Question for Advance Practice Mental Health Nurses

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    Hello, I am a pre-nursing student who is taking all my science courses necessary to apply for nursing school. I have a master's degree in clinical psychology, and for varied reasons (see my previous post, link below), am hoping to become a nurse. Because I love the work I did as a psychologist, and really have a gift for connecting with people, I'm wondering if I should explore the Advanced Practice (Graduate) degree in mental health. So a few questions for you to consider if you are currently working as an ARNP-MH or are a student currently:

    - Do you enjoy your work?
    - I what setting do you work?
    - Who are your clientale?
    - Why did you choose this work?
    - Would you do it again if you could?
    - What advice do you have for me?
    - What would you change?
    - How's the job market?
    - How's the pay, hours, benefits, etc?
    - What KIND of work do you do, and with what frequency? (meds, therapy, other)
    - Any other wisdom!

    Many thanks for reading, and your thoughts!

    Best,
    Jaime

    http://allnurses.com/general-nursing...ml#post4169260
    Last edit by GonnaBSN on Mar 10, '10 : Reason: added hyperlink
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  3. 9 Comments so far...

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    Moved to the post-grad forum (vs. the GN forum) to encourage responses. Good luck!
    GonnaBSN likes this.
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    I don't really have any answers to your questions, but I would like to ask you a question. I am finishing up my undergraduate degree in psychology and was debating on advancing onto a master's in counseling psychology or a MSN degree as a psychiatric NP. Obviously you are looking to change and was wondering were there disadvantages to holding a master's degree in clinical psychology? How were the benefits such as salary? By the time I'm done with a master's degree either way I go I'll be at least $100,000 in debt. I'm leaning more towards nursing because of the better salary that will help to pay off my debt. Thanks for any help and sorry I wasn't much of assistance to you.
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    Quote from beaconshome
    I don't really have any answers to your questions, but I would like to ask you a question. I am finishing up my undergraduate degree in psychology and was debating on advancing onto a master's in counseling psychology or a MSN degree as a psychiatric NP. Obviously you are looking to change and was wondering were there disadvantages to holding a master's degree in clinical psychology? How were the benefits such as salary? By the time I'm done with a master's degree either way I go I'll be at least $100,000 in debt. I'm leaning more towards nursing because of the better salary that will help to pay off my debt. Thanks for any help and sorry I wasn't much of assistance to you.

    It depends on what you want to do, where you will live, and in what setting you want to work. But in general - I encourage anyone who asks me to go for a masters in social work. I have known many people who chose this route and are happy with what they have been able to do. The downside to the MA in psychology is that many states will not recognize the degree. Last I checked, 14 specifically offer a license as a "master's level psychologist", others will call you various things like "counselor" "mental health professional" etc... but it's not the NAME/TITLE that really matters - it's how available is work. The thing I found was that most INSURANCE providers didn't want to reimburse LMLPs (licensed masters levels psychologists)... so employers wouldn't hire them. It has to do with the politics between PhD psychs and MA/MS psychs. While they've been duking it out, social workers are happy to fill the gap. Bottom line, social workers are able to bill where LMLPs cannot. If I remember correctly, I could bill 1) Medicaid, 2) Some medicare, 3) only a handful of private insurances, and 4) self-payers. And still under these, I was limited. In fact, I could bill for more with a "certificate" in substance abuse counseling (which I think is the equivalent of an Associates or less), than I could for in mental health.

    Start here: the North American Association of Masters Level Psycholgists (NAMP). This org will be able to tell you where you can get a license. From there, call a mental health clinic or two in each state you think you might eventually live in... and ask them if they hire Masters Level Psychologists. If they don't ask "why". If they do, ask what kind of work you would be able to do. Just tell them you're a student who is looking into her grad school options. They'll totally understand. You might ask for the person who does the insurance billing if HR cannot help you. You should also call a few hospitals, and do the same.

    I know, it's a lot of work - but I wish someone would have suggested the same to me. If I had known what I know now, I wouldn't be back in school!

    Good luck!
    SandBetweenMyToes likes this.
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    Thank you very much for the advice! I really appreciate it. As far as the master's degree I was thinking about, it was more along the lines of an LPC or LCPC. I don't know if that still makes a difference with what you can bill with insurance. It's still up in the air with what I would like to do, but the most important thing is that I have to be satisfied with the decision I pick and I believe both are fairly good options.
    GonnaBSN likes this.
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    It sounds like you're pretty familiar with some of the issues with mental health and reimbursement. If you're trying to do your own practice as an advance practice nurse, you can have some of the same issues. My psych professor in nursing school was teaching because she couldn't get payment from so many of her clients. If you want to just be able to work in a mental health facility and do counseling there, you would only need a nursing degree. From there you could decide if you want to pursue an advance degree or not. And I know the economy has made it hard to fine psych nurse positions as well, but with your background I don't think you'd have too much trouble getting something.
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    - Do you enjoy your work? -YES

    - I what setting do you work? - the VA, outpatient mental health clinic

    - Who are your clientele? - VETERANS, male and female, young adult to elderly age range, variety of psychiatric diagnoses and often complicated medical issues

    - Why did you choose this work? - I decided to go back to school after years in home health, hospice, telephone triage nursing and nursing education. I was interested in the psychosocial element of the work and thought about LMHC. Went for the APRN as I could prescribe and the difference in potential earnings was huge.

    - Would you do it again if you could? - YES

    - What advice do you have for me? - Search your soul as to what you are most interested, but also run the numbers. Also, look at DNP programs versus master's.

    - What would you change? - If I were physically up to it, I would have gotten certification as an FNP as well.

    - How's the job market? - It depends; right now times are tight, reimbursement is tough across the board. However, APRNs especially prescribers are in high demand in some areas, particularly rural.

    - How's the pay, hours, benefits, etc? - Pay can be excellent, especially with experience (depending on location and setting, low six-figure). Most outpatient jobs are essentially M-F 8-5. You may or may not be on call, it depends. Benefits are good if you work for the government or hospital systems. You can be successful in private practice but it is a tough economy. Some APRNs and MDs are struggling and some are coming to health care systems due to financial pressures in their practices.

    - What KIND of work do you do, and with what frequency? (meds, therapy, other) - Educated to do meds and group and individual therapy.
    I see patients in an outpatient clinic, 45-50 min for new patients, 20-30 min for follow up medication management. I also lead one or two groups. Knowledge of psychotherapy and the holistic background of nursing underpins everything.

    - Any other wisdom! - I am biased toward nursing. It is still a very rich and varied profession. You can choose to work in mental health exclusively, however the mental health component of many other specialties is great and you may find your interests change.
    If you are looking at an MSW mainly for reimbursement, I am not sure how you will fare in the economy. You may need to have many hours of supervision and become independently licensed in your state, so factor that in to your decision.
    Keep in mind that prescriptive ability is in high demand currently and differentiates APRNs from other mental health providers.
    SandBetweenMyToes and GonnaBSN like this.
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    that's good info oldstudent!
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    Very good info in this thread for me too. Thanks for the posts, all.

    In my state, people with master's level degrees in psychology cannot be licensed or reimbursed as "Psychologists", but they can be licensed as other mental health care providers, such as LMHC and LMFT, which are reimbursable for psychotherapy services, same as LCSWs. No difference in reimbursement rate between LMHC, LMFT, and LCSW. I think this varies a lot by state.

    It is my plan to go the PMHNP route, and if possible, take extra graduate psych courses along the way to bolster my nursing training.
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    Nursing advanced practice roles vary from state to state. Here in Virginia, a PMHNP can prescribe and monitor meds. But only a PMH CNS can be reimbursed for therapy (individual, family and group). Because of this difference in state regulations and reimbursements, we have constructed our nursing curriculum that a person can do a MSN for either PMHNP or CNS in 48 credits, or for dual certification by taking 1 extra practicum. We are finding that most students want the dual certification because of these difference in Nurse Practice Acts among the 50 states.


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