MSW to PMHNP/FNP (dangerous ideas!)

  1. Egad!

    I think after four or five years of stewing on this, I have decided to start down the path of nursing education, leading toward a PMHNP (family). I have a BA in psych, an MS in social justice studies, and an MSW in direct human service work. My prior work history includes running a DV shelter, working in boys' residential treatment and therapeutic foster care, ER social work (which I loved, loved, loved!), and now providing youth and family mental health crisis response.

    I see really clearly how having additional training on psychopharm and prescriptive authority would be really helpful. Plus, child and adolescent mental health has rather picked me as a specialty. I never intended to be "that annoying lady who tells you how to parent your kid but doesn't have any of her own."

    In addition, I FINALLY completed my WFR (wilderness first responder) 10 day training. It's been on my to-do list since 2004. It was some of the best training I've ever had in ANYthing. It helped me to realize exactly how excited I get learning medical stuff. Given my interest in emergency medicine, I wonder if I wouldn't be better off doing an FNP (focusing on acute care), or stopping after by RN to get some ER nursing experience.

    I took one biology and one chemistry class when I was an undergrad music major 20 years ago (EGAD INDEED!) now. So I will obviously have my hands full with prerequisites for a while. I've decided to start with the nutrition class to see how it goes.

    So I'm looking at at least 6 prerequisite courses-- 2 chemistry, microbiology, 2 anatomy and physiology, plus the nutrition. I have the statistics and developmental psych, as long as they aren't required to be in the last 10 years.

    Then *hopefully* an accelerated BSN program, and then into a DNP program for three years.

    I am working full time in the crisis response program, and it doesn't leave me with lot of extra energy for volunteering because of the level of self-care required to do my job well. Do you think this will count as "hands-on" health care experience because I'm in and out of emergency rooms and IPU (inpatient psych units) all day long?

    I want to make my application really competitive, and assume I will probably get mostly As with maybe a B for my science classes.

    Any words of advice or encouragement as I start exploring down this path?

    Oh, also, editing to add that I am *really* committed to working with under-served populations. Anyone have experience with loan forgiveness programs for PMHNP work?
    Last edit by NuggetsHuman on Aug 6, '12
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    About NuggetsHuman

    Joined: Aug '12; Posts: 18; Likes: 3
    clinical social worker


  3. by   cmhnp
    Ok, so it sounds like you are on track for what you want to do, and that is awesome! You and I actually have pretty similar backgrounds. I have an undergrad in psych, worked for a few years in MASS with children and adolescents on the autism spectrum, worked ems, then came back to Ohio and worked direct patient care in a state psych facility while going to school for my FNP. I completed a grad entry program about a year ago now and work for a FQHC funded community mental health center providing primary care. Have you considered one of the grad entry programs? they are a lot of work, but older students who know what real work is typically do very well in them.

    Loan repayment programs...... Ok, so the facility in which you practice would have to have a HPSA score for it to qualify (you will have to google HPSA score finder and it will bring you to a page that will list them by location). Loan forgiveness is strongly based on the HPSA scores of practices, the higher the better. All those applications for forgiveness who work at locations with a 14 or higher are processed first, and then those with lower 14 in decending order. This means (for me), my organization works with homeless, unstable housed, chronic mentally ill patients who typically do not have access to care. However, because my organization is urban and located between 3 major health networks/hospitals, their HPSA score is 0, leaving me with little chance of being awarded loan repayment.

    Seeing that you are not done with school, you can also apply to scholarships that work largely the same way, with the obligation to work in a shortage area (one that has a HPSA score) for a set time post graduation.
  4. by   NuggetsHuman
    Thanks for the vote of encouragement!

    I have thought about grad-entry programs, but I'm not sure how they differ from the plan I'm looking at... except that the grad entry program nearest me (Seattle U) leads only to a master's and not a doctorate. There appears to be a WA state regulation now that they are not issuing new ARNP credentials for master's prepared PMHNPs, or at least you have to have additional approved clinical hours or something... I'm not really sure what it all means.

    It sounds like it might be easier to take on loans that come with the forgiveness package instead of trying to find a location after graduation.

    But at this point, I figure I'll be in student loan debt until I die regardless of whether or not I pursue more education.
  5. by   PsychiatricNP
    I followed a similar path to yours. I had a BA in psychology and a MSW prior to going to to nursing school. I worked in a number of different settings as a clinical social worker (outpatient, treatment foster care, community mental health, inpatient, emergency department) while working toward my BSN. Immediately after finishing my accelerated BSN, I started a family PMHNP program and worked in the emergency department and on an acute gero-psych floor. I am now practicing as a PMHNP and haven't regretted the decision to pursue this educational pathway for one moment (other than perhaps because of the cost associated with completing two bachelor's degrees and two master's degrees). It is it the perfect marriage of skill sets and I really enjoy the work and NP role. Good luck!
  6. by   NuggetsHuman
    I definitely feel youb on the cost of several degrees, but it sounds like its working out well for yopu.Did your socia work work experience count as "hands on health care" experience in your ABSN application? Or did you do other things to make your app more competitive?
  7. by   PsychiatricNP
    A couple of the programs that I applied to were willing to consider my work as a social worker as "hands on" health care experience, while a couple of others did not. As I think about this a little more, this was more of a problem for the PA programs that I had applied to at the same time I was applying to nursing programs. I had the benefit of having been a certified dental assistant, certified pharmacy technician and phlebotomist (in addition to social worker) prior to applying to nursing school - I have spent most of my life in and around healthcare in one way or another. I would imagine that if you can discuss your role as a social worker (direct care provider to those who are ill) and your interface with a variety of other healthcare providers (physicians, nurses, PAs, etc.), programs should be more willing to "count" your very useful experiences.
  8. by   priorities2
    I read the webpage you linked to, oregonrobin, and it refers to CNS's, not NP's.
  9. by   NuggetsHuman
    I'm confused about the difference between CNS (clinical nurse specialist) and NP (nurse practitioner).

    Also, this is what I was looking at specifically:
    The requirements of psychiatric mental health ARNP program were described in more detail. Currently, our PMHNP program (not independent masters) meets these criteria. These programs should include: 1) at least 500 clinical hours in direct patient care in the psychiatric mental health NP role with clinical preceptor supervision and faculty oversight; 2) advanced
    pathophysiology; 3) advanced health assessment; 4) advanced pharmacology; and 5) both clinical and didactic course work in psychiatric mental health scope of practice.
    If the requirements for licensure have educational components that are not offered through a master's program, how else could you meet them?
  10. by   hbbenton
    Dear PsychiatricNP,

    I hope that this message finds you well!

    I am writing to ask you for career advice. I am planning to begin my MSW degree at Simmons College this coming September. In addition to earning a MSW degree, I am also interested in pursuing a MSN degree, to ultimately become a PMHNP. It is my hope that the combination of the clinical skills of the MSW degree, partnered with the medication management skills of the PMHNP position will allow me to be a more effective clinician in the field of mental health.

    However, I am a little unsure as to how to go about earning my MSN, after I earn a MSW degree. I am hoping to work full time as a social worker, after earning my MSW degree, while simultaneously pursuing my MSN degree. While working full time as a social worker, I am currently considering going to school part-time to earn an associate's degree in nursing, to become a registered nurse. At that point, I am considering entering a part-time MSN program, either online or in person.

    I was wondering, how did you go about earning a MSN degree, and becoming a PMHNP, while also continuing to work full-time as a social worker?

    Thank you very much for your time and resources!
  11. by   Psychcns
    Hbbenton. I suggest you go down one road at a time. Either nurse or SW. What do you think is your ultimate goal ?? There are other threads on AN about both roles. SW (at Simmons) used to be a therapy degree-not sure it still is?? See what the curriculums and job prospects are for each role are and which you would want to do everyday..
  12. by   elkpark
    Quote from oregonrobin
    I'm confused about the difference between CNS (clinical nurse specialist) and NP (nurse practitioner).
    In terms of psych, it doesn't matter. The psychiatric CNS credential has been "retired" and is no longer available. Psych NP is the only advanced practice psych option.
  13. by   PsychiatricNP
    Hi hbbenton - I have to let you know that I am feeling particularly disenchanted with working as a psychiatric nurse practitioner today, so know that my response may be a bit jaded by this

    In terms of pursuing nursing school while attending graduate school for your MSW…one word - IMPOSSIBLE. Seriously, you will be completing at least 16 hours per week of practicum placement hours every week for at least 4 semesters in your MSW program…attending nursing school is just not possible. I notoriously stretch myself way too thin and I couldn't even manage that…there aren't enough hours in the day.

    I would recommend completing your MSW and practicing as a social worker for a year or two. You could potentially work part-time as an MSW while you attend an associates/BSN program (I did this). You will have to find a way to balance class time, clinicals, homework and working, but I am proof that it can be done.

    If you enjoy mental health practice and feel that psych/mental health is the right place for you and you get through nursing school and work for a bit as an RN, then I would suggest applying to a PMHNP program. You could likely continue to work part-time or full-time as an MSW or RN while you complete a PMHNP program full-time (or potentially part-time).

    I personally worked full-time in a very unique role that utilized both my RN and MSW providing psych consults in a large hospital system and worked nearly full-time during my PMHNP program. My PMHNP program was hybrid requiring on-campus (out of state) visits regularly. My work schedule was very flexible (it was in a hospital and the psychiatry service provided 24/7 coverage) and my PMHNP clinicals were also flexible. I was fortunate that I had very supportive employers, preceptors and family to get me through the program.

    Again, I really suggest spending some time in mental health first before committing to the PMHNP route. Most days I am really content with my career choice/path, but recently I have been increasingly disenchanted with psychiatry. Nearly every patient I am encountering is medication seeking / addicted to a benzodiazepine or stimulant and isn't willing to consider non-psychotropic treatments that might have a healthier, longer lasting positive impact on their mental health. Few are interested in diet changes, sleep hygiene, exercise, meditation and instead want to know if I can give them more/another/a different/extra/stronger medication…it has become exhausting and disappointing…at least as an MSW I could engage the patient in therapy, encourage change, provide tools and then refer to psychiatry when the patient wasn't interested in doing the work anymore.

    Ultimately, I would recommend spending some time working as an MSW and then decide if nursing/PMHNP is right for you. Remember, before you can become a PMHNP you have to become an RN (and do the clinical work associated with this). The market is really good for LCSWs right now and wages are quite high (at least in my area). Best of luck to you!
  14. by   PsychGuy
    I typed up a very long reply and then it hit me that I could condense what I had to say. I think you're doing the wrong thing. There. Clear and concise. You've got two master's degrees, degrees aren't cheap, and you're wanting more even the frivolous DNP (which is NOT a clinical degree). Learning is cool. I'm an autodidact. I'm always doing something to learn. However, I'm Type A so I'm going to be very direct in my opinion.

    I think you should go to PA school. You've already got to return to college to take prereqs for nursing. In that EXACT same time period you could add a couple of others required for PA school. Once you're in PA school you're back out in 28 months. It'll be hard to work a side job - almost impossible. However, I really think the PA route will teach you what you're wanting to know.

    Nursing, at risk of offending many of my colleagues, is NOT very scientific, and nursing is often directionless. From your social work education, you'll see that it is a psychosocial discipline, and that does not bode well for someone wanting to learn "medical stuff." Sure, you'll learn about ulcerative colitis, and the many ways to have a bowel movement, but woopty doo you probably won't be treating that as a NP or a PA.

    As a PA, you're versatile. You do not NEED a FNP and a PMHNP to work. You'll only need a PA and a doctor willing to give you a job. If you find you want to learn more about ortho, cards, ID, EM, or even psych you can do a residency as a PA, have a true role in patient health, and make a living doing it although you don't need it. You won't get any psychotherapy training, but as a PMHNP you shouldn't be doing therapy other than having a therapeutic dialogue with your patients. The demand is too great for the current supply of psych prescribers. I don't know if PAs can even do therapy, in their present scope, however, their scope is whatever their doctor will let them do. That said, I did some searching just now and found that PAs can go to the same certification training to get a cert in CBT, etc.

    I'm interested in psychiatry and don't want to do anything hands on with patients, but I WISH I had gone the PA route instead with a psych residency. I'd have actually spent less time and only about the same amount of money and have gotten out into the workforce in a credentialed role years sooner.