Working as a PMHNP has been so rewarding. Some of my clients have just gotten insurance and so have been struggling for months or years. One of the key attributes of a FPMHNP is listening to the client as much as possible. Despite limited time, it is still imperative for the client to feel that you understand what their struggles have been. This then allows the provider to start to build the relationship between the client and themselves and allows for forward progression and ultimately, reaching treatment goals.
About Laura Hickman, MSN, FPMHNP-BC: Ms. Hickman is a Family Psychiatric Mental Health Nurse Practitioner (FPMHNP) at Southwest Behavioral & Health Services (SBH), a community mental health outpatient clinic in Phoenix, Arizona. As an FPMHNP specifically within SBH’s Tele-Medicine-Payson clinic, Ms. Hickman performs psychiatric evaluations and provides medication management services to psychiatric clients across the age spectrum who are severely mentally ill and who have been historically underserved in the health care system.
Prior to her current role at SBH, Ms. Hickman completed her MSN practicum hours in the Emergency Room at the New Ulm Medical Center, where she collaborated with the ER physician to treat patients suffering from psychiatric crisis, acute injury, delirium, intoxification, and/or other serious mental and physical conditions. She also completed practicums at Healing Connections Therapy Center, Plymouth Psych Group, Advanced Practice Psych Services, Inc., and Canvas Health. During her clinical practicums, Ms. Hickman performed medication management services and individual and group psychotherapy.
Prior to becoming a nurse practitioner, Ms. Hickman was a Registered Nurse (RN) at Spencer Hospital, where she managed the overall acute care of 10-15 patients per shift in the Mental Health and Intensive Care departments, and as a Care Coordinator/Case Manager at Mower County Public Health, where she coordinated with insurance companies, health care providers, and patients to maximize patient outcomes and independence. She also worked as a travel nurse to larger facilities, where she gained experience in cardiology, neurology, and psychiatry. Additionally, Ms. Hickman served as the Director of Nursing at Emmetsburg Care Center, for a long-term care facility in Iowa, and as an Executive Director at two assisted living centers in Minnesota.
Ms. Hickman earned her Bachelors of Science in Nursing Degree (BSN) from the University of Iowa (UI) in 2003 and her Masters of Science in Nursing Degree (MSN) from Saint Louis University (SLU) in 2013. She is currently attending Arizona State University (ASU) for her Doctorate in Nursing Practice Degree (DNP), and is also a Certified Case Manager (CCM).
[OnlineFNPPrograms.com] Could you please describe your role and responsibilities as a Family Psychiatric Mental Health Nurse Practitioner at Southwest Behavioral & Health Services? What kinds of medical conditions and challenges do your patients face, and how do you help them manage their conditions?
[Laura Hickman, FPMHNP-BC] My current roles and responsibilities include medication management services, psychiatric evaluations, and coordination of care for clients in a community mental health setting in Phoenix, Arizona. Patient education and coordination of care are key components for quality-based care in this setting. Treatment plans are individually tailored to best meet their challenges. Chronic pain, poor nutrition, chronic and severe health conditions, socio-economic issues, lack of education, and transportation issues are just a part of their needs. These challenges require unique treatment goals and coordination of care with their primary care provider and their case manager. It is a necessity to balance their physical and their mental health and for them to have an understanding of the importance of the relationship between the two. Many have not had mental or physical health treatment for years due to lack of insurance and the inability to pay for medications. Chronic conditions, such as a thyroid disorder, or diabetes can greatly affect their mood symptoms and so tailored treatment goals must be addressed in order to stabilize their mood.
My first year at Southwest Behavioral & Health Services involved meeting patients in person at our Metro outpatient clinic; however, since May of 2015 I have been providing tele-medicine services to patients in our Payson outpatient clinic on a full-time basis. Tele-medicine utilizes video and audio to communicate with clients that may not have services available to them in their area. The provider speaks with the client via video connection, much like Skype or Face Time, and is live and inter-active. Interview techniques and establishing a relationship with the client are tailored via tele-medicine, and is fully capable of meeting the treatment needs of the client.
[OnlineFNPPrograms.com] How are psychiatric/mental health services structured and delivered at Southwest Behavioral & Health Services, and what role do FPMHNPs play on a larger team of health care professionals?
[Laura Hickman, FPMHNP-BC] Southwest Behavioral & Health Services (SBH) structure services based on the population served, the specialty of the clinic, and the needs of the community. FPMHNPs play a large role in the health care professional teams at SBH. We work with teams of therapists, medical assistants, nurses (both LPN and RN), case managers, substance abuse counselors, high needs treatment teams, crisis response teams, and also with those health care professionals outside of SBH. A collaboration of care between primary care and psychiatry has been recognized by SBH and they have made this transition into collaborating care. Examples are Peer-to Peer telephonic conversations with the client’s inpatient provider prior to discharge, coordination of discharge by the Transition Specialist, a specific team member that coordinates the transition back to outpatient care, and the capability to directly communicate with the Primary Care Provider (PCP). This helps reduce costs and improve treatment outcomes.
I currently work at two of SBH’s clinics, one rural via tele-medicine and at one general mental health (GMH) clinic in Phoenix. Each clinic provides unique services based on the community needs. The rural setting is capable of serving those who struggle with SMI (Seriously Mentally Ill), or of GMH (General Mental Health), as well as those who struggle with Substance Abuse. This clinic was established and teams were built based on the capability of serving these individuals and so coordination of care is again important to the treatment goals of the client.
Several years ago schools of nursing recognized that combining their specified adult and child population mental health practitioner programs to formulate a Family Psychiatric Mental Health (FPMH)-NP program could prepare students to best serve the mental health needs in the community. While you will still see those NPs who are board-certified solely in either an adult population or the child/adolescent population, this has since evolved to one Family Psychiatric Mental Health NP so he/she may serve populations throughout the life span.
[OnlineFNPPrograms.com] What motivated you to work in psychiatric/mental health nursing, and what professional and academic experiences helped you determine that this area of advanced practice nursing was the right one for you?
[Laura Hickman, FPMHNP-BC] My nursing career started almost fifteen years ago in an Intensive Care Unit (ICU) in a small rural town in Iowa. I took advanced training to specialize in Intensive Care, but soon realized there was a wide array of career moves you can choose from as a nurse. Thus, my travel nursing began in hopes of gaining experiences in larger hospitals that could expose me to more services and treatments. After three years of travel nursing, I took a position as a Director of Nursing in a long-term care facility and formulated my love for senior adults. My husband’s career then took us to Minnesota, so I took a job as the Executive Director for two assisted living centers. A leadership role in nursing is much different than direct care, however, the enjoyment of learning the global aspect of care helped me realize how important it is to use evidence-based care and how important it is to contain costs. While I enjoyed this experience, I also missed the direct care I had with senior adults, so I transitioned into community health as a Public Health Nurse.
My main role was to assess the mental and physical need of senior adults and then based on that information I could arrange services to assist them with staying in their own homes as long as possible. I worked with contractors to build wheelchair ramps, or home health agencies to implement services to assist with Activities of Daily Living (ADL), or arranging for medication set ups and medical services, such as wound or Intravenous (IV) Therapy. Even though I really enjoyed this role I soon learned that they had significant unmet mental health needs and they had either not received any evaluation or treatment and/ or they were managed by primary care. I already knew I had a love for mental health so I decided to continue school and thus earned a Master’s Degree in Science in Nursing in 2013, allowing me to sit for the FPMHNP board certification.
[OnlineFNPPrograms.com] During your MSN program, you worked in a variety of psychiatric/mental health settings, including private psychiatry practices, community mental health centers, an adult and senior adult therapy center, and an Emergency Room setting. Could you provide a description of each of these work environments, how they differed from one another, and what you gained from your experiences in each of them?
[Laura Hickman, FPMHNP-BC] As I mentioned previously, each of the two clinics that I work for have specific needs. This is not only evident now, but also recognized as I gained experience during my internship/practicum hours. Most clients in the private practice world are two-income households and are raising children that may be struggling with ADHD or Autism, or mom or dad may be struggling with anxiety or depression. The needs of these clients are much different than the patients in community mental health, who struggle with finances, chronic health conditions, low education levels, domestic violence, lack of health care knowledge or treatments, chronic pain, and substance abuse, alongside with a mental health diagnosis. This is not to say that there are not these struggles in private practice, but the day-to-day challenges are more prevalent for those served in community mental health.
I also gained experience interning at a specialized clinic, serving adults who had a diagnosis of Borderline Personality Disorder. The evidence-based practice shows that DBT (Dialectical Behavior Therapy) is a “gold” standard treatment and I recognized how effective it is. This clinic offered Intensive Outpatient therapy, group therapy, and individualized therapy, all based on the DBT model. I gained a wealth of knowledge during this year and continue to use some of the aspects of its teaching today.
[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?
[Laura Hickman, FPMHNP-BC] Working as a PMHNP has been so rewarding. Some of my clients have just gotten insurance and so have been struggling for months or years. One of the key attributes of a FPMHNP is listening to the client as much as possible. Despite limited time, it is still imperative for the client to feel that you understand what their struggles have been. This then allows the provider to start to build the relationship between the client and themselves and allows for forward progression and ultimately, reaching treatment goals.
Sometimes, clients that come in have in mind what they believe is the “right” medication for them. Their neighbor, or friend has told them that benzodiazepines work wonders with anxiety and so they should ask for those medications when seeking treatment. For some, it is difficult to understand that these are generally not the best treatment choice for long-term management. When working with those with undiscovered substance abuse it is necessary to look at the controlled substance monitoring program in your state to see if that client may have some issues or alternative plans for the medication. These are generally the clients that get most upset, sometimes leading to threatening statements, or name-calling; however, I have found that if you display a genuine concern about the best treatment for clients, they feel that they have been heard and that you do have their best interests at heart. This is definitely a skill that the student should prepare for. During clinical practicums, it would be best to find a preceptor that is skilled in handling these situations, and who can teach you how to do the same, as such situations can quickly become escalated.
[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?
[Laura Hickman, FPMHNP-BC] I think having a good nursing background in med-surg nursing and gaining experience with inpatient stay would be extremely helpful. Volunteering at long-term care facilities or pre-schools to gain experience working with all ages in their habitats will prepare the student to help determine what they would like to specialize in. Becoming board certified in a specialty will help with the job search and salary potential. As far as becoming board certified I would recommend any of the study materials that are out there. I got the CDs and listened to the lectures and then went on the ANCC website and took practice exams.
Thank you Ms. Hickman for participating in our APRN career guide interview series!