I think after four or five years of stewing on this, I have decided to start down the path of nursing education, leading toward a PMHNP (family). I have a BA in psych, an MS in social justice studies, and an MSW in direct human service work. My prior work history includes running a DV shelter, working in boys' residential treatment and therapeutic foster care, ER social work (which I loved, loved, loved!), and now providing youth and family mental health crisis response.
I see really clearly how having additional training on psychopharm and prescriptive authority would be really helpful. Plus, child and adolescent mental health has rather picked me as a specialty. I never intended to be "that annoying lady who tells you how to parent your kid but doesn't have any of her own."
In addition, I FINALLY completed my WFR (wilderness first responder) 10 day training. It's been on my to-do list since 2004. It was some of the best training I've ever had in ANYthing. It helped me to realize exactly how excited I get learning medical stuff. Given my interest in emergency medicine, I wonder if I wouldn't be better off doing an FNP (focusing on acute care), or stopping after by RN to get some ER nursing experience.
I took one biology and one Chemistry class when I was an undergrad music major 20 years ago (EGAD INDEED!) now. So I will obviously have my hands full with prerequisites for a while. I've decided to start with the nutrition class to see how it goes.
So I'm looking at at least 6 prerequisite courses-- 2 Chemistry, Microbiology, 2 anatomy and physiology, plus the nutrition. I have the statistics and developmental psych, as long as they aren't required to be in the last 10 years.
Then *hopefully* an accelerated BSN program, and then into a DNP program for three years.
I am working full time in the crisis response program, and it doesn't leave me with lot of extra energy for volunteering because of the level of self-care required to do my job well. Do you think this will count as "hands-on" health care experience because I'm in and out of emergency rooms and IPU (inpatient psych units) all day long?
I want to make my application really competitive, and assume I will probably get mostly As with maybe a B for my science classes.
Any words of advice or encouragement as I start exploring down this path?
Oh, also, editing to add that I am *really* committed to working with under-served populations. Anyone have experience with loan forgiveness programs for PMHNP work?
1) I completed several courses in 2021-2022 year toward the MSN that qualifies to sit for the PMHNP board exam. Ironically or not, one of the classes was "family systems in primary care" (arguably the MOST social work-ey class I've encountered in nursing thus far). Assignments were, not kidding, "describe a family system experiencing a significant health stressor." [I just laughed, and said WOW!, and described my family dealing with my dad waiting for a liver transplant and decompensating by the day.]
2) I was taking advanced pathophysiology last fall while my dad was acutely dying from liver failure. (Did I mention COVID ruins EVERYTHING including organ transplants?!?)
He died not quite half-way through the semester. I'm incredibly grateful for the nursing education in combo with my social work education in addition to the general ability to be present with *** going down... so I could literally and emotionally be present with my dad the night that he died.
My mom has repeatedly said how she "can never thank" me enough for being there overnight with my dad when he died. She was *beyond* exhausted and really needed to go home. We had just made arrangements for my dad to get set up with hospice the next day, but for many, many reasons I had both a hunch and strongly suspected he wouldn't make it through the night. (Of course, this prompted me to fall down a rabbit hole later about the role of intuition in nursing care... you know... your patients "just don't look right".)
Initially, I was afraid that I didn't do right by my dad when he was actively taking his last agonal breaths. There's a part of me that wishes I had reached out and held his hand.
And at the same time, I have to remember that I only had book learning about agonal breaths and no practical knowledge about what I was seeing. Also, I woke up from a dead (not really a pun and not intended) sleep about 3:45am to my dad gasping for breath. In spite of how much pain he was in from being revived by CPR and having diminished lung capacity from his overwhelming ascites--his heart stopped earlier in the day when they were trying to give him a dialysis so the providers declined to give him paracentesis--I woke up to my dad sitting kind of upright and turned toward me with his eyes open wide while he took his last breaths. I'm not sure if I saw fear or wonder in his eyes, but I suspect it was both, coupled with a strange kind of childlike innocence. ❤️
I have some really great friends who were able to remind me that it's not about what I did/didn't do in that one moment, but ALL the moments of showing up over the last few years, particularly when my dad was ill and dying. One of them graciously said, "Love turns toward what it needs." To what degree that's objectively true, I will never know. But I have found it immensely comforting when I think about those last moments with my dad.
This is one of the hardest, though not the hardest, things I have ever done in my life thus far. It feels weirdly dismissive to say that, but trauma be like that.
Weirdly--this is my own personal work, btw--my mom also said she appreciated how gentle and informative I was with information about my dad's health that helped her prepare for him to die. [They were married for 53 years, HS sweeties since 1967.] These are not the kind of conversations I'm used to having with my mom. All I can think is that I'm grateful for my professional training as a social worker and nurse.
3) So... in advanced core (patho, pharm, health assessment) and clinical courses, one has to get a B in order to progress. A B- is not sufficient. If I had taken a grade in my patho class for the fall, I would have a B- and lose one of my two chances to pass with a B.
4) All that to say I'm retaking patho this Spring semester. It sets me back a full year in my program so that I will potentially graduate in August 2025 instead of 2024 if there are no other hiccups.
5) Since I get to have no classes this Summer, I am running away to Summer camp to be a camp nurse for a few weeks in the mountains of North Carolina.
6) I quit my full time LCSW job in October, 2022 when my dad died. There's nothing like a little existential questioning to rethink how one is "doing one's life". I decided time is truly my most limited resource, and I'd like to spend it with some more life-affirming activities for the time being (see also Summer camp nurse).
Forgot to say that I stumbled into teaching undergrad psych nursing this Spring and Summer. It's really fun.
Generally, my MO is to assume most of the people are not remotely interested in psych nursing. My goal is to have them not be stigmatizing asshats to my patients when my patients show up in their practice settings.
My clinical last semester was an inpatient geropsych hospital. Spring will be general outpatient mental health clinic. I'm still working on Summer because I'm trying my best to be able to spend time at camp as well as finish my program.
Thanks for continuing to ride along on this epic project.
NuggetsHuman, BSN, RN
78 Posts
Oh, hi there.
So here's what's happened since the last update.
1) I completed several courses in 2021-2022 year toward the MSN that qualifies to sit for the PMHNP board exam. Ironically or not, one of the classes was "family systems in primary care" (arguably the MOST social work-ey class I've encountered in nursing thus far). Assignments were, not kidding, "describe a family system experiencing a significant health stressor." [I just laughed, and said WOW!, and described my family dealing with my dad waiting for a liver transplant and decompensating by the day.]
2) I was taking advanced pathophysiology last fall while my dad was acutely dying from liver failure. (Did I mention COVID ruins EVERYTHING including organ transplants?!?)
He died not quite half-way through the semester. I'm incredibly grateful for the nursing education in combo with my social work education in addition to the general ability to be present with *** going down... so I could literally and emotionally be present with my dad the night that he died.
My mom has repeatedly said how she "can never thank" me enough for being there overnight with my dad when he died. She was *beyond* exhausted and really needed to go home. We had just made arrangements for my dad to get set up with hospice the next day, but for many, many reasons I had both a hunch and strongly suspected he wouldn't make it through the night. (Of course, this prompted me to fall down a rabbit hole later about the role of intuition in nursing care... you know... your patients "just don't look right".)
Initially, I was afraid that I didn't do right by my dad when he was actively taking his last agonal breaths. There's a part of me that wishes I had reached out and held his hand.
And at the same time, I have to remember that I only had book learning about agonal breaths and no practical knowledge about what I was seeing. Also, I woke up from a dead (not really a pun and not intended) sleep about 3:45am to my dad gasping for breath. In spite of how much pain he was in from being revived by CPR and having diminished lung capacity from his overwhelming ascites--his heart stopped earlier in the day when they were trying to give him a dialysis so the providers declined to give him paracentesis--I woke up to my dad sitting kind of upright and turned toward me with his eyes open wide while he took his last breaths. I'm not sure if I saw fear or wonder in his eyes, but I suspect it was both, coupled with a strange kind of childlike innocence. ❤️
I have some really great friends who were able to remind me that it's not about what I did/didn't do in that one moment, but ALL the moments of showing up over the last few years, particularly when my dad was ill and dying. One of them graciously said, "Love turns toward what it needs." To what degree that's objectively true, I will never know. But I have found it immensely comforting when I think about those last moments with my dad.
This is one of the hardest, though not the hardest, things I have ever done in my life thus far. It feels weirdly dismissive to say that, but trauma be like that.
Weirdly--this is my own personal work, btw--my mom also said she appreciated how gentle and informative I was with information about my dad's health that helped her prepare for him to die. [They were married for 53 years, HS sweeties since 1967.] These are not the kind of conversations I'm used to having with my mom. All I can think is that I'm grateful for my professional training as a social worker and nurse.
3) So... in advanced core (patho, pharm, health assessment) and clinical courses, one has to get a B in order to progress. A B- is not sufficient. If I had taken a grade in my patho class for the fall, I would have a B- and lose one of my two chances to pass with a B.
4) All that to say I'm retaking patho this Spring semester. It sets me back a full year in my program so that I will potentially graduate in August 2025 instead of 2024 if there are no other hiccups.
5) Since I get to have no classes this Summer, I am running away to Summer camp to be a camp nurse for a few weeks in the mountains of North Carolina.
6) I quit my full time LCSW job in October, 2022 when my dad died. There's nothing like a little existential questioning to rethink how one is "doing one's life". I decided time is truly my most limited resource, and I'd like to spend it with some more life-affirming activities for the time being (see also Summer camp nurse).