FNP vs PNP vs PMHNP

[KaleyBSNRN]

Hi all!

Thanks in advance for coming to my thread and answering my questions! I am currently a Bachelors prepared RN looking at a few different schools for my NP. I am stuck between three different specialties.... FNP, PNP, and PMHNP.

I like the idea of an FNP because you are not very limited in your scope... you can generally find a job pretty easy and can work with all age spans. I also like the idea of having a better family oriented schedule and a decent salary. Cons of this position is you usually have to get more certifications in order to work with certain settings (acute care for hospitalists, etc). I've also found that FNP's seem to be on the lower end of the salary range in FL- ranging from 85,000-100,000. Still a good salary but some other specialties make a lot more money with the same degree (MSN)

I've always been drawn to pediatric patients. I LOVE working with kids, babies specifically. Not wanting to do NNP because you are very very limited in scope (can only work with patients up to 2 y/o and usually in a NICU setting so the hours are crazy).... still working nights, weekends holidays as well. If I did PNP I would most like do primary care so again, I can work a better schedule to be with my family. A con for this is again, limited scope as I could only work with patients under 18 and jobs are few and far between where I work. My biggest fear is not being able to find a job once I graduate school.

Then there is PMHNP. I have worked psych for years in the past... not as an RN though. I have always LOVED psychiatry. In my research I have found that PMHNP can work in acute or primary settings and with all age spans. It's just obviously very different scope of practice because I would be working with those who are mentally ill and not necessarily physically ill. I have also found that psych NP's make significantly more money in my area... upward of 110,000-130,000 a year.. and I wonder why? Is it because the demand is so high for the providers?

If anyone can please shed some light for me...help me on making this decision and answer the questions I have it would be greatly appreciated! Thank you!!

[Katie82, RN]

If you love psych, I would go for PMHNP. You are correct in that it is tougher to get a job as a PNP, so if I had a choice between the other two I would definitely go for FNP. I am not a NP, but I have many friends who are. One of them is currently a PNP and tells me she has had trouble finding full time employment in the past, or left jobs because she felt her scope of practice was too restrictive. She is thinking to add FNP to her credentials. I believe there is an Advanced Practice thread to this forum...they would be the folks to ask.

[adventure_rn, MSN, NP]

I agree with @Katie82 that the Advanced Practice forum is the best place to pose these questions, but here are some things you may not have considered.

First, the outpatient schedule might not be as good for work-life balance as you're expecting. When you do shift work, you literally only work from the moment your shift starts until you hand off the patient and your shift ends. In primary care, there's nobody to hand off to, so you stay until the work is done.

Let's say that your clinic is open 5 days a week from 8-5. Every day, you'll be expected to come in 30 minutes to an hour early to review the charts of the patients you'll be seeing. After the clinic closes, you'll have to stay and finish up all of your notes, which could be 30 minutes to an hour (or longer). It's quite possible that you'll be working 5 days a week for 11 hours a day (7am-6pm)! Plus, the clinic might require you to take call on the nights or weekends; most offices have a provider available to answer semi-urgent questions from patients when the office is closed.

This is in comparison to shift-work NPs (often hospital-based like ED, ICU) who hand off their patients after work. They might be scheduled for 3 12s (36 hrs) or 4 10s (40 hrs), and once they hand off their patients, they can go. Granted, they may also have to take call in case somebody in the practice gets sick.

I've had friends who were miserable because they realized they were working far more hours than they did as bedside RNs, and were actually making less per hour as an NP.

Second, even if there are a bunch of FNP roles in your area, you may still have a hard time finding a new grad FNP job, depending on your market. The FNP field is notoriously oversaturated with new grads, especially if you live close to a school with an FNP program. Once you get experience it's much easier, but as a new grad, there's still possibility you'd have to either have to move or make a very long commute in order to gain that first year of experience.

Third, the PNP thing is...complicated. If you live somewhere that doesn't have large hospital with pediatric specialty services, then you're correct, it doesn't make sense to get a PNP unless you're willing to move.

However, with your FNP, you'll be restricted to only doing peds primary care. You wouldn't be able to do any sort of peds specialty care, even in a clinic setting (Peds Neuro clinic, Peds Urology clinic). Those clinics specifically require at least a Primary Care PNP, and some prefer an Acute Care PNP. Granted, if your city doesn't have those kind of clinics, that may not matter to you. You could probably get a job in peds primary care with an FNP, although I'm sure it would help to have recent pediatric nursing experience.

Fourth, I would pose the PMHNP salary question on the Advanced Practice forum, ideally on it's own post. I think the high salaries are in part because some providers don't accept insurance and get paid out of pocket, and in part because there's a relative shortage of psych providers. However, it seems that there are a lot of people (not you) who are only interested in PMHNP because it sounds like easy money, and those people are getting the degree/certification in droves. I'm guessing that in the next ten years, the field may become oversaturated, and salaries/reimbursements may start to decrease (which is precisely what happened in the FNP field).

Fifth, have you considered using an FNP to do urgent care? It pays well, and has as more 'shift-like' schedule (I.e. 4 10s). However, you still might have to do some evening or weekends. Also, I absolutely would not do it as a new grad; most require at least a couple of years of experience anyway.

I'm sure that some of this isn't precisely what you wanted to hear, but I hope it's helpful! It's better to know these things going in than to discover them after you've already spent time and money on the degree.