PMHNP in Psychiatry?

[hamstergang]

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Study after study shows our outcomes equal to physicians' (sometimes better).

With less training, both in the classroom and clinically, you think nurses can get better outcomes with the same patients as doctors? Makes the studies a bit suspicious to me.

 

[smalltownpsych]

With less training, both in the classroom and clinically, you think nurses can get better outcomes with the same patients as doctors? Makes the studies a bit suspicious to me.

Hah! Outcome studies can’t compare individual practitioners working on individual cases and our field has way too many variables to control in order to really compare different groups of practitioners with different groups of patients. Most of my patients improve thanks to combination therapy of regression to the mean, placebo, and a smattering of empathic attunement. Most of my training helps me to recognize these factors and avoid doing anything to screw the patient up because I think that I should actually try to fix something. I imagine we could do an outcome study of high school grads compared to doctoral practicioners and the high school grads might beat us.

 

[boogaaloo]

I see skeptism, and I don't blame students for this. They are new to it, although NPs have been around for over 50 years. With that said, I hope you will think of your PMHNPs on the team as colleagues. This is not a turf war as there are plentry of patients to go around. I agree, a couple years experience prior to working independently gives PMHNPs the experience they need to work independently. With that said, I've been practicing as a PMHNP (forensically trained) for 14 years. I own a private practice in TX. In my practice, I provide care
To over 1200 mentally ill patients, about 60% Medicaid, so they are very sick. I am part if the team in Corpus Christi, referred to by PCPs, psych hospitals, and numerous other mental health facilities. The psychiatrists refer their overflow and inpatient discharges to me. We are colleagues and friends, with much respect for one another. As for pay, I am reimbursed approx 85% of MD reimbursements by insurance companies. I would never take what some of you mention as "good enough" pay. I AM doing the same job. I am the first and only independent PMHNP practice in town, and am thankful that the old, seasoned psychiatrists took me in with open arms into the community.

Why are you on this forum, if not to try to get rid of your overwhelming inferiority complex?

 

[Sunny in Psych]

Seemed to have a different tone. Tough to tell on the interwebz.

Apology.

I suppose this is somewhat anecdotal, but today I took care of a patient in my military job who was started on Vilazodone after a "failed" trial of 2 weeks of 10mg of citalopram by his private practice ARNP. I told the patient to go to the VA and see a psychiatrist. I see garbage like this far too often.

welles84,

With less training, both in the classroom and clinically, you think nurses can get better outcomes with the same patients as doctors? Makes the studies a bit suspicious to me.

Over 15 studies in both medical and nursing journals. It's just a fac

Why are you on this forum, if not to try to get rid of your overwhelming inferiority complex?

Why are you on this forum, if not to try to get rid of your overwhelming inferiority complex?

Hah! Outcome studies can’t compare individual practitioners working on individual cases and our field has way too many variables to control in order to really compare different groups of practitioners with different groups of patients. Most of my patients improve thanks to combination therapy of regression to the mean, placebo, and a smattering of empathic attunement. Most of my training helps me to recognize these factors and avoid doing anything to screw the patient up because I think that I should actually try to fix something. I imagine we could do an outcome study of high school grads compared to doctoral practicioners and the high school grads might beat us.

Why are you on this forum, if not to try to get rid of your overwhelming inferiority complex?

Why are you on this forum, if not to try to get rid of your overwhelming inferiority complex?

Why are you on this forum, if not to try to get rid of your overwhelming inferiority complex?

Boogaaloo, I am here to shine a little light on PMHNPs, our role as providers, and how we SHOULD work as a team. I certainly have no inferiority complex. I'm quite happy with my career. I am reading such negative, uninformed, and even condescending comments on here. I think those people have the inferiority complex. There really is no turf war. Seasoned psychiatrists generally see our value. As a new MD or student, look to those who have embraced our discipline. That is my point. Your attack does not change my original point.

 

[hamstergang]

Over 15 studies in both medical and nursing journals. It's just a fac

When "facts" from studies don't make sense with real life, it should be a good reason to take a better look at what the studies are actually showing.

 

[Sunny in Psych]

What does this mean?

I don't understand your question.

 

[W19]

Psychiatrists are not your colleagues... You are not a physician

 

[NPsychoTherapist]

I likely won't be in the hiring position in any case. I'd rather raise the quality of my own services than dilute it for a wider audience. Unless the economics of future practice dictates that we become managers of lesser trained clinicians. I suppose that's possible.[/QUOTE]

 

[NPsychoTherapist]

"NPsychoTherapist, post: “likely won't be in the hiring position in any case. I'd rather raise the quality of my own services than dilute it for a wider audience. Unless the economics of future practice dictates that we become managers of lesser trained clinicians. I suppose that's possible.

It’s entirely possible that your solo practice will always remain solo.

 

[NPsychoTherapist]

Psychiatrists are not your colleagues... You are not a physicians

 

[NPsychoTherapist]

Oxford Dictionary:

Colleague: a person with whom one works in a professional setting

 

[NPsychoTherapist]

Psych NP guy,

“ If you didn't make the sacrifice but achieve parity through disingenuous complicity with your political bodies expect my professional, but not personal, disrespect unless your an old school NP and/or you've proved it otherwise.

I have been a PMHNP spanning nearly 2 decades. I have luckily been affiliated with wonderfully supportive physicians who understand and acknowledge our value, our contributions, our competency, our patient outcomes, our clinical decision making, our critical thinking, our diagnostic aptitude, our ability to perform in extreme highly acute settings with complicated patients, our knowledge base and clinical aptitude.

My son is completing his 3rd year of medical school. I’m quite proud of his journey. It’s a tough road to hoe, but will be well worth it in the end. He comes to me often, asking questions, respectfully appreciating my experience in the field (advanced practice Psychiatric Mental Health Nursing) and understands that access to experience is what will make him a better clinician, as I have seen tens of thousands of patients over the years.
The best advice I ever received going into the realm of being a nurse practitioner was:
1) History History History.
Obtain a thorough HPI, dig and probe, ask question after question until a clear picture arises as to what it is that you are actually looking at. Understand that there are co-morbidities but also be aware that some diagnoses look quite similar to others and one needs to ferrite out the differences because treatment may vary
2) Don’t necessarily medicate until you know what it is that you are treating and even then there may be other options
3) keep Medication regimens simple, as polypharmacy contributes to adverse reactions, Medication interactions, poor med adherence and adverse outcomes
4) Patients have access to a wealth of available databases, are often quite attune to their plights and know their own symtomology. They also become tired and wary of being switched from one to another medicine without having sustained adequate trials of those medicines at therapeutic doses (too often I see patients started on Meds by both NPs and Physicians that were never adjusted to levels that would actually help to mitigate symptoms).
5) Dont be afraid to ask another medical provider’s opinion - be it another NP or a Physician, because sometimes another eye is all one needs to figure out the key to a particular patient’s treatment going forward

I didn’t get into the bickering about an NPs ability to come out of school ready to treat every single person who lands on their doorstep, because simply that takes experience. I hope that both medical students and NP students learn as I have over the years that their competency will grow steadily and steadfastly mostly over time and that they need to be able to release the narcissism associated with becoming a graduate versus becoming a seasoned provider.

 

[OldPsychDoc]

Psychiatrists are not your colleagues... You are not a physician

Spoken like a med student who has limited experience working in real mental health settings...

 

[NPsychoTherapist]

Don't we usually keep these discussions confined to the pre-allo forum?>

I'm sure they'll be lining up in droves to work for an employer like you...

My collaborative physicians have all been wonderfully supportive, informative and kind. My hope is that all of the members here eventually realise that not a single one of us is competing with physicians/doctors and that we all play on the same team. It’s doctors like you, OldPsychDoc, who get it.
The latest data indicate that specialists are now even in greater shortage than primary care. Unless physicians decide to work 24/7 without Holidays, days off, sickness then they will never be able to keep pace with demand.

I'm sure they'll be lining up in droves to work for an employer like you...

 

[NPsychoTherapist]

Don't we usually keep these discussions confined to the pre-allo forum?>

Address the initial poster? I do think this is a fantastic opportunity to understand what NPs do and how we are not claiming to be physicians, are not competing and are actually on the same team, as are Respiratory Therapists, paramedics, nurses, imaging techs, social workers, etc even down to housekeeping folks who without them, your lives would be in total disarray

 

[boogaaloo]

I didn’t get into the bickering about an NPs ability to come out of school ready to treat every single person who lands on their doorstep, because simply that takes experience. I hope that both medical students and NP students learn as I have over the years that their competency will grow steadily and steadfastly mostly over time and that they need to be able to release the narcissism associated with becoming a graduate versus becoming a seasoned provider.

And pharmacological knowledge that you do not have.