Research Assessment #4

Date: November 17, 2016

Subject: Specialty Spotlight: What I Do As A Psychiatric Nurse Practitioner

MLA or APA citation: Stevens, Kristina. "Specialty Spotlight: What I Do As A Psychiatric

Nurse Practitioner." The Real NP. WordPress, 2015. Web. 17 Nov.

2016.<http://www.therealnp.com/specialty-spotlight-what-i-do-as-a-psychiatric-nurse-

practitioner/>.

Analysis:

Unfortunately, I wasnt able to schedule an interview with any Psychiatric Nurse

Practitioner in the Dallas Fort Worth area. Its a bit disappointing, and of course, Ive rethought

my decision in pursuing in Psychiatric Nursing, however, after reading this article, my desire to

help those who are mentally ill have grown stronger. Ive learnt about the ups and downs in

Psychiatric Nursing, the busy work schedule, and overall the dedication Psychiatric Nurses put

into their clients health. I hope that I will soon be able to have an interview with a Psychiatric

Nurse Practitioner and build on my understanding of my topic.

This is a thoughtful interview that truly allows me to see the many facets involved in a

Psychiatric Nurse Practitioners work. It made me feel hopeful about all the possibilities that can

emerge from this type of care. Kristina Stevens is a Psychiatric Nurse Practitioner working at

University of Illinois at Chicagos Psychiatric Outpatient Clinic in the Neuropsychology

Institute. She shared some insight on her daily life for those who are interested in pursuing this

route. Just through reading this interview article, I could feel Ms. Stevens passion for those who

are mentally ill.

 She discussed her typical day at work, which composed of seeing patients early in the day

starting from 8am to 4:30pm. She has 60 minutes for intake and therapy, stressing how she

cannot slack off during these meetings. She sees most patients every 2-4 weeks, and there are a

handful of patients she sees weekly if they need a lot of help. She spends an hour with them, and

for the first 15 minutes she tends to start on medications, whats going on with her patients life,

what their sleep is like, etc. Usually they come in with a pressing problem, something thats

urgently on their mind, so she address that first. Importantly, she handles her own scheduling, so

then she gives herself 30 minutes after chunks of patients to chart and have some downtime. I

learned that Psychiatric Nurses have to be quick and efficient, as well as organized. These

characteristics are some I need to work on, considering that Im quite slow and tend to move at a

pace that is right for me.

She stressed the importance of being mentally strong. Being in the mental health field

consists of listening to a lot of really hard stuff. Patients are telling her very personal stories

about their lives that she cannot envision. She asserts Psychiatric Nurses have to be

nonjudgmental, because it takes patients a long time to feel like they can trust you with stuff.

However, she claims her job doesnt exhaust her, and believes its due to the fact that she

mediates every day. Her mindfulness practice (which she frequently teaches her patients) allows

her to usually not bring her work home. This is also something I need to work on, separating

home life from work life. Since Im also in the Health Science program, I have been exposed to

many things in the medical field that most of my peers havent been able to experience. Since my

personality is easy going, Im able to form bonds quickly. Even though Ive been working at the

nursing home for about a month, every death that occurs really breaks my heart and at times, I
cant sleep due to my sadness. Its important to maintain work life from personal life, even

though it is extremely difficult to do so.

Ms. Stevens also shared the importance of talking things out. To overcome her

challenges, she meets with her physician a lot, she talks to her and is always asking for help. She

also talks to her risk assessment group to ask about what she should do whenever there are is any

doubt. Additionally, she belongs to a closed Facebook group specifically for Psychiatric Nurse

Practitioners, which are great forums for asking questions and learning from what others ask and

discuss. She instructs to never be afraid to ask for help, and reach out and get reassurance when

needed. She encourages anyone practicing in the medical field to do the same no matter how

long they have been in practice. Its important to never stop learning about yourself, and about

others.

She also gave advice to those who plan to pursue in Psychiatric Nursing. She claims one

of the most important things about a Psychiatric Nurse is that it is necessary to be really good

listener. Be a really good talker, and be good at not being judgmental. Its important to be willing

to tolerate really distressing emotions and be present for people in really distressing, sad,

uncomfortable situations and be able to sit with that discomfort. Basically, its necessary to be

really comfortable with being uncomfortable. Also, know your limits as well as your strengths.

Every patient you encounter will be different, and at times, you will not be able to cure every

single one of them. Know what you can do, and what you cant.

Through this article, I was able to get more into depth with my topic. Its fascinating to

hear about ones stories and what they deal with on a daily basis. Its also interesting to finally

hear a Psychiatric Nurses perspective on her job, and how she deals with her work life and

family life. I hope I will get the opportunity to finally interview with a Psychiatric Nurse and
enhance my understanding of my career topic. I definitely will be looking forward to the day I

am able to present a Psychiatric Nurse as my mentor for ISM, and learn about my field through

their perspective as well.

Specialty Spotlight: What I Do As

Psychiatric Nurse Practitioner
 As National Nurse
Practitioner week comes to an
end, it is with pride that I
showcase Kristina Stevens,
PMHNP-BC. Kristina is a zen-
filled Psychiatric Nurse
Practitioner working at
University of Illinois at
Chicagos Psychiatric
Outpatient Clinic in the
Neuropsychology Institute.
She started as an English
major in college and spent
twelve years in public radio as
a producer and editor before
switching over and becoming
a nurse practitioner. She was
kind enough to sit down for a one-on-one interview about how she became a
Psych NP, and share some insight into her daily life for those who are interested
in pursuing this route.

What made you pursue a career as a

psychiatric nurse practitioner?
I came from a family with a lot of mental health challenges and I personally have
dealt with a lot of mental health issues. I think that history makes me a better
mental health provider. Sometimes I share my experiences when appropriate and
a light bulb goes off for them because they see me as someone who gets them,
rather than someone who just read about their condition from a textbook. As my
own former psych NP told me, you only have to be more mentally well than your
patient for that hour you are seeing them. So it wasnt that hard for me to go to
the other chair.

There have been times where I experience counter-transference, when issues hit
a little too close to home. When this happens I talk about that during supervision
which is a monthly meeting I have with my mentor where I talk about cases,
professional worries, best practices, etc.

How did you know you were ready to go to

the other chair?

It felt very comfortable from the moment I started seeing patients during my first
clinicals, when my instructor just threw me in. It allowed me to give back what
was given to me when I was suffering. I had started with midwifery and it was
really hard to change, and I grieved for a good year about whether this was the
right choice for me, but once I started clinicals I just knew that this was right for
me.
And now looking back I can see that midwifery was definitely not my path and
Im glad I made the choice to change when I did.

Tell us about where you work.

I have a nice office where I see my patients. They let me pick a paint color so its a
nice light blue. Its Univerisity of Illinois at Chicago (a state facility), so I got
salvaged furniture, but I decorate it so that its a peaceful space for my patients
and myself.

What is your relationship with your

collaborating physician?

For Medicare patients UIC just changed their policy, and I have to have an
attending physician every 6 months just to review the plan of care. Otherwise if
theyre not Medicare patients, I am completely on my own. However, I am well
supported by my colleagues and my collaborating physician, and I can ask
questions when I need help. I frequently text or email my collaborating physician
with questions and concerns and always get a prompt, helpful, encouraging and
friendly responses.

Tell us about your typical day.

I start to see patients early in the day starting from 8am and my last patient is out
at 4:30pm. Sometimes I start later in the day so I end at 6. I have 60 minutes for
intake and therapy, and for patients I am seeing only for medications I am seeing
them for 30 minutes. However, most of my patients I see for combined
medication and therapy. I see most patients every 2-4 weeks, and there are a
handful of patients I see weekly if they need a lot of help. I spend an hour with
them, and for the first 15 minutes we tend to start on medications, whats going
on with their life, what their sleep is like, etc. Usually they come in with a
pressing problem, something thats urgently on their mind, so we address that
first.

I see patients back to back for 2-3 patients at a time. I handle my own scheduling,
so then Ill give myself 30 minutes after the chunks of patients to chart and have
some downtime that doesnt involve talking to patients to catch up on phone calls
and charting.

Being in psych youre listening to a lot of really hard stuff. Patients are telling me
very personal stories about their lives and sometimes this can be really difficult.
You have to be nonjudgmental, and it takes patients a long time to feel like they
can trust you with stuff. It doesnt exhaust me though, and I think thats because I
meditate every day. My mindfulness practice (which I frequently teach to
patients) allows me to usually not bring my work home.
How was it different when you first started
working?

In the beginning when I was seeing all new patients I would see 6-7 new patients
every day and it was really overwhelming. But now I dont see that many new
intakes and I have a regular panel of patients, so its much better. Also Ive
mastered the art of doing intakes so I can do them much easier.

What is the most challenging part of your

typical day?

I havent had to commit any patients yet, but I definitely deal with suicidal
ideation all the time. For example, I had two young college students recently who
werent suicidal with plan or intent, but they definitely had passive suicidal
ideation (they were thinking about suicide a lot). Then I had a mother later that
day who had just given birth and was a heroin addict, and I hadnt seen her since
she gave birth, but the day I saw her again was only three days after her baby had
died. That day I went home really emotionally drained.

To deal with this every day, I get to work early, I meditate for 30 minutes, and
then I start my charting from the previous days for an hour, before I start seeing
patients. I think Ive taken lunch three times since I started, but thats my choice
to chart through lunch so that I can walk out the door when my last patient
leaves. It helps me maintain a work life balance, especially helping to raise my 11
year old daughter.

How do you feel about your role as the

psychiatric NP?

You cant really see a psychiatrist for therapy anymore, and social worker cant
really do medications, but as a psychiatric NP I get to do both meds and therapy.
When patients learn that they can do both with me, they really like it because its
less of a hassle when they dont have to go back and forth between providers. Its
easier and better to have one person know your story and seeing the full picture.
When Im just doing meds I dont get the full picture because we dont have time
to talk, and same if Im doing just therapy. So its nice to be able to have the time
to manage both. I feel very fortunate where I work to be able to have so many
therapy patients. Unless you are in private practice, most psych NPs are hired to
do 15-30 min med management only. Most days I really love what I do.

What type of therapy do you provide?

I provide an eclectic type of therapy, drawing from mindfulness, interpersonal

behavior therapy, cognitive behavior therapy and other modalities. I actually do
pretty active, skill-based patient therapy -giving my higher functioning patients a
lot of homework, which a lot of my patients really like, because it extends the
therapy we do in one hour every two weeks. Having something to work on
between visits that involves learning instead of just talking usually helps patient
progress faster in recovery. I use various workbooks that Ive found over time for
PTSD, cognitive processing therapy for rape, anxiety and panic attacks, and
depression. Sometimes I assign bibliotherapy for patients who are interested I
give them book recommendations to read on their own time. I also love using a
lot of handouts so when I teach a new skill I give them a handout to help them
remember what we discussed after the appointment.

Do you tend to see patients that are under

a specific branch of mental illness or do
you take on patients from all over the
spectrum of mental illness?

For the most part my patients are mood-anxiety just because thats the most
common. I specialized in womens mental health so I get the pregnant and post-
partum patients as well, and in that population I get schizoaffective, bipolar,
schizophrenic, and a lot of depression and anxiety in the prenatal and
postpartum period. I deal with a lot of rape and PTSD from rape and childhood
molestation so thats become one of my specialties. I refer out the ones I dont
feel comfortable with, usually patients in autistic spectrum and ones who are in
heavy duty psychosis because Im not equipped to deal with those. We have a
psychosis unit so I refer to them. Otherwise I will treat pretty much everyone. My
business card says womens mental health but I still have a lot of male patients.
How did you choose to specialize in
womens mental health?

I chose this specialty because I started out in midwifery and it didnt work for me.
I didnt even know psych NPs existed until I started my accelerated nursing
program. When I left labor and delivery and when I started psych, I was
recommended to go into womens mental health because it was a very natural
transition and fit from midwifery. I did a year of clinicals with the hospitals
womens mental health and agreed that it was a great transition and fit. Also,
mentally ill pregnant and postpartum women is a really underserved population
that, frankly, most providers are scared to treat.

What are some challenges that you face in

your career as a Psych NP?

My biggest challenge is worrying about my patients, especially the suicidal ones.

Statistics show that most people who commit suicide have seen their mental
health provider in the last 30 days before they do it. So I always ask about suicide
and whether they have an intent and plan, but then if a patient is really intent on
doing it, are they really going to tell me? Hard to say. I tell all of my patients
during intake that if they say they want to hurt themselves or others, I have to get
someone else in the room and involved. I have a patient who told me then I
wont tell you anything. I remember one patient who I was really close to
committing, but she swore that she wasnt suicidal that day, so I didnt end up
committing her. But then again, she never came back because she didnt want to
be committed.

So yeah, worrying about the suicidal stuff is one of the scarier challenges.

My other challenge is trying not to bring work home with me. You worry about
your patients, and your mind is constantly thinking about the ones that are really
sick, what can you do better for them, and what therapy would work better for
them.

To overcome these challenges, I meet with my collaborative physician a lot, I talk

to her, I am always asking for help. I talk to my risk assessment group to ask
about what I should do whenever there are is any doubt. Additionally, I belong to
a closed listserv and Facebook group specifically for psychiatric NPs, which are
great forums for asking questions and learning from what others ask and discuss.
But I am never afraid to ask for help, I reach out and get reassurance when I need
it, and I encourage anyone practicing in the medical field to do the same no
matter how long they have been in practice. I dont want to ever stop learning.

If someone is interested in pursuing a

career as a psychiatric NP, what should
they think about and question themselves
before making that commitment?
One of the most important things is that you have to learn to be a really good
listener. I have always been a really good talker, and Im good at not being
judgmental, but I know Ive had to really consciously strengthen my listening
skills and to let patients talk while not interrupting them. You have to be willing
to tolerate really distressing emotions and be present for people in really
distressing, sad, uncomfortable situations and be able to sit with that discomfort.
Basically you have to be really comfortable with being uncomfortable. You also
should really know your own baggage and know what issues you arent
comfortable dealing with for instance I share custody of an 11 year old girl with
an ex and we are still working through a lot of custody issues; I dont for a minute
think I would be comfortable doing family therapy or couples therapy, because it
would bring up too much counter-transference. So you need to know your limits
as well as your strengths!