PMHNPs, like psychiatrists, can prescribe medications, which is one of the main differences between PMHNPs and other mental health providers such as psychotherapists and clinical social workers. In fact, for most of my career that is what I have focused on, psychopharmacological management of mental health diagnoses. We are trained to administer psychotherapy as well, but because the need for providers who can provide psychiatric medication management is so great, PMHNPs have functioned as the prescribers for the most part.
About Emily Weston, MSN, PMHNP-BC: Emily Weston is a Psychiatric Mental Health Nurse Practitioner at Wentworth Health Partners, where she provides mental health evaluations; medication consultations, prescriptions, and ongoing management; and behavioral health care coordination services to patients. Prior to her role at Wentworth Health Partners, Ms. Weston worked as a Psychiatric and Mental Health Nurse Practitioner at Great Bay Mental Health Associates and at Avis Goodwin Community Health Center, where she performed diagnostic assessments, behavioral health services, and medication management to adolescent and adult patients. Before her work in outpatient psychiatric nursing, Ms. Weston worked for almost two years in an inpatient psychiatric setting as a Registered Nurse for Holy Family Hospital, where she provided nursing care to patients on a locked Behavioral Health Unit and collaborated with colleagues to support patients in group settings and maintain safe environments for patients on suicide precautions.
Ms. Weston earned her Bachelors of Science in Nursing from the University of Southern Maine in 2004 and her Masters of Science in Nursing with a concentration in Psychiatric Mental Health Nurse Practitioner from the University of Massachusetts Lowell in 2010. Before enrolling in her MSN program, Ms. Weston worked as a Registered Nurse for Wentworth-Douglass Hospital in two Cardiac Telemetry Units, the hospital’s Emergency Holding Room, and the Surgical Unit, where she provided care to critically ill patients, educated new nurses in the facility, and participated in the Transforming Care at the Bedside Committee.
[OnlineFNPPrograms.com] Could we please have an overview of your academic and professional path in advanced practice nursing?
[Emily Weston, MSN, PMHNP-BC] I graduated from the University of Southern Maine with a BS in Nursing in 2004. I worked on telemetry, medical/surgical unit at Wentworth Douglass Hospital following graduation for about 4 years and then applied to graduate school. During my master’s program I worked as a nurse at Holy Family Hospital in Methuen, MA on a locked psychiatric unit. I graduated from the University of Massachusetts Lowell Psychiatric and Mental Health Nurse Practitioner program in 2010. I completed my internships at Bridgewell Counseling and Lowell General Hospital in Lowell, MA; Health Education Services and Addison Gilbert Hospital in Gloucester, MA; and at Great Bay Mental Health and Goodwin Community Health in Somersworth, NH.
I am board certified as a Psychiatric and Mental Health Nurse Practitioner by the American Nurses Credentialing Center. Since graduation I have worked in a group practice at Great Bay Mental Health Associates in Dover, NH. I saw patients there for psychiatric medication management. I did some psychotherapy during my first two years of practice but switched to medication management only after that due to the needs of the practice. While working for Great Bay Mental Health, I also worked one day a week doing psychiatric medication consultation at Goodwin Community Health Center in Somersworth, NH. This was an integrated care setting. I was located in the primary care setting and would start patients on medications and see them for a short period of time to stabilize them, then refer them back to their primary care provider to continue the medications. That is the setting I am working in now at Wentworth Health Partners.
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as a Psychiatric Nurse Practitioner for Wentworth Douglass Hospital? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Emily Weston, MSN, PMHNP-BC] My role within the Wentworth Douglass health network is within Wentworth Health Partners, which are a group of several outpatient practices that are owned and managed by the hospital. I am situated in the primary care setting as an integrated behavioral health care provider. Patients who present to their primary care provider and are in need of psychiatric medication consultation are referred to see me. I meet with them within the primary care setting to assess their symptoms, provide a psychiatric diagnosis and assess the need to start or change medications. I will meet with a patient anywhere between one and five visits, until they are stable. At that point, I will sign off on the case and primary care will continue to provide the medication refills. Sometimes cases are more complicated than what we can accomplish in five visits; the person may need ongoing psychiatric medication management, or primary care is not comfortable continuing the medications. These patients are then referred to another provider who will see them for a longer period of time. I also provide consultation over the phone and via the electronic medical record to primary care providers who have questions about medications or how to manage a patient if there is a wait to get in to see me. I sometimes provide some guidance on what medication to prescribe.
[OnlineFNPPrograms.com] Who is on your team at Wentworth Douglass Hospital, and how do you collaborate to provide patient care? In general, what role do PMHNPs play on a larger team of healthcare providers in medical settings?
[Emily Weston, MSN, PMHNP-BC] On my team in the integrated care setting are several people. I get referrals from 14 primary care practices. There are also therapists that are seeing patients at five of these offices. I communicate with them regularly. This helps me to assess how patients are doing on their medications. I also work closely with the primary care providers. They get an update from me after each visit I have with one of their patients. They often communicate with me when they are worried about a particular patient I have seen. I also have a clinical staff comprised of medical assistants and nurses who field calls from patients. I could not survive without them. They can often take care of refill requests and questions about how to take a medication without having to interrupt me while I am seeing patients.
[OnlineFNPPrograms.com] In your opinion, what are the main differences between PMHNPs and people in other helping professions, such as clinical social workers, psychotherapists, and psychiatrists? Is one of the main differences that PMHNPs can do health evaluations and administer medicine? What is the difference between a PMHNP and a Psychiatrist?
[Emily Weston, MSN, PMHNP-BC] PMHNPs, like psychiatrists, can prescribe medications, which is one of the main differences between PMHNPs and other mental health providers such as psychotherapists and clinical social workers. In fact, for most of my career that is what I have focused on, psychopharmacological management of mental health diagnoses. We are trained to administer psychotherapy as well, but because the need for providers who can provide psychiatric medication management is so great, PMHNPs have functioned as the prescribers for the most part. I did see patients for psychotherapy when I was first practicing, but due to the needs of the practice, I started strictly seeing patients for medication management about two years into my career. There are elements of counseling in every visit even though the primary purpose is to discuss medications; however, most patients are also seeing another provider for psychotherapy. I try to keep in touch with whomever they are seeing to ensure continuity of care.
The difference, in my opinion, between a PMHNP and a psychiatrist is our training. We function in the same role, for the most part. We go to nursing school and they go to medical school. Where I work, in New Hampshire, nurse practitioners can work independently so that makes our role even more similar to the psychiatrist. Our jobs and responsibilities are not very different, but PMHNPs are nurses first. I think we tend to look at things somewhat differently. If someone is complaining of depression, a PMHNP may be more apt to look into what is going on psychosocially that may be contributing to the symptoms. If a patient is not taking their medication properly, we may try to help come up with a solution as to how this can be improved. Having patient experience as a nurse is also an advantage in developing therapeutic relationships with patients.
[OnlineFNPPrograms.com] What motivated you to work in psychiatric/mental health nursing, and what professional experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Emily Weston, MSN, PMHNP-BC] In nursing school, my favorite clinical rotation was in the psychiatric hospital. I contemplated starting my career as a psychiatric nurse but was steered in the direction of getting some medical/surgical experience before doing that. I am glad that I did that. Now I work in a setting where having the medical background is very beneficial. While working as a RN on the telemetry unit, I became increasingly aware that even though patients were in the hospital to treat a medical concern, many of them also had psychiatric concerns that were not being addressed. I realized there was a grave lack of access to care in my community, and I wanted to help bridge that gap.
[OnlineFNPPrograms.com] What have been some of the most rewarding aspects of working as a psychiatric mental health nurse practitioner? On the other hand, what specific challenges have you encountered in this field of work, and how have you managed these difficulties?
[Emily Weston, MSN, PMHNP-BC] The most rewarding aspect of my job is when patients get better. With the lack of access to providers and stigma that unfortunately still surrounds mental health diagnoses, I am often the first psych specialist that a patient sees. Some are well into adulthood and have had symptoms throughout their lives. When we get the diagnosis and treatment right for people, they are so grateful. I have had many come back for follow up telling me they were able to go back to work, that they are having a more fulfilling time with their families, and were able to become social again. This is, by far, the greatest part of my job.
There can also be challenges. Sometimes we deal with lack of compliance with treatment. Sometimes there is lack of family support, which leads to noncompliance. Specifically with my current position, I have to work in concert with primary care and there are often disagreements about medications and treatment. That can be challenging too. I try to keep in close contact with the primary care providers. Usually, if we can discuss the case, we can come to an agreement about treatment.
One of the biggest problems in my area is inability to get patients hospitalized when they need to be. PMHNPs and psychiatrists are not able to directly admit patients to a hospital in most outpatient settings, no matter how much we feel they need to be there. They have to go to the ER to be evaluated, and many times are sent home. This is due to a number of reasons, but the must influential one is probably the shortage of beds for inpatient stays in the state. It is frustrating and sometimes unsafe. The way I have dealt with this is by making sure I present my reasons for wanting a patient admitted in writing. If I send a patient to the ER for evaluation, I always call to let the staff know they are coming and that I will be sending my office note for both them and the evaluator to review. I state in my note reasons why I believe they may be a danger to themselves and others, and that my recommendation is hospitalization. This has been successful in getting patients the treatment they need much of the time.
[OnlineFNPPrograms.com] For current and prospective MSN students who are interested in becoming psychiatric mental health nurse practitioners, what advice can you give them about optimally preparing for this field while pursuing their degree?
[Emily Weston, MSN, PMHNP-BC] I recently spoke at a career day and answered this question. My best advice for someone thinking about working in advanced practice psychiatric nursing would be to get some experience in the field either prior to applying to graduate school or during the process. I worked on a psychiatric unit while I was in graduate school. I actually didn’t like the setting. At the same time, I was doing clinical internships in outpatient settings. I was able to see that I would be much better suited to working in the outpatient world. Working in the hospital setting, I was able to see what happens when those patients I was seeing in the outpatient world get very sick. I think it was important to see what that looked like. It’s almost like I got extra clinical hours. I would go to clinical all day and then work an evening shift at the psych hospital that night. It was a crazy time, but I learned so much and felt much better prepared coming out of school.
Thank you Ms. Weston for participating in our APRN career guide interview series!