Experience for PMHNP

pro-student · Aug 29, 2018

Any quality program with prepare you to be a psych provider without having direct inpatient psych experience. There is a significant difference between the roles of inpatient psych nurse and PMHNP. Additionally, as you noted, you do have experience with psych patients. All nurses care of psych patients and need to understand the important issues like mental illnesses, psych medications, and therapeutic communication. I have a friend who finished the first year of a top ranked PMHNP program with only ICU experience. It absolutely does not have to be a barrier and sometimes having "other" experience is helpful in understanding things like ruling out physiological causes of mental illness.

Jules A, MSN · Aug 29, 2018

Any quality program with prepare you to be a psych provider without having direct inpatient psych experience. There is a significant difference between the roles of inpatient psych nurse and PMHNP. Additionally, as you noted, you do have experience with psych patients. All nurses care of psych patients and need to understand the important issues like mental illnesses, psych medications, and therapeutic communication. I have a friend who finished the first year of a top ranked PMHNP program with only ICU experience. It absolutely does not have to be a barrier and sometimes having "other" experience is helpful in understanding things like ruling out physiological causes of mental illness.

Are you a psychNP or psychRN? Again it blows my mind that people actually believe our short NP education is meant to take someone from zero to competent in two years with only one or two pharmacology courses. Very unfortunate that our vulnerable mental health patients aren't valued more.

pro-student · Aug 29, 2018

Are you a psychNP or psychRN? Again it blows my mind that people actually believe our short NP education is meant to take someone from zero to competent in two years with only one or two pharmacology courses. Very unfortunate that our vulnerable mental health patients aren't valued more.

Care to provide any evidence of your point? I think it's a pretty perverse assumption that because I suggested someone didn't need inpatient psych experience before PMHNP school that I don't value patients with mental illness. I hate to break it to you but there is nothing magical about a few years experience in inpatient psych that differentiates the potential for an APN especially since most PMHNPs work in outpatient settings.

Are you also going to suggest that someone needs experience in both adult and child/adolescent psych is all PMHNP programs as lifespan in scope? Experience can be a great thing and I'm in now way trying to diminish it. But, as I mentioned, all nurses do psych (MAYBE with the exception of OR nurses although with the personalities in the OR that's easily debatable). All experience isn't necessary good experience and it's a major misunderstanding to think that the only place you can build psych skills in on the inpatient unit. I'd love to hear what mythical difference you think x amount of time on a psych unit will make especially to someone like the OP who works with psych pts in the ED.

bryanleo9 · Aug 29, 2018

As we recommend to all people wanting to pursue a psyciayric mental health nurse practitioner certificate, please get real experience in the field. Volunteer in an acute inpatient psych unit and see if this is the patient population you can handle or want to spend a career in.

Violent Headbangers who try to knock their doors down with their head, flesh and feces eaters, people that will insert anything they can get their hands on into their various body holes....this is real acure psych and the self injurious behavior is seen in outpatient as well. Definitely talk to Psyciayric NP and psychiatrists who have worked so hard treating depression only to have their patient commit suicide. I have 8 years experience in the field and have seen everything listed above. Before dropping a lot of money in tuition please see what it's like first hand.

elkpark · Aug 29, 2018

Care to provide any evidence of your point? I think it's a pretty perverse assumption that because I suggested someone didn't need inpatient psych experience before PMHNP school that I don't value patients with mental illness. I hate to break it to you but there is nothing magical about a few years experience in inpatient psych that differentiates the potential for an APN especially since most PMHNPs work in outpatient settings.
Are you also going to suggest that someone needs experience in both adult and child/adolescent psych is all PMHNP programs as lifespan in scope? Experience can be a great thing and I'm in now way trying to diminish it. But, as I mentioned, all nurses do psych (MAYBE with the exception of OR nurses although with the personalities in the OR that's easily debatable). All experience isn't necessary good experience and it's a major misunderstanding to think that the only place you can build psych skills in on the inpatient unit. I'd love to hear what mythical difference you think x amount of time on a psych unit will make especially to someone like the OP who works with psych pts in the ED.

"All nurses do psych"? "All nurses" encounter psychiatric clients, but, in other settings (beside inpatient or outpatient psychiatric settings), they don't participate in treating psychiatric disorders. I've encountered, in psych settings, lots of clients with heart disease or kidney disease or lung disease. Somehow, I didn't really learn anything significant about the diagnosis and treatment of heart disease or kidney disease or lung disease from those experiences.

I've encountered and supervised psych NP students with psych experience and without psych experience and, in my experience, you could spot which was which from the proverbial "mile away," and the experience in psychiatric nursing, in psychiatric settings, was a big advantage for the students who had it. But, of course, that's just one person's experience.

FullGlass, BSN, MSN, NP · Aug 30, 2018

To the OP: You don't need the permission of anyone on this forum to become a PMHNP. If that is what you want, then apply to some schools! Here in California, there is a terrible shortage of mental health professionals even in the big cities, and more so in smaller cities and rural areas. Psych NPs here make top dollar - starting pay of $150K is common and experienced PMHNPs can easily make $200K+. There are also plenty of outpatient jobs available - there is higher demand for that than for inpatient here. Good luck.

RN356 · Aug 30, 2018

Hmmm, didn't realize this would be such a polarizing topic. I don't know why my years of critical care experience are considered starting from "zero". We treat psychiatric emergencies in the ER all the time, and when I am in the psych pod that is all I take care of. If the only reason to be a psych RN is to see if I can handle psych patients, well, I've seen plenty of head-banging, feces-eating, hole-shoving folks in the ER and it hasn't scared me away yet I'm also quite familiar with medical issues that can masquerade as or complicate psychiatric diagnoses. I've had plenty of suicide attempts, grief/palliative care conversations, addicts of all flavors, as well as TBI and dementia patients in the ICU. However, since I have never worked as a specifically psych RN, I don't know what I don't know and I can acknowledge that. What specific skills or knowledge might I gain from being a psych RN that I need to fulfill the APRN role that I am unable to gain from my current positions? As pro-student said, the roles of RN and APRN are pretty different.

I have a couple of main points of interest in the psych realm, which are my reasons for heading that direction in the first place. The patient populations I am most interested in are Veterans/PTSD/addiction/pain management, and I take care of these populations on a daily basis. I see the huge need for practitioners in these areas and I would love to fill a need. This would most likely put me in outpatient versus inpatient psych settings.

I'm still on the lookout for possible psych RN opportunities, but like I said none seem to be available that wouldn't put me in a very different financial situation, and no PRN jobs are around to be had (yet there are plenty of PMHNP openings!). Volunteering is a good idea, though, and I will look into that.

When I started out as a new grad in the ICU various people told me that it was a horrible idea and even that I would be dangerous to my patients. However, I think the opposite turned out to be true. I went into the position thinking critically from the get-go, and I am thankful I took the path I did because it made me a stronger nurse. I wonder if this is a similar situation to that? Either way, thanks to all who took time to give me their thoughts.

pro-student · Aug 30, 2018

"All nurses do psych"? "All nurses" encounter psychiatric clients, but, in other settings (beside inpatient or outpatient psychiatric settings), they don't participate in treating psychiatric disorders. I've encountered, in psych settings, lots of clients with heart disease or kidney disease or lung disease. Somehow, I didn't really learn anything significant about the diagnosis and treatment of heart disease or kidney disease or lung disease from those experiences.
I've encountered and supervised psych NP students with psych experience and without psych experience and, in my experience, you could spot which was which from the proverbial "mile away," and the experience in psychiatric nursing, in psychiatric settings, was a big advantage for the students who had it. But, of course, that's just one person's experience.

They sure do treat mental illness. Just because a patient is on a medical unit doesn't mean you're not treating their withdrawal or anxiety or psychosis just to name a few.

I don't understand how, on the one hand, we, as nurses, claim to treat the whole person while, on the other, claim to be able to divide them into parcels that match our units. I hope like hell that you did treat your patients with cardiac or renal disease even if they were on a psych unit. I hope your not confessing to withhold cardiac meds, ignore vitals, and failing to be vigilant for the signs of deterioration in their medical conditions simply because it didn't match the unit to which you were hired.

Similarly, I hope you're aware that nurses on other units (especially the ED) are doing things like screening for depression, delirium, and psychosis, evaluating a pts risk for self-harm, administering psych meds with a reasonable understanding of how they play a role in the treatment of the whole person as well as monitoring for side effects, using therapeutic communication with pts and families who may or may not have psych diagnoses. Not everybody with mental illness presents to a mental health setting. In fact, a greater number will have their mental illness detected in some other setting.

I appreciate you sharing your experience with students as well as recognizing the limits of that observation. The fact remains that PMHNP programs tend to be among these with the highest rate of student whose professional experience doesn't include inpatient psych. This includes the significant portion of primary care APNs that pick up additional psych training because primary care providers now provide the majority of mental healthcare in the United States, students entering right out of basic nursing training including direct entry students, and those who have worked in other settings as an RN.

To RN356, I think you hit the nail on the head. Some people have these preconceived notions about how one is "supposed" to move through a career in nursing. New nurses need at least 2 years med-surg experience before the can do critical care or emergency. APNs should have specific experience with the patient population they want to work with before they start school. Importantly these offer repeated expectations are not based on evidence and fail to recognize an individuals unique potential. It sounds like you are motivated and knowledgeable about what you want to do. So go for it and don't let naysayers hold you back because you didn't do it the "right" way. I'm some ways you will have a leg up on other students especially when it comes to physical assessment, adv pharmacology, and adv pathophysiology all of which will cover topics a psych nurse likely hasn't encountered since nursing school. The only danger would be if you didn't know what you don't know. As long as you're ready to learn, any quality program will prepare you for practice in which, as has been pointed out, you are desperately needed.

elkpark · Aug 30, 2018

They sure do treat mental illness. Just because a patient is on a medical unit doesn't mean you're not treating their withdrawal or anxiety or psychosis just to name a few.
I don't understand how, on the one hand, we, as nurses, claim to treat the whole person while, on the other, claim to be able to divide them into parcels that match our units. I hope like hell that you did treat your patients with cardiac or renal disease even if they were on a psych unit. I hope your not confessing to withhold cardiac meds, ignore vitals, and failing to be vigilant for the signs of deterioration in their medical conditions simply because it didn't match the unit to which you were hired.
Similarly, I hope you're aware that nurses on other units (especially the ED) are doing things like screening for depression, delirium, and psychosis, evaluating a pts risk for self-harm, administering psych meds with a reasonable understanding of how they play a role in the treatment of the whole person as well as monitoring for side effects, using therapeutic communication with pts and families who may or may not have psych diagnoses. Not everybody with mental illness presents to a mental health setting. In fact, a greater number will have their mental illness detected in some other setting.
I appreciate you sharing your experience with students as well as recognizing the limits of that observation. The fact remains that PMHNP programs tend to be among these with the highest rate of student whose professional experience doesn't include inpatient psych. This includes the significant portion of primary care APNs that pick up additional psych training because primary care providers now provide the majority of mental healthcare in the United States, students entering right out of basic nursing training including direct entry students, and those who have worked in other settings as an RN.
To RN356, I think you hit the nail on the head. Some people have these preconceived notions about how one is "supposed" to move through a career in nursing. New nurses need at least 2 years med-surg experience before the can do critical care or emergency. APNs should have specific experience with the patient population they want to work with before they start school. Importantly these offer repeated expectations are not based on evidence and fail to recognize an individuals unique potential. It sounds like you are motivated and knowledgeable about what you want to do. So go for it and don't let naysayers hold you back because you didn't do it the "right" way. I'm some ways you will have a leg up on other students especially when it comes to physical assessment, adv pharmacology, and adv pathophysiology all of which will cover topics a psych nurse likely hasn't encountered since nursing school. The only danger would be if you didn't know what you don't know. As long as you're ready to learn, any quality program will prepare you for practice in which, as has been pointed out, you are desperately needed.

Yes, I gave people their pills for their heart disease, kidney disease, and lung disease, etc., on the psych units on which I worked, monitored their VS as ordered, and watched for anything I might notice that might represent a deterioration of their medical condition. As I said, that didn't help me develop any particular insight into any of those illnesses or how they are diagnosed and treated. I've also worked in settings in which I am the psych person covering the ED of a general hospital, and on the psychiatric consultation-liaison team that provides psychiatric services in general medical-surgical settings. I'm doing the latter now, so I spend all day every day dealing with people with psychiatric problems in addition to whatever med-surg problem has them in the hospital on a medical or surgical floor (or ICU; we spend a lot of time in the ICU). I can tell you confidently that the medical and nursing staff are in no way "treating" anyone's psychiatric illness. They're giving them their (psychotropic) pills, and consulting the psychiatric service as soon as anyone raises their voice or says something unusual (in fact, you wouldn't believe the ridiculous consult requests we get). In my experience in ED(s), the ED people are triaging psych people and attempting to get them out of the ED as quickly as possible so they don't have to deal with them any more than necessary. And don't get me started on the utilization of "therapeutic communication" in non-psych settings ... I've not encountered, at any point in my career, anything close to the rosy scenario you're painting of how well non-psychiatric staff (physicians as well as nurses) are "treating" psychiatric illnesses and clients in other settings.

As you point out, people don't know what they don't know. But, as you also point out, the larger nursing community has decided it doesn't care and this doesn't matter. The current goal appears to be to crank out as many minimally prepared clinicians as possible, and hope for the best. We'll see how that works out over time.

pro-student · Aug 30, 2018

I'm not sure what your concept of "treating" a patients illness means for an RN because it seem to imply something far beyond the scope of practice on their own unit and something approaching negligence and gross incompetence when in a different setting. I'm truly sorry that patients like yours don't receive quality nursing care on the psych unit simply because it doesn't match your perceived job description. I personally believe that a psych patient deserves quality care of the whole person regardless of what unit they find themselves on. That would mean more than pushing pills and blindly following orders. I don't think the fact that one is a psych nurse obviates them from being a basic nurse and caring for the whole person in an effective and competent way. It truly fascinates me that you're willing to denigrate the level of care provided by RNs while simultaneously insisting that this lackluster experience is somehow essential. From what I can surmise based on your descriptions of nursing care, it would be advantageous for someone to have minimal, if any, experience in this atmosphere of ridiculously subdividing the individual pt and passing the buck because "it's not my job."

I never said people don't know what they don't know although some individuals might not. I said that would be a danger. But I don't think the average nurse has that poor of metacognition. You continue to contend, without anything but personal anecdotes, a very grim view of both nursing in general and particularly advanced practice nursing. But then again, if you think doling out pills and blindly following orders is not only what passes for an experienced nurse but also what others should be forced to go through before they have the privilege to become an APN then I could see how you would arrive at that conclusion.

The truth is that APNs, psych and otherwise, are and have been providing quality care for decades. Anecdotes such as yours or the medical community who have an agenda that APNs are grossly incompetent and woefully ineffective because they didn't get there the "right" way. However, if that were true, wouldn't there be some indication after decades of NPs in every healthcare setting of this kind of negligence and incompetence. I guess we will have to agree to disagree but it sounds to me like you have this preconception of the "correct" way to move through a nurse career (which is not based on my evidence) and that shades your experience with those you've encountered. I'm sure the PMHNP students/practitioner you've encountered couldn't meet your expectations when you admittedly decided they weren't qualified before giving them a chance. An therein lies the world of difference between evidence and anecdote.

umbdude, MSN, APRN · Aug 30, 2018

Hmmm, didn't realize this would be such a polarizing topic. I don't know why my years of critical care experience are considered starting from "zero". We treat psychiatric emergencies in the ER all the time, and when I am in the psych pod that is all I take care of. If the only reason to be a psych RN is to see if I can handle psych patients, well, I've seen plenty of head-banging, feces-eating, hole-shoving folks in the ER and it hasn't scared me away yet I'm also quite familiar with medical issues that can masquerade as or complicate psychiatric diagnoses. I've had plenty of suicide attempts, grief/palliative care conversations, addicts of all flavors, as well as TBI and dementia patients in the ICU. However, since I have never worked as a specifically psych RN, I don't know what I don't know and I can acknowledge that. What specific skills or knowledge might I gain from being a psych RN that I need to fulfill the APRN role that I am unable to gain from my current positions? As pro-student said, the roles of RN and APRN are pretty different.
I have a couple of main points of interest in the psych realm, which are my reasons for heading that direction in the first place. The patient populations I am most interested in are Veterans/PTSD/addiction/pain management, and I take care of these populations on a daily basis. I see the huge need for practitioners in these areas and I would love to fill a need. This would most likely put me in outpatient versus inpatient psych settings.
I'm still on the lookout for possible psych RN opportunities, but like I said none seem to be available that wouldn't put me in a very different financial situation, and no PRN jobs are around to be had (yet there are plenty of PMHNP openings!). Volunteering is a good idea, though, and I will look into that.
When I started out as a new grad in the ICU various people told me that it was a horrible idea and even that I would be dangerous to my patients. However, I think the opposite turned out to be true. I went into the position thinking critically from the get-go, and I am thankful I took the path I did because it made me a stronger nurse. I wonder if this is a similar situation to that? Either way, thanks to all who took time to give me their thoughts.

In ICU and psych ED you're only seeing a sliver of this population at a very specific point in time. Most of my patients who come in from psych EDs do not receive any treatment other than some benzos to keep them calm. The EDs are effectively a holding area while the ED staff do bed searches.

Having said that, you won't be the only one who has done this. Try an online Facebook group and ask around.

In the end, it's your prescription pad and your responsibility. Personally, I would not prescribe meds that I don't have a working familiarity with.