Need help with career choice: MSW/LCSW, MEd Special Ed, or ABSN/MSN/Psych NP

[arincoc]

Hi,

I need to make a career decision and would appreciate your feedback.

I am 31 year-old female, have a master's degree in counseling, and am working as a behavior specialist consultant in Philadelphia providing community-based behavioral health services to children with Autism and other behavioral and developmental disorders and their families.

After completing my master's, I realized that there is many limitations to my degree in the job market. The demand is low especially without license, and, even with a license (LPC), the license is not easily, if at all, transferrable in other states. The experience and skills I acquire from my current work is also not easily transferrable to other jobs in mental health field, and similar type of job is not available in many other states.

I am married to a graduate student who will be pursuing his studies for about next 10 years. During his studies, we are expected to move twice depending his choice of school and can really end up anywhere in the U.S. This puts me in a difficult position with a responsibility to make enough earnings to support our family (hopefully, we will have our first kid within next 2 years), but without a secure job prospect.

So, I am considering couple different options:

1) Get an MSW/LCSW to develop a career towards providing psychotherapy.

2) Get a MEd in Special Education with teaching certification to continue work with the population that I am currently serving.

3) Get Accelerated BSN and MSN to become a Psychiatric NP.

Important factors in making this decision are:

1) Job security

My husband will be pursuing PhD, Post-doc, and ultimately a faculty position for next 10+ years. It is very likely that we will be moving across the country for each transition depending on which school he gets into. Considering the current job climate for PhD's seeking faculty positions, this is a very uncertain and most likely unstable road in terms of job security and income. So, it is very important that I will be able to find a job wherever I am and will be making a decent income for a family.

2) Investment vs. output

I already have loans on my master's degree. And, my income really do not justify the loan I had taken out. So, I am a bit scared to take out more loans, and, if I do, I want to make sure that I make an investment that economically makes sense.

3) Job satisfaction

I am an artist at heart, but I wanted to help people, so I transferred out from a prestigious art school and got myself into counseling, which is something I've always interested in as well. But, I have realized that even within the scope of helping others, some type of work may not be a good fit for me, like my current job. In my current job, I like the aspect of working with children and providing counseling, but do not like the heavy focus on behaviors, hours spent on road driving to client's homes and schools, being on my own and not getting supports from co-workers and supervisors.

4) Work/life balance and flexibility

Family is very important for me. I consider being a wife and mom a calling and want to invest as much as possible in my time with family.

It seems to me, nursing is the best option from its face-value. But, there are few things that concerns me about the choice.

- I am not sure how I well I will handle the direct care part of training. I think I can handle bodily fluids, but not sure about sticking a needle (and anything worse) to a person.

- I am not really physically fit and have tendency to get anxious. My understanding is that I need floor experience to become an NP, which can be exhausting physically and mentally.

Can someone like me survive through it?

At the end, I wish to make a career that will be meaningful and enjoyable (despite the hardships that comes with it) for next 10-20 years of my life, while meeting the needs of my family.

I would really appreciate your input if you've had similar experience and concerns when making your own career choice, if you have useful information on developing a career towards psychiatric NP, or if you have a good reasons to advice for or against any of my options.

Thank you for your comments ahead of time!

[HouTx, BSN, MSN, EdD]

First things first - Have you completed the 'basic science' prerequisites & is your GPA within the competitive range for entry to a nursing school? If not, this may be a primary limitation for you. Although nursing programs may differ slightly, there core requirements are pretty standard. These courses normally begin to 'expire' after 5 years.

There could be several routes for completion of your BSN, but if you also have to finish pre-requisites, even the quickest (most expensive) route will take at least 2 years. It is worth noting that it is highly unlikely that you would be able to continue to work while in an accelerated program. Afterward, you would need to gain clinical experience in psych in order to qualify for admission to the NP program. Depending on the program, this may be another 2 years - if you are lucky enough to be able to land a psych job right after licensure. So - minimum of 4 years to achieve your goal. You can't really transfer between clinical programs, so you wouldn't be able to relocate while you are actively involved in either one (BSN & MSN).

It is true that a nursing license is probably more 'portable' than many other professions, but early-career nursing will involve direct care practice in order to achieve your goal. This means working nights, weekends & holidays on a very rigid schedule... may not be an ideal situation for starting a family & ongoing support for your student hubby. Most people find nursing to be a very stressful & physically taxing career, particularly since 12 hour shifts are the norm. If you have serious doubts, based on your own appraisal of personal strengths and weaknesses - would encourage you to move in a different direction.

[elkpark]

There could be several routes for completion of your BSN, but if you also have to finish pre-requisites, even the quickest (most expensive) route will take at least 2 years. It is worth noting that it is highly unlikely that you would be able to continue to work while in an accelerated program. Afterward, you would need to gain clinical experience in psych in order to qualify for admission to the NP program. Depending on the program, this may be another 2 years - if you are lucky enough to be able to land a psych job right after licensure. So - minimum of 4 years to achieve your goal. You can't really transfer between clinical programs, so you wouldn't be able to relocate while you are actively involved in either one (BSN & MSN).

It is true that a nursing license is probably more 'portable' than many other professions, but early-career nursing will involve direct care practice in order to achieve your goal. This means working nights, weekends & holidays on a very rigid schedule... may not be an ideal situation for starting a family & ongoing support for your student hubby. Most people find nursing to be a very stressful & physically taxing career, particularly since 12 hour shifts are the norm. If you have serious doubts, based on your own appraisal of personal strengths and weaknesses - would encourage you to move in a different direction.

Although I'm not a fan of them particularly, I do feel an obligation to at least point out that there are "direct entry" MSN programs for PMHNP, in which people who already have a BA/BS in something else enter with no nursing education or experience, and graduate as a licensed RN with an MSN that qualifies them to write the PMHNP certification exam. These programs are typically 2-3 years, basically an accelerated BSN + MSN program mashed together in a minimum amount of time, and do not require any previous nursing experience.

And again, while I don't think it's a good idea and wouldn't allow it if it were up to me, there are plenty of traditional PMHNP programs that will take nurses with no inpatient psych (or any other kind of) nursing experience. So, it's not really necessary to get licensed and then work for a year or two prior to pursuing graduate studies.

AFAIK, most direct-entry MSN programs would still require at least some prerequisites. Most of them are v. competitive and v. rigorous and demanding (don't know if you are planning on working while you are in school).

FWIW, I've been a psych nurse (and psych CNS) for many years, and have known many social workers and LPCs who thought about going into nursing because they perceived the psych nurses with whom they worked as doing much the same job as they did, but getting paid a lot more for doing it (with less formal education, in the case of staff nurses). In my experience, every SW or LPC who actually looked into it seriously ended up deciding not to pursue nursing. At least to get through school, you will have to deal with every kind of body fluid, and all kinds of invasive procedures. People's lives will be in your hands at times. And, as you note, it's fairly physically demanding. Even if your goal is to end up a psych NP, you will still have to complete all of a "basic" nursing program, rotating through and mastering, at an entry level, med-surg, OB, peds, critical care, and psych nursing in order to get licensed and be able to pursue specialized grad studies.

Best wishes for your journey!

[hopefulkim99]

Although I'm not a fan of them particularly, I do feel an obligation to at least point out that there are "direct entry" MSN programs for PMHNP, in which people who already have a BA/BS in something else enter with no nursing education or experience, and graduate as a licensed RN with an MSN that qualifies them to write the PMHNP certification exam. These programs are typically 2-3 years, basically an accelerated BSN + MSN program mashed together in a minimum amount of time, and do not require any previous nursing experience.

And again, while I don't think it's a good idea and wouldn't allow it if it were up to me, there are plenty of traditional PMHNP programs that will take nurses with no inpatient psych (or any other kind of) nursing experience. So, it's not really necessary to get licensed and then work for a year or two prior to pursuing graduate studies.

AFAIK, most direct-entry MSN programs would still require at least some prerequisites. Most of them are v. competitive and v. rigorous and demanding (don't know if you are planning on working while you are in school).

FWIW, I've been a psych nurse (and psych CNS) for many years, and have known many social workers and LPCs who thought about going into nursing because they perceived the psych nurses with whom they worked as doing much the same job as they did, but getting paid a lot more for doing it (with less formal education, in the case of staff nurses). In my experience, every SW or LPC who actually looked into it seriously ended up deciding not to pursue nursing. At least to get through school, you will have to deal with every kind of body fluid, and all kinds of invasive procedures. People's lives will be in your hands at times. And, as you note, it's fairly physically demanding. Even if your goal is to end up a psych NP, you will still have to complete all of a "basic" nursing program, rotating through and mastering, at an entry level, med-surg, OB, peds, critical care, and psych nursing in order to get licensed and be able to pursue specialized grad studies.

Best wishes for your journey!

This is interesting. I was looking into msw awhile ago then considered psych np because it's the "same work" but more pay, I read your post and I'm wondering why those social workers decided against going back.

[elkpark]

This is interesting. I was looking into msw awhile ago then considered psych np because it's the "same work" but more pay, I read your post and I'm wondering why those social workers decided against going back.

Psych NP and social work are not at all "the same work." Psych NPs are focused primarily on prescribing medications, which is v. different than what social workers do. The LPCs and social workers I knew decided against nursing for the reasons I listed in my original post -- although it appeared superficially to them that the staff nurses on the unit were doing similar work to what they were doing (for more money), they decided, when they looked into what would actually be involved in becoming an RN, that they were not interested in dealing with bodies and bodily fluids, and dealing with life-or-death emergency situations. They also realized that the nursing staff covered the inpatient psychiatric unit 24/7/365, while they had Mon-Fri 9-5 jobs, and going into nursing would mean the possibility (probability, at least early on in the career) of working nights, weekends, and holidays.

[hopefulkim99]

Psych NP and social work are not at all "the same work." Psych NPs are focused primarily on prescribing medications, which is v. different than what social workers do. The LPCs and social workers I knew decided against nursing for the reasons I listed in my original post -- although it appeared superficially to them that the staff nurses on the unit were doing similar work to what they were doing (for more money), they decided, when they looked into what would actually be involved in becoming an RN, that they were not interested in dealing with bodies and bodily fluids, and dealing with life-or-death emergency situations. They also realized that the nursing staff covered the inpatient psychiatric unit 24/7/365, while they had Mon-Fri 9-5 jobs, and going into nursing would mean the possibility (probability, at least early on in the career) of working nights, weekends, and holidays.

ah that makes sense psych nps have a similar job to psychiatrist? SW may provide counseling or therapy but do not handle the medication side. All help with the treatment of mental health though. IMO I think being a psych np would be a great way to treat the whole patient and earn a wonderful salary and I don't think SWs are paid enough ... but I understand not wanting to go through 3 plus additional years of schooling and work just to run the risk of having to give up ones desired work schedule, or handle bodily fluids (for a few years) just to make 50 -80k more per year. Anyways, just my thoughts as I decide which path I want to take. Thank you for sharing!