Day in the Life of The Psychiatric Nurse Practitioner: Running a Solo Practice 

Thank you so much 🙏

Thank you Geraldo. I do appreciate your comments, but with many outpatient practices a glass coffee pot and mirror will be in every private practice. If this was an inpatient psychiatric unit that would be a completely different story where everything you stated would be reasonable. Wish you the best with your studies

@@ThePsychNP Thanks for the response, man. I agree to some extent. I have mixed thoughts pertaining to meds. My experience is that psychiatry (which is the medical model and not the wellness model, of course; I assume the psychiatric nursing model is a little different, but I'm not sure) has really focused on symptomology. Well this seems to be great, right? Just understand the DSM and psychopharmacology? I can't speak for PNP because I have never worked with one specifically, but I have had my "discussions" with psychiatrists before. I tend to really focus on etiology, and by doing so, it reduces numbers of diagnosis. What I mean specifically, the comorbidity rate drops. Most psychiatrist take a very different clinical approach than one from a pure psychology background (I have degrees in psychology with a focus on neuropsych as well as a degree in counseling, fwiw). I used to work with kids only. Some of those poor souls were on 12-18 different meds (mostly GI and sleep meds due to side effects). One particular kid (well, the person was 18) had a dx of borderline. Now the reason I mention this is because I understand prescription for purposes of symptoms, but when I had discussion with the hospital (I worked at another agency) we could not come to treatment agreement. It has been well established that meds are not optimal for personality disorders per se, though is effective in symptom treatment (studies vary). Nothing would please me more to have health professionals be able to work together instead of intellectual "peeing contest". Should you ever want to do a collaboration video, I would be up for it. It would be interesting to see how different specialties come to different conclusions pertaining to treatment. As far as meds go, research has changed over the years (I've been at this a minute or two). Personally, I genuinely believe it depends upon a lot of variables, such as severity (how it effects livelihood) and dx. Would love to discuss anytime. Thanks for the response, pal.

@@drawncept8391 I hope I can explain my practice as a psychiatric nurse practitioner. I use a holistic approach to care. I am FNPC and PMHNPBC. I look at the big picture. I look at meds and interactions. I try to use the least amount of medications to treat. Meds and therapy work the best. Patients all have multifactorial causes when looking at a diagnoses. Childhood adversity is a huge factor in coping with future experiences. I use genetic testing. This eliminates using different medications which cause side effects because they are not metabolized appropriately or too rapidly. Psychiatric nurse practitioners focus on the psychological, spiritual, social and environmental factors with each patient and family. Some may not have the time due to employer expectations. This is why I am in solo practice. I made a previous comment on this thread earlier. I see where you mentioned borderline personality disorders. I find with intensive therapy and a drug regimen (i use a couple diff combinations, based on individual). In my practice I have noticed a significant improvement in symptoms and behaviors. I think we all should collaborate. Each discipline offers a unique approach to patient care. It takes all of us to provide our patients with the best outcome. We have some shared abilities. Psych nurse practitioners can utilize therapeutic techniques, but this is not our primary treatment for patients. This being said, we focus on medication management, but utilize short term interventional therapy. Motivational interviewing, psychoeducation, talk therapy. I feel my patients need more intensive therapy which is performed in that specialized setting. We should also collaborate with medical providers as well. This is the collaborative model all of our mental health disciplines are recommended. Personally, I have had the experience working with psychology and neuropsychologists. They are great for personality testing, autistic screenings, head injury issues, pain evaluations, and much more. . They do a comprehensive screening unlike anything I could provide. I take that information with my clinical assessments to formulate a plan of care for my patients. I think I spend a lot of time. I always say the more time you spend in the beginning with your patients, educating, evaluating and listening (really listening), the less time you spend later. With that being said, We should all work as a team and appreciate each discipline's unique abilities. This is what I would want as a patient, wouldn't you?

@@dianedavis7157 100%! Perfectly said! I'm happy to hear your response, and I greatly appreciate it. Collaboration is key. For sake of conversation, what do you think may be the largest barrier to this goal? Everyone talks about it, but more often than not it ends superficially at best (especially within the same agency). I have my own thoughts about it, and maybe it isn't something you are comfortable discussing. It is very impressive that you do genetic testing. I have never worked with another person (physician or otherwise) that does this. And I will admit that I do not know the first thing about it, but it seems such a fascinating and pivotal part of treatment. Actually, I will go a step further; it has always been one of my issues with psychiatry. As hypocritical as it sounds, this is one reason I have decided to pursue it. I live in an unrepresented part of the country where pills are passed out like candy (ranked #1 as far as drug epidemics, sadly), and there is more drug abuse in my area than any other part of the state (eastern Kentucky). I genuinely believe that one can combat this only from the inside (*cue tights and cape....just kidding). Now from what I have understood, physicians are incentivised to write scripts (reimbursement). And again, I could be all wrong about this, but I do know there is a problem with coding and diagnosing in respect to reimbursement (V codes, for example). So with what you are talking about with genetic testing, it seems that med management is scientifically correlated to specific regimes pertaining to one's genetic proclivity to have either a negative or positive effect, therefore reducing side effects (as well as other medications). Why isn't this more widely practiced? Or maybe it is and I'm simply out of the loop. Either way, I'm happy to hear this. Another question, perhaps weird, but oh well. You currently have two licenses, I suppose (family and psych). If you have a patient seeing you for one, can you see them for the other as well? Or does this lead to billing or ethical problems? Or do you do two different practices in two different places? Only curious because I intend to keep my current license up to date as well as do the FNP and PNP (I like options). Again, thanks for the discussion. Very much appreciated.

@@ThePsychNPVery true. did you hire someone to help with credentialing or are you doing it yourself?

@@ThePsychNP delighted to see you sharing 'raw' footage of your new steps into solo practice. GO FOR IT ! I have been in solo practice and also an NP-owner with employees. It is valuable to physically try out all the 'pieces' of the business, to learn (much like any small business). I have found it useful to outsource at some points and 'bring it all home' at other times in my career. In general, I've done my own credentialing in private practice. I had one bad experience paying a company to assist with my Medicare application -they made an error and CMS notified them, not me. I only had a 30 day response window. By the time I heard about the error (which was easily fixable) I'd lost the window, AND the money I gave that company. I usesd to outsource billing / coding and now do it in house. Way cheaper. While I have done some telepsych during that time (and even before this, with hospitals, courts etc.) the COVID crisis pushed me to the Doxy.me platform, how else could I assure care for all my patients? It has been wonderfully simple. I might have tried it sooner, but where my actual house is located is very rural -didn't think I'd have the internet pipeline strength. Now there are a few more cell towers and it is possible.

No