MSW to PMHNP/FNP (dangerous ideas!)

PG2018 · May 12, 2015

I typed up a very long reply and then it hit me that I could condense what I had to say. I think you're doing the wrong thing. There. Clear and concise. You've got two master's degrees, degrees aren't cheap, and you're wanting more even the frivolous DNP (which is NOT a clinical degree). Learning is cool. I'm an autodidact. I'm always doing something to learn. However, I'm Type A so I'm going to be very direct in my opinion.

I think you should go to PA school. You've already got to return to college to take prereqs for nursing. In that EXACT same time period you could add a couple of others required for PA school. Once you're in PA school you're back out in 28 months. It'll be hard to work a side job - almost impossible. However, I really think the PA route will teach you what you're wanting to know.

Nursing, at risk of offending many of my colleagues, is NOT very scientific, and nursing is often directionless. From your social work education, you'll see that it is a psychosocial discipline, and that does not bode well for someone wanting to learn "medical stuff." Sure, you'll learn about ulcerative colitis, and the many ways to have a bowel movement, but woopty doo you probably won't be treating that as a NP or a PA.

As a PA, you're versatile. You do not NEED a FNP and a PMHNP to work. You'll only need a PA and a doctor willing to give you a job. If you find you want to learn more about ortho, cards, ID, EM, or even psych you can do a residency as a PA, have a true role in patient health, and make a living doing it although you don't need it. You won't get any psychotherapy training, but as a PMHNP you shouldn't be doing therapy other than having a therapeutic dialogue with your patients. The demand is too great for the current supply of psych prescribers. I don't know if PAs can even do therapy, in their present scope, however, their scope is whatever their doctor will let them do. That said, I did some searching just now and found that PAs can go to the same certification training to get a cert in CBT, etc.

I'm interested in psychiatry and don't want to do anything hands on with patients, but I WISH I had gone the PA route instead with a psych residency. I'd have actually spent less time and only about the same amount of money and have gotten out into the workforce in a credentialed role years sooner.

DanaerysTargaryen · May 13, 2015

I would strongly recommend working for a few years with the BSN prior to and/or during your DNP program. You'll have a much better grasp on the medications, etc. you will be prescribing once you've given them and seen them in action. You'll also most likely be more employable if you're seen as an experienced nurse, but that is a guess based on my experiences at the BSN level. (Just starting the DNP part of the same path you're thinking of pursuing myself.) Not everyone will agree with that advice and there are direct entry programs for nurse practitioners that are actually based on the idea you *won't* have ever worked at the RN level (at least, other than while you were in school) prior to practicing as an NP. But since you asked for advice, I thought I'd give you my two cents. Whatever you decide, best of luck! The nursing profession and psych nursing specifically is in need of practitioners who feel the sense of purpose and passion your post clearly expresses.

meeep, BSN, RN · May 16, 2015

PsychGuy said:
I typed up a very long reply and then it hit me that I could condense what I had to say. I think you're doing the wrong thing. There. Clear and concise. You've got two master's degrees, degrees aren't cheap, and you're wanting more even the frivolous DNP (which is NOT a clinical degree). Learning is cool. I'm an autodidact. I'm always doing something to learn. However, I'm Type A so I'm going to be very direct in my opinion.
I think you should go to PA school. You've already got to return to college to take prereqs for nursing. In that EXACT same time period you could add a couple of others required for PA school. Once you're in PA school you're back out in 28 months. It'll be hard to work a side job - almost impossible. However, I really think the PA route will teach you what you're wanting to know.
Nursing, at risk of offending many of my colleagues, is NOT very scientific, and nursing is often directionless. From your social work education, you'll see that it is a psychosocial discipline, and that does not bode well for someone wanting to learn "medical stuff." Sure, you'll learn about ulcerative colitis, and the many ways to have a bowel movement, but woopty doo you probably won't be treating that as a NP or a PA.
As a PA, you're versatile. You do not NEED a FNP and a PMHNP to work. You'll only need a PA and a doctor willing to give you a job. If you find you want to learn more about ortho, cards, ID, EM, or even psych you can do a residency as a PA, have a true role in patient health, and make a living doing it although you don't need it. You won't get any psychotherapy training, but as a PMHNP you shouldn't be doing therapy other than having a therapeutic dialogue with your patients. The demand is too great for the current supply of psych prescribers. I don't know if PAs can even do therapy, in their present scope, however, their scope is whatever their doctor will let them do. That said, I did some searching just now and found that PAs can go to the same certification training to get a cert in CBT, etc.
I'm interested in psychiatry and don't want to do anything hands on with patients, but I WISH I had gone the PA route instead with a psych residency. I'd have actually spent less time and only about the same amount of money and have gotten out into the workforce in a credentialed role years sooner.

Really? (Genuinely curious, not being sassy!) All of the PA's I have spoken to have told me if you want to do psych, go for NP over PA. Care to elaborate?

PsychiatricNP · May 16, 2015

meeep said:
Really? (Genuinely curious, not being sassy!) All of the PA's I have spoken to have told me if you want to do psych, go for NP over PA. Care to elaborate?

This is the exact same thing that I have heard from PA colleagues countless times. In fact, earlier this year, in one of the facilities that I work in, they reassigned the PAs working in the psychiatric emergency department to other units because the medical executive/credentialing committee felt that PAs lacked the appropriate training to work in psychiatry. The two impacted PAs both said that they wished that they had pursued the PMHNP route rather than PA route (in this organization NPs have a higher pay band than PAs, they can take call and have admitting/discharging privileges).

Jules A, MSN · May 17, 2015

PsychGuy said:
I'm interested in psychiatry and don't want to do anything hands on with patients, but I WISH I had gone the PA route instead with a psych residency. I'd have actually spent less time and only about the same amount of money and have gotten out into the workforce in a credentialed role years sooner.

It might just be my state but PAs don't get reimbursed at the rate NPs do in psych and none of the hospitals or outpatient clinics I have worked for use them in mental health at all.

meeep, BSN, RN · May 17, 2015

The argument I have always heard is that the entirety of a pmhnp clinical hours are spent in psych, vs a PA's more generalist training.

PG2018 · May 17, 2015

Ok, so there are some questions about me feeling PAs are generally better trained.

Well, this is true PMHNPs don't do anything BUT psychiatry and their training is largely limited to psychiatry. If a PMHNP spent their RN career as in psychiatry then there's even less exposure to medicine in general.

PAs can do anything including psychiatry.

A PA will get one month of training in psychiatry, typically inpatient only, and leave with about 4, 40 weeks or 160 hours of patient training. No, that's not a lot. The ANCC only requires 500 or 550 hours of training, and I think my academic preparation provided 720 hours. That's still not even half of a working year.

I entered PMHNP with no specific psychiatric background beyond what one merely encounters when dealing with the general patient population, and let it be said that I do not feel deficient in psychiatry because of this. I am remiss that we as healthcare providers have training and scope only limited to psychiatry, and I think this does this harm. Psych patients take things besides psychotropics, present with comorbid conditions aside from psychopathology, and experience medical sequel not within the PMHNP's scope to address. A PA is not limited, and that's why I say a PA WITH psychiatry RESIDENCY training is a better clinical choice (other things equal). Even a medical school graduate has LESS psychiatry training than a PMHNP UNTIL they complete residency or in all actuality get about five months into their internship. Then, once licensed, let alone board certified, they can do whatever they want.

This is why I say if a PA wants to enter psychiatry then complete a residency in psychiatry and do so. They'll make a well livable wage during training, get MORE training than any PMHNP, and be versed to address the total patient - something PMHNPs can't do. So any time I see someone on the fence about what NP specialty to jump into or whether to be a PA or NP I always direct them to the PA route unless they desire to be 100% independent in which case I directed them to 20 something states where a NP can be that.

My PMHNP program was three years in length, yet it included a lot of frivolous garbage (community health?, not just one but two research courses, and nurse theory as examples) instead of useful clinical training. With three years of length, you'd think I could've been taught (and credentialed) to treat the arrhythmias, dyslipidemias, hyperglycemias, hyperinsulinemias, obesity, and diarrhea that psychotropics can potentially cause. Not that I want to be a therapist, but my training was grossly deficient in psychotherapy. I think some look at the brain, its structure and imaging, a little training in the EEG and polysomnography, cognitive science, neurophysiology, and endocrinology (among others) would have all been much appreciated and well received BEYOND the general patho and pharm courses that all NP students take. Why? Because those are all things related to psychiatry that PMHNPs get no training in. I spend so much time reading about psychiatry and tangentially related fields (including the latest for primary care) because I don't want to be the guy calling his collaborator all the time. I'm not saying PAs are well trained in those fields, but I am saying it's within their scope to learn it and do something about it.

NuggetsHuman, BSN, RN · Jun 22, 2015

So... three years later, here's an update... ?

I will be finishing a NHSC loan repayment contract August 2016. (I knew about that program when I started my MSW way back in 2001 and it feels AWESOME to know I can have a dream and make it happen!) Between now and then, I plan to keep chipping away at the prerequisites (A's in chem and nutrition, yay! taking my second chem course this Summer) then apply for ABSN to start Summer 2017. Assuming all goes well in that department, then right in to DNP for family psych MH NP.

Having actually gone through the NHSC program once with my LISCW and seeing that I really can actually pay off $50,000 (thank you for your tax dollars, everyone!) in exchange for working 2 hours outside of the metro area, I'm pretty convinced I can do it again as long as my marriage will stand it! My spouse has been in an MBA program while I've been working out of town 4 days a week. It might be a little different if I'm back in school and/or working away from home and he's just doing regular life.

I checked in to PA programs and the only one offered in my state is open only to people who already are working as medical assistants, usually in remote communities (it's the MEDEX program through University of Washington). Also, I'm not really interested in a credential that will require me to have a supervision agreement at this point, even if it is just cursory. In addition, I don't really see psych PA jobs posted where I live. I see a LOT of PMHNP postings, and essentially no PA psych jobs. I suspect this is because PAs aren't really used for psych much here.

To the person who suggested I work for a couple of years as an RN, I totally get why that's a good idea. However, I've worked as a psych tech, and have been around SPMI populations and therefore around a LOT of psych meds for most of my working life. I'm familiar with all the major (and some of the minor and off label) meds in psych. While of course I don't know as much about pharmacology yet, that's what I'd be learning in nursing school. The DNP says most people work while they are in the program. It might be a good way to pick up some RN experience during that time but it kind of depends whether I would be able to earn more doing therapy as an LICSW (depending on which insurance I bill; medicaid pays about 60% of what private insurance pays here).

I suspect that I will be a pretty competitive applicant because of my LICSW and all the experience it represents. But of course, I still worry about not getting in. UW used to have a graduate entry option for the ABSN/DNP program but they did away with it because too many people weren't continuing on to the DNP. However, I'm guessing that once you're a "known entity" to the department it's easier to get a DNP spot... particularly since I can articulate my career goals quite clearly. I'm also hoping because of the clarity of my career goals and commitment to underserved populations I might be able to score some scholarships because every bit helps!

With regard to the "hands on nursing observation" volunteer stuff, I've hooked up with a really neat place that was the original AIDS hospice (Bailey Boushay House--they now function as a level of care in between inpatient and skilled nursing and include people with end of life for all sorts of reasons, Huntington's, ALS, etc and not just AIDS since the meds are so much better now). I take my dog to do pet therapy visits and it's been truly transformative with regard to how I think about living and dying and having bodies that do things like fail us when we don't want them to.

A couple of psychNPs I've talked with have also suggested picking up FNP training when/if I can because it has helped them catch medical stuff that otherwise might have gone unnoticed by primary care.

Why the DNP commitment when I could get into an ABSN/MSN NP program? UW is the only one that offers the "family" focus so that I could keep working with children and youth. That and I don't really want the "triple crown" of master's degrees.

gettingbsn2msn, MSN, RN · Nov 30, 2015

I agree. I am already an Adult Nurse Practitioner. That said--I am back in school to gain a PMHNP. It will take me 2 more years. I should have just gone to med school at this point!!

MindfulMSWRN · Aug 21, 2016

oregonrobin said:
So... three years later, here's an update... ?
I will be finishing a NHSC loan repayment contract August 2016. (I knew about that program when I started my MSW way back in 2001 and it feels AWESOME to know I can have a dream and make it happen!) Between now and then, I plan to keep chipping away at the prerequisites (A's in chem and nutrition, yay! taking my second chem course this Summer) then apply for ABSN to start Summer 2017. Assuming all goes well in that department, then right in to DNP for family psych MH NP.
Having actually gone through the NHSC program once with my LISCW and seeing that I really can actually pay off $50,000 (thank you for your tax dollars, everyone!) in exchange for working 2 hours outside of the metro area, I'm pretty convinced I can do it again as long as my marriage will stand it! My spouse has been in an MBA program while I've been working out of town 4 days a week. It might be a little different if I'm back in school and/or working away from home and he's just doing regular life.
I checked in to PA programs and the only one offered in my state is open only to people who already are working as medical assistants, usually in remote communities (it's the MEDEX program through University of Washington). Also, I'm not really interested in a credential that will require me to have a supervision agreement at this point, even if it is just cursory. In addition, I don't really see psych PA jobs posted where I live. I see a LOT of PMHNP postings, and essentially no PA psych jobs. I suspect this is because PAs aren't really used for psych much here.
To the person who suggested I work for a couple of years as an RN, I totally get why that's a good idea. However, I've worked as a psych tech, and have been around SPMI populations and therefore around a LOT of psych meds for most of my working life. I'm familiar with all the major (and some of the minor and off label) meds in psych. While of course I don't know as much about pharmacology yet, that's what I'd be learning in nursing school. The DNP says most people work while they are in the program. It might be a good way to pick up some RN experience during that time but it kind of depends whether I would be able to earn more doing therapy as an LICSW (depending on which insurance I bill; medicaid pays about 60% of what private insurance pays here).
I suspect that I will be a pretty competitive applicant because of my LICSW and all the experience it represents. But of course, I still worry about not getting in. UW used to have a graduate entry option for the ABSN/DNP program but they did away with it because too many people weren't continuing on to the DNP. However, I'm guessing that once you're a "known entity" to the department it's easier to get a DNP spot... particularly since I can articulate my career goals quite clearly. I'm also hoping because of the clarity of my career goals and commitment to underserved populations I might be able to score some scholarships because every bit helps!
With regard to the "hands on nursing observation" volunteer stuff, I've hooked up with a really neat place that was the original AIDS hospice (Bailey Boushay House--they now function as a level of care in between inpatient and skilled nursing and include people with end of life for all sorts of reasons, Huntington's, ALS, etc and not just AIDS since the meds are so much better now). I take my dog to do pet therapy visits and it's been truly transformative with regard to how I think about living and dying and having bodies that do things like fail us when we don't want them to.
A couple of psychNPs I've talked with have also suggested picking up FNP training when/if I can because it has helped them catch medical stuff that otherwise might have gone unnoticed by primary care.
Why the DNP commitment when I could get into an ABSN/MSN NP program? UW is the only one that offers the "family" focus so that I could keep working with children and youth. That and I don't really want the "triple crown" of master's degrees.

Curious if you can share another update?

I'm an LMSW and RN in NYS and for many reasons, looking into PMHNP programs- Also, looking into programs with a family focus so that I can continue with my current clinical specialty (perinatal and early childhood MH). Seems like you had many of the same questions that I have as I consider this next step, and I'd be interested in how things are going in your program. Best wishes!

NuggetsHuman, BSN, RN · Oct 8, 2016

Howdy.

Here's another update.

Since we last spoke, I have finished OChem and A&P1 and 2... aaaaaaaand moved to Philadelphia of all places! My spouse got offered a "dream job" with his shiny new MBA. He's been here since May '16 and I've just gotten here as of end of August. (Spent my first 3 days in Philly inpatient getting IV antibiotics from one of our cats biting my finger while trying to sedate her for the flight).

The last year I have been in a primary care community health center in one of the most diverse zip codes in the country (South Seattle... who knew! 40+ languages in my first 4 months at that job.) doing primary care behavioral health and integrated BH care (using the AIMS model from UW in case anyone's familiar with that). I had the opportunity to speak with a lot of PAs and NPs, mostly FNPs and CNMs. Funnily enough all the PAs said I would make a great PA (as did one of my besties from undergrad who has been a PA for 10+ years), and all the NPs said, "You'd really be happier with the NP curriculum because of who you are."

I have decided to apply for Drexel's ACE (accelerated career entry) BSN and take advantage of the "early assurance" admission option for their MSN in psychMH. The only other program I can find in this area is Penn, and I'm already freaking out about the Drexel price tag, so I can't imagine what Penn's would be. I looked into some other accelerated BSNs, and I found myself liking the options at Drexel better. Compared to what I'm reading about people who applied this time last year to start Fall '16, I think I will be a pretty competitive applicant because of my undergrad and masters GPAs, plus rockin' a 3.9 in my lab sciences. Who knew, right???

A&P two nights a week for 6 months nearly killed me and definitely did a number on my immune system. Not a great combo while working in a primary care clinic. Partly why it was so hard was I am a bus rider, so an hour to work on the light rail or bus to work in the morning, and 1.5 hours to school two nights a week followed by 40 minutes home. That SUCKED.

With regard to the 11 month vs 24 month ACE options, I've stated the 11 month as my first choice and 24 month as my second. I may need to see if I can swap those depending on what my financial situation looks like.

I'm kind of surprised there aren't more specialized DNPs our here like there are at UW. The trend in Washington State is VERY much DNP-based. I think the state upped the clinical hours requirement and that's part of what's driving it.

What swayed me to finally apply this year was my *own* therapist saying that he's not seen me happier than when I was in learning in an academic environment. And the hubby showed me how to do a cost/benefit calculation on going back to school vs not. Zoiks!

NuggetsHuman, BSN, RN · Oct 9, 2016

mindfulmswrn, I feel you on the nuttiness of the psychotherapy endorsement on LCSWs in NYS. What a crock! I suspect psychologists lobbied for it to try to "protect their turf". (Also, I can't send you a private message yet because I don't have enough posts yet. But I'd love to keep in touch!)

I do actually notice some trepidation about PMHNPs being qualified to "do psychotherapy" with the training requirements I see for psychNPs. Especially since there isn't a post-graduate supervision requirement to do so like there is with other master's level counseling degrees.

DanaerysTargaryen, you'll be pleased to know the Drexel psychNP program requires at least 1 year of work as a psychRN prior to full matriculation into the program. They have the "early assurance" option which means if they like you, and you're doing well in the last term of the ACE BSN, you can effectively reserve a spot in the MSN of your choice and start taking classes while you are getting your year of experience in psych nursing.

Penn has a direct entry MSN, but good lord it's expensive! And I'd prefer to not live apart from my spouse again unless absolutely necessary, so I'm OK with things taking a little longer to finish the whole thing (4 or 5 years vs 3) to save about $70-100,000.