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.

[mindlor]

OK so I will chime in here as I have before on this topic. As many of you know I was attending the direct entry MSN program at Columbia University before being hit with cancer....anyway while at Columbia I had many a conversation with all of the top brass and the consensus was that being an RN had absolutely nothing to do with being an NP. As an NP one is working with and talking with doctors ie thinking in the medical mindset. Many of the nations top school allow people to bypass RN altogether. Columbia, Vanderbilt, NYU, just to name a few. So, cry, rant, disagree, whatever, but this is the way of things.

That said. once my battle with cancer was resolved I personally went and got my ADN and have been working as an RN for 2.5 years. I briefly just last year dipped my toe back into NP school but quickly withdrew as the program was laden with so many time wasting silly classes....I want to listen to lungs and hand out zpack which has zilch to do with studying the theorists who debated the pros and cons of treating impaired religiosity...

Furthermore, my experience says that an RN willing to work extra shifts can out earn an NP any day of the week......

[Jules A, MSN]

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.

I have seen this also but continue to wonder how do they know they are doing so great? In my experience there is no hand holding it is sink or swim. Where are the checks and balances? How does one actually know if they are ordering unnecessary antibiotics? Miss appendicitis or order CTs on everyone with right lower quad abdomen pain? Or in psych perhaps they giving everyone benzos which might make patients happy but can cause way more problems than they ever fix. Just some questions I think are worth considering.

[Jules A, MSN]

.anyway while at Columbia I had many a conversation with all of the top brass and the consensus was that being an RN had absolutely nothing to do with being an NP. ..

So I'm wondering how many of the "top brass" were actually nurses before becoming practicing NPs? In any event I would adamantly disagree with this sentiment and I think it is insulting to the hard working intelligent nurses who are administrating the ordered medications and monitoring reactions. Not to mention the many times they have called the ordering provider for "clarification" because they recognized the dose etc. was way off. There are differences to but say those valuable experiences aren't worth anything is out of line imo.

[CCuser]

The "top brass" are usually the reasons for all the problems in healthcare today. Their opinion means little to most experienced nurses who know how the game truly works.

As a patient, give me an NP that has been a nurse for a few years over one that hasn't. If you want to be nothing more than a prescriber, then go ahead, forget the art of nursing and the wisdom that can only be gained from working at the bedside.

As for most of us - we have earned something you will never have. Experience.

[middleagegal]

Wow,

Ok I really do appreciate the diversity of opinions from you guys. I think they are all valuable. I'm not sure it is making my decision easier, but it is definitely giving me plenty to think about.

Just for clarity,

I am interested in PMHNP because that is where my primary interest lies; it is where I think I would prefer to be eventually. My concern is whether to do direct route or do a BSN first, with a year or so of RN work, then apply to the MSN program.

Another option would be DE MSN without an NP specialty, then work a year and then do post-grad NP. (that is were the concern over student loans comes in)

As far as ease of getting in, at least where I am looking the dE PMHNP program is the most competitive to get into. Unfortunately I am married with a baby and moving is absolutely not an option. I either have to do a program near me or an online program, period. So my choices are limited by that. Additionally, I would like to get my NP as soon as possible to avoid any possible requirements for the DNP that may start in the next 5 years.

In terms of my current career, I didn't choose something I don't like, I chose something where I can't make a living. Being young and in college and all "I'm going to do what I love" didn't work out so well when I factor in the cost of my education and the rising cost of living. People in my organization haven't had a raise in 7 years. I work in research and since federal money to support research has dried up, we operate on a shoestring. I love what I do and in a perfect world I would finish my pHD and keep working in it. However, the world is not perfect. I need to be able to replace my husbands salary in a few years when he is forced to retire, something I will never be able to do in my current field.

As for PMHNP, I have volunteered for several years in an organization that serves at risk children, and have had experiences there as well as personal family and work experiences that lead me in that direction. I have seen so many families affected by the lack of access to mental health services that I feel like this is an area where I can have an impact. What I really like about PMHNP is the opportunity to prescribe when needed but to also recognize when shoving a pill down a kids throat may not be the answer. I would like to work with people across the life span but particularly with children as I have seen first hand again how difficult it can be to find practitioners who are comfortable treating children.

Ok, I hope that clears some things up. Keep the opinions coming as I am really interested in what people with experience have to say and feel about these options.

[CCuser]

I would see a career coach. They will help you reach a decision.

[middleagegal]

I may do that. My primary concern with asking this question is to get some feedback on employment outlook, especially if you go DE route. I just can't afford once again to follow my gut/heart and find myself unemployable or only employable making about half what I need for my family. You know?

[CCuser]

When in doubt. Don't do it. If your not sure, then it's not the time. That's why you should start out and get some experience as an RN first. There are overtime options available, and most RN's will make over an NP salary by just doing that alone. Then before you commit all those education dollars to a program you are not even sure about, you can get your feet wet and support your family.

THEN make the decision. It's too much right now it seems.

[middleagegal]

I don't think I'm clear. I'm not unsure about doing the PMHNP, what I'm unsure of is the best path to take. I know where I want to be, the only question in my mind is the best way to get there. Remember, I'm on a timeline here and that is a big part of my dilemma. I can't really afford to wait so long that the DNP may be in effect. Additionally, the sooner I finish and get out into the job market, the sooner I can not only help my family but start paying off my student loans. Not to mention saving for retirement.

As for waiting, time is a luxury I really don't have. I need to make a decision and head that direction in the most straight forward way possible.

When you are making a midlife, career change time is a very important factor. The longer it is before you start working, the less time you will be working in your career. This affects the math when it comes to weighing the cost of education against future earning potentials.

I feel like my question is a little lost now. I am not questioning the career, just the best way to get there and whether or not it would be a mistake to enter the DE MSN PMHNP program. This would be the most expedient path to take, but my question is would I have difficulty obtaining employment after taking that path. Perhaps I should also ask what the employment outlook is like in my specific area of the country as well?

[SydneyJo1]

I honestly don't think you would have trouble finding a good job as a PMHNP if you do a DE program. About half my class was DE (the other half, like me, were already RNs), and I know most people had accepted job offers by the time we graduated. Right now PMHNPs are in demand (this may change in a few years as more people go into this specialty, but who knows). So if your question is whether you will likely have trouble finding decent employment as a PMHNP if you go DE, my opinion is no, not at all.

[subee, MSN, CRNA]

Someone is going to lend you money when you already have outstanding student debt? Did I read that correctly. Watch some old Susie Orman shows and see how many middle ages folks are stranded with six figure student debt figures. Also, the the previous OP who went to Columbia. I would be very skeptical of what "top brass" says. I earned MSN from Columbia in 1984 - there were 9 people in the CRNA class. Now there are around 30. I have precepted them and there is no comparison between old program and the new. Columbia, like everyone else, has simply become preoccupied with graduating, not educating. They'll take almost anyone's tuition and then farm them out to other hospitals for their clinical "instruction". There is NO Columbia presence at these farms and no one has a grasp on a student's progress because they are only at one location for a short time. It has become a joke. It's graduates have become a joke(at least in anesthesia) I don't even think they require organic chem or physics as undergrad pre-reqs for the CRNA students. They are perfectly content to accept the money of the chaff, as well as the wheat.

[middleagegal]

Yes, someone will lend me money when I already have student debt. Most people finance graduate educations this way. It may seem crazy, it may be crazy, but with the currently exorbitant cost of higher education, there are few options.

Being a Suze fan myself I understand your point. Here is the deal, I am already a middleaged person strapped with more student debt than I will ever pay off with in my current field. I had the unfortunate luck of graduating in a field just at the same time the job market was starting to drop due to a change in the way research is looked at and funded in this country. Not entirely my fault, but hindsight is 20/20. I wish I had done something different, I didn't.

So now, I need to change careers and make enough money to pay back that debt as well as survive and if it means taking on more debt to do that, then that is what I need to do.

While student loan debt can be difficult to pay back, it is more difficult to pay back when staying employed has become difficult in your field and most job opportunities pay in the 40k range (forever, no advancement). When adjusting for inflation, I have actually taken pay cuts over the past 5 years. I can't continue to do that.

As was previously mentioned, there is assistance for paying back student loans. You can pay them back contingent on your salary, you can get credit for working in underserved areas, and you can get them discharged after 10 years for working full time in a non-profit or government agency.

For me, taking on more debt in order to more than double my current earning potential actually makes sense. Though I can certainly understand why there is hesitation. Certainly I would prefer to do it as inexpensively as possible, which is why I am currently restricting my school search to State Schools.