PMHNP Psych NP Questions

PMHNP-1 · Jan 4, 2015

The PMHNP program prepares you for the ANCC boards. Lots of generic make-work waste-time classes.....lots of group stuff where you get to pull lazy or stupid folks through the program on your back.....Then the internships, the best part, learning and doing psychotherapy for individuals, groups, families. There is a brief med management internship where you don't do much but observe a fast-paced setting, typically. You don't learn psychotropics in school: you study bio-neuro-chemistry on your own, and study the psychotropics you'll be prescribing 100% on your own, too, as most schools don't have a class for that.

But the actual job of PMHNPs is prescribing. Not talking to patients. Typically, in a typical PMHNP job, you've got about 15 minutes to meet and greet, assess, and prescribe, get them out the door. Next! Work can be inpatient, seeing patients in psych unit, or doing psych evals in general units.

Or outpatient, working with a psychiatrist, usually in a large practice setting with psychologists and social workers who get to do cognitive behavioral therapy and other modes of psychotherapy, and you will be the one in the office with the revolving door who does the med management as fast as possible so you can bill maximum amount (or lose your job).

Not a pretty picture, I know.

The other alt is setting up your own private practice. I'm struggling with mine, but after 2 years I've finally got on more insurance panels and getting more patients. Economy is rough. I know other PMHNPs who specialize in visiting patients in nursing homes, assisted living, and group homes, and they do very well: can do psychotherapy AND prescribing, as I do in my practice.

But like I said, if you like the quick in/out Rx model, it's not a bad idea to become a PMHNP. Otherwise, as my colleagues and I have said among ourselves many many times, "Why didn't we go to Psy-D school?"

TheOldGuy · Jan 4, 2015

Gosh PMHNP, I think you went to the wrong school! The program at UND was very strong. We had a very challenging semester of psychopharmacology on top of 2 other semesters of pharmacology, and 2 semesters of pathophysiology. Psych diagnostic reasoning was also a very good course. My clinical experiences were outstanding - I had nearly 1000 hours - and I felt well prepared to start working as an NP after passing the ANCC boards....You're right that most of the work focuses on med management - as is also the case with psychiatrists - but I enjoy incorporating brief therapy into my appointments...

To the OP - I would strongly suggest shadowing a psychiatrist or NP at a community mental health clinic setting - they are used to working with students and interns. You might also be able to work out something in an inpatient environment. You really should build up your psych experience - its not the same as dealing with someone on a medical floor who has psych issues....

harmonizer · Jan 4, 2015

I second " PMHNP-1, MSN, NP." Unless you find a few good jobs out there that allow you to spend quality time with patient, you will be stuck with quick in/out Rx model. Sorry but this is the reality. It is far from your perfect career. I do not recommend it. Sorry. If you are young, you can go psyD and came back for PMHNP route later. I am thinking about get extra training in psychotherapy or get trained so that I branch out and do something other than being stuck in this mode.

DivaliciousMe85 · Jan 4, 2015

I'm on another thread where everyone is of course dumping all over my idea to go PMHNP and possible PhD or PsyD. I want both the prescribing and psychotherapy aspect. Thank you, Harmonizer, for supporting this idea. How do you expect to get extra training in psychotherapy? Do you plan a whole new degree or just a few courses?

Jules A, MSN · Jan 4, 2015

I'm on another thread where everyone is of course dumping all over my idea to go PMHNP and possible PhD or PsyD. I want both the prescribing and psychotherapy aspect. Thank you, Harmonizer, for supporting this idea. How do you expect to get extra training in psychotherapy? Do you plan a whole new degree or just a few courses?

What about psych CNS? Do they still have those programs? I see the message board section here, maybe check them out. Their program is similar to psych-NP but without the prescribing. Either that or take additional social work- therapy classes on your own. Although I can't speak for others I often get questions from nurses who want to become a psych NP who picture themselves doing therapy in a holistic clinic of some sort and while it might sound lovely I don't see it happening like that. Not that we don't do some brief therapy and in fact in my NP program we had 8 therapy credits which I felt was overkill however I do use the skills briefly as I care for my patients. Bottom line is social workers make less than half what we do so from a business stand point it doesn't make sense to have the person making $90 an hour billing for therapy with a very low reimbursement rate when you could have a social worker doing it for $35 an hour. The beauty of being a psych NP is being able to command excellent wages secondary to our ability to bill for medication management. Therapy if you can bill for it is insignificant. To me a psychD will not only be overkill but it also has limited value as at least in my experience psychologists seem to largely becoming utilized less because of the above mentioned point about therapy unless you want to strictly do program design or research.

elkpark · Jan 4, 2015

What about psych CNS? Do they still have those programs?

The ANCC "retired" the psych CNS credential in 2014. Those of us who are already psych CNSs will be able to maintain and renew our credentials, but it is not an option for anyone going forward.

PMHNP-1 · Jan 5, 2015

I've taken training that is for clinicians, through various universities. sometimes it's "boot camp" style, i.e., a weekend of 12 hour days, other times, a lot of online followed by going to the site for supervision and review. Also there are cert programs in CBT, Rational living therapy, and others.

I DO believe PsyD or Psych PhD are the best route, then do a quick PMHNP bridge if you still want to prescribe (why not leave that to the psychiatrist....less than 19% of psychiatrists do ANY psychotherapy at all and that number is going down)

PMHNP-1 · Jan 5, 2015

Hey TheOldGuy - I sure did. And the two schools I went to were "the best" in the area where I live.I switched schools after 1 year at the first, because the courses were so useless. Also because I knew that if I didn't get out, I'd be dragging one lazy entitle person who was on my track, all the way to graduation, thanks to a preponderance of group-make-work that came across like assignments for third-graders. Horrid. That program was run by a social worker PhD - not even an RN PhD!! We had nothing like what you described. Not one psychopharm class at all - had to teach that to ourselves after graduating, as well as everything neuro/bio/chemical!

The second program - a university with a very good reputation - ha! - had no instructors. The classes were "taught" by researchers who abhor grad students. The pharm class (no psych there either) was so bad that they made it online so that people could pass by cheating...They advised people to team up, meet with laptops, and try to get a Pharm-D to help us out with the tests. It wasn't difficult so much as no lectures, just reference books and topics, and no expectations or objectives........just memorize a 2000 page reference manual. And cheat. The pharm-d's were unable to help - they looked at the quiz and test questions and all said, "*****" Actually the advanced pathophys class there was the same: it used an undergrad book, online lectures that consisted of the "instructor" reading a laundry list of things you must "know and understand and synthesize"........and then the weekly test, that less than 20% of each class passed........

So I left the second program and went back to the first. But yes, neither of those programs prepared any of us for the work of a PMHNP, I mean, not even at entry-level. Actually, not even for the boards: most grads of those programs study for at least a year after graduation before the ANCC.

I'm very lucky that I had the means of setting up a small private practice after getting training in psychotherapy (post cert).

PMHNP to be · Jan 24, 2015

The PMHNP role does revolve a lot around med management, but I enjoy that aspect of the job. I sure wish we would be able to spend more time with the patient, but you can't have it all. I'm still an NP student, but I work with many psychiatrists and some NPs and I can totally see myself doing what they do. I would imagine it can get tedious and draining at time, but what JOB doesn't?

notsosupernurse · Apr 9, 2017

Gosh PMHNP, I think you went to the wrong school! The program at UND was very strong. We had a very challenging semester of psychopharmacology on top of 2 other semesters of pharmacology, and 2 semesters of pathophysiology. Psych diagnostic reasoning was also a very good course. My clinical experiences were outstanding - I had nearly 1000 hours - and I felt well prepared to start working as an NP after passing the ANCC boards....You're right that most of the work focuses on med management - as is also the case with psychiatrists - but I enjoy incorporating brief therapy into my appointments...
To the OP - I would strongly suggest shadowing a psychiatrist or NP at a community mental health clinic setting - they are used to working with students and interns. You might also be able to work out something in an inpatient environment. You really should build up your psych experience - its not the same as dealing with someone on a medical floor who has psych issues....

@THEOLDGUY the admission deadline application date is January 15th, Do you know the earliest you can apply for the program at UND ?

TheOldGuy · Apr 12, 2017

No idea - try calling them....