The Mistake That Cost Me the Most Stress as a New Grad PMHNP

One of the biggest lessons I learned as a new Psych NP had nothing to do with choosing the “right” medication. It was learning not to assume that someone else had already provided the necessary education.

Early in practice, I would sometimes meet with a patient who had been taking a medication prescribed by another provider and think:

They've been on this for a while. Surely someone already explained this.

I would review the medication, confirm the dose, ask how the patient was doing, and move on.

I eventually learned that this assumption could create problems. Learning this lesson was probably the most stressful lesson I learned as I was starting out my practice as a psychiatric nurse practitioner.

One instance that really drove this lesson home for me involved a patient who had been taking a benzodiazepine for some time. I assumed the patient understood that the medication should not be stopped abruptly and that they should not take more than prescribed when they were feeling worse. I learned that I couldn't assume that education had been provided—or that the patient remembered it. That experience reinforced for me that when I take over a patient's care, I need to verify their understanding of how they're taking their medication and review the key safety information myself.

Just because a patient has been taking a medication doesn't mean they understand it

Believe it or not, a patient can have been taking the same medication for months—or even years—and still not understand:

• What the medication is actually treating

• How they are supposed to take it

• What side effects to watch for

• Which side effects are expected versus concerning

• What to do if they miss a dose

• What medications or substances may interact with it

• How long it may take to work

• What symptoms should prompt them to contact their provider

• When a medication should or shouldn't be stopped abruptly

And sometimes, the patient may have received some of this education—but they don't remember it.

That distinction matters.

As Psych NPs, we often overestimate how much information patients retain from a conversation that may have happened weeks, months, or years ago.

I started realizing that “they should know this” wasn't a safe assumption

One of the easiest traps for a new grad PMHNP is assuming that because something seems obvious to us, it must also be obvious to the patient.

We know the medication. We've read the prescribing information. We've discussed the common side effects dozens of times.

The patient may have heard the medication name once and been given a prescription.

Those are two very different levels of understanding.

And when something goes wrong, thinking “they should have known that” doesn't help us.

A better question is:

“Did I make sure they knew?”

The medication may have been prescribed correctly—but used incorrectly

This was particularly important when I encountered patients who weren't taking a medication the way it had been intended.

Sometimes the issue wasn't refusal or nonadherence — the patient simply didn't understand the instructions.

They may have misunderstood how often to take it, changed the dose on their own, taken it differently depending on how they felt, or stopped it because of a side effect they didn't realize was something they should discuss with their provider.

From the patient's perspective, their behavior may have made perfect sense based on what they understood.

That's when I learned an important lesson:

A prescription is not the same thing as medication education.

Now, I don't assume education was provided

This changed the way I approach medication management as a psychiatric nurse practitioner. Even when a patient has been taking a medication for a long time, I briefly revisit the basics.

Not because I think previous providers did something wrong.

Not because I want to repeat every detail about a medication at every appointment.

But because I am responsible for the care I'm providing today.

I'll ask questions like:

“Tell me how you're taking this medication.”

That question is surprisingly useful.

Instead of asking:

“Are you taking it correctly?”

—which can easily result in a quick “yes”—

asking the patient to explain how they're actually taking it can uncover misunderstandings.

I may also ask:

“What did your previous provider tell you this medication was for?”

“What side effects were you told to watch for?”

“What would you do if you missed a dose?”

These questions aren't just about testing the patient's knowledge.

They're opportunities to identify gaps.

Medication education doesn't have to be a 20-minute lecture

Another lesson I learned is that education doesn't have to be complicated.

You don't need to overwhelm a patient with every possible adverse effect listed in a prescribing reference.

Focus on what is relevant to this patient, this medication, and this treatment plan.

At minimum, I want the patient to understand:

Why they're taking it.

How they're supposed to take it.

What common side effects they might experience.

Which symptoms are concerning enough to contact me about.

What they should do if they have a problem with the medication.

And depending on the medication, there may be additional counseling that is clinically important.

The goal isn't to make the patient memorize a medication fact sheet.

The goal is to make sure they know enough to use the medication safely.

One of the best questions you can ask is: “What have you been told?”

This has become one of my favorite questions when taking over the care of a patient.

“What have you been told about this medication?”

It gives you a starting point.

Maybe the patient knows exactly why they're taking it and understands the potential side effects, which is Ggreat. You don't need to start from zero.

But maybe they say:

“I don't really know. They just told me to take it.” Now you know there is an education gap.

And sometimes the answer is somewhere in between.

The patient may understand what the medication is for but have no idea what side effects to watch for.

Or they may know the medication can cause sedation but not realize that combining it with another sedating substance could be a concern. Or that the medication cannot be discontinued abruptly.

The point is to assess what the patient understands instead of assuming it.

This changed how I think about inheriting patients

One of the realities of being a PMHNP is that you're often taking over care that someone else started.

You inherit medications, diagnoses, treatment plans and, sometimes, you inherit assumptions.

It's easy to think: Someone already explained all of this.

But even if they did, you don't know what the patient remembers today. So, get comfortable verifying rather than assuming.

The lesson I wish I'd learned sooner

If I could go back to the beginning of my PMHNP career, I would tell myself:

Never assume that a patient knows something simply because another provider should have told them.

Ask.

Verify.

Clarify.

And document the education you provide.

It may feel repetitive.

It may feel unnecessary sometimes.

But a few minutes of medication education can prevent a much bigger problem later.

And honestly, that's one of the biggest shifts that happens as you gain experience as a PMHNP:

You stop thinking only about “What medication should I prescribe?”

and start thinking more about:

“What does this patient need to know to use this medication safely?”

That difference is part of becoming a better psychiatric provider.

Explore our resources for more tips for the new PMHNP starting out in practice.