Some questions about midlevel practioners

[pharmdreamer]

I am currently a Psychology Major and I would like to work in mental health. I think I would rather become a midlevel practioner (NP,PA in mental health), then a psyd and almost positive not the psychiatrist route.

Questions:
If I know I want to work in mental health would the NP be a better fit?
What is the point of a DNP and will I eventually HAVE to be a DNP to become a Mental Health Nurse Practioner (MHNP)?
Also, where do MHNP's work. Are they in the majority of hospitals or is that mainly psychiatrists.
Lastly, if I choose to go this route... I will be entering a entry level MSN then getting a certificate in mental health nursing. Does this sound like a good road to take?

Thanks

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[bradt9881]

I am currently a Psychology Major and I would like to work in mental health. I think I would rather become a midlevel practioner (NP,PA in mental health), then a psyd and almost positive not the psychiatrist route.

Questions:
If I know I want to work in mental health would the NP be a better fit?

I honestly don't think it matters; from a practical point of view the job is essentially the same.

What is the point of a DNP and will I eventually HAVE to be a DNP to become a Mental Health Nurse Practioner (MHNP)?

Probably better answered by a NP. I personally think the trend towards clinical doctorates has gone too far, with more benefit to academia than the degree holder. As far as will you have to have the degree, if you believe the 2012 initiative will be universal, then yes.

 

[pharmdreamer]

whats the 2012 intiative? does that mean all NP's will have to be DNPS?

 

[184013]

pharm,
recommend you take a look at some of the organizations that are making these decisions so you can make your own decisions based on their info:
here are a few links....

http://www.nursecredentialing.org/default.aspx
http://www.aacn.nche.edu/Students/index.htm

I do think that clinical doctorates are valuable in many arenas of health care... I do feel that there are some well implemented DNP programs.. however I personally feel that the DNP implementation has been very 'rough' as there is a HUGE variance in the programs ... many that do not have an enhanced clinical portion and do seem to support the educational institutions. I hope that we see this problem self-corrected by the very institutions that advocated for them~
You will need to look at the NP regulations in your state - as it is a state by state process on how NP status is either earned, grandfathered in, etc.... check out all nurses.com for more NP/Nurse specific info.

 

[deleted6669]

consider that as a pa you would have the option of doing a 1 yr paid residency in psych...
see www.appap.org
there is 1 new residency that accepts both pa's and np's but it is not the better/established program....

 

[DocNusum]

consider that as a pa you would have the option of doing a 1 yr paid residency in psych...
see www.appap.org
there is 1 new residency that accepts both pa's and np's but it is not the better/established program....

Also consider that as a PA... You can work in Mental Health but when you get tired of it....

You can transition to:

Adult Ambulatory Care
Neurosurgery
Aerospace Medicine
Obstetrics/Gynecology
Allergy/Immunology
Oncology/Bone Marrow
Anesthesiology
Oncology/Hematology
Bariatric Surgery
Ophthalmology
Burn Management
Orthopedic Medicine
Cardiology
Otolaryngology
Cardiothoracic Surgery
Pediatric Cardiology
Cardiovascular Surgery
Pediatric Neurosurgery
Correctional Medicine
Pediatric Orthopaedics
Cosmetic/Plastic Surgery
Pediatrics
Critical Care
Perioperative Medicine
Dermatology
Physical Medicine/Pain Management
Domestic Preparedness
Preventive Medicine/Health Promotion
Emergency Medicine
Endocrinology
Pulmonary Medicine
Environmental Medicine
Radiology (Interventional)
Family Medicine
Rehabilitation
Gastroenterology/Hepatology
Rheumatology
Geriatric Medicine
Sleep Medicine
Industrial/Occupational Medicine
Spinal Surgery
Infectious Disease
Sports Medicine
Internal Medicine
General Surgery
Kidney Transplantation
Surgical Oncology
Liver Transplantation
Thoracic Surgery
Neonatology
Trauma Surgery
Nephrology
Urgent Care
Neurology
Urology
Oncology
Neurophysiology
Vascular Surgery
Addiction Medicine

WITHOUT being REQUIRED to go back to the university...

It is illegal in most states for a MHNP (or any other licensed ARNP) to accept a position or moonlight in any field of medicine/Advanced practice Nursing other than the field that their individual program focused on....

Ex.... A ACNP cannot work in a Family Practice clinic or the OR on the weekend to supplement their income...

A FNP or WHNP cannot moonlight as a First Assist in the OR and CANNOT join a humanitarian Surgical Team (unless they are also certified as RNFA) in third world countries and expect their malpractice insurance company/state board to cover them.

Just a few thoughts...

DocNusum

 

[zenman]

A FNP or WHNP cannot moonlight as a First Assist in the OR and CANNOT join a humanitarian Surgical Team (unless they are also certified as RNFA) in third world countries and expect their malpractice insurance company/state board to cover them.

Just a few thoughts...

DocNusum

Many third world countries have never heard of insurance...

 

[DocNusum]

Many third world countries have never heard of insurance...

Correct... but they HAVE heard of LAWYERS and money...!!!

It would be FOOLISH and ill-advised to practice ANYWHERE on his planet without insurance coverage, beyond YOUR "Scope of Practice," and without the backing of your professional organization.

... Imagine being accused of intentionally injecting kids with the HIV in a foreign country without insurance coverage, beyond YOUR "Scope of Practice," and without the backing of your professional organization...

 

[isoman2000]

partially true an NP can always work as a nurse in the OR, floor or anywhere else, why you would really want to after the extra education not sure, but you can.

 

[dfk]

partially true an NP can always work as a nurse in the OR, floor or anywhere else, why you would really want to after the extra education not sure, but you can.

i believe docnusum meant as an advanced practice RN.
APNs do not have the flexibility as stated above.
period.
yea, you can work as an RN, but that defeats the purpose and argument here.

 

[isoman2000]

Ex.... A ACNP cannot work in a Family Practice clinic or the OR on the weekend to supplement their income...

I think they did, but as I said it kind of defeats the purpose of attaing the additional education.

 

[DocNusum]

Yes they can work in as a RN in any area of medicine/nursing... just NOT as a APN/ARNP.... (A PNP has no business working with adults, in Cards, in the OR, or in GI med as a APN/ARNP)

One problem here is that when the ARNP/APN works as a RN... the liability threshold increases... (according to my attorney).

ex: PA-C or FNP works 3 days a week in a Internal Med practice as a PA-C/APN/ARNP, but also works 3 days a week in a LTC as a RN...

While working as a RN at the LTC... some bad stuff happens to a patient. This highly trained RN (who is also a PA-C and/or ARNP) has his/her hands tied because they were hired in this facility as a RN. This person can only function LEGALLY as a RN at this place... which means either sit and wait for the Primary care provider to respond (COULD be days) or simply "turf" the patient using EMS.

I used to "moonlight" as a nurse when in-between mid-level jobs, or simply to supplement my income around the holidays. I got the nick-name "Turf-Master" because my un-written policy was to give the Primary Care provider 6-12 hours to respond (shorter on the weekend)... then turf the patient to the ED at the first hint of trouble brewing. I've almost cleared whole wings of LTC facilities over a few weekend shifts...

Remember... that when the lawyers start sniffing around for the cash... the RN will be held accountable for action or inaction based upon their level of training... not neccesarily the "hat they are wearing" at the time of the incident.

Unlikely scenario but for the sake of discussion:

Imagine a Traumatologist working the bus (for fun) as a paid Paramedic.
Which standards of care will this person be held to..???
On one hand, he will/may be taken to task and not legally covered if he exceeds the Scope of practice of a Paramedic as defined by the state he lives in, on the other hand the plantiff's attorney will insist that he should have done more and are likely to win that argument.​

Just a few thoughts based upon personal experiences...

DocNusum, FNP/PA-C

 

[fab4fan]

I used to "moonlight" as a nurse when in-between mid-level jobs, or simply to supplement my income around the holidays. I got the nick-name "Turf-Master" because my un-written policy was to give the Primary Care provider 6-12 hours to respond (shorter on the weekend)... then turf the patient to the ED at the first hint of trouble brewing. I've almost cleared whole wings of LTC facilities over a few weekend shifts...


DocNusum, FNP/PA-C

That's hilarious! I would have loved to have seen the DON come in to a half-empty wing and see the look on her face! I'm sure you were infamous in the local EDs, too. ED nurses just love nursing home pts.

 

[DocNusum]

Yeah... I was/am "Infamous"... especially since those "in the know" understand how "census" sensitive LTC admin is... ($$$)

Imagine KNOWING that after that sodium laced thanksgiving dinner and the bag of pork rinds... Mrs. Johnson needs IV lasix NOW to avoid DeCompensated Hf.

Or... signing in for weekend coverage and finding Mrs. Johnson has significant gut edema and "cankles"... due to several days of slow but steady decompensated HF. There IS IV furosemide (or torsemide) in the med cart... and starting a IV is a cake walk, but the Primary Care Provider has NOT responded to 4 pages/calls.

As a PA/NP (working as a RN) you KNOW you could just write a order or simply do it yourself... but you are employed on the premises as a RN.

If you give the diuretic and the patient goes into renal failure, or becomes oto-toxic and YOU (the RN) don't have a order from the PCP... You're screwed...

If the patient dies... from basically drowning in fluids... you're screwed...

If the patient has a arrhythmia (got to monitor and replace K+... so now as the "RN" you got to "ILLEGALLY" order several rounds of Chem 7s and maybe K+ replacments) ... you're screwed...

The PCP WILL scream to the admin and his/her insurance company that YOU were functioning beyond your "employed" scope... (even though it was their lack of response that really escalated the problem and who do you think the "powers that be" are going to back up...??? The RN or MD/DO...?$?$?$)

If you do ANYTHING beyond the State defined RN scope of practice... while employed as a RN... you're screwed...

Also... if the Plantiff's attorney reads your resume/CV and finds all the "high-speed" training (Board certified NP/PA/EMT-P/ACLS/ATLS, FCCS, etc)... but a lack of "Gold Standard" action on your part... you're screwed...

If I don't protect my licenses... who will...???

 

[fab4fan]

It's where east of the rock meets west of the hard place. But didn't you wind up on a couple of DNR (Do Not Return) lists?

 

[DocNusum]

It's where east of the rock meets west of the hard place. But didn't you wind up on a couple of DNR (Do Not Return) lists?

Nope... there IS a Nursing shortage remember...

 

[fab4fan]

Yeah, but you're not just an ordinary nurse.

 

[guetzow]

Many third world countries have never heard of insurance...

Feel fee to go there

 

[zenman]

Feel fee to go there

I have. I'm in Dhaka, Bangladesh...and rather like third-world, I mean "developing countries."