16. AnnoyedByFreud

    AnnoyedByFreud

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    ... I just don't even know what to say, but you really don't seem to get it. Where are you getting this information? Do you mean clinical hours that a NP must gain before they can be licensed (ie: while they're in school?) But even then, the preceptor can be a NP or a physician, or even a PA.

    Can you please point out where it says that a NP must collaborate with a physician in the nursing acts of these independent states? The law is clear, a licensed NP does not have to collaborate with anyone in an independent practice state.

    BTW, Texas is an unfriendly state for NP independent practice (it has heavy regulations). Maybe you're assuming all states function that way? It isn't true... have you even looked at the links I've provided? They state it very plainly. There is no supervision required in these specific states, period. There's no exception or requirement that one must be supervised a certain number of hours, or any of that stuff. For better or worse, an NP is an independent provider when working in those states, with no requirement to collaborate.
    Last edited: Mar 17, 2012
  17. 4410

    4410

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    I believe you open up many ethical can of worms when you begin using such a strategy. Here in Texas, I believe the ANP have to have DO/MD signature on all of their progress notes and prescription notes. How do you get by advertising guidelines---Are you a licensed psychologist or an ANP. The one psychologist I know who is an ANP does not practice psychology anymore but she practices as an ANP at a psychiatric hospital. She is making a six figure income and working three twelve hour shifts per week and has a schedule where she has a block of ten days off of work every month.
    She basically has all of the responsibilities of the psychiatrist with psychology training and ANP training and she has a schedule and salary higher than she had with her thirty years as a psychologists before going through the ANP training.
    Last edited: Mar 17, 2012
  18. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    **Anyone interested in psychologist + NP training should REALLY take everything written in this thread with a large grain of salt. There is a TON of misinformation being spouted on here in an authoritative tone, without having sufficient evidence that what is being said is correct. Please consult your local licensing boards and state legislation for answers to scope of practice, titles, and related issues.**
  19. AnnoyedByFreud

    AnnoyedByFreud

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    Can you be more specific? I can't help but feel that you're referring to me as someone who is posting inaccurate info, and I'd really appreciate being corrected. Also, yes, I agree that if anyone is interested in being a NP they should familiarize themselves with the nurse practice act of the state they intend to practice in.

    Honestly, I resent the implication that I have posted something misleading or that my tone is deceptively authoritative. I really only have two points. The first is that there is no blanket physician collaboration requirement. It varies by state. Check with your state's nurse practice act. Anyone who says that NPs must always be supervised is not stating the truth, period. The second is the argument that psych NPs can never be reimbursed for therapy. That also varies by state. It's true that in some states one must be a CNS to be reimbursed, however, this is changing (especially since the ANCC is getting rid of psych CNS licensure and adult psych NP licensure and wants everyone to become family psych NPs). Even with that said, there are many states where psych NPs can currently reimburse for therapy. Really, those are my only points and I've just been trying to explain to 4410 (with plenty of evidence, might I add), that they are incorrect about nursing practice in independent practice states.
    Last edited: Mar 17, 2012
  20. AcronymAllergy

    AcronymAllergy Neuropsychology Fellow Moderator

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    If anyone who does have knowledge of these facets of practice wanted to share it (or throw a few links where to get started) as it pertains to their state, I think it'd be an excellent resource for those considering pursuing this path, as I believe I've seen at least a couple posters mention such interests. I can see how the double licensure/scope of practice and billing components could be confusing.
  21. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    I was referring primarily to 4410, though I thought it was a good time to remind people to do their own research and not just trust random people on the internet.
  22. AnnoyedByFreud

    AnnoyedByFreud

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    ah, okay. point well taken about doing your own research.
  23. medium rare

    medium rare Psychologist & Psych NP

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    I have been away from this forum for awhile and return to find a lively discussion on this topic.

    I'm both a licensed psychologist and a board-certified family psychiatric-mental health (PMHNP) nurse practitioner. I practice in an independent state for NPs and am in full-time private practice; I incorporate both roles (psychologist & NP) on a daily basis.

    One license does not take away from or prohibit the actions of the other. I practice completely autonomously and independently in every aspect and have no required collaboration or supervision of any kind for any and all aspects of practice.
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  24. 4410

    4410

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    Could you share how you have done both without running into some of the topics on this thread. I have interest in doing this but I have been told in Texas that you cannot do both. I am going to Louisiana to begin predoctoral internship next year and have interest in being a medical psychologist since I have already completed the two year postdoctoral clinical psychopharmacology training while working on my doctoral degree. I've heard that in Louisiana that you can prescribe medications under your NP if you are a licensed psychologist but my advisor who has the postdoctoral training has indicated that you cannot do both in most States. If you can do both, as in your State, it makes more sense to get the NP training, but I believe most States require supervision or collaboration with a MD/DO.
  25. medium rare

    medium rare Psychologist & Psych NP

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    You do both by meeting the training and licensure/certification requirements for both credentials in your state. Being licensed as a psychologist will in no way negatively impact your ability to practice as a psych NP - it's "both/and not either/or."

    If your state requires NPs to have a collaborative agreement, then you must abide by the terms of that agreement with regard to those aspects of practice that are specific to your NP role. Keep in mind however, a collaborative agreement is not "supervision." It usually means that there is something written on file with the Board of Nursing stating how the NP will use the identified collaborating physician - in most cases, it is the NP's decision to contact the collaborating if needed. There are only a few (2-3 state) that still require actual physician "supervision."

    If you're a prescribing psychologist in NM or LA, then you don't need to get the NP. If you are already a psychologist/NP and are in a state that certifies prescribing psychologists, you can qualify for a prescribing psychologist certificate, but you should only prescribe under one credential - there would be no need to do so under both NP and prescribing psychologist status. Same thing as a physician, NP, PA, etc. You can only Rx under one professional credential.

    Unless you are certain you want to live in NM or LA, you should consider getting the NP credential.
  26. 4410

    4410

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    Thanks for clearing up information. It seems that many psychologists, including psychology doctoral students as myself are not certain of how working as a licensed psychologist and NP works. My advisors and other psychologists have informed me that you could not use both licenses in the State of Texas.
  27. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    Im glad to see you can actually admit that you are wrong. Perhaps now you can start phasing things as questions (as most do), not as facts? I am unsure why one would need to be reminded of this, but you do not seem to learn from feedback.
  28. 4410

    4410

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    Are you my ex-wife? :smack:
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