I don’t understand, you’re a doctor nurse? What the heck does that mean?
A doctor of nursing practice is an advance practice nurse who has received a terminal degree. This means completing a bachelors degree in nursing (4 years), a masters degree in nursing (2 years), passing a national board certification in his/her speciality, and then completing a doctoral degree (2 years).
I don’t get it. What does a psychiatric nurse practitioner do?
The most basic way to describe it is, imagine what a psychiatrist does and you’ll have a good idea what we do. Most psychiatric nurse practitioners (like most psychiatrists) have a primary focus on addressing the biological side of mental health (utilizing the understanding of biology, physiology, anatomy, pharmacokinetics, pharmacodynamics, and pharmacology) through the use of psychotropic medications. Nurse practitioners often incorporate a holistic approach to their treatment assessing and addressing psychosocial, spiritual, and lifestyle areas in a patient’s treatment.
So, are psychiatric nurse practitioners therapists?
Well, yes. Psychiatric nurse practitioners are trained to provide therapy, however what we end up doing is primarily medication management (meaning sessions are typically 30 minutes once a month, versus a weekly hour-long therapy session). That being said, I do have patients who are seen either primarily for therapy or for weekly therapy in combination with medication management, but for all patients there should be some brief therapy incorporated into any session, which may be treatment focused cognitive behavioral therapy, supportive therapy, or treatment focused therapy.
Should I see a psychiatric nurse practitioner or a psychiatrist?
Whatever you feel comfortable with. Both are professionals trained to assess, diagnose, and treat mental health conditions. In many states nurse practitioners may practice 100% independently, however some states require collaboration with a physician.
What can I expect if I come in/bring my child in for an appointment?
You’ll get started with an initial evaluation, in which you’ll answer about a million questions. The provider should go over: what is currently going on, psychiatric history, medical history, current and historical medications/allergies, social history (work/school/job/relationship/military/abuse history/living situation etc.), family history, as well as a full review of systems. For kiddos gestational and developmental history should also be reviewed. Yes. It’s a lot. A lot of it may not seem relevant but all of these areas can factor into what is currently going on with an individual. This typically takes 45 minutes – 1 hour, depending on the thoroughness of the evaluation. An hour is generally sufficient to do a thorough evaluation, however when I do evaluations in which the patient/parent want to utilize a more holistic approach two or more hours can easily get eaten up doing a thorough assessment of dietary, exercise, and sleep habits as well as evaluation of other environmental factors. Follow up appointments are usually much briefer depending on the stability of the patient. Generally speaking my follow up appointments are 30 minutes, and review any changes to psychiatric, social, or medical history, evaluation of efficacy of current medications, any adverse effects, and any new concerns that may have arisen.
I want to bring my kid in, can I come in to the session with him/her?
Absolutely! Especially for kids providers should be getting the perspective from key people in the patient’s life, parents often bring up topics that initially the kiddo is hesitant to talk about. That being said, you may be asked to step out of the room at some point so the provider can talk to the child one on one. There may be things the child feels more comfortable discussing without a parent present. On that note, parents and the child should know that nurses, nurse practitioners, psychiatrists, etc. are legally bound by HIPPA which is a law to protect patient privacy, this means that there may be things discussed that your child does not want shared with you, and that, by law must be honored by the provider. A provider can share medical/psychiatric information with the patient’s consent, a court order, in certain emergent provider to provider situations, or if a person is an imminent danger to themselves, others, or cannot reasonably take care of their basic needs. That freaks parents out sometimes, what I will say is if there is something you, as a parent, should know, a good provider will work with the child to find a way he/she is comfortable expressing or discussing whatever the issue is.
I feel like my current provider isn’t helping, what can I do?
Like treatment for anything else, who you get care from is completely up to you! It is completely ok to express this or ask for what you need. If you don’t feel a particular medication is helping/you’re having intolerable side effects, or the therapy style isn’t working for you, speak up! Remember that this is YOUR TIME and YOUR TREATMENT. It’s a funny phenomenon that can happen that patients can actually get worried about expressing these concerns because they don’t want to ‘disappoint’ or upset the provider they are working with. As a provider, let me tell you this, it is not about us. It is about you. There are going to be people who click and who don’t click with others there are going to be different styles and different preferences, that’s fine. One of the most important aspects of treatment is that you feel comfortable with your provider. If a patient felt he/she wasn’t clicking with me or that treatment wasn’t progressing how he/she wanted I would much rather get the individual set up with someone who will be a better fit, so please, if you need to make a change, make it!
I think I need help, but I’m really afraid of medications, is there anything else I can do?
Absolutely. Sometimes prescription medication is necessary, however there are always alternatives! Ask your provider about nutritional/lifestyle modifications, natural supplementations, other complementary alternative therapies (acupuncture, sensory deprivation therapy, etc.), or TMS/ECT (Transcranial Magnetic Stimulation, electroconvulsive therapy).
I’m afraid to get treatment because I don’t want it to go on my ‘record’ what can I do?
First off, mental health conditions are no different than any other medical condition. If you had a broken arm would you forego treatment because you didn’t want anyone to find out about it? Absolutely not! You’d get it casted right?! One thing we as a society need to get better at is reducing stigma around mental health treatment. However if you are at a place where you still feel uneasy about seeking treatment here’s what you should know: If you use insurance, yes, the company will see you saw a psychiatric provider and possibly obtained psychotropic medications, with very, very, very, rare exceptions (court orders) no one will have access to this information without your consent. If you are admitted to a psychiatric hospital on an involuntary hold, meaning you were deemed to be an imminent danger to yourself, others, or gravely disabled (unable to provide for basic needs because of a mental health issue) and were unwilling to accept hospitalization voluntarily this is reported to a database for background checks related to the purchase of firearms for a period of years.
***laws may very state to state, this is what is currently applicable to California law***
I need help now. What do I do?
If you are experiencing a psychiatric emergency, go to your nearest emergency department or call 911. The National Suicide Prevention Lifeline can be reached 24/7 at 1-800-8255