New PMHNPs: Don't Wait to Send Orders
When I first started practicing, part of my psychiatric nurse practitioner workflow was waiting until the end of each patient visit — or if I was really busy that day, until lunch or the end of the day — to place every medication, lab, referral, and order.
It seemed more efficient to finish the conversation first and then complete everything at once.
Then, I started seeing that this was actually slowing me down and creating more work for me towards the end of the day.
By the end of a busy day, I was trying to remember exactly what I had discussed with each patient. Did I already send that medication? Did I remember to order those labs? Did I forget the referral we talked about?
The busier you get and the more patients you see in a day, the easier it becomes to overlook or forget something.
The PMHNP workflow change that made a difference
Now, as soon as I know an order needs to be placed, I try to enter it before moving on.
For example:
If we've decided to start or adjust a medication, I place the prescription while we're discussing the plan. It’s okay to tell the patient “Bare with me for one moment, I want to make sure I get this prescription ordered right away.”
If I know I want baseline labs, I submit those orders before we move on to the next topic.
If the patient needs a therapy or specialty referral, I submit it while it's fresh in my mind.
I don't wait anymore until the very end of the appointment if I already know what needs to be done.
Why this helps
Making this small PHMNP workflow change has helped me:
Reduce the chance of forgetting an order.
Spend less time having to go back because a patient messaged or called saying “You forgot to order the medication we talked about…”
Feel less mentally overwhelmed by the end of the day because I know all orders have been entered and all I need to do is finish writing any notes that are pending.
Finish visits with greater confidence that everything has been addressed.
It's a simple workflow habit, but over weeks and months it saves so much time and mental energy.
A few exceptions
There are times when it still makes sense to wait.
If I'm still gathering information, considering different treatment options, or discussing a decision with the patient, I hold off until we've finalized the plan.
The goal isn't to rush—it's simply to complete tasks as soon as you're confident they're appropriate.
Small habits add up
One thing I've learned while I was starting out as a psychiatric mental health nurse practitioner is that the biggest improvements often come from small workflow changes rather than dramatic ones.
You don't need a completely different system to increase your productivity and efficiency as a PMHNP.
You just need small habits that reduce cognitive load and make your clinic day a little smoother. They often have the biggest impact over time as you get your bearings as a new Psych NP.
Explore our resources for more tips for the new PMHNP starting out in practice.
