BSN to PMHNP for better financial stability?

FullGlass, BSN, MSN, NP · Jul 22

Only you can decide if it is worth it to become an NP. Your child's age is not a factor. If you plan to move to CA and work as an RN here, just be aware that CA RNs are paid the highest in the nation, up to $200K a year or more, even for permanent employees with benefits. That means that becoming an NP will likely not increase your pay and you would make less than an experienced RN for a few years.

If you are interested in becoming a PMHNP, you can get your BSN and go straight through to become a PMHNP (without working as an RN). It doesn't matter what people on this forum say, unless you want to be an acute care NP, working as an RN is not necessary or beneficial. Search on my name for a mini review I posted on this topic.

As you complete your RN rotations, think long and hard about whether you want to be a provider. These are very different roles. As a provider, you will be responsible for assessing, diagnosing, and develping treatment plans. RNs carry out orders. A lot of RNs who became NPs have posted here that they are unhappy in their new roles.

Personally, if you really want to be an NP, I strongly urge you to get an FNP. The experience you will gain in primary care will be invaluable in treating mental health outpatients. You can then get a post-master's PMHNP. I started out in primary care and am very glad I did.

FNP is the most versatile NP degree with the most job opportunities. Pay for FNPs is increasing markedly, at least in areas with a shortage of primary care providers.

The PMHNP role offers the most flexibility as there are many telehealth jobs available, as well as part-time jobs.

Best wishes

Advanced Practice Columnist / Guide · Jul 23

OP won't start at 200K a year even in highest paying hospitals in California as a new grad. UCSF pays the highest in all the UC system and RN's start at $80.76 per hour working 36 hours a week which translates to around $151K annually. RN's do quickly go to $94.27 per hour with 3.5 years of experience.

wage tables

FullGlass, BSN, MSN, NP · Jul 23

Corey Narry said:

OP won't start at 200K a year even in highest paying hospitals in California as a new grad. UCSF pays the highest in all the UC system and RN's start at $80.76 per hour working 36 hours a week which translates to around $151K annually. RN's do quickly go to $94.27 per hour with 3.5 years of experience.

wage tables

I'm not saying they will start at 200K per year. NPs don't either. But they can get up to that with a few years experience. I am in charge of recruiting for my employer and I see RNs who are making over $200K per year as employees with benefits for various employers in the Bay Area and Sacramento area. I even checked the public wage information for their employers and they were truthful. I've seen perm employee RN pay as high as $115 per hour.

Starting pay for FNPs is now generally $120K to $130K in CA. In areas with shortages they may pay higher and often will offer a sign on bonus and relocation assistance. But that is only in areas with shortages which are usually inland, not on the coast. They should be making $140 to $150K per year within a few years. Some NP specialties, like pain mgt or PMHNP pay more. I have 4 years experience as a PMHNP and am making $105 per hour as a perm employee.

So if a CA RN has 5 years experience and lives in the Bay Area, let's say they are making $190K per year (a lot make more than that). They complete their PMHNP and are interviewing for their first PMHNP job. They are NOT going to get paid $190K per year to start. They will take a pay cut of $10 to 40K per year to start. However, that should increase quickly with good performance.

Daddie O, BSN, RN · Jul 25

I disagree with the above response, suggesting that working as an RN is not necessary or beneficial. The experience you gain working as a psych RN is invaluable. Seeing how different mental health issues present, recognizing comorbidities, learning and honing therapeutic communication techniques, and becoming familiar with psychotropic medications will all help you in your future PMHNP education and practice.

I also disagree with the advice to go to FNP first. The pay differential between FNP and PMHNP is vast. In California, FNPs get paid less than acute bedside nurses fresh out of BSN school. In a PMHNP program, you will learn advanced health assessment and pharmacology before moving on to psych-specific assessments and pharmacology. Whether FNP or PMHNP, job opportunities abound. PMHNPs get paid nearly double what a FNP gets paid. Psychiatrists get paid more than general family practitioners as well. As a PMHNP, you will be headhunted.

dln0616 · Jul 25

Daddie O said:

I disagree with the above response, suggesting that working as an RN is not necessary or beneficial. The experience you gain working as a psych RN is invaluable. Seeing how different mental health issues present, recognizing comorbidities, learning and honing therapeutic communication techniques, and becoming familiar with psychotropic medications will all help you in your future PMHNP education and practice.

I also disagree with the advice to go to FNP first. The pay differential between FNP and PMHNP is vast. In California, FNPs get paid less than acute bedside nurses fresh out of BSN school. In a PMHNP program, you will learn advanced health assessment and pharmacology before moving on to psych-specific assessments and pharmacology. Whether FNP or PMHNP, job opportunities abound. PMHNPs get paid nearly double what a FNP gets paid. Psychiatrists get paid more than general family practitioners as well. As a PMHNP, you will be headhunted.

I hear conflicting opinions regarding the demand for PMHNP. Some were saying the field is over saturated & that it's becoming a "trend"? I think I'd definitely skip over the FNP portion personally. & certainly I'd be working in psych while in school- I love the specialty & am not sure what else I would be doing as a nurse if it's not psych.

FullGlass, BSN, MSN, NP · Jul 25

Daddie O said:

I disagree with the above response, suggesting that working as an RN is not necessary or beneficial. The experience you gain working as a psych RN is invaluable. Seeing how different mental health issues present, recognizing comorbidities, learning and honing therapeutic communication techniques, and becoming familiar with psychotropic medications will all help you in your future PMHNP education and practice.

I also disagree with the advice to go to FNP first. The pay differential between FNP and PMHNP is vast. In California, FNPs get paid less than acute bedside nurses fresh out of BSN school. In a PMHNP program, you will learn advanced health assessment and pharmacology before moving on to psych-specific assessments and pharmacology. Whether FNP or PMHNP, job opportunities abound. PMHNPs get paid nearly double what a FNP gets paid. Psychiatrists get paid more than general family practitioners as well. As a PMHNP, you will be headhunted.

dln0616 said:

I hear conflicting opinions regarding the demand for PMHNP. Some were saying the field is over saturated & that it's becoming a "trend"? I think I'd definitely skip over the FNP portion personally. & certainly I'd be working in psych while in school- I love the specialty & am not sure what else I would be doing as a nurse if it's not psych.

The PMHNP field is oversaturated now. Crappy for-profit schools are churning out subpar PMHNPs. There are fewer PMHNP jobs than FNP jobs, so it is not that easy to get a PMHNP job.

Whether you agree with me on working as an RN first is irrelevant. I wrote a mini-review based on actual EVIDENCE. As NPs, we practice EVIDENCE-based medicine.

If you want relevant experience, go for the FNP, work in primary care for a couple of years and also work on the post-master's PMHNP while working. Do you know who provides most psych care in the US? PCPs do. An FNP or AGPCNP will be treating less severe cases of mental health issues such as depression, anxiety, and insomnia. That will be far more valuable than working as an RN. NP experience trumps RN experience.

I have posted elsewhere about FNP jobs now paying a lot. There are places in CA that will start new grad FNPs up to 160K per year, with an additional sign on bonus, with relo assistance, even mortgage subsidies, and student loan repayment. Frankly, I have yet to see such offers for new grad PMHNPs.

I also find it odd that someone who isn't even an NP would think they know more than me about the best route to becoming an NP.

dualboardNP, MSN, RN, NP · Sep 25

Nursing will give you financial stability in California, whether you go the RN or NP route. PMHNP is appealing to a lot of folks right now for all the wrong reasons. A PMHNP, the wife and mother of four children, just about to start her DNP at my nursing school, Duke, was tragically stabbed to death in the Fall of 2022 by her patient during clinic. Psych comes with risk, a high potential cost to us, that should always be contemplated, too.

My partner is a PMHNP and I am a semester away from completing my PMHNP postgrad cert. I worked as an RN full-time during my entire MSN, something that I do not recommend btw, and made more than him. The responsibility and stress he deals with each shift, especially when seeing between 16-18 complex patients, is substantial compared to anything I ever did as an RN, but I was making $40K more than him a year easy. Considering how much goes into our NP training and how much we are responsible for with every patient under our care, it's unfair to get paid so little at the start of advanced practice. However, we all have to start somewhere and not all of us become NPs for the money.

Are you interested in becoming a provider and the responsibility that goes with assessment, diagnosis and management of someone's care? Have you considered the potential risk factor for you as a future psych provider, especially as a single parent? These are the questions that I'd ask myself if I were you. And hopefully this will help guide you in determining whether pursuing the PMHNP MSN is worth it or not. NP school is ultimately more time, more money and more effort, especially if your school doesn't source your clinical rotations and preceptors and the onus falls on you to find those clinical experiences every semester. And if you don't know or are perhaps more motivated by the California RN compensation from the start, perhaps NP isn't for you or just not right now. You can always do NP later if things change. Best of luck to you!

FullGlass, BSN, MSN, NP · Sep 25

dualboardNP said:

Nursing will give you financial stability in California, whether you go the RN or NP route. PMHNP is appealing to a lot of folks right now for all the wrong reasons. A PMHNP, the wife and mother of four children, just about to start her DNP at my nursing school, Duke, was tragically stabbed to death in the Fall of 2022 by her patient during clinic. Psych comes with risk, a high potential cost to us, that should always be contemplated, too.

My partner is a PMHNP and I am a semester away from completing my PMHNP postgrad cert. I worked as an RN full-time during my entire MSN, something that I do not recommend btw, and made more than him. The responsibility and stress he deals with each shift, especially when seeing between 16-18 complex patients, is substantial compared to anything I ever did as an RN, but I was making $40K more than him a year easy. Considering how much goes into our NP training and how much we are responsible for with every patient under our care, it's unfair to get paid so little at the start of advanced practice. However, we all have to start somewhere and not all of us become NPs for the money.

Are you interested in becoming a provider and the responsibility that goes with assessment, diagnosis and management of someone's care? Have you considered the potential risk factor for you as a future psych provider, especially as a single parent? These are the questions that I'd ask myself if I were you. And hopefully this will help guide you in determining whether pursuing the PMHNP MSN is worth it or not. NP school is ultimately more time, more money and more effort, especially if your school doesn't source your clinical rotations and preceptors and the onus falls on you to find those clinical experiences every semester. And if you don't know or are perhaps more motivated by the California RN compensation from the start, perhaps NP isn't for you or just not right now. You can always do NP later if things change. Best of luck to you!

As someone who recruits NPs for a mental health practice, I see a big difference in the NPs who had primary care experience vs the NPs that only have a PMHNP. The FNPs or AGPCNPs have a big leg up when they beome a PMHNP, as many conditions may have medical causes and there are many conditions with comorbidities. In addition, primary care experience provides a lot of experience treating common mental health issues such as depression, anxiety, and insomnia. That is why I recommend that someone who knows they want to be an NP should go straight through to NP school. It is pretty quick and easy to get a post-master's certificate in another NP specialty. For example, an FNP can get a PMHNP in 1 to 2 years by going to school part-time.

Working as an NP is far more valuable to a future PMHNP than working as an RN.

And, I can't emphasize this enough, the evidence supports that RN experience does not improve NP competency. You can find my mini evidence review on this forum. What improves NP competency is NP experience. Period.

dualboardNP, MSN, RN, NP · Sep 26

FullGlass said:

As someone who recruits NPs for a mental health practice, I see a big difference in the NPs who had primary care experience vs the NPs that only have a PMHNP. The FNPs or AGPCNPs have a big leg up when they beome a PMHNP, as many conditions may have medical causes and there are many conditions with comorbidities. In addition, primary care experience provides a lot of experience treating common mental health issues such as depression, anxiety, and insomnia. That is why I recommend that someone who knows they want to be an NP should go straight through to NP school. It is pretty quick and easy to get a post-master's certificate in another NP specialty. For example, an FNP can get a PMHNP in 1 to 2 years by going to school part-time.

Working as an NP is far more valuable to a future PMHNP than working as an RN.

And, I can't emphasize this enough, the evidence supports that RN experience does not improve NP competency. You can find my mini evidence review on this forum. What improves NP competency is NP experience. Period.

Not sure if your response was aimed at mine, but since you quoted me...

My response was specific to the original poster's question re: financial stability in the State of California between RN and NP not competency. Also, adding a postgraduate certification in psych isn't 'fairly quick and easy' if already trained as an NP as you mention above. Nor should it be. There is a financial commitment for the NP to contemplate, specifically tuition and reduced work time/salary in current roles, an additional 540-750 clinical hours in psych (varies by individual PMHNP program requirements), not to mention the study time dedicated to psychiatric disorders. And I cannot think of a single PMHNP PGC program that gets you what you need in a year on a part-time enrollment basis. It's a year full-time at a minimum just about everywhere in California that offers it at least, but can be 2 years part-time.

Most of the FNPs in my cohort feel they lack the foundation and skillset to diagnose and treat mental health disorders in the primary care setting hence why they are doing PMHNP. There is a huge difference in being exposed to a variety of mental health conditions in the primary care setting with the level of expertise in managing the mental health condition no matter how 'common' in addition to understanding the different psychopharmacological interventions and therapeutic modalities.

PMHNPs work within a specialty scope, mental health, regardless of how many board certifications they have. So while I appreciate that, yes, there's an advantage to knowing more and having more in your NP tool kit, patients with co-morbidities will, ideally, have their PCP, specialists. RN experience is to be valued. Is it necessary in most specialities and will it make you a better provider? Of course not. But for Nurse-Midwifery and Psych especially, it will definitely provide a serious advantage especially if not doing a fellowship and going straight into practice as a new grad NP.

FullGlass, BSN, MSN, NP · Sep 26

dualboardNP said:

Also, adding a postgraduate certification in psych isn't 'fairly quick and easy' if already trained as an NP as you mention above. Nor should it be. There is a financial commitment for the NP to contemplate, specifically tuition and reduced work time/salary in current roles, an additional 540-750 clinical hours in psych (varies by individual PMHNP program requirements), not to mention the study time dedicated to psychiatric disorders. And I cannot think of a single PMHNP PGC program that gets you what you need in a year on a part-time enrollment basis. It's a year full-time at a minimum just about everywhere in California that offers it at least, but can be 2 years part-time.

Most of the FNPs in my cohort feel they lack the foundation and skillset to diagnose and treat mental health disorders in the primary care setting hence why they are doing PMHNP. There is a huge difference in being exposed to a variety of mental health conditions in the primary care setting with the level of expertise in managing the mental health condition no matter how 'common' in addition to understanding the different psychopharmacological interventions and therapeutic modalities.

PMHNPs work within a specialty scope, mental health, regardless of how many board certifications they have. So while I appreciate that, yes, there's an advantage to knowing more and having more in your NP tool kit, patients with co-morbidities will, ideally, have their PCP, specialists. RN experience is to be valued. Is it necessary in most specialities and will it make you a better provider? Of course not. But for Nurse-Midwifery and Psych especially, it will definitely provide a serious advantage especially if not doing a fellowship and going straight into practice as a new grad NP.

I earned my post master's PMHNP through Johns Hopkins in 1 year and 3 mos. Many of my classmates worked FT, I personally reduced my hours to 24 hours.

As I have repeatedly stated, the EVIDENCE indicates that RN experience does not increase NP competency. I suggest you read my mini evidence review on this topic.

I will qualify my previous statements. Most PMHNPs work in outpatient care. For this population, it is my professional opinion that primary care NP experience is more valuable than RN experience. NPs assess, diagnose, and treat, and RNs do not. FNPs should be able to treat mild depression, anxiety, and insomnia. The majority of mental health care is delivered through primary care. So, I am rather alarmed that FNPs don't feel able to do this. I was a primary care NP and treated a fair amount of mental health issues. The other reason primary care experience is helpful is that one experiences the comorbidities common between mental health and medical issues. It trains the NP to probe on possible medical causes of mental health issues. The PMHNPs I work with who do not have any other NP experience do not have a good grasp of how to help patients with comorbidities.

For a CNM, yes, L&D RN experience would be helpful. For a prospective PMHNP that wants to work in-patient, psych RN experience would be helpful.

Overall, I'm sorry, but the evidence does not indicate that RN experience increases NP competency. These are 2 different jobs. The way to increase NP competeny is through NP experience. That should be obvious.

In addition, especially in CA, RNs make good money. When recruiting new NP grads who have been working as RNs for several years, they are shocked they are going to take a pay cut in their first NP job. So being an RN for more than 3 or 4 years is going to make it hard for many new NPs to adjust to the possible financial hit of becoming an NP.

BSN to PMHNP for better financial stability?

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