Choosing first job (psychiatric nurse practitioner)

[Shikima]

And that is exactly how they've come to exist as a profession. Grifting off the efforts of psychiatrists--or whatever specialist they presume to mimic the specialty of, without even a basis from which to specialize. Monkey-see-monkey-doing it on the job. By the agency of some slapstick, half-hazard, half-baked notion of The Greatest Good For the Greatest Number. Whereas I'm of the opinion is that this stuff done shabbily would be better off not done at all.

This is the mantra of the VA.

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[Nasrudin]

This is the mantra of the VA.

yeah. that corroborates some other things i've been hearing. thanks for the tip.

 

[857770]

You're probably not going to like what I am going to say here, but, well, you did come to a physician forum, so here's an honest opinion:

If you were coming to work with me, quite frankly, I would refuse to have anything to do with training you. I feel no obligation to help people take shortcuts to do my job. Would you help a HUC with no nursing experience who thought she could just kind of wing it and learn how to be a nurse by just asking for some tips from RNs while working as a nurse herself? That's what it looks like to me when NPs think they can do my job but expect me to help them learn how.

I suspect the reason you're not finding jobs that offer supervision is because other than CA, those states you're looking at allow NPs to practice independently. NP advocacy groups have convinced legislators in places like WA and OR that NPs don't need supervision. In theory, you were supposed to be trained for your job by the training program you went through, not by finding a random doctor who feels sorry for you and/or your patients.

It's a very sad state of affairs when vulnerable patients are seeing people for care who really are not prepared to deal with their issues. Since you mention having your own mental health struggles, I also question how much training you've been given on how to maintain healthy boundaries - which is a very crucial aspect of doing good psychiatric care and hard to learn on the fly in a short period of time.

But, hey, NP groups keep telling me that they have "the heart of a nurse and the brain of a doctor". Let's see how that holds up once malpractice attorneys catch on to how poorly trained so many NPs are nowadays.

This is an awesome post. I give it ten thousand likes!

 

[857770]

These are the reasons that posts above more tactfully mentioned the importance of furthering education with quality psychiatrists.

The most dangerous part about being a NP/PA is not knowing what you don't know. Starting off with quality supervision is an absolute must, or there may be plenty of harm done.

I've brought this up with physicians, including my own, only to be met with this: "Well, doctors don't know what they don't know either. And most of medicine is routine." This problem with midlevels will never go away as long as physicians keep taking this attitude.

 

[Shikima]

I've brought this up with physicians, including my own, only to be met with this: "Well, doctors don't know what they don't know either. And most of medicine is routine." This problem with midlevels will never go away as long as physicians keep taking this attitude.

You're right. It won't change because physicians, as a group, are complacent and taught to be this way. They're poor advocates for themselves. Especially in psychiatry. For example, there are many threads on how to negotiate jobs or bitchin' about the work environment (including management). Hell, we wouldn't have MOC if physicians were organized better.

 

[TexasPhysician]

I've brought this up with physicians, including my own, only to be met with this: "Well, doctors don't know what they don't know either. And most of medicine is routine." This problem with midlevels will never go away as long as physicians keep taking this attitude.

That's just ignorance and other physicians being polite. .

The problem with midlevels is that such a professional starts working in the field with a sub-MS4 knowledge base. To make up for the knowledge deficiencies, midlevels should do plenty of self study, attend many more than required conferences, and ask daily questions of their supervising physician. There is sooo much that they don't know, but I've never seen one push to attain the knowledge. They are happy basking in the unknown. That which a physician doesn't know is a small fraction of the midlevel. Even then, most physicians I've met recognize their deficiencies and refer out.

One of my residency pediatric sites included a midlevel with 10+ years experience "supervising" the PGY-1's on paper. I quickly learned that in truth the PGY1 needed to supervise the midlevel.