Common Nursing Complaints & Psych NP's - Not As Bad?

Ellen NP, MSN, NP · Jun 9, 2012

I'm a PMHNP and am very happy with my career. I had been an RN for 32 years when I finished my NP program. Most of my experience was in psychaitric nursing. i would advise anyone hoping to work as a Psych NP to work in psychiatric nursing BEFORE entering the NP program. I know NP's who have not done so and they are not really as well educated. I suppose that it depends on what you want to do as an NP.

I would also caution people against direct entry programs. You need experience as an RN before you can understand exactly what advanced practice means! If you want to work in any setting with RN's you will have little credibility if you have not walked in their shoes.

Ellen NP, MSN, NP · Jun 9, 2012

RE salary.....it depends on the state, type of setting, etc. I'm in Maine. There are certainly plenty of positions; the salaries, however, are not as good as in other parts of New England....and I'm in a large, academic medical center.

myelin · Jun 9, 2012

As a DE student, I think it's completely ridiculous that an RN won't respect me because I haven't "walked in their shoes." Shouldn't they be judging me on whether or not I am an astute and competent provider? I have several years of assessing and diagnosing psychiatric illnesses under my belt, this background is what led me to be accepted to multiple nursing FPMHNP programs. The idea that my background is somehow less useful or deserving of less respect than if I'd worked med-surg for some arbitrary number of years is just silly. I do think people should have a strong background in the field of their interest. I think RN experience is a great background to have, I just disagree that the only way to develop such a background is with RN experience. I hope my classmates-to-be (many of whom will likely have extensive RN experience) are more collaborative.

Ellen NP, MSN, NP · Jun 9, 2012

I don't believe that you need med-surg experience at all. You need experience in your field and it sounds as if you have it. Most direct entry NP's who I've met have NO experience. One woman that I know is a PhD biochemist with no experience working with people at all....and it shows. She doesn't understand boundaries, gets caught up in staff splitting. You learn more about psychiatric illness by working in the field than you can in an NP program. That's not to say that the program curricula aren't good, but what you bring to the program is enriched by experience.

I'm in an academic medical center working on a consultation liaison service. It would be hard to do MY job if I had not been an RN first because I understand what the staff are dealing with while they try to manage psych problems on a med-surg unit. I can help them manage the behaviors in the context of the rest of their work. I canl help them with restraints or medicate pts when they are uncomfortable with the meds. This isn't something that most NP's will be called upon to do in their work settings.

The feedback that we, the NP's, get is that we provide more support and education than the other clinicians(physicians) because we work not just with the patient but with the staff. The situation is different on the inpatient psych unit where there isn't so much difference between my work and that of the physicians because they have spent years working directly in inpt settings.

I also don't want mean to suggest that staff RN's won't respect you. They will be more trusting of someone who has shared their experience. Trust and respect are different. The situation will be different in an outpt clinic or private practice because the role is different from the inpatient world.

Ellen NP, MSN, NP · Jun 9, 2012

I know NP's who have entered practice in outpatient positions and have done so successfully. I prefer inpt just because I prefer the high acuity setting. I like the hospital world. My friend worked in outpt psychiatry for 30 years as an RN and came right to inpt on graduation from her NP program. She had some initial work to do to get comfortable with the medically ill pts on our consult service but her psych skills were excellent.

I think that you will find most positions in community settings. The important thing is to find a setting in which you are comfortable with the other providers and the type of services provided.

Ellen NP, MSN, NP · Jun 9, 2012

The pay is often higher for part-time and per diem people because they aren't costing the organization as much in benefits and because they aren't guaranteed a certain number of hours. I get a slightly higher pay rate for moonlighting than I do as a salaried NP. I make about $45/hr as a salaried employee. That would be about $93,600 for full time. Maine salaries for NP's aren't great but I love my job.

zenman · Jun 9, 2012

I don't believe that you need med-surg experience at all. You need experience in your field and it sounds as if you have it. Most direct entry NP's who I've met have NO experience. One woman that I know is a PhD biochemist with no experience working with people at all....and it shows. She doesn't understand boundaries, gets caught up in staff splitting. You learn more about psychiatric illness by working in the field than you can in an NP program. That's not to say that the program curricula aren't good, but what you bring to the program is enriched by experience.
I'm in an academic medical center working on a consultation liaison service. It would be hard to do MY job if I had not been an RN first because I understand what the staff are dealing with while they try to manage psych problems on a med-surg unit. I can help them manage the behaviors in the context of the rest of their work. I canl help them with restraints or medicate pts when they are uncomfortable with the meds. This isn't something that most NP's will be called upon to do in their work settings.
The feedback that we, the NP's, get is that we provide more support and education than the other clinicians(physicians) because we work not just with the patient but with the staff. The situation is different on the inpatient psych unit where there isn't so much difference between my work and that of the physicians because they have spent years working directly in inpt settings.
I also don't want mean to suggest that staff RN's won't respect you. They will be more trusting of someone who has shared their experience. Trust and respect are different. The situation will be different in an outpt clinic or private practice because the role is different from the inpatient world.

Very good post. I also do some CL work as well as inpatient and not only do I consider the patient when writing orders, I also consider what it is like for the nursing staff, and they know I will as I've been in their shoes.

I can also give the Level III ED staff here hell when they try to dump on psych as I've been a Level I ED manager, lol! I know just what those buggers are trying to do!

Ellen NP, MSN, NP · Jun 9, 2012

We have an Acute Psych Unit within our ED.....I'm always trying to educate the ED staff and suggest that they need to r/o medical etiologies for new onset altered mental status chamges. They also tend to think all bad behavior is a psych problem. Some humans are just unpleasant!

apocatastasis · Jun 10, 2012

i would also caution people against direct entry programs. you need experience as an rn before you can understand exactly what advanced practice means! if you want to work in any setting with rn's you will have little credibility if you have not walked in their shoes.

i've just finished my alternate entry fpmhnp program. i've worked as an rn in critical care for over a year and then in the emergency department for the past two years, dealing with all manner of crises-- psychiatric and medical and not infrequently both at the same time, and often flying by the seat of my pants to get a patient worked up because we don't know what's wrong with them. by now, i've taken care of thousands of people from all walks of life. in the er, almost every day we care for patients with suicide attempts, overdoses, drug and alcohol addiction and/or intoxication, violent behavior, and bizarre family dynamics. we frequently have to provide continuous care for psychiatric patients held in the er for days before they even get to an inpatient psych facility, and have been started on meds and/or are detoxed from whatever substance they were on... and still manage the million other patients that rotate through our beds.

i don't at all appreciate the assertion that because i went through a different route than you did that i have no experience. i didn't sit around for 4 years twiddling my fingers. thanks for the vote of confidence.

:yawn:

Ellen NP, MSN, NP · Jun 10, 2012

You certainly do have experience. You worked as an RN with patients. I'm talking about people who go from never having seen a patient in any setting to NP through that kind of direct entry program. You have exactly the kind of experience that will be a solid foundation for your practice as an NP.

apocatastasis · Jun 10, 2012

It seemed like you were saying that DE programs were, across the board, to be avoided because of the experience component. Thanks for clarifying.

I would say that 90-95% of my classmates who became APRNs worked to gain RN experience while going through the APRN portion of the program. I took only two classes my second year to work full-time for the experience; some programs are actually structured so that you have to "step out" for a year in order to work.

As with anything else, you get out of a DE program what you put into it. Working is part of the necessary education, I think. DE programs need to be very selective with the applicants they accept-- too many bad apples and it makes the whole profession look bad.

Ellen NP, MSN, NP · Jun 11, 2012

Unfortunately, not everyone has the same work ethic! I know a number of students who were in such a hurry that they couldn't find the time to work as RN's while they continued with their NP studies. That becomes everyone's loss. I'd love to see programs encourage students to get experience, even if it's built into the program. My friend's daughter just graduated from her DE program. She was a poet prior to her DE program. She worked as a Psych tech during the undergrad piece and as an RN during the NP part. Another friend has done the same during her program. They went to entirely different programs but were both encouraged to get clinical experience along the way. I think that it makes the NP program easier, too.

Our Acute Psych Unit (within the ED) certainly doesn't have room for all the psych patients who need to be seen. I think that our ED RN's and techs have more truly acute psych experience than do the RN's on the inpt psych unit...and they have to manage pts in a chaotic, less secure area.

So, no, I am not against DE programs across the board. Each student needs to choose the program that best meets their individual needs and experiences. The best students will work harder to gain the experiences that they need. It would be good if the programs could have open discussions about some of these kinds of issues.

I graduated from Drexel's online program. Some people would take issue with that concept. I know, however, that we worked very hard to get good clinical experiences. We had both synchronous and non-sychronous learning. We had group discussions in real time and even did group projects and 'real time' presentations. We had campus visits with sim labs and assessments of mock patients who were individuals trained to assess OUR skills and to give feedback on our interview style as well as history and physical exam skills. I worked harder and was more rigorously tested in my online Psych NP program than I was in my earlier, campus based Pedi NP program.