When I first started practicing as a psychiatric mental health nurse practitioner (PMHNP), I felt like I needed to answer every question and concern patients messaged or called about between appointments.
If a patient reached out with a question, I wanted to help. If they had a concern about their medication or symptoms, I wanted to address it as quickly as possible. My intentions were good. I wanted my patients to feel supported, and I wanted to be a responsive, accessible provider. But I eventually realized how quickly this approach could get out of hand.
The Pressure to Be Available as a New PMHNP
When you're a new provider, it's natural to want to do everything you can to help your patients. You're still developing confidence in your clinical judgment, learning how to manage your caseload, and figuring out what it means to take responsibility for patient care.
You may feel pressure to answer every message, address every concern immediately, and find a solution whenever a patient reaches out. You might even worry that setting limits on between-appointment communication will make you seem dismissive or uncaring. But being a good provider doesn't mean being available to address every concern through a portal message or phone call. Sometimes, trying to resolve everything between appointments creates more work without giving you the opportunity to fully assess the situation.
A patient's concern might require additional questions, a more thorough assessment, a medication discussion, or a reassessment of their treatment plan. Those things aren't always appropriate to manage through brief messages.
Setting Boundaries Is Part of Providing Good Care
One of the things I learned with experience was that setting boundaries with patients is not the same as being unresponsive to their needs. Boundaries help establish how and when certain concerns should be addressed. They also help you recognize when a patient's needs require a different level of attention.
For example, a patient might send several messages about worsening symptoms or concerns about their medication. You could find yourself going back and forth trying to address each question individually. But sometimes, the more appropriate response is to arrange an earlier appointment so you can assess the situation more thoroughly. Instead of continuing the conversation through messages, you might say:
“I'd like to schedule you for a sooner appointment so we can discuss this in more detail.”
This communicates that you're taking the patient's concern seriously while recognizing that a message exchange may not be the best way to address it. Of course, the appropriate response depends on the nature and urgency of the concern. Some issues can be addressed through routine messaging, while others require prompt assessment or more urgent intervention. A boundary should never replace appropriate triage or a timely response to a safety concern.
The important thing is learning to distinguish between what can reasonably be handled between appointments and what needs a more comprehensive evaluation.
How to Start Setting Better Boundaries With Patient Communication
If you're a new or early-career PMHNP who struggles with this, here are a few things to keep in mind.
1. Pause before responding.
Before answering a message, consider what the patient is asking and whether the concern can reasonably be addressed through messaging. Does the patient need a simple clarification, or does the situation call for a more thorough assessment?
2. Recognize when a sooner appointment is appropriate.
If a concern requires a more detailed discussion, additional assessment, or a potential change in the treatment plan, consider whether scheduling an earlier appointment would be more appropriate than continuing an extended message exchange.
3. Use clear, supportive language.
Setting a boundary doesn't require a harsh or dismissive response. You can acknowledge the patient's concern while explaining the next step. For example: “Thank you for letting me know. I'd like to discuss this with you in more detail, so let's arrange an earlier appointment.”
4. Establish expectations for communication.
Make sure patients understand your practice's policies regarding portal messages, response times, medication questions, urgent concerns, and after-hours care. Clear expectations can help reduce confusion and establish a more sustainable communication process.
5. Remember that boundaries are part of professional development.
You may not feel entirely comfortable setting these boundaries at first. That's okay. Like other aspects of clinical practice, recognizing when to redirect a conversation or arrange a more appropriate evaluation takes experience.
Explore our resources for new grad PMHNPs and Psych NPs new in practice.
