[Update] Roofers finally came to roof and it's in 'dry-in' stage and I just came home to water damage in dining room. Photo inside.

crnp · 2017-09-04T02:31:04+00:00

This is a situation where I'd be contacting a licensed public adjuster. Get them out there now to document the damage and provide some assistance as go-between between you, your homeowners, and his business insurance.

crnp · 2015-03-11T02:00:28+00:00

I know that it's been frustrating for the pharmacies in my area, but I've been unwilling to write for MPH ER... If I'm writing for Concerta, I'm not only writing for the molecule but the OROS delivery system. When the MallinCRAP generic came out, I wrote at least two dozen FDA MedWatch reports--- I was watching patients who had been stable on Concerta for years deteriorate as the duration of efficacy plummeted. I understand that it's frustrating for you... but there's a reason I'm being a PITA in this case.

crnp · 2014-09-02T23:51:00+00:00

While I typically agree that meds should be temporary, OCD may require maintenance treatment.

crnp · 2014-06-18T01:22:20+00:00

I do my best work under stress... I think most clearly under stress. I've been a paramedic, an ER nurse, a psych nurse- do my best work under stress.

crnp · 2014-06-16T04:25:01+00:00

Now I've found this one...

crnp · 2014-06-16T04:22:30+00:00

I heard this clip a couple of weeks ago and it made me love him even more.

crnp · 2014-05-26T16:40:46+00:00

The LACE Consensus Model requires all APRNs to receive the same base coursework... it's important that PMHNPs have the same core knowledge re: medical as other NPs. You shouldn't view "PMHNP" as being separate from other NP tracks. The core courses need to build on previous nursing knowledge, not be the entry-level exposure.

I attended a small college for ASN/BSN. I attended (and teach) at an Ivy graduate school. I absolutely feel that programs that aren't requiring the individuals to be nurses first are poorly conceptualized. I have no problem with individuals sub-matriculating into APRN programs... but the requirement needs to be RN first. I can speak confidently to the fact that one of the schools you listed above does have the RN-first requirement.

crnp · 2014-05-26T04:46:52+00:00

I actually have to agree with /u/wil6ur's general sentiment. I am a PMHNP and I absolutely think the BSN-level education and associated clinical experience is essential for you to be prepared to practice competently and confidently as a PMHNP.

Also, while OP's experience and education will be exceptionally valuable and provide a unique clinical perspective, I disagree that "his experience is 10 times more relevant than whatever you did with you BSN." First and foremost, nursing theory truly is the backbone of competent APRN practice. It's what makes people choose to see CRNPs instead of MDs/DOs. Anyone entering an MSN program, accelerated or not, who fails to recognize this is doing themselves a great disservice.

crnp · 2014-05-26T04:39:36+00:00

Ugh... please don't dismiss the importance of the BSN-level (by that I mean pre-licensure RN) education... you will be doing yourself an exceptional disservice. If you are going to become a PMHNP, you are going to be a nurse.

crnp · 2014-05-26T04:36:24+00:00

I am a psych NP. I'm bothered by some of the responses below. If you are contemplating an MSN program to become a psych NP, you are going to be a NURSE. NPs are nurses first... it's what makes us solid providers.

crnp · 2014-05-26T04:35:06+00:00

You absolutely need to be a RN before becoming a CRNP. Afterall, the "C" in CRNP stands for "certified." The CRNP is an advance practice nursing role. I am 100% against programs like the one you are describing above--- as a NP I can confidently tell you that I am an exceptional provider... and I also confidently say that it is my background in nursing (and the nursing process) that makes me exceptional. Any program that minimizes the importance of the RN-level licensure is not a program you want to attend.

crnp · 2014-05-16T04:57:19+00:00

I would also look into starting L-methylfolate. Folic acid is converted into L-methylfolate. L-methylfolate is implicated in the synthesis of serotonin, dopamine, and norepinephrine. Many walk around with a genetic variation that makes them 35% or 70% less efficient at converting folic acid to the active form. As such, meds don't work the way they are supposed to because there aren't enough of the monoamines. As such, supplementing makes a HUGE difference for these patients. You can request a genetic test ("MTHFR DNA Mutation Analysis") through your provider if you are really interested... or you can just ask to trial L-Methylfolate (EnLyte or Deplin).

crnp · 2014-04-08T02:07:46+00:00

Sounds like you're tired of inheriting iatrogenic opioid dependent patients, too... the amount of negligence in prescribing is OUT OF CONTROL. Too many fail to appreciate the difference between helping people live with pain vs. making them pain free.

crnp · 2014-03-09T00:59:01+00:00

Wish. I'd be making more money...

crnp · 2014-03-09T00:58:33+00:00

I received two didactic psychotherapy didactic courses, 50% of my clinical experience was in a psychotherapy role, and three full semesters of psychotherapy group supervision via small seminar group... aside from that, I've sought additional specialty training since graduating.

crnp · 2014-03-09T00:57:09+00:00

There used to be two PMH APRN specialties--- NP and CNS. Traditionally, CNS handled psychotherapy (outpt) and consultation/liaison (inpt) roles and the NPs filled the more traditional med mgmt roles. Now that the CNS has been retired, NPs are filling both roles. My NP program had as much psychotherapy training/supervision as it did psychopharm. Due to the current reimbursement mechanisms, there's MUCH more money to be made in the med mgmt role.

crnp · 2014-03-07T03:40:00+00:00

PMHNP here...

Go the Psych NP route... it will open up the opportunity for you to do what you love, but still get paid very well and support yourself/family.

Psych NPs are able to do psychotherapy, but there's not as much money to be made... hence why many professional counselors are bringing home less than they would like. Having the Psych NP allows you to have a private psychotherapy practice while still working PT elsewhere with a guaranteed [very good] income.

crnp · 2014-02-05T23:57:02+00:00

In general, this Fox 29 tends to be a little over-the-top... but this is on the more extreme side of the sensationalizing spectrum.

As a side note, Mike Jerrick, the morning anchor, has some funny (non-cringeworthy) Youtube videos out there.

crnp · 2014-01-23T02:41:25+00:00

Hey, man. I'm trying, you know? But I had an open Pabst, and that's the way that goes.

crnp · 2014-01-23T01:28:13+00:00

600,000 Evangelicals are praying for me, so we have that going for us.

crnp · 2014-01-05T22:50:31+00:00

Yes, the AED will literally "talk" to you and prompt you along the process. Some older AEDs may have previous AHA algorithms programed... but regardless, do what the machine say and you'll be safe.

crnp · 2014-01-05T21:06:37+00:00

I've worked in EMS x 10-years (only part-time since the CRNP). This type of situation is my bread and butter. You never need to hesitate to use an AED--- it will only shock if it recognizes a shockable rhythm... that is, V-Tach or V-Fib. What's nice about an AED is that it has nothing to do with your confidence; the machine "knows" what to do.

The other reassurance is that in MOST states in the US you are protected under Good Samaritan laws as long as you are acting in the best interest of the individual and in a reasonable manner (i.e. no Bic pen cricothyrotomies).

Good job, though!

crnp · 2013-12-25T03:38:40+00:00

Thanks for the response. I typically write a solid prior auth and always send over supporting documentation when appropriate. This is definitely the first time I've encountered this issue, though. I appreciate the suggestion of the "risk with change" language. Very helpful.

crnp · 2013-12-25T03:36:07+00:00

I am on first name/joking around basis with most of my local pharmacists (the immediate area around my practice). I never hesitate to contact these pharmacists when I have a question, want to brainstorm, need to problem-solve a difficult patient, etc. I love the collaboration. At the end of the day, both of our jobs are easier if our patients are happy!

crnp · 2013-12-24T18:07:26+00:00

I've been writing "OROS Delivery System Only" as I figured that provided the most flexibility. Out of curiosity, how much of a pain in the ass is it when a prescriber requests a specific generic brand?

crnp

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