MSN for PMHNP and Post-Masters for FNP?

Jules A, MSN · Sep 7, 2015

I got my FNP after my psychNP and had no intention of doing H&Ps but instead to expand my prescribing abilities on my inpatient acute units.

40 is not too old to become a NP, imo, and trust me I'm one who thinks everyone needs to retire at respectable age, lol. What I'm not sure makes sense is the money and time you have already invested in education and now taking on another degree seems like overkill to me. Keep in mind also that as a psychNP you will not be doing counseling or therapy only medication management. Not that you can't slip in a bit of therapy but during a 20-30 minute medication check it doesn't leave much room and no employer who pays a decent rate is going to pay a NP to do what they could pay a therapist to do. There are some in private practice who do this but not many because again unless you are doing a cash only practice billing insurance doesn't pay to make it worth doing therapy.

SarahMaria, MSN, RN · Sep 7, 2015

I have a law degree and BSN. I am also 35. I have considered a NP degree. I do not see anything wrong with getting further education at this stage in life.

Birthday_Girl · Sep 7, 2015

I should have included that before working for myself, I also hoped to join the military and serve three-four years working with sexual assault survivors. I think I could leverage both my JD and MSN into a victim advocate/SANE type role. I know from working in the child welfare system that there is a dire need for individuals who can do psych evals for children. In fact, when I spoke with that assistant dean, she mentioned that she had just received an email looking for PMHNP to do that type of work.

Thanks for the info. Taking on more loans is scary.

Jules A, MSN · Sep 7, 2015

I should have included that before working for myself, I also hoped to join the military and serve three-four years working with sexual assault survivors. I think I could leverage both my JD and MSN into a victim advocate/SANE type role. I know from working in the child welfare system that there is a dire need for individuals who can do psych evals for children. In fact, when I spoke with that assistant dean, she mentioned that she had just received an email looking for PMHNP to do that type of work.
Thanks for the info. Taking on more loans is scary.

I'd be sure that with your present credentials you could find or create a position working with your desired population without spending another $60,000+ and 4 years on a completely new career. There would also be a fair amount of income lost during those years in school also.

You are smart to be concerned about adding more loans. There are so many posts here about people working into their late 60s-70s despite poor health because they didn't financially prepare for their future.

PG2018 · Sep 7, 2015

Why do you have to be a FNP to do a H&P? Maybe it's a state thing, but in mine all APRNs are expected to be able to competently perform a total H&P.

Look, it's not that you can't. You won't have time.

I can do them if I wanted, but most psych people don't like hands on patient stuff. Also, most psych people find their schedule to be so replete with psychiatry that they haven't the time or energy to inspect, auscultate or palpate anything. For that matter, the psych hospitals and RTFs will often contract someone else such as a family practice or internal medicine doc, a PA, FNP, or some other NP. It's more cost effective to do this. If you're peculiarly constrained or limited on your ability to conduct H&Ps in your state, I assure you your practice or revenue stream won't suffer!

I second want Jules said. If you want to be a therapist, by any measure, turn your back on biologically based care (the PMHNP) and pursue a MSW as the most succinct yet comprehensive therapy training. You can also bill Medicare if you do that. The counselors and other therapists can't. We can, psychiatrists can, and psychologists can.

As a PMHNP, your bread and butter will be psychiatric evaluations and subsequent management of medications. Your employment will dictate how long you take to do these. I tend to work much shorter than most in the field. You can make tons of money doing evals and MMs, but not so much with therapy. The reason is you can't do a lot of therapy in the course of a day. My therapists' schedules usually have maybe five people on them so between the appointment times, groups, and then writing notes their day is milked. Keep in mind that you can engage in therapeutic dialogue, and you can conceivably engage in some psychotherapy. I've done it and so do others. Mine typically centers around wasting my breath on crappy parents. However, love it or not, your role as a psych NP will not be one of therapy. You will either A) be hired to do med checks, B) do it all, or C) be the scut puppy of some psychiatrist doing everything they don't wish to. In my region, I can name practice sites with each, A-C, being the predominant theme. In my job, I do B, and I'm the only prescriber in the clinic (or on this side of the state).

I understand that you may not be satisifed in your current career, however, you've spent a lot of time and money pursuing graduate study in sociology and then law school. I admire your legal training, and for many years of my life I thought my trajectory would include that as well. Like many, I realized court is largely nothing but a dog and pony show, as you may have, and thus I turned away from it.

Additionally, I want to point out that you've taken on some kind of altruistic mentality that compels you to serve the abused and the addicted. That's fine. However, in your practice you'll see others. You'll see everything. You'll see the actively psychotic, the borderline, and the malingerer. People with SA problems often have another mental illness, and the mentally ill are often substance abusers. Likewise, as I'm sure you've seen, whether kiddies or adults, the abused often have comorbid psychopathology. In kids, it can be quite difficult to tease out as well.

If you're going to do this you need to do it as economically as possible so less years in school with less overall cost. That makes me think you'd most need a direct entry NP program or a RN program that you can build around your current work schedule. You'll want to incur little to no debt to do this efficiently. Once you've gotten the RN out of the way, you can move onto PMHNP. At that point, short of having no accessible programs, I'd encourage you to pursue the MSN over the DNP as the latter will only cost your more money and time (thus also more money). The faster you can get into a psych clinic or hospital the faster you'll start making money to pay all this back. You'll aslo be closer to your desired career. Having said that, if you choose to become a FNP as well, do it as a post-grad cert. and do it while you've negotiated a PMHNP work schedule that gives you a four day week or something. Don't not see patients to do the cursory FNP training. Also, there's nothing to be gained from the forensic certification. Your testimony would always be trumped by a psychiatrist with forensic training or not. Just do some papers and get some intern work in the system, and that'll be enough.

Birthday_Girl · Sep 7, 2015

Why do you have to be a FNP to do a H&P? Maybe it's a state thing, but in mine all APRNs are expected to be able to competently perform a total H&P.
Look, it's not that you can't. You won't have time.
I can do them if I wanted, but most psych people don't like hands on patient stuff. Also, most psych people find their schedule to be so replete with psychiatry that they haven't the time or energy to inspect, auscultate or palpate anything. For that matter, the psych hospitals and RTFs will often contract someone else such as a family practice or internal medicine doc, a PA, FNP, or some other NP. It's more cost effective to do this. If you're peculiarly constrained or limited on your ability to conduct H&Ps in your state, I assure you your practice or revenue stream won't suffer!
I second want Jules said. If you want to be a therapist, by any measure, turn your back on biologically based care (the PMHNP) and pursue a MSW as the most succinct yet comprehensive therapy training. You can also bill Medicare if you do that. The counselors and other therapists can't. We can, psychiatrists can, and psychologists can.
As a PMHNP, your bread and butter will be psychiatric evaluations and subsequent management of medications. Your employment will dictate how long you take to do these. I tend to work much shorter than most in the field. You can make tons of money doing evals and MMs, but not so much with therapy. The reason is you can't do a lot of therapy in the course of a day. My therapists' schedules usually have maybe five people on them so between the appointment times, groups, and then writing notes their day is milked. Keep in mind that you can engage in therapeutic dialogue, and you can conceivably engage in some psychotherapy. I've done it and so do others. Mine typically centers around wasting my breath on crappy parents. However, love it or not, your role as a psych NP will not be one of therapy. You will either A) be hired to do med checks, B) do it all, or C) be the scut puppy of some psychiatrist doing everything they don't wish to. In my region, I can name practice sites with each, A-C, being the predominant theme. In my job, I do B, and I'm the only prescriber in the clinic (or on this side of the state).
I understand that you may not be satisifed in your current career, however, you've spent a lot of time and money pursuing graduate study in sociology and then law school. I admire your legal training, and for many years of my life I thought my trajectory would include that as well. Like many, I realized court is largely nothing but a dog and pony show, as you may have, and thus I turned away from it.
Additionally, I want to point out that you've taken on some kind of altruistic mentality that compels you to serve the abused and the addicted. That's fine. However, in your practice you'll see others. You'll see everything. You'll see the actively psychotic, the borderline, and the malingerer. People with SA problems often have another mental illness, and the mentally ill are often substance abusers. Likewise, as I'm sure you've seen, whether kiddies or adults, the abused often have comorbid psychopathology. In kids, it can be quite difficult to tease out as well.
If you're going to do this you need to do it as economically as possible so less years in school with less overall cost. That makes me think you'd most need a direct entry NP program or a RN program that you can build around your current work schedule. You'll want to incur little to no debt to do this efficiently. Once you've gotten the RN out of the way, you can move onto PMHNP. At that point, short of having no accessible programs, I'd encourage you to pursue the MSN over the DNP as the latter will only cost your more money and time (thus also more money). The faster you can get into a psych clinic or hospital the faster you'll start making money to pay all this back. You'll aslo be closer to your desired career. Having said that, if you choose to become a FNP as well, do it as a post-grad cert. and do it while you've negotiated a PMHNP work schedule that gives you a four day week or something. Don't not see patients to do the cursory FNP training. Also, there's nothing to be gained from the forensic certification. Your testimony would always be trumped by a psychiatrist with forensic training or not. Just do some papers and get some intern work in the system, and that'll be enough.

Thank you for the very thorough response!

In my field, I work with many licensed social workers and, for some reason, their job satisfaction does not seem very high. It may just be this particular field, and it may be very different for someone who did family therapy.

Thank you for highlighting that this work isn't focused on therapy. I did think that therapy would be a huge component of the work PMHNP did, but that's why I joined this site, hoping to gain more info. I'm okay with not doing therapy; I'm really looking to do psych evals with treatment plans. I'm also okay working with DV perps (there is a shortage of providers in my area) and other individuals with criminal backgrounds which is why I was thinking the forensics credentialing might be helpful. But, again, I'm open to receiving advice and guidance on that. I'm still in the gathering info phase.

PG2018 · Sep 7, 2015

I find most therapists aren't really happy whether social worker or not. Granted, I don't know any in private practice so their views may differ.

Likely, you won't be involved much with treatment plans either. If anything, you may have to approve them, but you won't author them. They can be rather time consuming.

For the simple fact that you're willing to work with corrections they'll snatxh you up. Jules does it, but the extent if malingering and my own experience working with and putting people into the system turns me against it.