Dr. Shayla Buckler (00:00)

The bulk of my patients cannot sleep. And so that's usually one of the main causes of executive dysfunction. If the brain does not get the full rest that it needs, at least the six to eight hours, then we cannot function.

Sheela (00:14)

Welcome to Not on the List, where we have conversations with professionals about executive function, support, and the things we don't talk about. For those of us with never-ending lists, I'm Sheela Ivlev, a neurodivergent occupational therapist with chronic health conditions and founder of Todo-Ish. We're in conversation today with Dr. Shayla Buckler, a board-certified psychiatric mental health nurse practitioner. She's also an assistant clinical professor for over 20 years.

Her clinical work focuses on providing trauma-informed psychiatric care to adolescents with mental health and substance use disorders. And Dr. Buckler is dedicated to improving outcomes for under-resourced populations and preparing the next generation of nurses. This conversation is for education and not medical advice. Dr. Buckler, welcome.

Dr. Shayla Buckler (01:05)

Very happy to be here.

Sheela (01:06)

So I'm gonna get right into it. Can you tell us what a psychiatric nurse practitioner is and how that role might differ from, say, a psychiatrist, a therapist, or even your primary care physician?

Dr. Shayla Buckler (01:20)

so a psychiatric nurse practitioner, we are board certified through the American Nursing Credentialing Center. we are able to diagnose, treat, and provide medications for patients. We started out as registered nurses. the basics for psychiatric nurse practitioners

Is to obtain a master's in science and nursing, or you can be doctoral prepared, such as myself. So I'm a doctoral prepared nurse practitioner, so I have a doctorate degree. in the world of academia, they call me Dr. Shayla. but seeing a psychiatrist, they went to medical school and they're medically trained. We do primarily the same things except for we can't practice independently in certain states, but they can practice independently in every single state. So when I say practice independently, that means that I have a psychiatrist that is my supervising physician that I collaborate with. So I have my own private practice, but if I had questions or anything regarding care and I needed some support, then I'm able to contact my collaborating physician. psychiatrist, they went to medical school, they're medically board.

Certified, and so our roles do typically overlap. So a lot of psychiatrists hire us to come in and help support their practice because we can function in the role of doing assessments, doing diagnostic testing, providing medications, and coming up with treatment plans with patients. And then a primary care physician, there's also family nurse practitioners that work side by side with primary care physicians, where the primary care physician takes the role.

Of the overall general care of the patient. So it's more of a generalized care where you can go to anywhere from head to toe. Psychiatry is a specialty. So when someone is having some mental health challenges, then their primary care would refer out to a psychiatrist or psychiatric nurse practitioner. So we can have our own practices. We can work independently in certain states. I'm in the state of Texas where I have to have a supervising collaborating physician that I work with.

And then a therapist, we work hand in hand with a therapist because we also do psychotherapy with our patients. It's I think as a psychiatric nurse practitioner, it's very challenging to be able to not listen to your patient and their concerns and be able to give them some guidance and some coping skills and not just prescribe them medications and send them out the door. Our goal is to help everybody to be able to maintain mental stability and to be able to offer them that support.

Through psychotherapy, giving them some coping skills where they're able to maintain their condition and work through some of life's challenges that they have. So that's kind of our differences. But I have a I have two therapists actually that I collaborate with and send patients to, and so we kind of send patients back and forth. I'm very eager at teaching my therapists about psychopharmacology because that's my specialty. I teach in the psychiatric nurse practitioner program as well. And I

I love to educate and make sure that we're giving patients the medications that they need and to make sure that they're understanding how the medications impact their lives and how we need to make sure we monitor certain lab values and their care.

Sheela (04:41)

That's amazing. So it sounds like you are really an instrumental part of the most important parts of a person's mental health care.

Dr. Shayla Buckler (04:50)

Yes,

Sheela (04:51)

I would love to hear about your practice. you're in Texas. can you tell us just what's unique about your practice and kind of what brought you to it? what brought you to where you are right now?

Dr. Shayla Buckler (05:01)

Well, my practice is in Mansfield, Texas, which is part of the DFW Dallas Fort Worth area. Mansfield is a very large population, very diverse. I love working with diverse populations. And my biggest goal is what I've recognized is that people think that seeking mental health care is something bad, or they people are going to think that they're crazy, or people are gonna think, it's something wrong, or look upon negatively. I am so vocal.

In the community, about talking about mental awareness. You know, we all have something that we have challenges with, even if it's just anxiety or depression or having issues with sleep, people think that it's a negative thing, I am wanting everyone to get the care that they need, and so that we don't have an incidence of suicide because this is suicide awareness month. And so if the more people that we can impact, the less suicide we have and family members I want them to be able to recognize the signs of when people are having challenges and don't be afraid to seek help and you know certain cultures cultures of color being African Americans Hispanic Asian

They don't recognize mental illness as a thing. It is truly a condition that we all need to seek help for. And as family members, recognize the signs when someone is having self-harm behavior, such as cutting or pulling their hair, and not just say, they're trying to get attention. We need to seek the help that they need, give them the attention that we need so we can identify what's going on with that patient. I became a psychiatric nurse practice.

Practitioner because I am the daughter of a man that was a Vietnam veteran who struggled with PTSD, who struggled with alcoholism, who struggled with bipolar disorder, who struggled with schizophrenia. And so as I maneuvered him through the veteran system, I found it very challenging. And so I thought, well, I'm going to go become a psychiatric nurse practitioner so I can help my father and take care of him so that he has the mental health care that he.

He needs. So that is why I am a psychiatric nurse practitioner. I want to be able to help people recognize when there is a problem with mental illness, what can we do about it? And there's so many limited resources for people who have mental illness. The families don't know who to call, they're struggling, and mental illness doesn't just impact the patient, it impacts the entire family, the support group. And so making sure that the families have the support that they need for the patient.

Who are struggling with those mood disorders or alcoholism or substance abuse? So that is why I opened the Calming Mind Psychiatry Group.

Sheela (07:42)

first of all, thank you for the work that you do, for your dedication. I'm imagining a child version of Dr. Shayla that is wanting to help your dad and then in the process learning you mentioned so many different layers of just your dad's lived experience. and you mentioned the

Cultural components that add to stigma and shame. And there's so many layers of the cultural components, obviously, and accessing care and finding the right kind of care. And so thank you for building what you have built and your dedication to not just helping your dad and the people in your community, but thinking forward in how to build this workforce of people that are going to be providing this kind of care and really doing it so thoughtfully. So thank you for that.

Dr. Shayla Buckler (08:31)

Thank you.

Sheela (08:32)

this podcast is about executive function. And so I'm just going to say it in the simplest way possible. Executive function is just about getting stuff done, there's a lot more, we can talk about neurology and how the brain works and and the systems and all that, but really it's just about getting stuff done. And

All the things that you just shared, whether it's past trauma, different diagnoses, different stressors, family systems, the systems that we're exposed to, the things beyond our control, all of those things impact our executive function. can you tell me about what you have seen

in your professional experience when people are saying i'm not able to get stuff done or i'm not able to get started what does that look like and i'll i'll just throw in for some people it might seem small it's just getting stuff done but everyday life not being able to do the things that are important to you meaningful to you

maybe not being able to be able to be consistent with your medication routine or the coping strategies that you've worked so hard to come up with with your mental health providers, really affect all the things that are very serious about mental health, making your life worth living. executive function is critical. It's not just getting things done off of a checklist. So what has that looked like for you in practice?

Dr. Shayla Buckler (09:53)

I have a lot of patients do come in. Like I've had a whole slew of patients come in here recently. It's like, I have ADHD. I can't seem to function. And so I typically kind of go through, well, is it depression? Because depression can overlap with executive difficulties. is it anxiety? Is it something physiologically going on in the body? Is it a medical condition that's causing you to have low energy fatigue, low mood, low motivation? And so as a psychiatric nurse practitioner i start there tell me about your medical history tell me about your mental health history what medications are you on are you using any drugs or alcohol

And if so, how often all of those things play a role in executive difficulties? Your sleep. The bulk of my patients cannot sleep. And so that's usually one of the main causes of executive dysfunction. If the brain does not get the full rest that it needs, at least the six to eight hours, then we cannot function. Diet plays a huge part in that. The foods that we eat. So if you're eating very high carb rich foods,

High sugar content foods, those affect your executive dysfunction. And so I start there. I want to be able to analyze the entire patient to see what exactly is going on, and then let's not forget the stressors that are going on at home. The patient may have stressors, may be going through a divorce, may have problems with a child at school, the work demands are high, and then throw on top of that that the patient's not getting enough rest. So I like to look at the patient as a whole and identify and break down each system to ensure that we aren't missing anything again that's physiologic or something that we're putting into our bodies, exercising. You know, a lot of people don't have quote unquote time to exercise, and so our bodies need healthy foods, vitamin rich foods, we need water, we need rest, and so those things are primarily. as a psychiatric nurse practitioner, not only do I just get to

Look at the mental components of it, but I'm looking at that physiological side, that's where that medical nursing assessment part comes in, and we're able to identify. And then in my practice, I do draw the labs and make sure that labs for their thyroid are tested, their iron studies, vitamin D. Most people don't realize that vitamin D it helps your mood, helps you to focus, and a lot of times people of color are deficient in vitamin D because of the melanin in our skin and don't get enough sun for that reason. vitamin B12 levels, if those levels are low, so a lot of those things will impact our executive function.

Sheela (12:39)

Thank you. I absolutely love how holistic your approach is. and I appreciate you naming all those things because it sounds like you don't need to have a formal diagnosis to have your executive function impacted. I have low vitamin D and I didn't learn until I was an adult. I think a lot of melanated folks weren't taught because our parents weren't taught. We're supposed to wear sunblock. I didn't know that.

Dr. Shayla Buckler (13:04)

We are supposed to wear sun block

yes.

Sheela (13:06)

I'm indoors often doing telehealth, doing a lot of work from computers. and then when I go outside, I'm wearing sunblock. And so I have vitamin D deficiency and I have fatigue and it's so interesting because I always think, it's because I'm working from home. I never even thought that melanin is blocking that vitamin D. And then I'm adding the the layer of sunblock.

I know there are safe ways to supplement or to get some of that vitamin D directly from sunlight. I wanted to ask you more about the assessments. it sounds like executive function can be based on situation, it can be based on biology, it can be based on many things.

How and when do you decide somebody needs an assessment? And I know that there are different types of assessments. You've already shared your assessment is very holistic. you're getting to understand all aspects of a person's life. but I know you also do formal assessments. Can you tell us more about that assessment process?

I'm guessing people are coming to you saying, I might have ADHD, I want to get tested, and you're like, no, we gotta look at this whole thing.

Dr. Shayla Buckler (14:08)

yes, we do the PHQ 9, which assesses for depression. So these are all screening tools. So we do a lot of screening tools. There's definitely not like a definitive test for executive dysfunction but we assess their depression. We do a GAT seven that can assess their anxiety because anxiety is another thing that can cause those issues. And then we walk through, make sure there's not any substance abuse. so we're making sure that we're doing assessments to assess to see if how often the

Patient is drinking alcohol. A lot of people don't realize drinking alcohol every single night is alcoholism. And so making sure that they're not drinking too many drinks in a day, and then making sure that there's not any substance abuse. So we use several diagnostic studies, and then also for ADHD, one of the simple tests that we can do is an ASRS, which is an adult self-reported assessment for ADHD or Vanderbilt for assessment of ADHD, those types of things just

To make sure that we're covering all the bases and again not missing something. So, why is this person not able to sit in a seat at a meeting, or why is this person finishing the other person's sentences all the time, or why is this person not able to start and complete tasks? So there are many different reasons again that could also be a sign of bipolar disorder because impulsive behavior falls under bipolar disorder. So there's so many different disorders. I would do an MDQ on that patient to assess for bipolar disorder.

Disorder and then looking at DSM 5 criteria, which is the diagnostic statistic manual that we use in mental health to diagnose our patients. So assessing doing a lot of diagnostic studies and then comparing that data and coming up with the formulary diagnosis through the DSM 5 criteria, there are psychologists that do long, like kind of like two or three-day neuropsychological testing that's different from

what we do here in the nurse practitioner office. that may be a little bit more extensive done by a psychologist. And again, it takes like two to three days to get those assessments where they assess their entire neurological status.

Sheela (16:12)

Okay, so it sounds like again, you're looking at the whole picture and you're going step by step. Is that right?

Dr. Shayla Buckler (16:19)

Yes, ma'am.

Sheela (16:20)

doing kind of an initial screening and then deciding this seems like the right next thing to assess.

Dr. Shayla Buckler (16:26)

Yes.

Sheela (16:27)

OTs don't diagnose.

But I know that a lot there's a lot of bias in the norming of those tests. I can only assume that by getting to know the full picture, it it kind of fill things in. But you've had to figure that out on your own, right? Because probably how you were taught in school is this is how you do the assessments. but as you and I know, and you know better than I do in practice, because you you diagnose, there's a lot of under and misdiagnoses of people of color, especially with black folks.

Dr. Shayla Buckler (16:54)

Yes.

Sheela (16:57)

and I imagine it's even harder because you're working mostly with adolescents, their brains haven't fully developed yet, their bodies are still growing. can you speak to your learnings or how you do things based on your experience and the people you're working with?

Dr. Shayla Buckler (17:12)

Ironically, the younger people I feel like are more in tune with mental illness. There's more self-awareness with younger people. The older adults that I tend to work with, it's like, no, I don't have a problem, no, that's not an issue. So it is a little bit more challenging, and especially like you said, African Americans, because again, people seeking mental health care is like, my gosh, they're gonna think I'm crazy. And it's like, no, we all have different challenges. And so trying to work through that process, but

one thing that I can appreciate with the adolescents and young adults is they're like I know that something is wrong with my brain I know that something is off and they're able to describe that to me after I kind of help them understand. So my role as a professor allows me to educate them about their condition and help them to understand what's going on with their bodies as well. So the subjective data that I obtained from the patients is very helpful for me to use the like I say the diagnostic tools to study the patient.

and then to be able to use their you know subjective and then also objective data that I observe with the patients and so knowing that and looking at them over time developing a great relationship with your patient to make sure that they're honest and upfront with you and so that is where I start that from the moment you know from start to finish that is probably the biggest piece of it because then they will give me the other pieces that I don't know. They will fill in those pieces and if they're very truthful about it then we can come work together to come up with a diagnosis and a great treatment plan.

Sheela (18:44)

I'm sure that every psychiatric nurse practitioner has is a slightly different form of how they do their practice depending on who they're working with and how they've come to build their practice. for you, what would somebody expect when you're doing the initial assessments, is it meeting with you more regularly and then over time tapering it off? Are people seeing you pretty consistently, like they might see, say, a psychiatrist. some people do therapy weekly, some people do it monthly. So I'm curious, what people might expect when they work with you.

Dr. Shayla Buckler (19:17)

So yes, initially, the therapy and medication management go hand in hand. Technically, it's not a psychiatric nurse practitioner's ongoing role to continue like weekly therapy as where we are kind of not set up for that. But sometimes there are patients that are going through something substantial and trying to regulate their medications. So if I'm regulating medications, then I may see them more frequent than less. And then if I have to do lab values and things like that for certain medications.

they're taken they can see me frequently typically if I see a patient I may assess them bring them in get labs to have them come back in two weeks so we can come up with a treatment plan I've had them do the diagnostic screenings such as the depression anxiety adh screenings even the trauma and then the Columbia scoring which also for depression or suicide and so doing all those screenings so I have them do those and actually I have them do those screenings just about every time that they come in

So that I can see the progress and see how we're either improving or not improving, so that'll give me some statistical data for their care. And then usually, if I have a patient that continues to need weekly therapy, I will refer out to my counterparts that I have. And then that way we're in one big network and we can collaborate and make sure. So when they're seeing the therapist and say, my medication's not working, how can I adjust accordingly? And so we collaborate in that sense where we can meet and adjust medications.

So usually it's every two week, once a month visit, and then once you get a patient more stabilized, you can go to every three months and then every six months, just as you've built that rapport with the patient. But when you get them initially, you want to make sure. And then let me just say this too again, very holistic in my practice, where there's sometimes I just have patients that just aren't sleeping, and I will just tell them, Hey, go and buy some ashwagandha and some magnesium glycinate depending on their health status and that helps them sleep. That helps with their anxiety. Or let's get some vitamin D supplements and that helps with their mood. So it's not just actual prescribed medication. Sometimes it is supplements that I do implement into practice as well.

Sheela (21:27)

And it's wonderful that you're running labs. So you have their their body chemistry, you have the medical background, and the behavioral mental health information as well. let's be real, there's so much stuff on social media, there's so much content, right?

Dr. Shayla Buckler (21:44)

There is.

Sheela (21:45)

there is awareness building, but a lot of it is just from social media. people will recommend these supplements. And even though they aren't prescriptions, it's still helpful for you to have their medical information to make those recommendations. Is that right? some supplements, will make my heart race and they make my anxiety

Dr. Shayla Buckler (22:01)

Yes.

Sheela (22:02)

worse, even though it's not a prescription.

Dr. Shayla Buckler (22:04)

Yes, so yes. If I have a patient that has any cardiac issues, any heart problems, I'm definitely not gonna give them ashwagandha because I don't want to increase the workload of their heart. And so yes, being a trained psychiatry, nurse practitioner, you're able to identify which supplements work, which ones don't, with their health condition, you don't want to cause their other medications to become affected as well. So it is definitely not safe for patients to just start doing supplements on their own without seeking health care professional.

Sheela (22:35)

Thank you. I I think that's so important because, it's not in my scope to recommend medications or supplements, but so many people recommend supplements to people without having that information. I think it's so important to ask a trained medical professional who understands the

Dr. Shayla Buckler (22:51)

Yes.

Sheela (22:52)

effects. most of us don't realize that some supplements will mess with our prescribed medications.

We're gonna share your information, how people can access care with Dr. Shayla and put all the links for Calming Mind and all of your links on this episode. But for people that are not able to work with you, how can somebody find this kind of holistic care. I don't know how easy it is across the country or even in in your state for people to be able to access psychiatric nurse practitioners. do you have any recommendations of how people can access this care or put that holistic picture together if it's not that easy or if maybe they can't afford it?

Dr. Shayla Buckler (23:32)

Absolutely.

So one thing for patients who have healthcare insurance to call the number on the back of their insurance card to find out if they have a psychiatrist or psychiatric nurse practitioner in network. So the 1-800 number on the back of their insurance cards works well. Zoc Doc, Z O C D O C Zoc Doc is one platform. Psychology Today has a plethora of therapists, psychiatrists, nurse practitioners. And you can even filter.

if you want someone that is Hispanic or African American or Caucasian, female or male, and then your zip code. And then even Google, you know, patients tell me, I saw Google. And then by just kind of looking at reviews and, you know, it has to be a good fit, you know, for people to be comfortable to talk to a provider about mental health, it has to be a great fit. it's almost like a relationship with your therapist and your psychiatric nurse practitioner.

So that's where the psychology today works well to put that filter in and you're looking for someone that's young and of your ethnicity that you're looking for or if they're looking for someone that's like LGBTQ affirming they can do the filter, break that down and find someone that fits well that they think they'll receive the best care from and then look at reviews.

Sheela (24:50)

thank you for that because I advise people when they're looking for new therapists to really look at what experience, identity, training, what things are important to build that trust. And you bridge the medical and mental health. And sometimes people feel like, well, I don't have a choice in my medical specialists and it sounds like

It is possible, depending on insurance, there's some restrictions, but I appreciate hearing that because I think of that in therapy, but we don't hear that as much for medical care and psychiatric medical care. as we're wrapping up, I wanted to ask you if there's any kind of last things you wanted to share, what you want people that are struggling with their executive function to hear.

Dr. Shayla Buckler (25:33)

Reach out and get help. Find out if it's something that's going on mentally, physically. don't be afraid to say I'm going to see a therapist or I'm going to see a psychiatric nurse practitioner. Sometimes it's okay not to be okay. And if you feel like you are having some issues with like planning and organization and just kind of completing tasks, then something may be off. And so go to your primary care doctor or go to a psychiatric nurse practitioner or psychiatrist.

get an evaluation so we can start the process and come up with a treatment plan because it is okay not to be okay, but it's not okay not to get the treatment and help that you need.

Sheela (26:11)

Thank you, Dr. Shayla. Really appreciate you educating us today. Again, we're going to share your practice info, social media, so people can reach out to get care from you or learn from you if they're not in your locale. And so everybody that joined us today, we hope you found our conversation helpful and are looking forward to you joining us next time. Thank you.

Dr. Shayla Buckler (26:34)

Thank you. Have a good day.