New Grad Job Market PMHNP

[middleagegal]

Hello all, I am hoping to get the low down dirty truth here. I've recently found myself at a dead end in my current M.S. level career (not nursing) and need to make some decisions. I have kicking around the idea of becoming an NP. I have a friend who went to PA school and tried to talk me into that, but NP is more appealing to me for a number of reasons. I am especially drawn to PMHNP for a number of reasons, and the fact that I can do it in an AE program in only 3 years adds to the appeal. I do however have concerns about the job market for PMHNP.

I am in a financial situation with current student loans and a family to support that just will not allow me to gamble with this. I spent too many years and way too much money on my first M.S. only to find myself unable to even keep up with the interest on my student loans for over a decade. While I have always been a proponent of doing what you love, at some point I have to make a large part of my decision based on the ability to find employment and make a reasonable living for my family. My first degree was chosen by following my heart and it has been a financial disaster. I can't afford to make that mistake twice.

What does the job market look like for PMHNP? I have read some instances where PMHNP's have complained that they are unable to find jobs or MD's willing to allow them to work under them. I know that money should not be the primary reason you choose a specialty and I realize that FNP or even PNP would offer more flexibility in finding a position. However, I also realize it would take more time, which means more time until I can start earning a living, and I really do keep feeling myself pulled to PMHNP.

I also realize the AE PMHNP programs can be highly competitive and therefor it may not even end up being an option, but I don't want to count it out, if it is where I want to be, then it makes sense to just try for the AE program.

Also, it is my understanding that if you get your MSN without doing NP, then post graduate work can not be funded with student loans, if that understanding is correct then it puts me in a further predicament, once again making the PMHNP AE program seem appealing.

I would appreciate any insight into the realities of finding work as a PMHNP. Additionally, I am located in Texas and would not be able to move in the near future.

[Jules A, MSN]

So the schools could care less if you are competent its not their problem. They want someone who will pay their tuition and pass the boards the first time. In my area there are tons of jobs for new grads and all they care about is if you are licensed and can fog up a mirror if held close enough to your nose. Seriously. These are the NPs who's patients I repeatedly admit on my acute unit for medication management.

I believe there is a need for actual inpatient psychiatric nurse experience and think you will be at a severe disadvantage when it comes to being a competent psych-NP. Not saying there are none who aren't ok just that to be able to accurately recognize the subtleties in order to diagnosis and medicate there is a huge value in having seen the different presentations and responses to medications many times over. This is not like blood pressure, asthma or diabetes where there are well established algorithms. While I really like Stahl's literature there have been some things in his guidelines that do not translate into practice in my experience as well as some medications with no recommendations on titrating up, when to order labs etc. It would be very difficult to establish a competent practice simply by being good with the patients and thumbing through a book. There are very few checks and balances especially in outpatient where no one sees what you are writing until your patient decompensates and is admitted to the hospital.

As I have said before for the inexperienced practitioner there can be a fine line between BiPolar vs. Borderline vs. SUD or a child with abuse/neglect vs trauma vs a true mood disorder. What about psychomotor agitation vs disorganized psychosis vs akathesia? Have you ever seen EPS? I could go on and on. You won't know what you don't know and anyone who is arrogant enough to think there is no need for actual experience in this field is at risk for doing their patients a disservice, imo, in particular those who haven't been successful in other areas of nursing and figure psych is prime for the picking because its easier.

Although imo our education is lacking in hours and prescribing compared to physicians which they will all point out my experience with psychiatrists has been excellent overall. I present as a professional who is experienced in hard-core psych. I cut my teeth being precepted by physicians so I know many of them and fit in with them. There can be some NP co-dependency angst that I avoid and I think turns off the docs. I have no delusions that I'm going to be everything to everyone or that my patients will be miraculously cured of their chronic illness because I coddle them. I conduct myself like a physician easily setting boundaries with both admin and patients as needed.

I am a huge supporter of my fellow NPs provided they are competent if not they are a detriment to our patients and profession. My advice to anyone would be to put in some time working as a psych RN and after that if you enjoy it and have an affinity for it apply for your graduate level program.

[Jules A, MSN]

Why was this moved to NP students? Although they might benefit from reading this I don't think they will have much to offer in way of being hired or working as a NP.

[Barnstormin' PMHNP]

Good Question JulesA. I don't even know why there is a student NP forum, it's all abut schools and getting into one. I learn more lurking on the NP/APN forum.

[sirI, MSN, APRN, NP]

The NP forum header describes what content is most appropriate there:

Nurse Practitioners can use this section to network, discuss, and share trends and practices with other Nurse Practitioners.

The Student NP forum header:

Student Nurse Practitioner is available for the Nurse Practitioner Student and those interested in becoming a nurse practitioner (NP). Ask questions about your current NP program and discuss clinical situations including how to locate a preceptor. Get helpful information from students and seasoned Nurse Practitioners as you seek certification for your specialty area.

Since OP is inquiring about becoming an NP in the future, the thread was moved to this more appropriate forum, the Student NP forum.

Students and NP's can still advise; the OP has received good advice and will continue to receive good advice here.

[middleagegal]

Ok, well my thoughts were similar with regard to posting on the NP forum, however since it has been moved to the student forum; are there any PMHNP students here doing what I am considering, the AE MSN program without practicing as an RN first? If so, what have you learned about employment prospects via this route?

[Jules A, MSN]

T

Students and NP's can still advise; the OP has received good advice and will continue to receive good advice here.

Thanks for your consideration. I just don't see many NPs acutally posting here because like Barnstormin pointed out it seems to mostly be dominated by NP school selection.

[SydneyJo1]

I'm a new PMHNP. I was a RN for a few years before becoming a NP, but I never worked in psych. I can see the point Jules is making about the value of previous psych nursing experience, but so far I've done very well in this role (I work outpatient and may have struggled more in an inpatient psych NP role). In my experience, this specialty is very much in demand and jobs are plentiful. Some of this is probably dependent upon where you live, but in my area there is a huge need for psych prescribers. I had several job offers when I graduated last summer. Additionally, all the psychiatrists I've met, including the ones I work with, have been very open to me as a NP and treat me as a respected colleague. I'm sure there are some psychiatrists who look down on PMHNPs, but that is true of other specialties as well. So far I'm very happy with this career path and have no regrets.

[chemokine]

Also, it is my understanding that if you get your MSN without doing NP, then post graduate work can not be funded with student loans, if that understanding is correct then it puts me in a further predicament, once again making the PMHNP AE program seem appealing.

Graduate student loans are not exclusively for NPs. You can get an MSN or MS in whatever you want and still get student loans. It has nothing to do with becoming an NP or not. I am still trying to make sense of this statement. Even if true, how does it make PMHNP AE more appealing than another NP route?

Let me just put it this way: you can get student loans regardless of which nursing educational pathway you take. Student loans are not exclusive to PMHNP AE.

[middleagegal]

I am still trying to make sense of this statement

I"m sorry. Maybe I did not make this very clear. Let me try to clarify.

What I was speaking of was the option to get the MSN first without an NP specialty. Then do post-graduate classwork to fulfill the NP requirements in order to become an NP post MSN. This would allow me to get the MSN, (skipping the BSN), then work as an RN before doing coursework for NP as a post-graduate.

Because post-graduate training does not lead to a degree, I was given the impression by something I read that it does not qualify for student loans. My understanding was that in order to qualify for student loans you have to be in a degree program, not just taking classes.

Soooo, if I do the MSN without NP first. I would not qualify for student loans to do the post graduate training in NP. On the other hand if I did the AE PMHNP, I could still work as an RN afterwards in order to gain some experience but would not have the additional classwork to worry about later in order to obtain my NP.

Gee, that was a lot. I hope that made more sense.

[chemokine]

Ok I got it. Maybe I am just really tired. I can't give you a 100% answer but I am very skeptical that student loans are not available for these types of programs. From the FAFSA website, it clearly states that student loans are for students seeking a "degree or certificate" and a cursory look at a few post-master's schools shows that they award a certificate.

Also there are some other options besides this post-master's idea in case you aren't aware:

1) accelerated BSN followed by MSN NP program (probably working as an RN in between)

2) direct entry MSN/NP

[middleagegal]

Thanks chemokine,

I need to double check that post-grad issue. I felt like that was something I read on the schools website, maybe I need to double check that.

As for the DE MSN/NP, that is what I am really interested in, and started the post with. However several responders seemed to indicate that they felt this was a bad idea as I would enter the NP field lacking any practical RN experience.

What are your thoughts on that? Would a DE program make it difficult for me to obtain employment or be successful in an NP career?

[chemokine]

Thanks chemokine,

I need to double check that post-grad issue. I felt like that was something I read on the schools website, maybe I need to double check that.

As for the DE MSN/NP, that is what I am really interested in, and started the post with. However several responders seemed to indicate that they felt this was a bad idea as I would enter the NP field lacking any practical RN experience.

What are your thoughts on that? Would a DE program make it difficult for me to obtain employment or be successful in an NP career?

Maybe it depends on the specific school and whether they actually award a certificate or not. That is a fuzzy area I'm not clear on.

Anyway, I got the impression from your first post that you were considering DE for PMHNP but that you appeared to think DE FNP was not an option or would take longer?

I think you should first see these as two separate questions to yourself:

1) Which speciality are you really interested in?

2) DE vs non-DE

As for 1, you stated that you felt your old job was not the right fit. I would be careful then to choose an NP specialty that is really going to be right instead of just doing it based on some logistical issues unless those issues are truly insurmountable. Again, I am not seeing how psych is a clearly easier profession to get into if all specialties have DE (which they do). If your main concern is being employed and having a reliable good paying job then I don't think the problem of specialty should be too worrisome. NPs are needed pretty much in all specialties.

As for 2, I can only tell you my opinion. I worked bedside for 3 years and I can appreciate all the things I learned. I am doing the CRNA route, but I can't imagine doing NP without any RN experience at all. I think they should require 1 year experience at least for acute care NP like CRNA school does. Then again, some people come on here and say how they did it with no RN experience and they are doing great as an NP. Maybe someone does it but I think it is at the very least going to make your first job as an NP very tough with a lot of hand holding. Knowing what I know now, I would not do DE NP. Just my two cents.