Importance of floor nursing experience for PMHNP

SHGR, MSN, RN, CNS · Jan 1, 2012

Hey there-

Having worked extensively in both areas, I would highly recommend working in a primary care clinic to get your nursing experience in, rather than as a floor nurse or a med-surg nurse. (ER would probably be good choice too, but I can't speak to that personally.)

I so wish we had a PMHNP that could work with our patients! We are in a high-need, low income area and there is such difficulty in accessing mental health service. No lack of mental health NEEDS however. Not only treated and untreated mental illness, but situational too, as well as being a complicating factor for our patients with chronic illnesses. Bless you for choosing the mental health route!!

Also, I've been mulling over this article from AHRQ, Research Activities, January 2012: Feature Story: Experts call for integrating mental health into primary care In a nutshell it is recommending that mental health care be added as an integrated component in primary care. I hope there is more money in the future for this.

That said, every experience you have is going to help you in the future in some way if you are open to learning and growth.

apocatastasis · Jan 4, 2012

I'm a FPMHNP student, graduating in May. I started an alternate entry MSN program in 2008 and have been a nurse for about two and a half years. I went part-time for the year after I became an RN to work ICU in San Antonio. After a year or so, I moved back up to Austin to finish at UT, where I've been an ER nurse for over a year.

My ICU and ER skills have proved totally invaluable in my NP studies, especially in advanced patho/pharmacology and in primary care clinicals. I've seen much of what you'd see in a primary care clinic and more. The patients in ER/ICU are often much sicker than what you'd see in primary care, which has been a great learning experience for me, as I've gotten lots of exposure to and awareness of various medical conditions, which, I feel, you should understand the basics of if you work in psychiatry, even if you won't be treating those complaints (e.g. in liaison psychiatry, is this a psychiatric problem, a neurological problem, a drug side effect, a dematological problem, etc.).

Some of my classmates went straight into psych after school. I was nervous when I started my PMHNP courses in August because some of them have been psych RNs for the whole time I've been in critical care. Thus far, I find that my fears have been unfounded. I felt like my classmates initally had a better knowledge of psych meds and dosing and side effects, but after 6 months of so of nothing but psych studies, I think it's really a wash there. We're about even when it comes to initiating and managing med regimens.

What working ICU and ER got me, that my classmates did not get in their psych settings, is caring for all kinds of non-psychiatric and psychiatric emergencies. Some of the psych-related things I've cared for include overdoses, drug addiction, Stevens-Johnson syndrome from lamictal, neuroleptic malignant syndrome, and a variety of self-injurious behaviors and suicide attempts.

I feel like I'm used to using therapeutic communication in talking to patients about a wide variety of illnesses and how they affect the family (e.g. mom has cancer, dad has dialysis, grandfather's in the hospital, etc.), which I've found important in therapy settings.

Overall, I don't know that med/surg would be of benefit to you, though you will find that you have a lot to learn and will learn in any setting. ICU and ER, however, can give you a wealth of knowledge if you put your mind to it, study, observe, reflect, which are all traits you should have as a provider.

Sorry if this is disorganized and long, but this was my initial reaction... it's 6:13 and I gotta shower and get to the ER for work! Agh! Let me know if I can help you in any way.

Psychcns · Jan 5, 2012

[This is a great question. I received my BSN in 1982. The common recommendation at that time was one year of med-surg. I did two years. I learned lab values, basic med-surg skills, time management and team work. Then I went to inpatient psych. I learned how to talk to patients, how to assess patients, and how to manage acute psychiatric patients. I worked mainly in teaching hospitals so there were always lectures and expert clinicians available. I had very good supervision. I still love to present patients to expert clinicians and get their opinions. I learned psychotherapy first. Then I got my Psych CNS in 1993 and I built on my psychotherapy skills with psychopharm skills. I am very good at picking meds for patients. I think this is because I have a good psychodynamic foundation. I do a symptom focused psychopharm interview now but I learned to interview with the aim of a good clinical formulation for therapy. It is different now. I think if you are going to be a psych NP, you might as well go directly into the role. Although you learn a lot as a floor nurse, it is not a requirement and with mentoring and education you can learn anything, anywhere. If you are looking for RN experience as you work on your MSN, I think a psych ER would be a good beginning, but they usually expect floor experience. I think floor med surg experience is too busy and pressured. So see about psych floor experience.--it is more containing than an ER. I have done some stints as a psych travel nurse and it is interesting to review med combinations without being the one prescribing them. Therapy seems less valued now. But it will come back. Meds have limitations as a treatment modality. Good luck.

zenman · Jan 10, 2012

I do psych consults as well as outpatient and inpatient work. I just did a consult on a med-surg floor for a patient with COPD. In this case it helps to know med interactions as well as possible medical reasons for anxiety and how to treat it without interfering with her other med treatment or functioning.

zenman · Jan 12, 2012

And today I changed a physician's order for Nortriptyline to Cymbalta on a pain patient with cardiac and liver problems, and obesity. You better know why as well as all the interactions with other meds.

mpolen6497 · Oct 8, 2012

Apocatastasis! I would love to ask you a few questions. I'm starting a a PMHNP program in the fall and have a few things I need to feel a little more clear about. If you can, please respond to this post. I don't have email priveledges yet on this site. Not sure why! Thanks so much!

jmnurse09 · Feb 16, 2017

Do you really have to have psych experience to become a PMHNP? I have a little psych experience as a mental health clinical instructor.

Jules A, MSN · Feb 16, 2017

Do you really have to have psych experience to become a PMHNP? I have a little psych experience as a mental health clinical instructor.

No unfortunately you don't. Schools will admit anyone who can pay the tuition however that does not mean our brief, superficial NP education is sufficient to teach the subtleties necessary to accurately diagnose and safely prescribe medications to this vulnerable population. Please get inpatient psychiatric experience to see the multiple presentations and reactions to medications.