Licensed therapist considering nursing school.

Heylove, BSN, RN, EMT-B · Mar 21, 2018

My questions:
Does it REALLY matter where I go for the BSN? Is it WORTH getting myself into debt of about 100k? (I'm assuming where I go for the MSN/PMHNP would be more important?)
What advise do YOU have, as a nurse for me, a therapist? What might I be overlooking?
Finally (and I may come back to hit you all with more questions), should I keep up my therapy license? I don't see how it could hurt...

1) No, I do not think that it matters where you obtain your BSN, or your ADN for that matter. All that is important is that you are a licensed RN or PMHNP and understand your scope of practice in your state. Unless you want to go into teaching at some big-name school, I guess. I don't know.

2) As a nurse, I would really want you to consider how much time you would get to spend with patients as a nurse compared to how much time therapists spend with patients. I've never been a therapist, but the feedback that we get from patients confirms this. One patient even stated "I want to be a therapist when I grow up so I actually get to help patients." Needless to say, the other nurses and I felt like that was a huge kick to the gut.

3) I don't know the answer to this. Would you work as a therapist in addition to nursing? Can you work as a therapist part-time while you go to school? There are overlapping scopes of practice, but I think the reality is (at least where I work) is that they are very different in clinical practice.

Congratulations and welcome!

Oldmahubbard · Mar 21, 2018

Get the cheapest accredited ADN/BSN you can. No BSN is worth 100k, or even close.

Therapists typically spend an hour (or close to it) with their patients. As a PMHNP, you would typically be spending 15-20 minutes at the max. Mostly focused on the drugs. Always an eye on the clock.

You should shadow a local PMHNP before making the time and money investment.

Salaries vary greatly by region, and practice laws in NC are not NP friendly, from what I have read.

Of course, keep your therapist license.

Sounds like more research is needed.

Rose2017 · Mar 22, 2018

I've also been a licensed counselor for the past decade and have just recently been accepted into a 2 year accelerated MSN program. I decided to go this route, as opposed to getting a BSN, due to the the shortened timeframe. I have two friends who got their MSWs and then went the MSN route. Their main advice was for me to get very clear about what the difference in roles is, and to not be deluded into thinking that if I was hired as an NP that I would actually get to do therapy; the role of a PMHNP is to prescribe medications. I plan on keeping my therapy license, as I hold a credential in clinical supervision which is tied to that license; I have a dream of being in private practice and doing both medications and therapy.

Oldmahubbard · Mar 22, 2018

As long as you understand that the only money for a PMHNP is in seeing 3 patients an hour. And to see 3 patients an hour, you have to book 4 patients. There is always a 25% no-show rate. No getting around it.

I don't care if you do back flips, call patients, send post cards, telegrams or use drones. There will be a significant no-show rate.

Fifteen years ago, a private practice LMSW with an R designation, extensive experience, and credentialed with multiple insurance companies, could earn a hefty income. Approaching some 130 dollars an hour. Yes they had some overhead, but a determined person could theoretically take home close to 200k after expenses, especially if they were willing to work evening and weekends.

Before long, the market was flooded, and insurance companies no longer accepted more of these therapists.

I don't know where the market stands now for the MSWs, but Psych NPs will have to see 3 patients an hour to survive, and that will not be changing anytime soon.

If you only book 3 patients an hour, 2 will show up on average. Your numbers will not add up, reimbursements vs expenses, and your practice will eventually fail.

My experience only.

I hope it helps.

Ladydaae · Mar 23, 2018

Thanks for your perspective. I understand the vast difference in *how* the professions approach patients/clients in regards to time. However, I think the goal is more to carve my own route, eventually creating a practice where I can basically do what I want, even if that means going to another state after my education is complete. I have looked at NC laws (there is currently legislation in the NC House aimed at giving full authority to NPs) and the supervision that is currently required is more of a physician/NP agreement rather than intense oversight from what I can tell. By the time I'm a licensed NP (I'm guessing about 4 years), maybe that won't be a concern anyway. I work with trauma patients using somatic experiencing and yoga which does take TIME, but the hassle of always needing to find psychiatric referrals is daunting, time-consuming and not always successful. My plan is to do what I already do, minus the case management duties of finding appropriate referrals for medication evaluations. Upon much thought and consideration, I do not ever plan to work in a setting where I am forced to give up my integrity as a clinician or where I am not "allowed" to take the time with patients that is actually needed for healing and positive change. That's the whole point of what I do and why I do it. The system is broken in that regard and I by no means plan to enable that system, fall victim to it myself or bow to it for financial gain. I may be forced to work in such a setting to gain clinical hours and experience for educational purposes, and if so, so be it. But once I am licensed, I will likely bill out-of pocket, probably with a sliding scale, and not hassle with insurance companies (which I see as the bane of good healthcare anyway). My ultimate goal is to minimize limits to care and make it as accessible and affordable as possible for folks. In my mind, having the ability to do both therapy and prescribe meds is the route that will accomplish this. Maybe I'm naive, but I have a vision and by golly, I'm gonna try!

Ladydaae · Mar 23, 2018

Rose, if you don't mind me asking, in which state do you reside and to which program did you apply? As far as I know, there aren't any such accelerated MSN programs near me...I also can't afford to go to school full time without income for 2 years! Yikes. Can you describe your plan a bit more? I'm interested.

Rose2017 · Mar 26, 2018

I'm in TN and will be going to Vanderbilt.

Rose2017 · Mar 26, 2018

I currently work full time as the clinical director of an agency and have a private practice where I see about 5-7 clients per week doing EMDR, brainspotting, sandplay and clinical licensure supervision. My plan post MSN is to work in either an outpatient psychiatry clinic or at a treatment center while also doing private practice. I don't think I'll ever want to work full time in private practice- I enjoy working as part of a team and the fees associated with private pay psychiatric services are outside of what most people can afford.