You know those moments early in your career that make you cringe a little when you look back? If you’re a new grad psych NP—or even an RN—you’ve probably had a few moments like that too.
When I started as a psych NP, I made several mistakes that I now view as valuable lessons. Here’s what I believed then:
- Every SSRI would work similarly for all patients
- I had to prescribe medication on the first visit
- If a medication worked for a patient’s family member, it would work for them too
Why You Don’t Have to Prescribe Meds on the Initial Visit
The biggest mistake I made was feeling pressured to prescribe a medication during the initial psychiatric evaluation. It made sense at the time—patients come in distressed, and it feels urgent to “do something” right away.
But the truth is, you don’t have to prescribe medication on the first visit. Sometimes, moving forward without prescribing is the best, safest, and highest quality care you can provide. That might mean:
- Gathering collateral information
- Obtaining past psychiatric records
- Getting baseline labs before starting medication
In some cases, meds are prescribed on the first visit. But often, it’s not only ok, but wise to wait until you have a fuller picture.
The Framework That Built My Confidence
One thing that helped me tremendously was working with an experienced psychiatrist early on. Meeting weekly to discuss my questions helped me realize a simple but powerful framework: Assess → Diagnose → Treat.
He would challenge me on what assessment questions I asked, push me on diagnoses, and help narrow down treatment options. It’s basic—but when done well, this framework creates better outcomes and reduces mistakes.
Build Your Confidence in Treatment
If you’re working on building confidence as a psych NP student or provider in practice, consider adopting a structured framework like this. It’s not about rushing to med management but about doing the right thing at the right time for each patient.
🎓 To get more practical tips, check out my free Master Mental Health training for students and providers who want a clearer path in treating mental disorders.