Everyone is in NP school !

shibaowner, MSN, RN, NP · Aug 11, 2017

And by your logic unless you go to a top ten school don't go because only they are the best and get the jobs. Lol have a nice day

Your response is interesting. You say the barriers to entry for NPs are not high enough, yet object when I point out that only the best candidates will get hired! Isn't that enough of a barrier to entry?

In addition, I never said top 10 schools only - I was just giving some examples of good schools. My point is to go to a solid reputable school and there at least 100 of those for NPs, according to USN&WR. In addition, I am a staunch advocate of, and greatly admire, individuals who start out as ADNs and work their way up to NP or CRNA. Personally, I think it is wonderful that nursing provides this flexibility.

Here is a link to the USN & WR ranking of graduate nursing programs:

Access Denied

lwsoccjs · Aug 11, 2017

I object because I know only the best NP's don't only get hired. It's flawed logic. In theory only the best get hired but we all know that's not true. Second I am well aware of the US news rankings. You also argue that NP is equal without experience in multiple posts and yet state advocate for the flexibility and admire. But this arguing is obviously pointless. We are on two sides of the coin here. I believe that barrier is way to low. Believe there is indeed an over satuatation that you state there maybe or maybe not. I believe that it is who you know that gets you hired unfortunately. So we will agree to disagree.

shibaowner, MSN, RN, NP · Aug 11, 2017

The fact that this is a thing:
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While this is also a thing (same facility):
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Where someone can literally make more as an RN than an NP at the same facility - with lower liability? Tells me that there is a glut of Nurse Practitioners. And yes, I know people who have taken this job, no they weren't for profit students, and yes they came from well known schools (plus they had in specialty nursing experience). This is a problem and when stuff like this exists? There tells me that people are graduating desperate enough to sell themselves, very, very short.

I don't know why you don't name the facility, as this information would be available to the public anyway. I have seen a similar listing here in San Diego for a County position. The PMHNP position is always listed. No one is forcing anyone to take this job. Given that there is an acute shortage of psych professionals in California, I would venture the only people who would take this job are the ones who cannot get hired elsewhere. That is truly unfortunate for their patients. But $79K to $97K isn't bad money - many people would be thrilled to get paid that much. Government employees can also get some great benefits like loan repayment, more vacation time, and better retirement plans than the private sector. If an NP did take that job, I would venture that after a couple years' experience they could get a higher paying job easily as a PMHNP.

Jules A, MSN · Aug 11, 2017

No one is arguming that hopefully employers will only hire good talent. Does not make up for the core issue of over saturation.

Raises her hand. I absolutely believe that many places could care less about the quality of those they hire especially if they can get them cheaply. The exception in my experience is some private practices where physicians recognize the potentially large variation in quality and are willing to hire and appropriately compensate NPs who have solid experience and education.

lwsoccjs · Aug 11, 2017

Refer to my last post that will demonstrate my thoughts on your post Jules lol.

Jules A, MSN · Aug 11, 2017

I am a new grad NP w/o RN experience and I just started a PMHNP job for $95K, increasing rapidly to $140K within 18 months, assuming I meet performance objectives. And this is in a very affordable location (I can rent a nice 3 BR 2 BA house for $1200 to $1600). Our clinic is looking to hire TEN NPs and/or PAs in the next year. And I know the top pay for an NP is $190K now at this facility. They provide a 3 to 6 month intensive training program as well.

Most importantly you are NOT a PMHNP and frankly I am shocked that your company is hiring FNPs to work solely in psychiatry as if a training program is sufficient in place of formal education and a board certification. My guess is this will come back to haunt them in the near future.

I'm also surprised that you have written here that Johns Hopkins School of Nursing is the one who instructed their FNP students that they are eligible to practice outside their scope in a specialty that has a board certification if they receive training. Those statements will likely come back to haunt you as JHH is very particular about their pristine reputation.

Also your rate of pay for working as a PMHNP is horrid, especially in a state like California. You are making around $50,000 a year less than would be expected of a new grad if a PMHNP-BC. The potential bonuses are all well and good but the amount of money you are losing in the meantime and the degradation of our specialty's rate when NPs accept subpar wages is part of the very problme this thread was built on.

JustKeepDriving · Aug 11, 2017

Most importantly you are NOT a PMHNP and frankly I am shocked that your company is hiring FNPs to work solely in psychiatry as if a training program is sufficient in place of formal education and a board certification. My guess is this will come back to haunt them in the near future.
I'm also surprised that you have written here that Johns Hopkins School of Nursing is the one who instructed their FNP students that they are eligible to practice outside their scope in a specialty that has a board certification if they receive training. Those statements will likely come back to haunt you as JHH is very particular about their pristine reputation.
Also your rate of pay for working as a PMHNP is horrid, especially in a state like California. You are making around $50,000 a year less than would be expected of a new grad if a PMHNP-BC. The potential bonuses are all well and good but the amount of money you are losing in the meantime and the degradation of our specialty's rate when NPs accept subpar wages is part of the very problme this thread was built on.

I'm curious how this even works. I get managing stuff like simple anxiety and depression but as far as I know FNP/AGPCNP/ PNP don't get tons of training in managing stuff like schizophrenia, OCD, personality disorders, Bipolar type I etc and many I know generally even refer out stuff like refractory depression.

There are a lot of risks in psychiatry. Lets say someone decided to go ahead and work in the scope of practice as a PMHNP without a PMHNP certification - and the patient kills themselves and the family sues. A lawyer is going to ask, "Are you certified to practice psychiatry". The answer to this is going to be "No". I'm no expert, but I'm just going to take a wild guess that would look bad.

Like in psych we often manage pain in the context of psychiatric dx (ex. prescribing duloxetine or gabapentin for someone who has anxiety or depression with some chronic pain/neuropathic disorders, or doing CBT for chronic pain etc) but taking a pain management job where I'd be managing complex opiate regimens? Heck no. Even if they told me they'd provide "on the job training" I wouldn't take it. Once again no expert, but if anything were to happen I'm relatively confident I'd be in some serious code brown.

It's short sighted to believe that places won't try and take advantage of the NP. Places try to push the limits all the time - healthcare is a business (that's why medicare/medicaid fraud is a thing) and some places really don't care about scope of practice. Believe me I've seen enough to believe that to some facilities - we're just warm bodies there to generate revenue and the first people to get thrown under the bus when things go wrong.

Which also goes hand and hand with the pay - like if I can earn that pay an RN (Without even doing overtime! And in California, I totally have) that's a huge problem as the liability as an NP is much higher than that of an RN and one should be compensated accordingly.

Owlgal · Aug 11, 2017

This whole discussion reeks of elitism. Which is something I find distasteful and usually find only on physician forums. You know, where they bemoan the fact that they aren't treated like gods anymore and that those upstart NPs are stealing all their thunder.

There is not an oversaturation of NPs -- Sure, at some point in the future, there might be -- but then again, maybe the profession will evolve to meet whatever practice environment we'll be facing at that time, then. I remember 7-10 years ago when everyone was predicting that there would be an oversaturation of the RN market -- this was quickly followed by the realization that there was, in fact, a shortage.

And for the few who are sneering at the "low" pay some NPs accept -- that's okay. Not everyone lives in California or has the desire to bust ass for $180k. I'd suggest that you do you and be content with that.

shibaowner, MSN, RN, NP · Aug 11, 2017

I object because I know only the best NP's don't only get hired. It's flawed logic. In theory only the best get hired but we all know that's not true. Second I am well aware of the US news rankings. You also argue that NP is equal without experience in multiple posts and yet state advocate for the flexibility and admire. But this arguing is obviously pointless. We are on two sides of the coin here. I believe that barrier is way to low. Believe there is indeed an over satuatation that you state there maybe or maybe not. I believe that it is who you know that gets you hired unfortunately. So we will agree to disagree.

How do you know that "only the best NP's don't only get hired?" Are you hiring NPs? In fact, if that is the case that crappy NPs get hired, that suggests there in indeed a shortage of NPs, as the natural preference is to the get the best NP for the buck.

I agree with you that who you know matters - that is true in any profession. Any job seeker must have good job hunting and networking skills. So, someone with impeccable credentials who does not now how to look for a job, present themselves well, and lacks networking skills will indeed have great difficulty finding a job. A mediocre job seeker who has great job search and networking skills will likely find a job fairly easily.

It is not inconsistent to say that RN experience is not necessary to be a good NP and to also admire those who do bootstrap themselves up from ADN to NP. I feel there is room in our profession for multiple pathways to NP or CRNA.

shibaowner, MSN, RN, NP · Aug 11, 2017

Most importantly you are NOT a PMHNP and frankly I am shocked that your company is hiring FNPs to work solely in psychiatry as if a training program is sufficient in place of formal education and a board certification. My guess is this will come back to haunt them in the near future.
I'm also surprised that you have written here that Johns Hopkins School of Nursing is the one who instructed their FNP students that they are eligible to practice outside their scope in a specialty that has a board certification if they receive training. Those statements will likely come back to haunt you as JHH is very particular about their pristine reputation.
Also your rate of pay for working as a PMHNP is horrid, especially in a state like California. You are making around $50,000 a year less than would be expected of a new grad if a PMHNP-BC. The potential bonuses are all well and good but the amount of money you are losing in the meantime and the degradation of our specialty's rate when NPs accept subpar wages is part of the very problme this thread was built on.

I am sorry if I was not clear. You are correct, I am not a PMHNP. However, I am working in a PMH outpatient clinic. I have previously explained this at great length, but I will do so again. Here in California, there is not a state requirement to be a PMHNP in order to work in psych. Individual employers may require the PMHNP credential, but it is not mandated by law. We haven't had any legal issues around this in the state of California. Therefore, here in California I am working within the scope of my practice. If you are concerned about this, please feel free to complain to the State of California.

In addition, I am working in an outpatient clinic. High acuity cases such as schizophrenia and so forth are referred. Our patients generally suffer from depression, anxiety, ADHD, and substance abuse. About 60% of mental health patients receive care through their primary care provider right now. Should we prohibit MDs, PAs, and NPs from treating low acuity mental health outpatients?

Furthermore, I am working in a designated HPSA shortage area for both primary care and mental health care. Most of these patients would have NO care if it were not for our clinic. Some of the patients literally live in the mountains 4 hours away from any sort of healthcare facility and are so poor they do not have a car. We are providing an important community service for this population. Mentally ill people w/o access to care often try to self-medicate with ETOH and street meds, which leads to a whole host of other problems. In addition, untreated mentally ill persons may pose a danger to themselves and people around them. I find it hard to believe that you think it is better for these folks to have no care rather than be treated by an NP with solid PMH training.

Another interesting factor is that there are social and cultural issues at play that are unique to this local population. I doubt any PMHNP programs would provide preparation in dealing with these population-specific issues.

And this facility also hires PAs. I am not aware of PAs having special credentials to work in mental health beyond what an AGNP or FNP has. In fact, one of our founders is a PA and he is just awesome.

I thank you for your concern about Hopkins' reputation. I have already spoken with my former professors, advisor, and the head of the PMHNP post-master's certificate program. They are delighted with my new position and are looking forward to my application for the PMHNP post-master's certificate. However, you are free to write Hopkins and complain about me.

My rate of pay is not horrid. It is excellent. My work location has a very low cost of living. Cost of living does influence pay. This area is way cheaper than Baltimore and Baltimore seened very inexpensive to me. Inland California has many very affordable locations. I also have good benefits, can work four 10-hour days, no oncall, no overtime. And I am getting a salary - I start out at $90K because I am in training. After training is complete (3-6 months) I get a raise. And once I am seeing a full patient load independently I get another raise to $140K salary and after that regular raises every year. While I know in the Baltimore/DC area some PMHNP new grads can get $150K to start, this is also a higher cost of living area (especially DC metro). I'd also like to point out that pay for NP residency programs is abysmal and people compete to get into those programs. I feel blessed to get this intensive training similar to a residency and to be getting paid very well while doing it.

As for pay, I don't know how much you are making. Here in Calif, our healthcare professionals are actually paid less than in many other states. Yes, you read that correctly. I just searched on psychiatrist (MD) salaries here in Calif and they are averaging around $230-$240K. Given that the current top salary for an NP in my facility is $190K, that is excellent pay. There is no way anyone is going to pay an NP the same, or more than, an MD. Psychiatrists who go into private practice can make more money, as they can charge $300 per hour, but not everyone wants to go into private practice. However, if you want to contact my employer and demand that they pay NPs and PAs more, I won't complain!

I am not just in this for the $. I truly love psych. And it is hard to find people who are passionate about psych. If I just wanted to make a lot of $, I would have become a CRNA or gone into derm (some derm NPs make $500K per year). My goal is to maintain my PCP skills thru volunteer work or home health assessment (part time), get my PMHNP cert, then eventually get my PhD and move into teaching. I had a very lucrative business career prior to becoming an NP and I was miserable. At this point in my life I am happy to do something for the greater social good while making a decent living doing what I love.

Jules A, MSN · Aug 11, 2017

This whole discussion reeks of elitism. Which is something I find distasteful and usually find only on physician forums.
And for the few who are sneering at the "low" pay some NPs accept -- that's okay. Not everyone lives in California or has the desire to bust ass for $180k. I'd suggest that you do you and be content with that.

I can see why you might think that on the first point but it really is only maybe one person repeatedly referring to Hopkins, Yale, Columbia, U Penn, UCLA, UCSF, U of Maryland, etc. What I read from the majority is there should be consistent and high admission standards which I feel is very reasonable and a far cry from elitism.

As for your last point I'd urge you to consider that my just shy of $200,000 base salary doesn't require I "bust ass" any harder than the person who accepted a position making 1/2 that and yet it does require that I know my worth, negotiate and most importantly am keeping wages at a decent rate which only aids my peers in this specialty.

shibaowner, MSN, RN, NP · Aug 11, 2017

I'm curious how this even works. I get managing stuff like simple anxiety and depression but as far as I know FNP/AGPCNP/ PNP don't get tons of training in managing stuff like schizophrenia, OCD, personality disorders, Bipolar type I etc and many I know generally even refer out stuff like refractory depression.
There are a lot of risks in psychiatry. Lets say someone decided to go ahead and work in the scope of practice as a PMHNP without a PMHNP certification - and the patient kills themselves and the family sues. A lawyer is going to ask, "Are you certified to practice psychiatry". The answer to this is going to be "No". I'm no expert, but I'm just going to take a wild guess that would look bad.
Like in psych we often manage pain in the context of psychiatric dx (ex. prescribing duloxetine or gabapentin for someone who has anxiety or depression with some chronic pain/neuropathic disorders, or doing CBT for chronic pain etc) but taking a pain management job where I'd be managing complex opiate regimens? Heck no. Even if they told me they'd provide "on the job training" I wouldn't take it. Once again no expert, but if anything were to happen I'm relatively confident I'd be in some serious code brown.
It's short sighted to believe that places won't try and take advantage of the NP. Places try to push the limits all the time - healthcare is a business (that's why medicare/medicaid fraud is a thing) and some places really don't care about scope of practice. Believe me I've seen enough to believe that to some facilities - we're just warm bodies there to generate revenue and the first people to get thrown under the bus when things go wrong.
Which also goes hand and hand with the pay - like if I can earn that pay an RN (Without even doing overtime! And in California, I totally have) that's a huge problem as the liability as an NP is much higher than that of an RN and one should be compensated accordingly.

I have discussed my training at this PMH facility at length elsewhere. But to address your concerns, this is an OUTpatient clinic. We do not handle high acuity cases. There is intensive 3 to 6 month individualized, mostly one-on-one training that also includes academic assignments in addition to full-time work. I am doing med mgt, not psychotherapy. We have a one to one ratio of psychologists to providers. Every patient is required to see both a provider and a psychologist.

The State of California does NOT require PMHNP cert. We also have not any issues around legal liability.

60% of mental health care is already delivered by PCPs. Is anyone suing them? Should we prohibit this when we have an acute shortage of PMH professionals of all types?

There are NPs and PAs that work in pain management. I did a pain mgt clinical rotation under 2 fantastic doctors. Pain mgt NPs and PAs do a lot more than just prescribe opioids. The trend now is to minimize use of pain meds and focus on other treatments such as TENs, injections, procedures, lifestyle, and nonopioid meds. For those NPs and PAs, they generally learn through OJT. There are also courses available. A responsible FNP or AGNP would refer a chronic pain patient to a pain mgt specialist. But these specialists are in short supply - what if there isn't one available in your area? Is your argument that the pain patients are then just out of luck? PCPs have a professional responsibility to continually educate themselves and gain skills to meet their population's needs. In addition, they need to develop a good network for referrals.

I have yet to see an organization that knowingly hires crappy NPs just to save a buck. And even if that were so, there are also plenty of crappy MDs out there who are working and killing/maiming people, too. In a recent Texas case, a surgeon was indicted for a form of murder because he literally killed and/or badly crippled several people before he was caught and sent to prison!

Dr. Death: The Shocking Story of Christopher Duntsch, a Madman with a Scalpel

https://www.dallasnews.com/news/courts/2017/02/20/doctor-sentenced-life-prisonfor-botched-spine-surgery-dallas-county

It is up to individual NPs to be aware of quality, ethical, and legal issues and act accordingly.

Also, I would love to know what kind of RN job pays $140K to $190K without OT within 18 months of graduating from nursing school. If these jobs do exist, they are quite rare. And even if that were so, so what? I don't begrudge RNs making good $. But being an RN and being an NP are 2 very different jobs and I want to be an NP. Guess what, if had I gone to law school, I could start at $160K a year and if I made partner, I'd be making over a $1 million. But I don't want to be a lawyer. Or I could have gone to Wall Street and look forward to being a multimillionaire or even billionaire within 10 or 15 years - but I don't want that. Or I could have stayed in business and easily made $300K to $400K per year, but I was miserable.

My training and work experience to date has been very positive. I am very grateful that I have this opportunity and I encourage all NPs and future NPs to pursue their career goals and dreams with positivity (and a lot of hard work!). There are plenty of successful, happy, positive NPs out there who are mentors, preceptors, and instructors.