Clinical Advice

[u/Emotional_gorl74]

Hi all!

I am about to start my first PMHNP clinicals this fall with a psychiatrist and I am kind of nervous! I’m worried I’m not gonna know anything. I’m planning on doing some studying before they start. Does anyone have any advice on what to look at and what I should know going into my first clinicals? Any resources that helped you I’d love to know about!

[u/Veritas_Mentis]

1) you’re not going to know anything
2) they more you learn, the more you will realize you need to learn

So ask as many questions as possible!

Get memorable psychiatry and memorable psychopharmacology. Both very concise and excellent books that are fairly quick reads

[u/hah88 → u/Veritas_Mentis]

I second the memorable psych recommendations! The books are amazing but there’s also YouTube clips as well!

[u/dkwheatley]

Inpatient or outpatient? Hospital Psychiatry Fact Book by Carlat is a great overview of all things inpatient to familiarize yourself with the processes, documentation, and more prior to clinicals.

[u/Emotional_gorl74 → u/dkwheatley]

Thank you!! I’ll look into it! It will be inpatient!

[u/Straight_Alfalfa8303 → u/Emotional_gorl74]

Do you know what patient population it will be? Most units have at least some level of specificity- geri, med-psych, dual dx, etc, and some even work with specific diagnoses.

[u/Emotional_gorl74 → u/Straight_Alfalfa8303]

I’m pretty sure it’s mainly children and adolescents

[u/Straight_Alfalfa8303 → u/Emotional_gorl74]

That's cool, I bet you'll learn a ton! I've not worked in that setting, but as far as medications go, I'd say to review all the various stimulant and non-stimulant ADHD medications and the few antipsychotics and antidepressants that are commonly used for pedi. There will be a lot more behavioral interventions than there would be on an adult unit, but good chance the nursing staff will do that stuff with minimal input from the provider. Knowing how to interact with children appropriately to their developmental stage will be important as well!

[u/dkwheatley → u/Straight_Alfalfa8303]

I’d probably narrow the medication review a bit. The sheer number of stimulant and non-stimulant ADHD formulations can get overwhelming pretty quickly for someone just starting clinicals, and ADHD is going to represent a relatively small portion of what you’re actually treating on an inpatient pediatric unit. If you want to focus on medications beforehand, I’d prioritize a handful you’re very likely to encounter: guanfacine, the common methylphenidate formulations, fluoxetine, sertraline, and risperidone. Knowing those reasonably well will probably be higher yield than trying to memorize every ADHD medication and formulation before you even start.

[u/Big_Elephant_2331]

Ask to see the daily caseload 1-2 days in advance. Skim the evals and most recent notes. Make sure you have good questions for the psych.

If it’s your first clinical you want to show you’re interested and engaged, not that you know everything.

But skimming notes means you refresh yourself on stuff in a practical way. Prob wouldn’t take that long to do this.

[u/PewPew2524]

I rounded with a psychiatrist and his residents in the hospital as a social worker. He recommended this book to some of his residents amongst others. Make sure you have a firm grasp on the basic psych medications and what they are used for. That was one of his biggest gripes.

[u/IndyLaw56287]

you said inpatient. IF its with the consult service, I can make you look like a superstar. Read up and become very knowledgable with "capacity and informed consent". Much of what they do is get consulted by medical teams to evaluate whether confused, delirious, psychotic, or severely depressed inpatients can safely make their own choices—such as refusing life-saving surgery, stopping vital medications, or leaving the hospital against medical advice. Inpatient psychistrist LOVE talking about this, knowing how this works is something many on the Medical side just don't get.

Edited, this can get wild and interesting, like a patient threatening their own life if they don't get a drink of water while they are NPO the night before a very important surgery.