ACNP and Phmnp

[TelemetrytoBSN]

I'm going to be graduating with my BSN shortly and have an interest in Acute Care Nurse Practitioner- Intensivist and Psychiatric Nurse Practitioner and I'm interested in being licensed with both boards but I'm not sure on which program I should go to first. Please note I would not practice these specialities together I plan on practicing each specialty independently in different settings, i.e ICU as my main focus and Mental Health on a part time basis/gig and vice versa.

[Jules A, MSN]

In regards to Phmnp I don't believe I would require much floor Psych RN experience as I believe the program would definitely provide me with a solid base,

It makes me both sad and angry to see this sentiment although I know it is a common belief. First if you think most of these finance driven NP programs provide a solid base in anything you are mistaken, secondly it is unfortunate that so many don't believe our vulnerable mental health patients deserve an experienced provider.

[TelemetrytoBSN]

It makes me both sad and angry to see this sentiment although I know it is a common belief. First if you think most of these finance driven NP programs provide a solid base in anything you are mistaken, secondly it is unfortunate that so many don't believe our vulnerable mental health patients deserve an experienced provider.

I do believe that the patients do need an experienced provider as we are their advocate, however being a floor Psychiatric RN does not provide you with the education and the base of a managing provider who is now prescribing psychotropics, as it is out of a RN's scope of practice and understanding. I do understand that experience may provide more knowledge in the case of providing psychotherapy and in regards to familiarity with different mental illnesses and the comorbidities and teaching individuals and families how to cope with their loved ones mental health illness. However, expertise comes with practice the NP school teaches you just enough to manage just like RN school.

[djmatte, ADN, MSN, RN, NP]

I do believe that the patients do need an experienced provider as we are their advocate, however being a floor Psychiatric RN does not provide you with the education and the base of a managing provider who is now prescribing psychotropics, as it is out of a RN's scope of practice and understanding. I do understand that experience may provide more knowledge in the case of providing psychotherapy and in regards to familiarity with different mental illnesses and the comorbidities and teaching individuals and families how to cope with their loved ones mental health illness. However, expertise comes with practice the NP school teaches you just enough to manage just like RN school.

I'd argue against this when it comes to psych just as where acute care (justifiably) mandates inpatient experience to get in at most schools. Psych nursing absolutely prepares you by seeing and interacting with patients who as a pmhnp will be eventually treating. You gain an understanding of the effects a range of medications/therapies have on patients and the conditions they are geared to treat. Just like as an icu nurse you have real knowledge in acute care a psych nurse would never know without working in that area. The other (justifiable) concern for experience is your consideration for the roles as if the two are somehow something you can easily drop on a dime when maybe one might be more appealing financially or as far as access to a job factor. Talk about a waste of about 20,000 plus fees to stay certified not to mention the likely burnouts if you tried to do both at once.

The reality as I pointed out earlier is you need a certain number of hours working over 5 years in both settings to maintain certification. Meaning you will drop employers to do so or moonlight in your spare time. Both of which fails to really help your patients in places like psych where those providers are their own form of primary care provider. Those patients in particular need a provider in for the long haul rather than someone hoping to keep their options open.

[Oldmahubbard]

Without extensive experience in the field and a large amount self preparation, a Psych NP typically hands out whatever drugs the pt is asking for. Filling out a ton of disability paperwork for "PTSD" and "schizophrenia". Putting patients on depakote because they complain of "mood swings".

All a bunch of garbage, but you won't know it, because you won't know what these conditions really smell like.

[Jules A, MSN]

I do believe that the patients do need an experienced provider as we are their advocate, however being a floor Psychiatric RN does not provide you with the education and the base of a managing provider who is now prescribing psychotropics, as it is out of a RN's scope of practice and understanding. I do understand that experience may provide more knowledge in the case of providing psychotherapy and in regards to familiarity with different mental illnesses and the comorbidities and teaching individuals and families how to cope with their loved ones mental health illness. However, expertise comes with practice the NP school teaches you just enough to manage just like RN school.

It has very little to do with psychotherapy, which NPs really don't do anyway, or interacting with loved ones. It is about the differentials and the medications, seeing what they do, the doses and indications. It is not out of the RNs scope or understanding to know the medications, their indications, appropriate dosing, risks, benefits and alternatives. Since it sounds like you have no first hand knowledge with either role I'd ask you consider keeping an open mind.

[TelemetrytoBSN]

It has very little to do with psychotherapy, which NPs really don't do anyway, or interacting with loved ones. It is about the differentials and the medications, seeing what they do, the doses and indications. It is not out of the RNs scope or understanding to know the medications, their indications, appropriate dosing, risks, benefits and alternatives. Since it sounds like you have no first hand knowledge with either role I'd ask you consider keeping an open mind.

I'm aware of the role of a PHMNP significantly as well as the RN Role and my response was misinterpreted. However, if Physician's are able to be dual board certified in Internal Medicine and Psychiatry then I believe I could be a dual board certified NP and be a competent provider with provided training and experience. I feel it shouldn't be bashed for a individual to want to have dual focus in the nursing community as it is never bashed in medical community but encouraged.

[elkpark]

I'm aware of the role of a PHMNP significantly as well as the RN Role and my response was misinterpreted. However, if Physician's are able to be dual board certified in Internal Medicine and Psychiatry then I believe I could be a dual board certified NP and be a competent provider with provided training and experience. I feel it shouldn't be bashed for a individual to want to have dual focus in the nursing community as it is never bashed in medical community but encouraged.

The double-boarded physicians I know don't encourage it -- they discourage residents from pursuing double- or triple-boarding (this is in a large, well-known, well-regarded academic medical center). The reason why? You can't find settings where you can really use both specialties; you end up working in one or the other, and knowing more than the other providers about your other specialty, but it doesn't really make a lot of difference and doesn't really change your practice.

[djmatte, ADN, MSN, RN, NP]

I'm aware of the role of a PHMNP significantly as well as the RN Role and my response was misinterpreted. However, if Physician's are able to be dual board certified in Internal Medicine and Psychiatry then I believe I could be a dual board certified NP and be a competent provider with provided training and experience. I feel it shouldn't be bashed for a individual to want to have dual focus in the nursing community as it is never bashed in medical community but encouraged.

Not bashing. Just explaining to you the realities of care. Those physicians who can dual board easily operate in both capacities and in many cases can keep up competencies easier. They also can bill directly in those capacities. Almost all nurse practitioners bill under a collaborator and even in independent states, insurance still require collaborators to bill. This means that you will rarely if ever be hired to perform both roles and also means you will need to meet expected patient contact hours in order to maintain both certs. This will typically require a second job or frequently changing jobs to accommodate both requirements. Working as an ACNP, you will likely never get hired to dual role as psych. Primary care np you could pull something off, but the company you work for world need to be meticulous in how they bill and balance tbe patient load.

[TelemetrytoBSN]

Not bashing. Just explaining to you the realities of care. Those physicians who can dual board easily operate in both capacities and in many cases can keep up competencies easier. They also can bill directly in those capacities. Almost all nurse practitioners bill under a collaborator and even in independent states, insurance still require collaborators to bill. This means that you will rarely if ever be hired to perform both roles and also means you will need to meet expected patient contact hours in order to maintain both certs. This will typically require a second job or frequently changing jobs to accommodate both requirements. Working as an ACNP, you will likely never get hired to dual role as psych. Primary care np you could pull something off, but the company you work for world need to be meticulous in how they bill and balance tb-r patient load.

My goal is to not practice in the same facility as a PHMNP and ACNP my goal is to practice and utilize the certifications separately. I.e full time ICU NP Intensivist at Xyz Facility and part-time Crisis PHMNP NP at ABC Facility and vice versa.

[TelemetrytoBSN]

The double-boarded physicians I know don't encourage it -- they discourage residents from pursuing double- or triple-boarding (this is in a large, well-known, well-regarded academic medical center). The reason why? You can't find settings where you can really use both specialties; you end up working in one or the other, and knowing more than the other providers about your other specialty, but it doesn't really make a lot of difference and doesn't really change your practice.

Definitely agree as my goal is to not practice in the same facility as a PHMNP and ACNP my goal is to practice and utilize the certifications separately. I.e full time ICU NP Intensivist at Xyz Facility and part-time Crisis PHMNP NP at ABC Facility and vice versa. In which would provide me with more expertise in one and not the other that is understood, however my goal is to still persue both until I have decided.

[elkpark]

Definitely agree as my goal is to not practice in the same facility as a PHMNP and ACNP my goal is to practice and utilize the certifications separately. I.e full time ICU NP Intensivist at Xyz Facility and part-time Crisis PHMNP NP at ABC Facility and vice versa. In which would provide me with more expertise in one and not the other that is understood, however my goal is to still persue both until I have decided.

I understand your goal, which you have made v. clear. I was responding to your statement that double-boarding is "encouraged" in medicine. Not in my experience.

As to your goal, if I needed psychiatric services, I would definitely not want to receive them from an NP who is working in psych part-time as a side gig. How do you expect to become really competent and develop any real expertise in that scenario? At the least, it would take you much longer to do so than actually committing to practicing as a psych NP would. Since you mention working as a "crisis" psych NP, is your plan to work at some facility where people don't have a choice of provider, and you will have a "captive audience"? Those are the people who most need an expert clinician. Too bad for them, I guess.

[umbdude, MSN, APRN]

.....In regards to Phmnp I don't believe I would require much floor Psych RN experience as I believe the program would definitely provide me with a solid base....

I'm not one who is adamant about getting years of psych RN experience before PMHNP. However, I think your belief that the NP program will provide you with a solid base is perhaps misguided. NP programs don't do a good job preparing students, especially if you have zero experience in the specialty and/or you don't put in lots of extra effort into learning from materials outside of your curriculum. Some programs are better than others, but overall there aren't enough clinical hours.

No matter what, if you want both certifications, it only makes sense to go for ACNP first.

To be competent, you will likely need at least 2+ years of full-time experience in each specialty separately. Psych cases can be highly complex. There will be a large amount of learning and experience you will need to put into it even as a side gig.