Can Psych NPs wear suits to work?

Specialties NP

Published

This may be a silly questio, but I'm sincerely interested in psych nursing and would like further insight into work environment and work attire specifically. I'm a firm believer in the look your best do your best idealogy. Can psych nps wear suits to work?

Specializes in Outpatient Psychiatry.

PMHNP-1 you need to relocate to another state or change career fields. Presently, PMHNP work is the best kept secret in advanced practice nursing. However, we're seeing that the secret is out. Some states have better practice rights than others. Mine is collaborative for prescribing only, and it doesn't matter if it's scheduled or legend meds. However, with all other aspects, we're independent. We can diagnose you, test you, cut you, and sew you (et cetera) without physician involvement. Of course, we can also bill you. The med collaboration part is ridiculous. I have a moonlighting gig on some of the Fridays that I've negotiated off from my regular employer who offers a standard benefit package with insurance, retirement, CME, malpractice, and paid time off both for holiday, sick, and CME. The malpractice gig is an hourly rate, and the collaborator there is quite selective about meds. At my regular practice, the collaborator has no restrictions or barriers. Compared to your statements, my training in psychotherapy largely lasted one semester with the rest focused on psychopathology diagnosis and appropriate psychopharmacology. I still believe it was substandard, but apparently it was infinitely better than your training.

Having said all of that, you're in a really crappy job, and I'm sorry you have to deal with that. I would not. Moving is a big deal especially when family and kids are in the picture, but if you relocated you could have every option available to you ranging from solo practice to 200k income. You've been handed a rotten egg, and now you're slinging it around. Be careful because not everybody has been handed the bum deal you have. Just as I managed to get a stellar job as a new guy, you've gotten a POS gig as an experienced person. Everyone's results may vary, but rather than sucking it up it seems like it would be in your best interest, and perhaps your family's, to move elsewhere or find a new profession.

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I'm reading through this thread and it seems that either someone has me on ignore or a couple of posts have been deleted?

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Specializes in Hospital medicine; NP precepting; staff education.
I'm reading through this thread and it seems that either someone has me on ignore or a couple of posts have been deleted?

To which posts are you referring?

As to the mention of a desire or preference for doing psychotherapy, I find it interesting that you are trained in that and are not being permitted to practice that.

I wonder if it is an hour-earning thing. For example, Clinical social workers can facilitate psychotherapy in my state. This requires first an LMSW and then 2000 post graduate hours of clinical supervision to apply for the LISW.

Does your state require so many hours of clinical supervision outside of school? Is it just the organization's structure? Or is it your state's laws?

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I was reading PMHNP-1 responses. They read like they were responding to another poster, but I think they may have been responding to the OP instead. My mistake.

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Also important: are you thinking about becoming a psych/mental health NP because you like both the psychotherapy and the med management parts? Because if you were thinking that NPs are ever allowed to do psychotherapy, despite MSN programs focusing over 3/4 of your specialty training on psychotherapy (and just 1/4 on the med mgt), be in for a surprise. We're not allowed to do psychotherapy. Not allowed.

@zenman - Is this true in the VA setting? The VA is where I intend to work.

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Specializes in Outpatient Psychiatry.
@zenman - Is this true in the VA setting? The VA is where I intend to work.

They do one hour evals and 30 minute med checks. They record minutes of psychotherapy used in their EHR (Vista I think?). I know some NPs at the local VA outpatient mental health clinic do (or try to do) psychotherapy altruistically believing that they have to provide this since there aren't enough therapists. Interestingly, the supply of therapists to prescribers is a bit inverse to what you typically see in life. Even when I was an intern at the VA, I had trouble filling a 30 minute time slot with my panel of patients. I liked the setting and the population a lot, but if I worked there I'd rather have appointments only half as long and get some bonus money or otherwise higher wages.

Mostly the NPs just speak therapeutically and ask a lot of questions. There's no structured psychotherapy, e.g. social skills training, CBT, DBT, IPT, EMDR, etc. going on. Of course, they see their veterans as infrequently as the therapists. I have a few VA drop outs in my clinic because they didn't feel they received adequate psychotherapy there. They probably didn't, but I have a menu of therapists/counselors for them to pick from. I don't do it and have no interest in doing it. Frankly, I don't really know how to even go about with any continuity but rather what modalities seem to work best with sundry disorders so I let "expertly trained" persons do that while I focus on diagnoses, ruling out organic problems causing mental illness, and treat with meds.

I know as much about providing psychodynamic therapy as I do picking birth control meds.

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