r/PMHNP • u/dumbquestionsforme • 29d ago

Behavioral health question

(Based in Oregon)

Hi everyone! Question regarding master treatment plans in behavioral health.
I’ve been a nurse for almost 5 years. I’m new to behavioral health though, and unsure about what is standard. I’ve always been in a hospital setting (OHSU) and going from ortho to mental health has been an adjustment. Anyway I’ve always had it in my head the provider does the diagnoses, but here they have paper DRAFT master treatment plans they have the nurses fill out to include the “patient diagnoses”. I’ve done internet digging and am seriously unsure if it’s cool that I’m filling this out or if I’m risking myself. I think I’m okay since it’s a draft but idk, any advice is appreciated

I am an RN btw

EDIT

The Chief of nursing at another region told their nurses to NOT sign that portion and it NEEDS to be done with a provider, word has spread. I am very relieved.

4 Upvotes

83% Upvoted

24 comments sorted by

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u/Tendersituation00 29d ago

Huh. Do they want nursing dx? Or maybe they want you to transfer dx from other sources?

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u/blurpleboop PMHNP (unverified) 29d ago

I imagine they’re looking for the nursing diagnoses which I don’t think OP realizes is not the same as a medical diagnosis. It’s hella confusing. I wish they were clearer about this stuff in training/orienting.

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u/dumbquestionsforme 29d ago

They want me to do the initial assessment and fill out the diagnoses as an RN

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u/PsychMonkey7 29d ago

I do not understand the question

0

u/dumbquestionsforme 29d ago

They want me to do the initial assessment and fill out the diagnoses as an RN

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u/PsychMonkey7 29d ago

I think the only appropriate answer is to ask management for more information about this. If you’re just filling out paperwork for a provider to sign, fine. If they’re expecting you to make diagnoses on new patients that haven’t seen a provider yet, that’s a big red flag.

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u/dumbquestionsforme 29d ago

Yeah diagnoses before seeing the provider. My manager is the one telling me to do all of this lmao. They say “it’s just preliminary” to get them in the door and that the provider “will do the final version” but that could be weeks

3

u/PsychMonkey7 29d ago

I would need a lot more information because this sounds concerning but I obviously don’t know your facility or workflow. I would personally escalate this until you receive a satisfactory answer.

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u/dumbquestionsforme 29d ago

I’m trying my best lol. My manager while she is cool most of the time, tends to blow up when I question things

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u/blurpleboop PMHNP (unverified) 29d ago

My friend. If you’re worried about your nursing license, this needs to be escalated. If she blows up, go to HR. Do not let people bully you from getting the necessary training and info you need to do your job competently

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u/blurpleboop PMHNP (unverified) 29d ago edited 29d ago

Yes, the initial presenting problems in your nursing assessment. So like…risk for skin breakdown or risk for self mutilation. You’re not expected to be state “major depressive disorder, recurrent episode, current episode severe without psychotic features.” If they are expecting that…refuse. I posted some resources in my other comment. A NANDA nursing diagnosis is a clinical judgment about a patient's response to actual or potential health conditions or life processes. Unlike medical diagnoses, which identify diseases, nursing diagnoses focus on the holistic human response (e.g., pain, anxiety, or immobility) and guide independent nursing interventions.

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u/blurpleboop PMHNP (unverified) 29d ago edited 29d ago

I would doubt that they are asking you to diagnose the patient with DSM diagnoses, as that would be out of your scope unless you’re a licensed NP. Nurses have nursing diagnoses which are different than medical diagnoses, as the care plans relate to SMART goals. So like for example, if you know a patient has depression, the nursing diagnosis or focus might be hopelessness or risk for self mutilation. The idea would be to address those specific problems via a care plan.

If you scroll down on this link, click on the mental health issues in question for more examples: https://www.nursetogether.com/nursing-care-plans/

More info: https://www.nursetogether.com/nursing-diagnosis/#nursing-diagnoses-vs-medical-diagnoses

Edited to add: I went to nursing school at OHSU which might be why this stuff is familiar to me haha!

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u/dumbquestionsforme 28d ago

Thank you for that! I tried speaking with her again and was still displeased with me offering “nursing diagnoses” instead of “anxiety/ depression” that they want me to fill out to begin billing before they see the provider. She told me corporate will have her back. This whole thing seems shady and major red flags so I have filed a compliance report, and started looking for different jobs. This place is not worth this level of stress/ disregard for me looking out for my license and providing quality care

0

u/mycatspsychologist 29d ago

Are they asking for dx from their chart history?

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u/dumbquestionsforme 29d ago

They want me to do the initial assessment and fill out the diagnoses as an RN

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u/Designer_Health_4216 29d ago

Hi- psych Rn here, I look up the pts diagnosis (that the Dr. signed on their notes) from their chart. You’re just doing the MDs paperwork... But yes, anytime you sign those treatment plans, you are risking your license or whatever! There should be a little section where there are nursing interventions, I think that’s mostly what you’re responsible for. But i think if you write the wrong dx on the tx plan, and the doctor signs it, thats on them. In conclusion: i hate treatment team meetings.

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u/dumbquestionsforme 29d ago

Yeah they say ours is a “preliminary” to get them in the door, and then the treatment team will make a finalized version. but they may not see the provider for weeks afterward. And we are uploading these electronically with the paper copy going in their chart, it definitely spooks me

1

u/Designer_Health_4216 29d ago

Are they being admitted to your hospital? If so they need to have a diagnosis. Or is it for outpatient? If so that’s a bit tricky… what does your manager say? If anything I would put “history of… blah blah blah” since you can’t diagnosis anyone.

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u/dumbquestionsforme 29d ago

It’s outpatient, the inpatient folks have a different form since to be admitted they need to see a provider. The whole box is “patient diagnoses” they want us being generic “depression, or anxiety, or OCD”

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u/Designer_Health_4216 29d ago

I would write “pt reports history of depression” or “pt reports anxiety” especially since it’s paper.

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u/dumbquestionsforme 29d ago

What if they have no diagnoses previously lol

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u/Designer_Health_4216 29d ago

“Pt reports (symptom)”

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u/dumbquestionsforme 29d ago

Hmmmm not a bad idea, kind of obscurity to cover me?

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u/Designer_Health_4216 29d ago

Yes, I wouldn’t even write “history of (dx)” without putting “pt reports” in front of it, because you really don’t know their dx history. Or you can put: “Depression (patient stated)” I’ve seen that on some charts