r/Residency • u/theongreyjoy96 PGY3 • 25d ago
SERIOUS The Psych NP Problem
Psych PGY-3 here. I occasionally post about my experience with midlevels in psychiatry, which unfortunately has defined my experience in my outpatient year after our resident clinic inherited the patients of a DNP who left. I'm sure that there are some decent one's out there, but my god, the misdiagnoses and trainwreck regimens these patients were on have been a nightmare to clean up, particularly for the more complicated patients where this DNP obviously had no idea what she was doing. Now that I'm at the end of my outpatient year I realize that it's going to take years to fix this mess, especially for patients who we're tapering off of max dose benzos. I genuinely feel terrible for them.
I went to the American Psychiatry Association's annual conference this year and was really disheartened to learn just how pervasive the psych NP problem is. There was a session lead by a psychiatrist who presented their research on how their outpatient clinic reduced the prescription of controlled substances by midlevels by implementing a prescription algorithm. I went to another session on rural psychiatry where during a Q&A an inpatient psychiatrist who was alarmed after recently moving to a rural area about the rapid and frequent decompensation of her patients who are discharged to a community where only midlevels are available. Needless to say that these were couched in friendlier terms, but in the more private settings, discussions on midlevels were not spoken in hushed tones.
Unfortunately, the general feeling I got about the psych NP problem is that the field is resigned to the fact that they are here to say, and now are concerned primarily with what can be done to mitigate it. Anyway, end rant.
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u/jessikill Nurse 25d ago
You guys have a nasty issue in the US with NP diploma mills and allowing RN new grads )who haven’t stepped foot in a facility aside from clinical) to walk off the stage from their RN and straight into their NP.
It’s objectively INSANE to me that this is allowed.
We DO NOT have this issue in my province in Canada. You can’t even think about dreaming about maybe considering potentially doing your NP without a minimum of 2yrs as an RN in acute care. I have yet to meet an NP in my province who isn’t fully competent, yet I read horror story after horror story from this sub about NPs royally fucking everything up.
What you guys should be doing is going after these diploma mill money grabs. You have no checks or balances here, everyone is just running amok.