How can APPs best work with supervising doctors in TRD and MDD treatment?

In this discussion, Brooke Kempf, PMHNP-BC, MSN, hospitalist at the Hamilton Center, and Rakesh Jain, MD, MPH, clinical professor, Texas Tech - Permian Basin, dive into the power of teamwork, sharing strategies for APPs to initiate impactful conversations with medical colleagues. From leveraging fresh perspectives to embracing mutual respect, they highlight how breaking down silos enhances care for even the most complex cases. Join Jain and Kempf to discover how collaboration can unlock new possibilities in TRD treatment.

To catch up on previous parts of this discussion with Jain and Kempf, visit the MDD Learning Library.

Read the Transcript: 

NP Institute Online Learning Hub: Many advanced practice providers work in coordination with a supervising doctor. Could you offer some suggestions on how APPs can initiate conversations with other medical professionals about novel approaches for depression treatment?

Brooke Kempf, PMHNP-BC: When we encounter patients from the advanced practice practitioners' perspective, we get complex cases and a multitude of comorbidities. But when dealing with somebody with treatment-resistant depression, I think sometimes we might get stuck in a rut, and I don't know that everybody knows exactly how to ask for help. I hope that seeing our relationship and what Psych Congress offers shows that we can, amongst all professions, have a collaborative relationship where I don't hesitate at all coming to ask you advice for something. Is there any advice that you can give to us as advanced practice practitioners on how you feel if we were to come to ask you on recommendations? 

Rakesh Jain, MD: First of all, we're in the same boat. It's not like there are 2 separate boats and one's going one way and the other's going the other way. We're all in the same boat and we all have these difficult-to-treat patients. I very often seek help from another colleague who might be doing TMS because I don't do TMS in my office or maybe a colleague who does intravenous ketamine. One of my more common people to refer to when I run into TRD patients, Brooke, is a nurse practitioner in Austin because she does intravenous ketamine. The relationship isn't one of an NP turning to the MD, it's the MD turning to an NP. It's a relationship of "we're in this together" with true collaboration. Perhaps a few things to remember might be that it's always a good idea, when you meet a patient with TRD, to get someone else to look at them, because—what happens with me when I've been with a patient for 20 years—I have blind spots.

Kempf: Yes, we need fresh eyes,

Jain: We need fresh eyes. Sometimes the fresh eyes are someone who's younger than me, sometimes older than me, but it's somebody different. So I think collaboration is wonderful. There might be specific skills an MD might have, for example, ECT. I send patients to ECT; I don't do ECT. It actually doesn't matter who it is, as long as we all remember that collaboration is the name of the game and respect for each other's capabilities and professionalism. Once that is set, collaboration actually is very easy.

Kempf: We can all bring something to the table for our patients

Jain: And we do. We are powerful when we are together as a team. Absolutely.

Rakesh Jain, MD, MPH, attended medical school at the University of Calcutta in India. He then attended graduate school at the University of Texas School of Public Health in Houston, where he was awarded a “National Institute/Center for Disease Control Competitive Traineeship.” He graduated from the School of Public Health in 1987 with a Masters of Public Health (MPH) degree. Dr Jain served a 3-year residency at the University of Texas Medical School at Houston. In addition, Dr Jain completed a postdoctoral fellowship in research psychiatry at the University of Texas Mental Sciences Institute, in Houston. 

Brooke Kempf, MSN, PMHNP-BC, has worked as a psychiatric nurse at Hamilton Center in Terre Haute, Indiana, since she graduated from Indiana State University with an associate degree in 1994. Her passion for mental health was sparked as she worked as a charge nurse on the Inpatient Unit and continued to grow as she served in their outpatient setting while obtaining her bachelor’s degree from ISU in 1996. She was awarded the 2008 Hamilton Award for Outstanding Staff Member. Kempf was then able to obtain her master’s degree from the State University at Stony Brook of New York and is board-certified by the ANCC as a psychiatric mental health nurse practitioner. She currently practices as the Hospitalist for the Inpatient Psychiatric Unit of Hamilton Center Community Mental Health Center in Terre Haute, Indiana and is an adjunct lecturer for IUPUI’s PMHNP program, teaching and was awarded the 2022 Daisy Award for Extraordinary Nursing Faculty.

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