How to go from confused in class to kick ass in practice

I wish I had had a playbook in NP school of the things I needed to be doing in order to enter practice knowing what I was doing (or at least feel like I knew what I was doing).

Looking back, there are several key things I would have done differently that would’ve been a game changer as an NP in practice treating patients with mental disorders. 

5 tips for success – psychiatric nurse practitioner students

1. Independently learn on your own through talking to psychiatric professionals in practice 

The first thing I would have done differently would have been to not rely on my school to provide me all the knowledge I needed. I fell into a false sense of security thinking that if I got As on all my coursework, that I would be well prepared for practice. Wrong. I needed to have been talking to psychiatric providers right as I entered school and throughout my MSN program. 

Providers in practice are a wealth of knowledge. I would have been so much better prepared for what was to come if I had talked to psych NPs or psychiatrists in practice. I would have gotten a sense of what their day-to-day was like, the most challenging parts of the job, what some of the most complex patients were. Talking to NPs in practice, while still in school, would have provided me with a lens of perspective while going through school. 

Sounds great, right? But how do you do this? 

Well, if you’re currently working as an RN while you’re in school, you’ll want to be chatting with your physician or NP colleagues. Learn about their experiences day to day. Ask about anything you’ve been wondering about or struggling with. What are the top 3 medications they use every day in practice? What are the most challenging types of patients they see? If they were to return to school today knowing what they know now, what would they have done differently or wished they had been prepared for?  

Talking to providers in practice gives you insight on knowledge beyond the textbook. The more conversations you have, the more you’ll learn things like what are different providers’ favorite medications and why. Or how they treat particularly challenging cases. 

Utilizing the knowledge of an experienced provider allows you into a snapshot of years, sometimes decades, of another provider’s expertise. Don’t let these opportunities pass you by. Make sure to get to know the psychiatric professionals around you.  

2. Learn how to write an effective, efficient psychiatric evaluation note 

The second thing I would have done differently would have been to spend more time learning how to write a psychiatric evaluation and follow up note prior to entering practice. As a provider treating mental health patients, you spend most of your days charting. Much of your time is spent writing notes. 

It makes sense, then, to have killer skills at writing effective, efficient, quality notes. 

I would have prioritized this while in school so that I could find my own flow for how I wanted to write notes, what was most important to be documenting about, and ways to make this process efficient. 

As a new provider entering practice, you’ll already have so much new information to learn, you don’t want charting to be another thing to need to learn that will slow you down. Basic components of writing an effective note are described here if you want to know them. And if you want a template for writing psych evals and follow up notes, check out this template bundle

3. Learn the most common mental disorders and medications to treat them

I wish I had realized there are only so many common disorders to treat as a psychiatric provider while in school. I wish I had learned the most prescribed medications used for treating psychiatric patients and I would have understood them fully – like how I know everything about each of the characters on Friends – for example, I would’ve become intimately familiar with the most common anxiety disorders actually encountered in practice and then the most common medications used to treat these disorders. 

Learn the most common disorders you’ll be encountering in practice and the evidence-based medications used to effectively treat those disorders. Know how long each mediation takes to reach efficacy. Learn what the common side effects are. Understand the basic mechanism of action of each medication. Learning even the top ten most commonly prescribed medications and knowing them intimately before entering practice would have been a life saver. 

4. Less is more: Learn how to de-prescribe

The fourth thing I would have wanted to know ahead of time was how to avoid or address polypharmacy. In school, you generally learn in a very controlled (often unrealistic) environment.  

You get case studies in class where a person comes to see you with one singular issue (i.e., depression) and they have never been on anything else before, and you learn that your job is to prescribe them an SSRI. And that’s really where the story ends. You learn what the different SSRIs are and the starting doses for titration. Basics.

No discussion of what happens if that same person were to come to you but with a realistic presentation – like that that person was actually on five different medications – one for sleep, a high dose of a benzo they’ve been taking for years, two different medications in the same class, and various medications for their multiple medical comorbidities…

This situation, while nightmarish, is more realistic for what you sometimes encounter in practice. Learning the art of deprescribing, even at a basic level, would have been amazing. 

Just a quick pro tip on deprescribing. Your impulse when a patient presents to you on 15 different medications is to start removing medications at that first visit. Don’t do this. While polypharmacy needs to be addressed, and medications will likely need to be tapered and discontinued, don’t do it at that first visit. Often less is more, and deprescribing should occur but there’s a process for deprescribing psychotropic medications

Patients were prescribed medications by providers who, at the point that you’re meeting them, know the patient better than you do. There may have been very clear rationales for why patients are on the medications they’re on. You don’t want to suddenly remove everything and destabilize these patients (in the outpatient setting as a mental health provider). 

5. Systematize your practice for diagnosing and treating your psychiatric patients

The last thing I wish I had learned or understood in school was learning a framework for how to think about approaching each and every patient in practice. As a new grad, I absolutely floundered in the beginning with the feeling that every patient was so incredibly different and that mental health was very gray, abstract, and without any sort of structure. 

While mental health as a field is definitely more gray than some other fields which makes it tricky at times to know what to do, there’s definitely some structure that should be followed. 

For example, it’s critical to add structure, and thus simplicity, into how you approach each of your patients.  I like to think about there being a framework of how you approach each patient you see. 

The basic framework is assessment, diagnosis, and treatment. A common mistake is to jump to treating after getting a few pieces of assessment data. Big mistake. This leads to trialing many different medications with your patient and not easily or effectively treating the underlying condition. 

So first, you’ll want to assess what’s going on by doing an effective psychiatric evaluation. Then, having conducted a complete assessment, correctly diagnose your patients. Here you’ll need to understand there are 3 common “buckets” of diagnoses you should be mentally funneling your patients into as you’re assessing – mood disorders, anxiety disorders, and psychotic disorders. 

Finally, once you have the right “bucket” or “buckets”, follow best practices for how to treat your patient, keeping in mind their particular history that you collected during your assessment.

That’s how you create more structure in your days and ensure you have a systemized approach for how you treat your patients. Why’s that important? It allows you to get through your days more efficiently and it allows you to more effectively treat the patients you see. Now who doesn’t want that?

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I believe that last tip is probably where many NPs can get tripped up. 

While this framework is simple, and very straightforward, actually implementing in practice is a different skill. So if you want quick a 60-minute intro into a framework for how to diagnose and treat mental disorders, you can sign up for my free Mental Disorders Training

If you want my most detailed, step-by-step support, you can sign up for my Mental Disorders Crash Course

Either way, I’m here to support you as you treat your patients with mental health needs!

Get the Psychiatric Templates Bundle!

Your reference for creating clear, high quality notes (for Psych NPs!)

psychiatric evaluation template bundle contents

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