Psychiatrist or Advanced Practice Registered Nurse

Discussion in 'General Parenting' started by Masta, Jan 17, 2007.

  1. Masta

    Masta Member

    For details of my difficult children current mental health you guys can look at my other post: Attention Seeking.. Cutting.

    My question now is... I just found out about the lady who does my difficult child's medication management she is a: MSN, APRN, BC:
    Master's of Science in Nursing
    Advanced Practice Registered Nurse
    Board Certified

    Is this lady qualified to be managing my daughter’s medications? I have been told she cannot diagnose.

    My difficult child is in states care: she is seeing a therapist every other week (will be bumped up to weekly till she gets her cutting under control), she also sees this medication management lady once a month for 20mins.

    I’ve heard good things about the medication management lady but I’m not sure if she is qualified to treat my daughter. She is in the process of getting her degree in Psychiatry. I’m wondering should my difficult child be seeing a Psychiatrist instead of an Advanced Practice Registered Nurse.
  2. Sara PA

    Sara PA New Member

    I have to say that I don't believe it as important what letters come after the person's name, what matters is how much they know about the medications and the side effects.

    Towards the end, my son's psychiatrist, who treated more kids diagnosed with ADD/ADHD than with bipolar, told me point blank that I knew more about bipolar medications than he did. Could be because I had time to sit and read the prescribing informations, journal articles and studies; he had to see patients. He is a board certified child and adolescent psychiatrist as was my son's first psychiatrist. Both missed antidepressant induced bipolar; both kept him on the antidepressant far longer than he should have been.

    There is no guarantee that a doctor will be better. Or worse.

    It's a crap shoot.
  3. dreamer

    dreamer New Member

    My kids see an advanced practice nurse who has a PhD in nursing and also I believe in psychiatry and she is a professor of nursing and also of psychiatry at a major university teaching hospital. we affetionately call her Dr Nurse.

    as to what is within their legal abilities, it can be different state by state. Ours has been our main care provider for over 5 years and has diagnosis'ed and followed my kids all that time. The only time there was a problem was when we ordered medications from another state thru ouur insurance and it was a controlled substance and that got tricky.....

    The care we have recieved etc has been the very very very best quality we have EVER EVER gotten from AYONE anywhere ever.

    AT the VA where my husband has been being followed for the last 10 years, he has for his primary caretaker- an advanced practice nurse, as well.

    One of the big differences in more recent years beteeen MDs and adv prac nurses is how they look at a person, and the "problem"- typically a doctor mostly focuses specifically on JUST "the problem" where a nurse has a bigger kind of focus and takes more into account how something affects them as a whole human being.
    Please note, I did not say ALWAYS or NEVER. This is a general thing, not an exact thing. - and due to some differences in the philosophies behind their professions, but not entirely concrete.

    do keep something in mind.....everyone continues to learn on the job etc.....a good caare provider is going to LISTEN......listen to patient......and keep current on newest research.....
    Prior to my husband current adv prac nurse caregiver, he had a doctor with FIVE PhDs and his MD and that doctor was .....useless.
  4. judi

    judi Active Member

    I can speak to some of this. I'm an advanced practice RN in the state of IL. However, my specialty is nephrology. I have a master's degree in nursing plus I then went back and did another year for a clinical nurse specialist certificate. I also have 15 years of nursing experience. In IL, I can diagnose, order appropriate tests, interpret those tests and prescribe medications.

    Those posters that said it depends on which state you are in, are right on. In the end, I think the relationship between provider and pt and family is the most important aspect of the care.
  5. Masta

    Masta Member

    your posts have eased my mind allot. it sounds like my difficult child is getting good care.

    thanks guys!!
  6. hearts and roses

    hearts and roses Mind Reader

    I just wanted to chime in because our regular dr is an APRN and we actually switched to her because like someone posted - she sees us as people and patients. She's really awesome because when you're scheduled for an appointment, she gives you her time and her ear - she listens and tries to understand before just diagnosing and prescribing.

    My difficult child's psychiatrist is also an APRN. I have been less than thrilled with her at times, but she is good and she listens well and she consults with a real pyschiatrist for difficult situations. The good psychiatrists around here are all far away and quite honestly, I feel that at difficult child's age, this APRN is fine.
  7. witzend

    witzend Well-Known Member

    I use an APRN for some of my regular medical care. For diagnosis'ing, she has to run things past my regular doctor, so it can cause some delay. But I have been comfortable with my care.

    I think that if you are comfortable with her and whoever is backing up the diagnosis'ing, it shouldn't be a problem.

    In my area, I find it difficult to find a psychiatrist that I like. I had a wonderful one for years, but she retired. And to get a referral you had to wait months. husband was seeing a PhD, and I saw him from time to time as well. I asked if he would do the therapy part, and make referrals to my MD when we felt that things needed to be tweaked. It seemed to work out, but I still don't see him often. I just hate trying to squeeze 20 years of why I am PTSD and need medicinal help sometimes into a 10 minute doctor visit.
  8. OTE

    OTE Active Member

    "She is in the process of getting her degree in Psychiatry."

    There is no such thing. A psychiatrist is a person who must first finish medical school and then do an internship. Then a residency in Psychiatry. As I recall the residency is 2 yrs for adult psychiatry and 3 yrs for child. Then pass the various aspects of the state licensing, psychiatry boards, etc.. All of this is full time. If she's working she's not going to be a psychiatrist. As above, perhaps there some kind of training for being a psychiatry specialist within the advanced practice reg nurse system in your state.

    But I do feel very strongly about psychiatrist vs psychiatric practicing nurse or whatever your state calls this. Yes, the nurse is much cheaper and maybe that's all the state will pay for. But the training is hardly the same. I've met some fabulous nurse practitioners and saw them for what I believed to be non-complex issues such as my child needed an antibiotic. I think they have a place in the medical system.

    Personalities and "bedside manner" are individual. Presumably nurses are trained to be more caring and attentive than doctors are trained to be, isn't that what we hope a nurse is? Again, this is very personal, and I and my son have had some docs with no bedside manner. But I am more concerned about their knowledge than their bedside manner. For 20 minutes a month or whatever, they can be rude to me all they want. Actually a psychiatrist in the beginning might be once a month for 50 minutes but once there's medication stabilization .. well I'm once every 3 or 4 months for years now. I'd happily see a psychiatric nurse practitioner now because I'm stable on medications for some time now.

    For my child I see psychiatry differently. Children, particularly teens, have changing hormones which mean changing medications. Growth means increase in dose some times. Changing symptoms (whether they actually changed or you just realized a behavior is a symptom) means the psychiatrist needs to think about changing diagnosis and changing medications. So personally, unless the person has passed early adulthood (the possibility arising of schizophrenia and the settling of hormone changes) I would have my child see a psychiatrist.

    I'll add a couple of other points, a psychiatrist is trained in how the brain works, they are trained to know what tiny part of the brain does what, how the hormones, electical impulses, etc of the brain work. In fact, many also have additional training and/or certification in neurology. So they know which part or function of the brain triggers a particular symptom. Also, obviously, how a specific medication affects each of these things. And there are a lot of tiny differences that can indicate a particular medication, that's what thousands of medical studies a year point out. eg an anxiety patient with tinitus responds best to one particular medication.

    Also, the psychiatrist spent years to learn how the entire body works. They know specifically what function of the liver is affected by each medication, eg Depakote. They know all the other possible things which could affect that function so they can go down a list of questions to determine if the combination of foods, alcohol, subs being abused, etc, etc and medications will cause the liver to have a problem. A nurse practitioner might know the same list but unlikely would be willing to override the list based on amt of food, amt of sub abuse, etc. Obviously I'm using examples here that I've run across, these would not be the only times I would be looking for a psychiatrist's knowledge. While I may object to it, I also understand that things like gender, race, ethnicity and such play into diagnosis and medications too. eg believe it or not I apparently have a very mild form of lupus most common the blue eyed blonds, which I happen to be. Is a nurse practicioner trained to know which type of lupus responds best to each medication, which new or recurring symptom might indicate a change in medications?

    Again, this is only MHO based on what I have observed from docs I know, am a patient of, etc over the years. Yes, I'm very picky about docs and have the usual doctor prejudices against those who did not go to US medication schools, have had ethical problems, did not do the residency for the thing they are specialized in, etc. These are prejudices, nothing to do with reality any more than a specific psychiatrist is better for you than a specific nurse practitioner.

  9. Sara PA

    Sara PA New Member

    When I was in college I had a therapist who had a PhD. in psychiatry. I believe dreamer mentioned that their doctor did too. Neither are psychiatrists, who are medical doctors, but they do have degrees in psychiatry.

    My doctor couldn't prescribe medications but then they weren't used that much back in the dark ages.
  10. dreamer

    dreamer New Member

    actually that "rudeness" can detract from proper treatment, becuz if in being rude the doctor is not LISTENING and HEARING your symptoms and complaints, they will not be able to have a clear picture of what the problems are.
    And antibiotics issues are not always just a "simple" matter- it is the misuse overuse and improper use of antibiotics that is thought to be a huge contributing factor in antibiotic resistant problems currently going on.
    A "great" adv nurse practioner can be every bit as knowledgeable as a doctor can be.
    ANd not all nurse practitioners are paid less than docs.
    And depending on their education, some adv prac nurse practitioners do teach some classes to doctor students.

    There are good and bad in all professions, and there are differences in professions-----and truth told, lots of what our kids are being diagnosis'ed with and the treatments being used on our kids- it is all new relatively speaking in the world of medicine, and how great your treatment might be can depend a lot on field experience of the care provider.

    All the local docs in my area- 8 for my dtr alone- none of them would even consider my dtrs symptoms as anything to even SEE her for------nevermind the school was demanding it....our docs were closed minded back then and they clung to the belief of old- it was parenting and nothing more. It was our adv prac nurse who got the ball rolling, ordered MRIs etc and did more than simply dismiss us.
    ANd I cannot even tell you how many times it was when I called my doctor for something and my doctor would say "gee, I do not know, let me grab the nurse"

    ADvanced practice nurses are professionals in their own right and are also as legally liable as a doctor. and they can be every bit as knowledgeable in their chosen field.

    Having an adv practice nurse is not accepting less than The Best.
  11. OTE

    OTE Active Member

    OK. I stand corrected. I personally have never seen or heard of such a degree. But there are a lot of things in this world I have never seen or heard of.
  12. OTE

    OTE Active Member

    Dreamer, I thought I was clear that a psychiatrist is not better in any one particular way than any other person on this Earth in my humble opinion. I would never say that one profession or another is better than another. Each has it's own strengths and weaknesses as we all do as humans.

    We all have our different experiences. My only one with a psychiatric nurse practitioner was for my son. After a 45 minutes explanation of my son's symptoms and issues this person looked at me and said what medication do you want? What's the dose? Needless to say I did not fill that script. I would never assume that my knowledge from reading is better than any trained professional's. Nor would I say that any one person's knowledge is more or less than anothers, trained or not.

    I was not aware that a nurse practitioner's billing rates are comparable to a docs, I thought that was the point that insur companies were using in sending people to nurse practitioners. I stand corrected if that is true in your area.

    We all have our own opinions and beliefs. I expressed mine.
  13. dreamer

    dreamer New Member

    and yes, adv prac nurses do understand the medications and the functions of medications on body systems etc. ANd more often nurses see the results of such things as they appear in the "real world" or "out in the ield" more so than the docs do. A doctor can often tell you in words what nausea for example is and what it looks like but- the might not be able o tell you all the ins and outs that are involved with nausea. Often it is the nurses in the trenches dealing 1-1 with the whole set of issues leading up to - during and after. The docs world is often far more removed, more sanitized.
    and while a doctor might use the term "defecate" and a patient might feel intimidated and simply respond so as not to appear "stupid" a nurse might say "poop" and get a more relaistic accurate answer.
    Altho- I am not tryingto bash docs..there are some awesome docs out there..I am speakign more in general here with that type exampe

    Choosing between a psychiatrist who maybe does not limit his pratice to children or children with a specific diagnosis-----or an adv prac nurse who does ---I would RUN to the nurse. I want someonewith experience- ands on experience.
  14. dreamer

    dreamer New Member

    OTE, and I stated mine. I did not say ote you are wrong. I did not say OTE change your opinions and beliefs.

    I was stating mine.

    IN some areas adv prac nurses migt be cheaper. In some areas, they might be more ...availale? some geographical areas cannot get docs in there. But here by me? the billing is the same. Many of our clinics offer yuou your choice of APR or a doctor......same charge, same gfee, same billing rate- just personal preference.

    I am thinking it might be kinda similar to how some docs are DOs and some arent? The education s a little different- the philosophy of care is a ittle different, and APRNs tend to be more holistic than MDs.
  15. Sara PA

    Sara PA New Member

    [ QUOTE ]
    OK. I stand corrected. I personally have never seen or heard of such a degree. But there are a lot of things in this world I have never seen or heard of.

    [/ QUOTE ]
    The only reason I'm aware of it is that the doctor explained it to me. And she was sort of defensive about it. I think she got a lot of questions about her credentials from people who had never heard of it.
  16. judi

    judi Active Member

    PhD - Doctorate of Philosphy, not psychiatry. A PhD can be a varied number of profesionals, including advanced practice nursing. Believe me, even for those of us that are advanced practice nurses, the acronyms can be confusing.

    As to the billing, Medicare allows APN's to bill at 85% of the MD billing rate. So, yes, they are cheaper but I doubt if the savings is passed on to the consumer. However, I could certainly be wrong on this aspect. I know that I must generate income to keep my job!

    As someone else already stated, there are good and bad in every profession. No one is going to say that ALL psychiatrists are wonderful, knowledgeable and the answer to everything. No one is going to say this of any professions.

    In the end, it is what works for your child, your family and your situation.
  17. Sara PA

    Sara PA New Member

    I am fully aware of what a PhD is. The person I am speaking of has a PhD in psychiatry. She is not nor has she ever been a nurse; that's dreamer's doctor.
  18. ROE

    ROE New Member

    PhD, Doctorate of Philosophy does that equate to psychologist and not psychiatrist?

    I believe that there are good ones and bad ones in every profession. I agree with OTE. I too, am very particular about medical care for my difficult child. Not only do I take him to a psychiatrist but he’s a child/adolescent as well. But my difficult child was pretty young when he his MI issues began.

    I don’t mean to offend anyone, but I would not take my difficult child to a nurse practioner for his MI issues any more than I would take him to his pediatrician. I admit that the first difficult child ever saw was a complete bozo. We never went back after the initial visit. We’ve been very fortunate that the two that followed were awesome.

    I think Judi says it well, its what works well for you and your family that counts.
  19. Sara PA

    Sara PA New Member

    [ QUOTE ]
    PhD, Doctorate of Philosophy does that equate to psychologist and not psychiatrist?

    [/ QUOTE ]
    Psychologist, at least now. Back in the early 70's psychiatrists and psychologist weren't like they are now. Then she functioned more like a private practice psychiatrist did.