What do you think of psych nurse practitioners?

[psychRN]

I am in the deciding stage of what I want to be when I grow up. I am an RN with lots of child psych experience. I would like to have my own clinic. I am deciding between psychologist, psych nurse practitioner, or psychiatrist. My interest is female adolescents. Psych nurse practitioner would be the shortest route to this, but I dont know if it is the best way. Have any of you had any experience with Psych nurse practitioners? Knowledgeable or not? Asset or not? Thanks in advance.

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[Rapunzel]

I think it's got potential. If what you really want to do is work directly with clients, you could go for the psych nurse practitioner and go ahead and go to work with that, and then add a master's degree in counseling. You could manage meds and do therapy. I think that would be very useful. But it really depends on what you want to do with it. If you are interested in research and teaching and writing for publication, then you might do better to get a PhD in psychology. It's what matters to you that counts, and why not use what you already have if it can be a step in the direction you want to go?

 

[50960]

In theory they are good, but my experience is that they can grossly manage meds for patients relatively well if there is a good, solid diagnosis. However, they have very little diagnostic skills. I have worked with Psych NP's who did the Rxing and labs for me, and that works pretty well as a collaborative way to practice, much like a psychologists with RxP training with a GP. I have known a few psych NPs who did not know enough to know the limits of their knowledge, and this was counterproductive for most patients.

 

[Therapist4Chnge]

I think the Dx piece is very important to note. I think matching Dx with RxP solution is already challenging, and being shakey with Dx will just complicate things. I think differential Dx is one area where a clinical psych has a real advantage over other providers. This is one reason why I think prescribing medical psychologists have a distinct advantage over NPs. Also, being able to provide therapy and spend a significant mount of time with the pt. makes differential Dx easier. The nuances involved can really make a difference in what to prescribe. I think NPs can be a great asset, but their ability can be compromised by a poor Dx (whether by the NP or the referring clinician)

-t

 

[Logic Prevails]

I think differential Dx is one area where a clinical psych has a real advantage over other providers. This is one reason why I think prescribing medical psychologists have a distinct advantage over NPs.

And I think prescribing medical psychologists with neurological and neurosurgical training have a distinct advantage over those psychologists with only prescribing privileges.

Seriously, why do we feel the need to take on everything and put down other providers?

 

[psychwhy]

Logic Prevails: Seriously, why do we feel the need to take on everything and put down other providers?

Perhaps it is because PhD/PsyDs have put in the time, effort, and endurance to earn (supposedly) the premier credential for mental health providing only to feel they need to defend their "turf" from every "Can't we all get along?" philosopher?

Seriously, name me any other profession where the practitioner holding the highest degree is supposed to "share" components of the practice with nearly a dozen lesser-trained titles?

Do CNAs dispense medication?
Do teacher's aides grade tests and meet with parents?
Do paramedics perform surgery?

Even PA/NPs are supposed to have MDs sign off on their work.

Yeah, I know, expressing such a view violates my "psychologist helping ethic" -- a phenomenon that has permitted psychology to be Balkanized in to a dozen different competing professions because psychologists don't want to appear "mean" or "demanding." Other professions have evolved tiered provider systems where education/qualification credentials clearly delineate a hierarchy -- why is psychology somehow denied the same?

Some assert that the PsyD is a "shortcut" to earning the title "psychologist".
It would seem that the psych NP is really the shortcut to being permitted to BE a psychologist without the title -- or at least seem to be. As an independently licensed practioner the psych NP has does not have the depth of training of either a psychologist or psychiatrist but would be allowed a scope of practice putting them at essentially the same professional rank.

Could the danger that sort of backdoor qualification provides be motivation enough to "take this on"?

 

[Healthmed101]

I think the Dx piece is very important to note. I think matching Dx with RxP solution is already challenging, and being shakey with Dx will just complicate things. I think differential Dx is one area where a clinical psych has a real advantage over other providers. This is one reason why I think prescribing medical psychologists have a distinct advantage over NPs. Also, being able to provide therapy and spend a significant mount of time with the pt. makes differential Dx easier. The nuances involved can really make a difference in what to prescribe. I think NPs can be a great asset, but their ability can be compromised by a poor Dx (whether by the NP or the referring clinician)

-t

 

[erg923]

But if psychologists are primarily trained in the mental health arena, how are they going to be able to assess and look for a diffential diagnosis that might not be mental health related?

Did we not just go over this with you here?

http://forums.studentdoctor.net/threads/health-psychologist-assessments.1216785/

 

[Fan_of_Meehl]

One of the core skills/practices that doctoral-level psychologists do develop during their training is learning how to think critically about information, to put forward and aggressively (and empirically) test their hypotheses (e.g., with respect to diagnoses or other critical elements of their case formulations), and to be aware of the multitudinous logical and perceptual fallacies (e.g., confirmation bias, arguments from authority, etc.) that beset human reasoning in general and practice within the mental health field, in particular. There's not quick/easy way to 'test for PTSD' or to rule in/out the various other factors that may be influencing a patient's self-report of severe insomnia, social avoidance, gloomy outlook on reality, 'anxiety,' and relationship problems. And, contrary to what a lot of ER docs, psychiatrists, and nurse practitioners seem to be implicitly saying in their 10 minute work-ups to diagnose PTSD, for example--it isn't something you can reliably/validly accomplish in a single brief encounter. If differential diagnosis (and its handmaiden, case formulation) are to be done competently, the person doing them needs to be exceptionally well-versed in the philosophy of science, epistemology (where does our knowledge come from? How to we know what we think we know?), and various forms of inductive and deductive reasoning. I don't think that general medical training (whether it's in medical school or nursing school) really prepares practitioners to think in this way because the practice of general medicine (e.g., working someone up for diabetes or coronary heart disease) rests on, frankly, a more developed set of theories about the underlying (physiologically-based) pathology and how it manifests in particular symptoms (and is detectable on discrete tests--e.g., blood analysis or imaging).

 

[MJPsych]

I work with several psych NP's because there is a shortage of psychiatrists in my area (and I think this is a general problem as well). As far as knowledge, in my opinion it's definitely lacking. Where I work, the therapist has the give a dx prior to the NP seeing the patient. In my opinion, the NPs do not have the depth of knowledge of a psychiatrist or psychologist. I spend half my time in primary care in the role of a Behavioral Health Consultant so I have more than a basic knowledge of psych meds. I honestly wish I lived in a state that gave psychologists prescription privileges and I would consider doing the 2 years in psychopharm.

 

[deleted343839]

My experience with psychiatric NPs has been hit or miss. The best have honed solid skills within the scope of their competence (meaning actual competence, as distinguished from legal scope of practice), are able to recognize when they are at the bounds of their competence, and are not afraid to consult or refer out. And really, that's true of all professionals including MDs and PhDs. But you have to be comfortable in the knowledge that, even if you are able to practice independently, your skill set is just not the same as that of a psychologist or psychiatrist. On the other hand, that range and depth of knowledge and skill might be overkill. Only you can decide what level of training will satisfy your career development needs. But be honest with yourself.

Since no one has brought it up yet, I'll add that the financial ramifications of all three paths are different, too.

 

[singasongofjoy]

I've had wonderful opportunities to work with knowledgeable, well-trained NPs who truly knew both scope of their own competence and stayed abreast of new research, etc. They were invaluable at residential settings. But they also worked very closely with psychology. Together w/ well-trained and competent psychology I found it to be an excellent combo. I do think that competent psych NPs are in short supply and would like to have more around.

 

[Andeve33]

I've had wonderful opportunities to work with knowledgeable, well-trained NPs who truly knew both scope of their own competence and stayed abreast of new research, etc. They were invaluable at residential settings. But they also worked very closely with psychology. Together w/ well-trained and competent psychology I found it to be an excellent combo. I do think that competent psych NPs are in short supply and would like to have more around.

generally I think that it doesn't really matter what you're working, working very closely with psychology will help. whatever with psychology is an excellent combo IMO and that's even if you're working as a programmer and it seems that there you don't need any psychological activity/knowledge.