Any Psych NP's with advice???

Jules A, MSN · Jan 1, 2015

First I would urge you to get a job as a RN on an inpatient, acute psychiatric unit before you commit to becoming a psych NP. Imo the experience and knowledge you will gain from observing a variety of diagnosis and administering many different medications will be invaluable for you and your future patients. If you want to work inpatient you would be unlikely be able to find a job as a new grad without a serious psych background.

NP school was easy and although interesting not especially enlightening. The diagnostic course was excellent and I loved the pharm courses although to think we graduate and prescribe with only 8 or 9 hours of pharm is frightening. Clinicals were decent but I arranged them myself with Drs I knew who were excellent so the knowledge I got from them was excellent. As with anything there are NPs and Docs who are great and some who are horrible so I am always particular about who I am learning from. There were more than enough courses on nursing leadership fluff that imo seem not much more than patting ourselves on the back and celebrating how important we now are that we can add more letters behind our names.

A majority of psych NPs work in outpatient, the M-F hours. I do hospital work as an attending on the inpatient unit. I start the day checking the emar for vitals/labs, go to rounds then see patients for med checks, discharge or intake evaluations. I call patient's OP providers for collateral info then go to the ED and medical floors for consults as needed. There are a lot of conversations with social work for admits and disposition. I absolutely love my jobs but the hours can be erratic, I rarely eat lunch and even when not on call I can get calls 24/7 for orders, updates and crisis.

elbumphis02 · Jan 3, 2015

Thanks for the advice. I may very well start looking at different RN psych positions to get some experience. Your insight is greatly appreciated.

PMHNP-1 · Jan 3, 2015

Grad school starts with horribly boring, tedious, and make-work intensive classes that are generic to all NP specialty (actually all MSN) areas: more "advanced" nursing theory classes, more policy classes...an "advanced" assessment.....a good set of classes on evidence-based practice (to try to get you to volunteer your time to help the PhDs as a scut dog worker on their research projects). There's advanced pathophys, ignoring the entire brain except maybe Alzheimers......Typically, there is a generic "advanced" pharm class, but it is at the level of a pre-nursing-school med class: it will not help with prescribing at all, and is a bunch of make work that is more appropriate at the undergrad level. Oh, and it doesn't necessarily even COVER psychotropics. Nice, eh?

After that, some specific classes, none of which will help you as a PMHNP. Usually the classes are make work, group stuff full of games and posters. The internships, if you're able to get good ones, are the only learning experiences in the entire program, but they won't help you in your job as a PMHNP.

See, PMHNPs are meant to be prescribing machines in the hospital or O/P setting. Revolving door kind of thing. Drugs only! Schools focus on psychology, learning theory, change theory, etc.......every kind of psychotherapy for individuals, groups, and families. But in reality, the JOB of a PMHNP, if you can't have your own practice (good luck with that!) is going to be 100% prescribing. you will not be ALLOWED to do any kind of therapy.

So, basically, when you look at the mismatch between the education and the actual job, it's huge. There aren't even med classes that cover psychotropics. Difficult to imagine, isn't it?

As for the DNP, it has more of the exact same stuff, nothing really adding to what you know. Oh, they do tout the "management" classes - as if you should have to do 2 more years of school, and 500 more same-old-same-old internship hours just to get some "management" classes: i.e., nothing really beneficial, except an ego-sop "DNP" after the name, if you're someone who needs that....and it doesn't sound like you are.

Basically, if you're interested in quickly seeing patients and prescribing to them without really knowing them, do the PMHNP program. If you want to actually talk to them, do some CBT, etc., you'll have to either have your own practice (! taking me years to get even a part-time practice going in this economy!) OR become a psychologist (PsyD or PhD) instead. Or get the MSW, social workers earn more than NPs anyway, and get to talk with patients more.

elbumphis02 · Jan 4, 2015

@PMHNP-1 I'm not really interested in the therapy aspect but I am interested in getting to know the patients. I'm even more interested in being able to prescribe medicines. It's very discouraging to read the part where you said psychotropics weren't necessarily covered. The psych np program that I am interested in offers courses in Advanced Pharm and Psychopharm across the life span. I hope those are able help me! What school did you attend, if you don't mind me asking?

whill08 · Jan 4, 2015

I am one week away from my last semester of a masters PMHNP program at a state university and we had a psychopharmacology course and pharmacology content in all of our specialty theory courses. I do agree that the majority of the generic masters courses are not all that helpful, especially for the psych specialty (sorry but I never plan to use much of what we did in health assessment). It is also true, from what I have seen, that the primary role is med management. However I do know some PMHNPs that do therapy as well, but personally I do not feel educationally prepared to do in depth therapy. I do feel that come May when I graduate I will have a sound knowledge base to begin my practice on. The advise of getting inpatient psych experience is very good, you will see the nitty gritty of mental health that is hard to come by anywhere else. Good luck!

elbumphis02 · Jan 4, 2015

Congratulations on coming this far in the program! Thanks for the advice and best of wishes to you!

Jules A, MSN · Jan 4, 2015

Grad school starts with horribly boring, tedious, and make-work intensive classes that are generic to all NP specialty (actually all MSN) areas: more "advanced" nursing theory classes, more policy classes...an "advanced" assessment.....a good set of classes on evidence-based practice (to try to get you to volunteer your time to help the PhDs as a scut dog worker on their research projects). There's advanced pathophys, ignoring the entire brain except maybe Alzheimers......Typically, there is a generic "advanced" pharm class, but it is at the level of a pre-nursing-school med class: it will not help with prescribing at all, and is a bunch of make work that is more appropriate at the undergrad level. Oh, and it doesn't necessarily even COVER psychotropics. Nice, eh?
After that, some specific classes, none of which will help you as a PMHNP. Usually the classes are make work, group stuff full of games and posters. The internships, if you're able to get good ones, are the only learning experiences in the entire program, but they won't help you in your job as a PMHNP.
See, PMHNPs are meant to be prescribing machines in the hospital or O/P setting. Revolving door kind of thing. Drugs only! Schools focus on psychology, learning theory, change theory, etc.......every kind of psychotherapy for individuals, groups, and families. But in reality, the JOB of a PMHNP, if you can't have your own practice (good luck with that!) is going to be 100% prescribing. you will not be ALLOWED to do any kind of therapy.
So, basically, when you look at the mismatch between the education and the actual job, it's huge. There aren't even med classes that cover psychotropics. Difficult to imagine, isn't it?
As for the DNP, it has more of the exact same stuff, nothing really adding to what you know. Oh, they do tout the "management" classes - as if you should have to do 2 more years of school, and 500 more same-old-same-old internship hours just to get some "management" classes: i.e., nothing really beneficial, except an ego-sop "DNP" after the name, if you're someone who needs that....and it doesn't sound like you are.
Basically, if you're interested in quickly seeing patients and prescribing to them without really knowing them, do the PMHNP program. If you want to actually talk to them, do some CBT, etc., you'll have to either have your own practice (! taking me years to get even a part-time practice going in this economy!) OR become a psychologist (PsyD or PhD) instead. Or get the MSW, social workers earn more than NPs anyway, and get to talk with patients more.

OMG, did I write this post? Perhaps I had a blackout? This cracked me up. I thought I was the only person either this cynical or with the balls to actually say it. :) I went to a well respected university and my education was lukewarm at best. Thank God I had the background I had or I know I would have missed some pretty serious stuff early on in my NP career. Since I work inpatient/acute I do get to spend some time doing tiny bits of psychoeducation but my passion is the amazing things that can be done by adding the right medication or more often taking away the excessive offending medications that someone else prescribed.

DivaliciousMe85 · Jan 4, 2015

This thread has really opened eyes! I have been thinking about becoming a PMHNP for a while now. I want to work with children in a psych setting. But after having read these last few comments it's making me think otherwise. I want to do more therapy than prescribing. I'm leaning now towards PNP with a PMHNP post-master's cert (so I can still prescribe when necessary) and getting a PhD in psych for the therapy end. Thank you for the info and insight...and for not being afraid to share the reality of it!

zenman · Jan 4, 2015

This thread has really opened eyes! I have been thinking about becoming a PMHNP for a while now. I want to work with children in a psych setting. But after having read these last few comments it's making me think otherwise. I want to do more therapy than prescribing. I'm leaning now towards PNP with a PMHNP post-master's cert (so I can still prescribe when necessary) and getting a PhD in psych for the therapy end. Thank you for the info and insight...and for not being afraid to share the reality of it!

Let me start at the end of this thread and see if I can get through it with any nausea medication. I do 30 minute sessions with both meds and therapy. The most important part of any therapy is the therapeutic relationshipâ€¦look it up. Kinda of a bummer to spend all that money getting a Ph.D. in a therapeutic modality to learn that. Even more of a bummer to find out that with your new Ph.D. you'll make less than a Psych NP. MSWs make even less than a psychologist. So, if you can prescribe and do therapy you are big cheese.

zenman · Jan 4, 2015

I am one week away from my last semester of a masters PMHNP program at a state university and we had a psychopharmacology course and pharmacology content in all of our specialty theory courses. I do agree that the majority of the generic masters courses are not all that helpful, especially for the psych specialty (sorry but I never plan to use much of what we did in health assessment). It is also true, from what I have seen, that the primary role is med management. However I do know some PMHNPs that do therapy as well, but personally I do not feel educationally prepared to do in depth therapy. I do feel that come May when I graduate I will have a sound knowledge base to begin my practice on. The advise of getting inpatient psych experience is very good, you will see the nitty gritty of mental health that is hard to come by anywhere else. Good luck!

Did someone forget to tell you that a great many mental health patients have physical problems? That's why I do a complete ROS with every new patient and followup every visit for any new problems. That means you need to know all physical conditions that can mimic psych conditionsâ€¦and there are a lot, plus all the meds that can cause psych symptoms. I was on vacation last week but the week before I ordered PT gait training for a patient that had been given a cane with no instructions on how to use it. I also ordered an OT consult to teach a patient how to use assistive devices since he had so much trouble getting his boots on due to back pain. Then, since primary care wouldn't order a urology consult on a patient with ED, I did so. Normally, I would send him back to primary care since he was on no meds that cause ED. But, since he had "emotional distress" due to the ED and that primary care wouldn't help him, he now fell in my backyard and I got things going. See how this works?

TheOldGuy · Jan 4, 2015

Gee PMHNP, you're not a real happy camper are you? You posted essentially the same thing on another thread - and here's my response again....

Gosh PMHNP, I think you went to the wrong school! There are classes specifically in psychopharmacology. 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. We used Stahl's text and I got to talk with Stahl - still trade emails with him. 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...you might want to consider a different practice setting if you're prescribing to people without "knowing" them....

By the way, social workers don't make close to what I make....