How A Dual-Certified NP Connects Mind And Body with Dr Jen Wittman

Anxiety, anger, brain fog, panic, “can’t focus” days, and a body that feels like it’s betraying you often get treated like separate problems in separate clinics. That split can be costly. We’re joined by Dr. Jennifer Wittman, a dually certified Family Nurse Practitioner and Psychiatric Mental Health Nurse Practitioner, to talk about what changes when one clinician is trained to assess the whole system and take your story seriously.

Jennifer shares her non-traditional path from an art degree and car sales to nursing and dual certification, and why she believes mind and body care belongs in the same room. We get specific about what integrated care looks like in practice, including a striking example where “just anxiety” was not the full answer and a cardiovascular issue needed attention too. Along the way, we dig into how she builds shared decision-making from the first minutes of a new patient visit, naming options clearly while keeping control where it belongs: with the patient.

We also spend time on ADHD, especially the wave of adults, often women, getting diagnosed later in life. Jennifer explains how medication can help without changing who you are, why education and behavioral strategies matter, and how therapy can support relationships, executive function, and self-trust. We even name the grief that can come with a late diagnosis, the “what if” years, and how validation becomes a clinical tool.

Finally, we get practical about dual-scope practice in Iowa as a full practice authority state, including how billing can work when psychotherapy is part of care. If you care about holistic healthcare, patient empowerment, ADHD treatment, and Peplau’s interpersonal nursing theory in the real world, this conversation is for you. Subscribe, share with a colleague, and leave a review so more listeners can find the show.

Let’s Connect

Dr Dan Wesemann

Email: daniel-wesemann@uiowa.edu

Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner

LinkedIn: www.linkedin.com/in/daniel-wesemann

 Dr Kate Melino

Email: Katerina.Melino@ucsf.edu

 Dr Sean Convoy

Email: sc585@duke.edu

 Dr Melissa Chapman

Email: mchapman@pdastats.com

Transcript

Welcome And Guest Introduction

SPEAKER_01 0:30

I think we're recording. Welcome back, everybody, to another episode of Peplau's Ghost. I am so excited for our next guest. It's just, it fills my heart with these students that I've had in my program come back and see all the amazing things that they're doing and then have them here on this podcast to really just kind of shine a light on how the how these students have really just kind of continued to grow. So I am really excited to introduce Dr. Jennifer Whitman. Dr. Jennifer Whitman is a duly certified FNP psych mental health nurse practitioner. She currently works at Golden Oak Health and Corridor Academy in Iowa City, Iowa. And she's amazing. She's one of those students that as you get to know students sometimes, and as you are a faculty, you just

From Art Degree To NP

SPEAKER_01 1:13

kind of, you know, it's like being a parent. We all love, we love our kids, we love all our students best, but but there's always a couple students who are like, you're gonna do great things. And I think Jennifer was definitely one of those students. So Jennifer, thank you. Welcome. I also will introduce our my you know consummate uh partners, Dr. Kate Molino, Dr. Melissa Chapman Hayes, thank you for being here. And let's get into it. You know, I I think Jennifer, you said you listened to a couple of uh episodes before, so this next question may not come as a surprise, but I am a big origin story person. So so I really want you to, you know, maybe share a little bit about what brought you to Psych Mental Health. Obviously, you have both certification areas and and you know, kind of getting to know you before you were a student, things like that. I would really just love to get your thoughts on kind of where your life kind of took you to get to this point and, you know, both your education as now as well as now here in your professional life. So so I'll turn it over to you. Thank you.

SPEAKER_06 2:09

Thank you so much for having me. I love listening to podcasts, and this has been it's kind of a dream realized to be on a podcast. So this is really exciting. I'll give you the long, short version of how I came to be what where I am today. So I am the oldest of five kids. I'm a first generation college student. So the first time I went to college, I was very lost in kind of what college met and what I was going to do. So I ended up finishing with an art degree. And I feel like it's a very logical step process. After my art degree, I sold cars for about four years. While I was in the car business, I was like, I really love helping people. I love interacting with people, I love getting to the basis of what people's needs are. But I don't want to work every Saturday for the rest of my life. So I thought about, you know, a career that could help me foster that like desire to benefit other people. So I'm like, nursing is very logical. So I went to nursing school as a non-traditional student, knowing that I wanted to be a nurse practitioner. When I graduated from nursing school, I worked in med surge and then applied to the University of Iowa Failing Nurse Practitioner Program. After starting the F program and meeting some amazing mentors, such as Dan, I realized that the psych mental health component would be a really well-rounded approach to this career. So I added on the psych mental health component during my FP program and finished both in 2019 because I wanted to really focus on treating a whole individual. So using my background in kind of a little bit of everything kind of brought that to my life experience, school experience, all of that kind of combined to end up where I'm at today. So long short version.

SPEAKER_01 3:52

I love it. I love it. No, that's great. Thank you. I I I think I remembered the part about the car salesman, but no, yeah, when you said that, that's uh and again, I I bet you did very well there, but but yes, we we kind of want to balance that uh work life balance for sure. So so yeah, thank you very much. I'll turn it over to Kate now to uh for the next question.

SPEAKER_03 4:09

Yeah, thank you, Jen. I I just want to say I love what you just shared. I think I know that I am a sort of quote unquote second-entry nursing person. I know Dan is as well. So I always love to hear about people's pre-nursing lives and kind of what brought them in. And I also really have observed over the years that, in my opinion, people who are drawn to psychiatry and mental health are really creative, often have backgrounds in arts and you know, all kinds of other dance and you know, cooking and all kinds of other cool stuff. So thanks for highlighting that. That was great.

Breaking The Mind Body Silo

SPEAKER_03 4:43

My question for you you said that you sort of chose this path so that you could manage the patient as a whole person with your dual expertise. And we know that Peblao really fought against, you know, reductionist views of patients or diagnoses and really encourages to take a holistic approach. So I'm curious, given our current modern healthcare system that really segregates mind and body, how does your model really bring together Peblau's version and give it life?

SPEAKER_06 5:16

Yeah, I think as a system, we're still working through how to do that. There's so many barriers in our healthcare system to providing that integrated care or that dual care. So, my previous role, I was in a family practice setting where I saw all of my patients for primary care and a large portion of my patients for psych med management. And when I would meet my clients for the first time, I would tell them, you know, our body and minds are so connected, right? Like our physical health and our mental health are connected. If we're not feeling good physically, we're not feeling good mentally. And we have to learn how to assess the entire system approach. And so what I would, what I would kind of how I would bring that in is really in every appointment, look at where their physical health is and mental health is and how are they connected and what underlying what what's the underlying cause of their symptoms today? And so could that be, could that be thyroid, could that be gut health, could that be depression, could it be anxiety? So we're so used to siloing healthcare where we have these people over here that work on the body and these people over here that work on the brain, and like our head is not over in this direction, right? It is all connected. So kind of doing the program that allowed me to understand all of that. And then as nurses, right? Like in nursing school, we're taught all this dick care, the bio, psychosocial, what makes a human tick. And so it was, it felt, it felt just ingenuine to me to not learn both of that in grad school when that's what we learn as nursing students.

SPEAKER_03 6:45

So was that kind of does that answer your answer your question about absolutely if it would be okay if I could ask a follow-up. Of course, of course, yeah, absolutely. I'm I'm curious if you could maybe give an example of a patient you saw and then having this dual experience, something that you were able to identify that had they needed to go to a separate primary care and a separate mental health might have been missed or fallen through the cracks.

When Anxiety Is A Heart Rhythm

SPEAKER_05 7:08

Oh my gosh, that's a really good question. Trying to think back through my primary care life.

SPEAKER_01 7:13

Well, Janet, let me, you know, I think we were just talking about a couple examples before we started recording, right? Um of some situations. Maybe that can kind of springboard to some some other examples we can think of too.

SPEAKER_06 7:23

Yeah. So finding a patient that would have maybe missed a diagnosis. Is that what you're saying in terms of like if they saw separate separate providers? Also thinking about like length of time in our healthcare system, right? About time we're able to spend with clients too, kind of plays a role in that as well. I do have, you know, a patient of mine who actually I still see today in my current practice who was able to follow me for mental health needs, but I still follow her primary care stuff very closely. She is a young black woman. She is very insightful and very intelligent and had constantly been dismissed in the healthcare system. She came to me with a lot of anxiety and had been kind of treated in the psychiatry world as like she said that she was diagnosed with DID as a child, uh but had a lot of trauma. And when she would come in and talk about our symptoms, we focused a lot on anxiety and anger issues. But then I also kind of started to delve into her family background and her medical background. And she did end up having cardiovascular tachycardia SVT. And so I feel like most people would dismiss her as being anxious. Like she would go to the hospital with these symptoms and they'd be like, You, you know, you have anxiety, you should go talk to your psychiatric provider for that. And then when we really kind of delved into her symptoms and background and family history and kind of the experiences she had up till then, it was like, Yeah, you you have anxiety. This is true, but also like you do have a cardiovascular reason that makes you feel anxious. And if we could kind of help collaborate care with cardiology and really get you treated, we can then assess better how that affects her anxiety. And then also gave her some like autonomy to be able to speak for herself in a medical system when she had been dismissed so often by providers. And so I still to this day, I'm like you stand up for yourself and I constantly tell her how insightful and smart she is. She's very well read, she's very intelligent, and she just doesn't know how to speak up for herself sometimes. And so kind of empowering her to do that in a in a in a bigger system.

SPEAKER_03 9:33

Thank you so much. It's an incredible example. Yeah. I'll turn it over to Melissa.

Building Shared Power From Minute One

SPEAKER_04 9:38

Like, yes, Ditto, it's incredible. And I think maybe you want to stay with this patient example or not, because my question is going to focus on that team effort in the orientation phase specifically. So Peplau's theory emphasizes the relationship between a nurse and a patient as collaborative, a shared human experience. And you've mentioned that you firmly believe that healthcare works best as a team effort where patients are active partners in making decisions, as you just gave a great example about. So, how do you deliberately cultivate that shared power dynamic during that orientation phase? I mean, you've you've mentioned it. So I don't know, that's why I said maybe you want to dive deeper into this example, or or you could talk higher level, you know, whatever you, whatever strikes you.

SPEAKER_06 10:24

At every new patient appointment, I tell the patient, I start, I'm I start with, I'm gonna talk about me for just a minute, and then we'll get into why you're here. And I tell them about my practice style is it is important that they understand I will not make them do anything. I can't make the person do anything when they leave my office. It's not fair for me to try, it's not fair for them for me to go through some checklist and be like, boop, boop, boop, boop, boop. Okay, Dan, you're gonna do this, and good luck. We'll see you in six months or whatever the follow-up is, right? And so I explain to them like, I will always tell them what I see, what I recommend, what options are available, what I'm observing as a clinician. But ultimately the care plan is their decision. And I explained to them that I want to take a team approach. So I will give them my medical expertise based on what I'm seeing. So they have all the all the information to make a sounded decision, but I help guide them in decision making. I'm very conservative with medication management. I start low, go slow, change one thing at a time, and I'm a strong advocate for integrating psychotherapy, which is, you know, a big part of this conversation today. Um, I'm a big fan of integrating that. And so I will always present them all aspects of a care plan and help them choose what parts of the care plan work best for their lifestyle and what they feel is most doable for them when they leave the office. So it's kind of a broad approach. Um, but that's how I start every new patient appointment and then get into what brings you in to see me today.

SPEAKER_04 11:47

I really appreciate that example. Both your example with Kate and then your response here because it is very strongly coming through how you are kind of buttressing and supporting these people and their own power and knowledge about themselves and then what you bring to the table and how you work together as a team. Thanks. I'll pass it to Dan.

ADHD Beyond The Prescription

SPEAKER_01 12:08

Yeah, this is great. I maybe get a little more nuanced here and talk a little bit about your, you know, your area of expertise of helping people with ADHD. You know, as we know, ADHD, you know, can really impact a lot of people's, you know, interpersonal dynamics, relationships, and their executive functioning. And I think it does, you know, it requires more than just a prescription. Obviously, medications are very effective, but how do you see, you know, counseling and therapy kind of being helpful for people that have ADHD symptoms and getting them better on their interpersonal dynamics and their relationships and and other areas of their lives as well?

SPEAKER_06 12:42

Mm-hmm. Yeah. So a lot of it is education, right? And you know, this theme that I'm seeing in practice is how it's probably overgendered, but mostly women, right, that are diagnosed with ADHD later in life have been validated because they've not just developed ADHD as an adult, right? They've had it their whole lives, but they're typically highly intelligent, never had to really pay attention to be good at what they do. And then they get into an area of their life where the work is harder or it's different and the things that they've done before to get by don't work. So we have this education on how the medication works, right? I always tell them like, my goal with your medication is you're able to reflect on the back of your day, the rest of your day and look back and be like, oh, that was easier. I don't want anyone to feel their medication. But I'm also very, you know, straightforward on the medication will get you to a level where it's easier, but these are the behavioral modifications in which can be beneficial. And it's really custom to what the person does. Is it their job that they're having the most difficulty with or school or home or collaboration of all of those things? Like what kind of custom behavioral modifications work best? Is it time chunking? Is it organization? Is it taking things one step at a time? Is it making lists? In terms of interpersonal communication, just acknowledging the fact that being neurodivergent is not a disability, it is could almost be like a superpower, right? It's like there's nothing, it's it's just a different way that your brain works and and the world is set up in a neurotypical way. But I feel like the more there's education out there, there's, you know, YouTube, there's all these things now that we didn't have when we were younger, that are kind of helping people also understand how to interact in that world of being neurodivergent and neurotypical world. So, but just really helping them identify where their weaknesses are and what behavioral modifications or things can benefit them specifically. So I kind of take bigger ideas and kind of custom it, customize it using the patient's ideas too, right? Like that motivational intervention is really important. Like, where do you see your detriments or what do you see as being a benefit in in your in your role or your job or wherever you're at?

SPEAKER_01 14:51

Yeah, that's awesome. Uh, you know, if I can follow

Late ADHD Diagnosis And Grief

SPEAKER_01 14:54

up with that too. I mean, I I agree, you know, it does, and I've talked to colleagues about this too. There seems to be this influx, especially post-pandemic type of thing where people are coming and looking at ADHD symptoms. And unfortunately, the research does say that we we've missed the boat very much on women and and young girls kind of with diagnosis of ADHD. And I think, and thank you for highlighting that too. But one of the things I've I've talked to a colleague about is, you know, making that diagnosis later in life. Is there any, or have you seen this, or what are your thoughts on this as far as maybe like there should be a grieving process a little bit? Like, like I was missed, you know, and and and life didn't have to be this hard, you know. And I've I've there's been decades that, you know, we can't go back, there's no time machine or anything. So I can only look forward, but still there is that kind of grieving process of, oh man, there's there's so much in my life that could have been different if if this was identified and treated. So do you see any of that? Or do you do you see that in your practice? Or are how do you deal with that too?

SPEAKER_06 15:46

No, I think that's a great point. Um, I how often do we hear what if my life could have been? What could my life have been? And I and I acknowledge it, right? It's valid. It's a very valid, very valid response to this, like, oh, I feel so validated, this whole like relief that they have a diagnosis and now there's I know there's nothing wrong with me. It's just this is the diagnosis. And then you see that shift in the like, man, what would I have done differently in college or would I have gone to college or you know, would I have done this job differently? And so it's it's validating that response and then helping them work through like you wouldn't be who you are today if you didn't have the experiences you had with what you were working with. And so it's not as simple as if we turned a light switch and now all of a sudden you're, you know, 12 again, and your teacher's like, hey, wait a second, you're daydreaming over there. Let's give you some medication. That might have not created a path that led them to where they're at currently. You know, so it's it's validation of that response because it's it's a true initial response to that grief process, but also help them see that this is where your life is now and this is how we move move forward, and you wouldn't be who you are today without the experiences you've had with who you are.

SPEAKER_01 17:02

I love it. That's great. That's great. Thank you, Jen. That's uh appreciate that perspective. I'll turn it back to Kate.

Creating Safety Through Time And Trust

SPEAKER_03 17:09

Something that is just really coming through for me in this conversation is just your real focus on sort of validation and empowerment for people who have not traditionally been empowered in these spaces. You know, you talked about working with clients of color, you know, women who, you know, often are really underdiagnosed with a lot of things. And then I know you also work with children, adolescents, and LGBTQ plus patients. I'm curious if there are any other kind of you know, boundaries or clinical approaches that you intentionally use, given your focus on this, to make sure that people feel genuinely safe when they step into your clinic.

SPEAKER_06 17:49

Can you help me understand that question a little bit more? Like as like in addition to like validation and empowering what kind of strategies do I use in my clinic?

SPEAKER_03 17:57

Yeah.

SPEAKER_06 17:58

Like I I really think that like I like to spend time getting to know each individual as who they are. And so if it's more of, you know, think of like some examples of people that gosh, you were coming up with the hard ones, Kate.

SPEAKER_03 18:18

You can also feel you can say pass also. That is always an option on Pebbles.

SPEAKER_06 18:24

Um no, it's just uh I sometimes I don't think about what I'm doing when I'm doing it. Does that make sense? Like I don't sit back and think, okay, I'm using validation, I'm using empowerment. I just feel like I genuinely care about what people's stories are, who they are as a human. And I help cultivate that and meet them where they're at. And so I mean you can't intelligently speak through what those strategies specifically are, which is why I'm kind of like trying to think through what are the actual like names that you would learn in a book about what this actually is. But but no, it's it's I I like to have you know longer appointment times because I really genuinely care about the human and who they are. And and part of the reason I went to family practice is I love understanding the whole family system, like who is in their family. And when I was in family practice, I loved that I had a couple large families that there was one I called the family. And it was I literally saw the grandparents, the aunts, uncles, cousins. There was like that core family that I started with, and then all of their extended family came to see me. And every single person I'd meet in that family, I'd be like, this makes so much sense as to why this person is X, Y, or Z. So I know that's not directly answering your question, but kind of how I find joy in what I do is connecting with the person and spending time, getting to know who that person is, and then building kind of that trusting relationship and then being able to walk with them on what their needs are. So I don't know what you would call that.

SPEAKER_03 19:51

Yeah, well, I really appreciate what you just said about finding joy in your clinical work because that is such a that's so important for being able to continue in this career and being able to help people like we want. So thank you for saying that.

SPEAKER_06 20:06

Yeah, my previous job, they kept trying to tell me, you know, if you want more time to document, then you just spend less time with your patients. You still need to see this higher volume of patients. And I kept telling them, like, you're taking all of the joy out of what I do. Like, I would rather see less patients and spend more time with them and bill accordingly, right? Like, we do have the ability to bill for that. Um, but yeah, do not take away my ability to spend time with my patients because that's what I truly enjoy about my job. The other stuff I do, but I would rather talk to people all day, you know. And that girl in school that got in trouble for talking to people all day. And I'm like, well, now I get paid to do that. So, you know, Dan nods his head because he knows me.

SPEAKER_04 20:48

Um, so the next question is back to the name of the podcast, Peplow's

What Would Peplau Approve Of

SPEAKER_04 20:59

Ghost. It's named that because we look at how her pioneering pioneering spirit haunts and guides the current generation of nurse practitioners. So, as an independent clinician practicing at Golden Oak Health, if the ghost of Hildekard Peplau were to sit in on one of your collaborative treatment planning sessions today, what aspect of your integrative practice do you think would make her say, yes, this is exactly what I meant?

SPEAKER_06 21:27

Oh my gosh, could she though? That would be so amazing. I do believe her spirit is with all of us, right, at all times. I really do spend a lot of like the medication part is important in an appointment, right? We have to know if there's side effects, but that that part of my approach to my appointments is kind of spread out throughout. I'm never one that sits there and is like, okay, you're on this dose, 200 symptoms. Um, it kind of comes up, it's more a conversational appointment. Um, and so I feel like she would be happy with the fact that we're not. Just follow me in a checklist like, okay, I have your anxiety symptoms. Do you have irritability, anxiety, worry? Are you, you know, we talk about those things, but it's more of a conversation. So I started my appointment with tell me how you're doing since the last time I've seen you. Describe how your anxiety feels to you. And then once they start kind of going through how they're experiencing their anxiety, then we can bring in cognitive behavioral techniques and we can bring in motivational interviewing, and we can bring in activation without thinking, okay, now I'm going to do cognitive behavioral therapy with this patient. It really is a conversation, and you're using these skills through your interview process while slipping in the medication stuff as you go. But really, the appointments focusing on each individual and how they experience their symptoms of their diagnoses.

SPEAKER_01 22:50

That sounds like an interpersonal process to me. That's awesome. Very good. Yeah, that's awesome. Thank you, Jennifer. This is great. So we're going to introduce something new here on this podcast. We are going to have our previous guest, Dr. Karen Cavarno, kind of in a ghost and spirited way. She's going to come back to us from the last episode and ask you a question.

SPEAKER_05 23:11

Okay.

SPEAKER_01 23:11

And so we're going to have you listen to their question and then respond to it on the other side. So all right, we're back. All right. We're going to try something new here on Peplau's Ghost, where we're going to have the current guest, well, current sitting here in my chair right now, ask our future guests. So we have Dr. Karen Carvarno asking question of Dr. Jennifer Whitman.

Dual Certification Scope And Billing

SPEAKER_00 23:30

Hi, Dr. Whitman. I understand that you're dually certified Psych NP with an FNP and Psych NP certification. And I have been very interested in that for a very long time. I started when we first started the NP back when I was at University of Maryland, we tried to bring the two together and call it a primary care psych NP. Well, it didn't, it's never been quite that easy, as you know, and there's the certifications have stayed separate. So my question is: how did the addition of uh the psych NP uh impact your legal scope of practice in your state? Because I think each state's a little different. So you might want to. I mean, I'd love to hear what you say about how it is for you, whether you can practice both scopes, whether you have to kind of choose one or the other. Because we've had that kind of a controversy about that in my state of Maryland.

SPEAKER_01 24:41

Thanks, Karen. Great.

SPEAKER_06 24:43

What a question. What a great question. Luckily, thanks to the advocates before me, I practice in Iowa, which is a full practice authority state. So I am very fortunate where I'm able to practice autonomously with my license. In the dual role, insurance is still set up that we can bill for one or the other. But the but how I practiced dual, especially when I was in the primary care world, is it really just matters what your for insurance purposes, what your primary code is and and kind of what you're doing with the patient. So, you know, if we're looking at medical decision making, you know, if my primary code is psych mental health focused, I can still address physical symptoms. I can still address physical diagnoses like a blood pressure or an A1C and still put it in my note and still treat the patient. We just don't bill insurance for that, but we're already have enough for medical decision making to be billed as, you know, a 99214. And if we're spending a majority of the appointment in supportive psychotherapy, we can still bill the 90833 or whatever else, you know, however long we're spending in that appointment. And so it's not, I guess, legally stated or insurance recognized, but we're still able to I still have the credentials to be able to treat both while the patient is in front of me. You just bill creatively, maybe is the best way to put that.

SPEAKER_01 26:11

We'll wrap up there so we keep Jennifer from getting into legal trouble. No, I'm just kidding.

unknown 26:15

No, no.

SPEAKER_01 26:16

No, that's great. I mean, the one of the questions too that I get asked, and and you may have even asked me this as a student, but I I students to continue to ask me, is like, what what other billing codes can I use as a psych mental health that other nurse practitioners can't, right? As an FNP, is there certain and I don't know if there is anymore. There used to be kind of you know a psych evaluation, but I think we use, and correct me if I'm wrong, I think we use kind of the same evaluation codes at this point, too, the 9921, you know, 99204 or 5, depending on severity. But yeah, it's do is there any kind of real difference as far as you know the codes that you use between both certifications, or pretty much like you're talking about medical decision making and things?

SPEAKER_06 26:57

The exact same EM codes in a primary care setting, uh a straight certified primary care provider, even if they are doing psych med management and support psychotherapy, wouldn't be able to build those additional psychotherapy codes. But I was able to build them in a primary care setting because of my credential as a PMHMP. So awesome. Um yeah.

SPEAKER_01 27:18

So great. No, that's awesome. Thank you again, Jennifer. This is again, this is Build My Cup. It's so good that you are doing so amazing things, helping

Where To Find Jennifer And Closing

SPEAKER_01 27:27

so many people. And uh, if you're interested in getting in touch with Dr. Jennifer Whitman, she is published in uh psychology today. And uh obviously her email will be available here on this podcast. So look forward to that. Please like, subscribe, comment. Please let us know if you like this idea of having the past guest give a question to our current guest. Hopefully, there's no latitude fallback with that, but because we have seen it in other podcasts too, and we'd love to steal good ideas. But otherwise, look forward to another episode of Peplo's Ghost coming out soon, and thank you so much.