Ketamine infusions are an in-demand mental health service which has shown powerful results in the treatment of many psychiatric disorders. According to the Elite NP Model and niche practice guide, ketamine infusions are a great option for NPs looking to become business owners or expand their practice. Here, Elite NP founder Justin Allan chats with Heather Pearce-Shew, CRNA, MSN, a successful advanced nurse practitioner and IV infusion clinic owner.
During this short interview, Heather will answer questions surrounding ketamine infusion therapy and speak on her personal journey with integrating this type of treatment into her practice. She stresses razor-sharp focus, and urges NPs to hone the skills necessary to monitor patients during treatment. We reflect on the best work styles and personality types suitable for an IV infusion practice, and both Justin and Heather agree that “Type A” individuals will thrive in this environment!
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Justin Allan: I’m excited to meet today with Heather, an advanced nurse practitioner and owner of a thriving IV infusion practice. Heather performs ketamine infusion therapy all while finishing her NP degree and working full time. Talk about a superhero AP! She has operated her business out of North Carolina for the past five years and loves what she does. I’m thrilled to collaborate with her on the development of Elite NP’s ketamine infusion course. This course really is a treasure for the NP community and for those interested in this niche practice.
Hi Heather, please tell us about your experience as an RN and CRNA.
Heather Pearce-Shew: I did not become an RN until I was 32 years old. As a more mature student, I quickly realized that I did not want to stop at the undergraduate level and definitely intended to attend graduate school. As I encountered various advanced practice nurses during clinicals, I gravitated toward the CRNA role. So, when I graduated nursing school, I immediately took a job in an ICU to start working on the practical skills and satisfying requirements that I would need to apply to anesthesia school. I was 37 years old when I graduated from anesthesia school and have been a CRNA for 15 years. I now work in an office-based setting providing anesthesia for office-based procedures, which means that not only do I now keep office hours (fabulous!) but I’m also the sole anesthesia provider on-site with a lot of autonomy.JA: Why did you decide to open a ketamine clinic?
HPS: I was, of course, familiar with ketamine as an anesthesia medication, often used in combination with other anesthetics. When I began hearing about ketamine being used for treatment resistant depression and other mood disorders, I was fascinated. Then I learned that CRNAs and NPs were opening their own offices and realized that I could do that as well! There were few ketamine clinics in my area, so I saw a perfect opportunity. There are no other ketamine infusion clinics within three miles of me, so now I am providing a very needed service and I have no competition. It’s been great!JA: You are going back to NP school. Why? Do you believe it is advantageous to be an NP when operating a ketamine infusion clinic?
HPS: The clinic that I opened over five years ago is a ‘wellness’ style clinic, not just a ketamine clinic. In North Carolina, CRNAs do not have either prescriptive authority or diagnostic authority. Unfortunately, our recognition of being an advanced practice provider is limited to the anesthesia setting. I quickly realized that if I felt that a ketamine patient could benefit from home-prescribed lozenges or nasal sprays, I had to convince their PCP or psychiatrist to prescribe it for them, which means that most patients are going without the benefit of home-use ketamine.
Most PCPs are honestly afraid of ketamine! They do not understand it, they’ve never utilized it for other patients, and they’d rather write a script for Percocet or Xanax rather than ketamine! This is insane once you understand how well it [ketamine] works!. I would also like to take advantage of the telemedicine opportunities with ketamine and I cannot do that as a CRNA.
Additionally, I am adding other services to my clinic, such as vitamin/hydration infusions, aesthetics, weight loss, and HRT, which of course are not categorized as part of an anesthesia concentration. Adding an FNP certificate to my scope of practice will allow me to continue to expand my clinic while broadening my own knowledge base. You NPs are lucky as you can do it all, within reason of course!JA: What types of patients do you see in a ketamine clinic?
HPS: For awhile, most of my patients tended to be pain patients. Then I started picking up more psych patients. So right now, I have about a 50/50 mix of mood and pain patients. There isn’t just one type of ketamine patient. The demographics are wide-reaching: men and women, ages ranging from 25-70, with so many different types of backgrounds, from unemployed on medical disability to business owners. It is very diverse!
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Many of my current patients have some sort of healthcare background. I have several nurses, EMTs, and MAs as patients. I even have a few patients with histories of addiction. These patients come from all walks of life and just want to get their lives back on track. Overall, they want to be more functional. If intelligence and discipline could fix their problems, none of these patients would have any issues at all. But of course, that is not what fixes difficult medical problems. It requires some thinking outside of the box with a non-standard approach. That is why they come see me. Many find out about ketamine online and actively seek out treatment.JA: What do you find rewarding about providing ketamine infusion treatments to your patients?
HPS: The most rewarding thing is to hear someone tell you how ketamine truly saved their life! It’s giving people their lives back and helping them function normally again. The funny thing is that they treat me like I invented ketamine all by myself, rather than just simply being the one who starts the IV and hits the “Go” button on the pump (it’s a little more complicated than that, but it’s still relatively easy!).
They can’t get this treatment just anywhere and they’re grateful that I have the courage to do this. Yes, many people think that what I do is strange. But I don’t mind that at all! In fact, a number of therapists that I refer patients to frequently tell me that that’s what they love about me. I do the strange thing that baffles other providers. I don’t mind being the “psychedelic sheep”.
JA: Is there a passive income opportunity with ketamine infusion?
HPS: Yes! This is the perfect add-on to an existing clinic. It’s possible to employ an RN or paramedic managing the infusion while the nurse practitioner sees other patients. The NP can do various office visits (weight loss, other infusions, HRT, etc.) while the RN/paramedic is in the other room managing the infusion. The RN is basically generating the ketamine revenue for you. Many ketamine clinics are doing this now and I will be moving in this direction once I finish my NP degree.
JA: What type of nursing background would be ideal to have for the NP interested in providing ketamine infusion therapy?
HPS: I think anyone who has ever spent time doing sedation, monitoring and/or managing IVs would be a good fit for ketamine infusion. However, this skill set is not completely necessary! Really, any NP who feels comfortable in an ED setting would be ideal, because you have to be ready for whatever walks in the door and you never really know what that could be. You need to be ready for the unexpected, the challenges, and know that sometimes you have to act quickly. Essentially, you need to be an NP that can think on their feet! You also should have your ACLS certification. JA: Is ketamine therapy safe?
HPS: People don’t realize just how safe this medication is. It is extremely difficult to give enough ketamine to cause someone physical harm. Remember, you are giving patients a sub-anesthetic dose of ketamine for their mental health disorders and/or chronic pain. The biggest concern with larger doses is an unprepared patient being dropped into that ‘K’ hole—high anxiety, disassociation, unresponsiveness. While not a medical emergency, it can be distressing to the patient. This can be a scary situation if you aren’t expecting it, but even this is rare. I’ve heard from numerous patients that they received ketamine either at the ED or on an ambulance after an injury and it really scared them.
Whomever administered the ketamine didn’t understand that in an acute setting like that, you absolutely have to give something else to take the edge off of the dissociation that ketamine induces. However, a bit of education would help people be more conscious of this, and I cover it all in the course. Ketamine is a wonderful and safe medicine when used properly. It just takes the right instruction on how to do it right.JA: How much did it cost you to start your ketamine infusion clinic?
HPS: All the equipment for my ketamine room, including my comfy recliner, cost less than $5,000. Now, I am also doing hydration and vitamin infusion therapy in the office, so my total start-up cost was closer to $20,000 because of all of the other furniture I purchased and the remodel of my office that needed to be completed. I had to replace floors, put walls in, paint the office, etc., so let’s just say the costs went up a lot. I actually put all of it on a 0% credit card and had it paid off within a year. I essentially gave myself an interest-free loan! If I didn’t have to do the remodel, I would estimate the total cost to be less than $10,000 all in.JA: How profitable are ketamine infusion clinics?
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HPS: Now, keep in mind that I’m doing this part time, since I still work full time and I’m also back in grad school part time. So, for now and probably the next year, I’m limiting my patient base so that I don’t spread myself too thin. But here’s an example:
In addition to my small regular patient base, I took on one new mood patient in December 2020 (I postponed three new patients because I was building this course) and my ketamine income for the month was still $3,500 for December. This was about 12 to 16 hours of work for the month. In October 2020, I accepted two new pain patients and my ketamine income for the month was $8500. All of this was done very part-time, in addition to my full-time job and doing grad school part time.
I would say that for someone who already has an established practice and either has an RN or can hire a trusted RN or paramedic to assist with the ketamine patients, you could literally fill your schedule all day long. I’ve been declining new patients for several months because I know that it will spread me too thin. I still have my current patients and other obligations in my life. When my schedule is more flexible after I finish my NP degree, the sky is, literally, the limit. I am very excited! I know I could easily make this a $20,000 per month part-time practice on 15 to 20 hours of work per week.
JA: How difficult is it to get started? Has malpractice insurance been an issue? Any specific regulations, certifications, or licenses that you need to have to administer ketamine infusion therapy?
HPS: It’s not very difficult to get started. You can find most of this equipment relatively easy online and all the medications you need are available from standard medical supply companies. Once I got the word out, the patients started calling very quickly. I was surprised by how busy I got in a relatively short amount of time!
Malpractice hasn’t been tough because most companies that provide medical malpractice understand that there are just a few less common medical treatments out there. You will very likely end up answering a lot of questions about ‘how’ you do what you do, such as patient monitoring, acquisition, etc. I’m accustomed with my anesthesia job to carrying a $1 mil/$3 mil policy, and I have the same coverage with my ketamine clinic. There are a few extra hoops to jump through, but it is very doable.
As for certifications, I would suggest brushing up on conscious sedation skills (even though this therapy isn’t even as deep as that.) just because it helps you refamiliarize yourself with the need for individualized care and vital sign monitoring, or how to designate your RN to do this.
You should also be ACLS certified because you need to try to think of a few acute things that could happen and you need to be ready for it. Someone may have a seizure or a person’s blood sugar could drop to the point of them becoming symptomatic, even though this is very rare. I once had a patient go into bigeminy towards the end of a long pain infusion. After stopping and restarting the infusion twice, I finally just stopped it completely, gave them the telemetry strip, and sent them to a cardiologist for follow-up. It did not become an emergency because I was on top of it and doing something about it. That’s really the key when monitoring the patient during treatments like this. You need to be very focused on the patient’s condition and the monitor. When you are noticing everything, you immediately know when something deviates from the norm and can immediately provide an intervention or troubleshoot the issue.JA: Any additional information you would like to share to the Elite NP readership about ketamine infusion therapy?
HPS: If you’re looking to start a clinic from scratch and are on the hunt for an office space, feel the landlord out before telling them what you are going to be doing. Many are turned off by the word “ketamine.” I have known several practitioners who were denied renting a space when the landlord heard the word ‘ketamine’. I think they equate it to a methadone clinic, so they think there will be many questionable patients in and out, or maybe the word just scares them. Heck, it scares many other practitioners, so a layperson may be hesitant as well.
JA: Thanks for your time in answering those questions, Heather! I hope this interview was enlightening to readers who have considered integrating ketamine infusion therapy into their practice. If you are not interested in the infusion component of treatment, then consider integrating the use of ketamine troches and intranasal sprays into your practice. It makes for a great alternative medication for patients with mood disorders or chronic pain conditions. These services can also be provided through a telemedicine platform to help patients who have stabilized from infusion therapy but do not want to continue paying for the infusions. This is covered in more detail in the course.
Remember, The Ketamine Infusion Course is currently available online for $499. This is the most affordable ketamine infusion clinic course on the market today, and I am very excited about providing a budget-friendly ketamine course to the nurse practitioner community!
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