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]

Every last on I spoke with had at least a DNP and at least 25 years experience combined as a practicing RN and mid-level provider. disagree with the sentiment that is your choice, however in the academic world this is the thinking. Columbia is considered by many to be a very prestigious school and I cannot imagine them taking this position and subsequently offering this program if they thought Columbia NPs would be out there tarnishing the schools reputation.....

[mindlor]

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.

In my 2.5 years in the acute hospital setting the NPs think like doctors. The NP schools are teaching the medical model. NPs do not care one lick about the "art of nursing"....they care about making sure the right tests are ordered and that the right MEDICAL diagnosis is made and treated..

Maybe not always true, but, certainly my experience. I would guess that an NP practicing as a primary care provider may have a different outlook....

[Jules A, MSN]

All other specialties take an additional semester longer to graduate from, and the psychiatric specialty is the only specialty in which TWO pharmacology courses are taken. We take the same pharm that everyone else takes, and we take psychopharm that the other students can't even enroll in. We all share the common core, but the psych program has that extra training for the intricacies of the medications we use.

And it still blows my mind that they give us a prescription pad with only two pharm courses.

[Jules A, MSN]

In my 2.5 years in the acute hospital setting the NPs think like doctors. The NP schools are teaching the medical model. NPs do not care one lick about the "art of nursing"....they care about making sure the right tests are ordered and that the right MEDICAL diagnosis is made and treated..

This is great news to me. I wish my school was more of a medical model. Although I wouldn't say I don't care a lick about the "art of nursing" I also strive to emulate the skilled physicians I work with. My job is stabilization and medication management. I have no desire to be a disheveled nurse/social work hybrid mopping the brows of the masses.

[Barnstormin' PMHNP]

Hi JulesA, just a added comment. My preceptor is an older psychiatrist with almost 40 years of experience. He has had me doing H&P's, "diagnosing" , & "prescribing" since the first day I started clinical and he "collaborates" with me on interesting cases and always has nuggets of wisdom and info each clinical experience. My classmates are almost all with PMHNP's that have barely let them do anything in clinical. Am I fortunate? you bet, he is a great role model and teacher. The physicians have been great in my experience and the NP's have too, although I have never had the pleasure of working with a PMHNP, just FNP's.

[Jules A, MSN]

Hi JulesA just a added comment. My preceptor is an older psychiatrist with almost 40 years of experience. He has had me doing H&P's, "diagnosing" , & "prescribing" since the first day I started clinical and he "collaborates" with me on interesting cases and always has nuggets of wisdom and info each clinical experience. My classmates are almost all with PMHNP's that have barely let them do anything in clinical. Am I fortunate? you bet, he is a great role model and teacher. The physicians have been great in my experience and the NP's have too, although I have never had the pleasure of working with a PMHNP, just FNP's.[/quote']

That sounds excellent. I did my clinicals with psychiatrists also and feel very fortunate to have been brought into the physician fold.

The only thing I have observed with the real old dudes that makes me take pause is if they aren't current and still endorse free flowing benzos especially for patients with borderline pd, substance abuse and the gero-crowd.

[Barnstormin' PMHNP]

JulesA, fortunately he stays very current and is always telling me about new developments he is reading about or rationals for meds. I rarely see him prescribe benzos for anything. We have rampant substance abuse in my area, and he is very cognizant of that. Our unit is great in that it is not a "Give them a shot/pill to shut them up" mentality.

[Jules A, MSN]

JulesA fortunately he stays very current and is always telling me about new developments he is reading about or rationals for meds. I rarely see him prescribe benzos for anything. We have rampant substance abuse in my area, and he is very cognizant of that. Our unit is great in that it is not a "Give them a shot/pill to shut them up" mentality.[/quote']

That sounds like a great atmosphere. Are you thinking about staying there as a NP? I do some OP work on a very part time basis but the inpatient acute units are where my heart is. :)

[Barnstormin' PMHNP]

Yes I am JulesA. I am actually the first NP student he has accepted for precepting, I worked perdiem there for a while and when I realized what a great unit it was I asked about clinicals and he accepted me. I would love to work there, I also like inpatient and acute. It depends a lot on what they offer me as far as pay. I won't work for peanuts, and I know my worth, especially after seeing what my fellow classmates are like. Not being grandiose, but honest.

[Jules A, MSN]

Yes I am JulesA. I am actually the first NP student he has accepted for precepting I worked perdiem there for a while and when I realized what a great unit it was I asked about clinicals and he accepted me. I would love to work there, I also like inpatient and acute. It depends a lot on what they offer me as far as pay. I won't work for peanuts, and I know my worth, especially after seeing what my fellow classmates are like. Not being grandiose, but honest.[/quote']

Absolutely and be prepared with actual quotes from other local facilities that HR can verify. That is how I did it initially and later I started providing my other contracts or copies of my check stubs to justify the rate I was requiring.

Is your preceptor the medical director? If so he will be able to tell them to freaking hire you if they try getting cheap so I'd start broaching the topic of psych-NP wages with him at some point before you graduate so he is well versed in the present market and willing to go to bat for you.

All the physicians I have worked with have been very supportive of my value and it isn't like it takes money out of their pocket. If the medical director wants you it will usually happen. When docs are working for $110 an hour they could care less if you are asking for $80 because it sounds like peanuts to them. I have had two medical directors and one exec. director tell the hospital they wanted me and were insistent they pay what I was requesting. In my experience it hasn't been as if there were other psych-NPs or psychiatrists applying for the job anyway so they were in a jam.

I always go back to knowing how much they pay their psychiatrists and if they start to sniffle about how much I'm asking thats where I go. I make at least 75% of what psychiatrists make and for me that is non-negotiable at this point in time. Things are changing and I would look for our worth to take a dive as all the FNPs decide they can "do psych" and with the push to integrate mental health with primary care but at least for now I am able to tell employers how much I'm willing to work for rather than accept the pitiful number they usually have in mind for a "nurse".

[empatheticRN]

Right now PMHNP seems to be the hot ticket item among APRNs. As the CRNA "thing" has come and gone, I think right now is the moment you could become a PMHNP and seriously get ahead.

In my area, the demand for them is huge because there are few NPs choosing psych, and there are few psychiatrists (or physicians wanting to be psychiatrists). Having said that, you'll find a job, and you'll make a good living.

I think a three year direct entry program is great, and I'm envious. I only became a RN to become a PMHNP, and although I finished the two year BSN/RN program I did start working as a RN when I enrolled in a three year MSN/PMHNP program. However, I haven't worked in psych before, and the first couple of jobs I had were not really good for getting nursing experience. The first was in a medical unit in a 25 bed, rural hospital. I bet the same 90 patients kept the whole hospital open all the time. I detested that job. Next, I worked in an office doing almost nothing related to nursing, and it was pretty nice. I now work in an ER, and it's too much. I don't feel like I don't know what I'm doing. I don't like the speed at which it moves, and for that reason I'm leaving in six days. I've kept a different nursing job for every season of my graduate school experience. Has that hurt me as a PMHNP student? No. I'm very much a biologically-oriented practitioner, and for that reason I'm very studious with such things as neurobiology, psychopharmacology, etc. I'm blessed with a good memory so I've done well with my training. I've gotten great reviews from preceptors, and the patients I work with like me. That said, YES, you can become a PMHNP without ever having been a nurse before.

You sound like I did when I started, and a lot of people were negative. "Be a nurse first for a while." Nah, that's not for me. This area, however, is something of interest to me so when you're really interested in something you tend to really soak it up. Graduate school has been all consuming for me, and I'm really ready for it to be over.

I recommend when you begin your studies that you include as much other psychological material in your reading list as possible. Avoid the nurse-esque stuff because it won't help you a lot. Read Kaplan and Sadock as you can. (It's kind of a long, slow read.) Read all of Stahl. Learn about cognitive psychology, social psychology, and personality theory as that'll give a certain leg up. Learn your DSM as if you're memorizing statutes, and know how to talk with people.

Are you doing your PMHNP online? If so where? Your experience sounds similar to mine. I've done LTC , and currently in a hospital on a telemetry floor. Everyone told me to do medsurg nursing first so that I will not lose my skill. Working is a drag because deep down I know this is not what I want to do. Ever since I was in nursing school, I loved psych. Everything about psych excites me. My ultimate goal is to become a PMHNP.

[Jules A, MSN]

Are you doing your PMHNP online? If so where? Your experience sounds similar to mine. I've done LTC , and currently in a hospital on a telemetry floor. Everyone told me to do medsurg nursing first so that I will not lose my skill. Working is a drag because deep down I know this is not what I want to do. Ever since I was in nursing school, I loved psych. Everything about psych excites me. My ultimate goal is to become a PMHNP.

Then why not get a job in psych as a RN?