NP/PMHNP Work Culture

MentalKlarity, BSN, NP · Jun 30, 2021

Hi, I'm a PMHNP.

First, the market is saturating fast. There are a huge number of diploma mills popping up online graduating thousands of nurse practitioners, including PMHNPs. I continuously see advertised salaries and benefits dropping, and jobs now have multiple applicants. Six years from now I have no idea how easy it will be to get a position. Are you interested in psych or just hope it will be higher pay/better jobs? I don't think that is true any longer, and much less likely in six years.

As for lifestyle, I call out by simply putting my days I want off on my schedule ahead of time so patients aren't scheduled on those dates. Obviously for an emergency or illness patients will be rescheduled or see another provider.

Pay can be salary, hourly, or per patient.

Iamchasingdreams · Jul 1, 2021

Thank you MentalKlarity. Out of curiosity, where do you currently practice at (state)? How many years did you practice as an RN before going for your NP and how long did it take for you to land your first position? I am interested in psych, I also feel like as a pharmacist I am spending more time with drugs and making small talk with patients and I want to have a deeper understanding of my patients.

Neo Soldier, BSN, RN · Jul 1, 2021

I'm really curious as to why a pharmacist would switch careers to become a nurse.

MentalKlarity, BSN, NP · Jul 1, 2021

9 hours ago, Yao Jiang said:

Thank you MentalKlarity. Out of curiosity, where do you currently practice at (state)? How many years did you practice as an RN before going for your NP and how long did it take for you to land your first position? I am interested in psych, I also feel like as a pharmacist I am spending more time with drugs and making small talk with patients and I want to have a deeper understanding of my patients.

I'll be honest, most nurse practitioners do NOT get to take time to talk with patients and get to know them. Most PMHNPs do med management which basically means discussing medication options based on a diagnosis and adjusting that medical over time. You'd spend all your time talking drugs once again! The deep understanding is usually more for therapists. Perhaps becoming an LPC or LCSW is a better route? It would certainly be quicker and you'd get 1+ hour appts with patients instead of 15 minute med checks.

Iamchasingdreams · Jul 2, 2021

5 hours ago, Neo Soldier said:

I'm really curious as to why a pharmacist would switch careers to become a nurse.

I honestly don't see myself working as a retail pharmacist in the next 30 years. Long hours on your feet all day, sometimes it's even impossible to eat, or use the bathroom. With reduced drug reimbursement, I am seeing many of my juniors taking lower wages as well. I also fear our occupation is going to be taken over my automation in the near future. Part of the switch is definitely for job security, the other part is for a better work environment, but lastly I honestly want to put my medication knowledge to better use. I have an interest in psychology, so I think this is a worthwhile switch. I am planning on switching to the hospital soon, but I don't see my passion in dispensing. At the same time there are limited positions in my state for a clinical psychiatric pharmacist position.

Any chance you might share your journey as a PMHNP, Neo?

Iamchasingdreams · Jul 2, 2021

28 minutes ago, MentalKlarity said:

I'll be honest, most nurse practitioners do NOT get to take time to talk with patients and get to know them. Most PMHNPs do med management which basically means discussing medication options based on a diagnosis and adjusting that medical over time. You'd spend all your time talking drugs once again! The deep understanding is usually more for therapists. Perhaps becoming an LPC or LCSW is a better route? It would certainly be quicker and you'd get 1+ hour appts with patients instead of 15 minute med checks.

I think I would be interested in therapy management because at least I have some knowledge there. As a retail pharmacist, I don't even spend time talking about drugs, just looking at them ? It feels like a step backwards rather than a step forward if I go the LPC, LCSW route. All the years of school I went to got med knowledge wouldn't be used. Thanks for your advice tho!

MentalKlarity, BSN, NP · Jul 2, 2021

19 minutes ago, Yao Jiang said:

I think I would be interested in therapy management because at least I have some knowledge there. As a retail pharmacist, I don't even spend time talking about drugs, just looking at them ? It feels like a step backwards rather than a step forward if I go the LPC, LCSW route. All the years of school I went to got med knowledge wouldn't be used. Thanks for your advice tho!

Ha, makes sense and good luck! Again, though, be wary of "job security" as an NP. Thanks to Walden, Chamberlain, Phoenix and all the other diploma mills we've gone from 10K to 35K graduates a year, and the market is saturating fast. There are NPs now working for less than RN wages with 1-2 weeks vacation and 50-60 hour work weeks. It seems likely that it will only get worse unless the nursing boards start to weed out and shut down the programs with no entry standards but it seems they're too greedy to ever do that.

umbdude, MSN, APRN · Jul 2, 2021

8 hours ago, Neo Soldier said:

I'm really curious as to why a pharmacist would switch careers to become a nurse.

You really don't know?

A friend of mine graduated from pharmacy school in around 2000-2001. The pharmacy job market back then (and prior) was like PMHNPs a few years ago. She got multiple high-paying job offers within 15-mile radius with sign-on bonuses from retail pharmacies. These retail pharmacies were begging her to work.

Over time people caught wind of the "lucrative career", Pharm associations kept touting "huge pharmacist shortage," and schools with low standards started popping up everywhere graduating thousands of PharmDs. The upshot is that nowadays new grads lucky to get a job as a pharmD after shelling out $200k tuition. PharmDs work in crappy environments for pay that's lower than RNs with associate degree. Many are talking about going to Alaska to get their first job. Pharmacists are dime a dozen and easily replaceable, and many older pharmacists are basically forced out so companies can replace them with cheap new grads.

MentalKlarity, BSN, NP · Jul 2, 2021

17 hours ago, umbdude said:

You really don't know?

A friend of mine graduated from pharmacy school in around 2000-2001. The pharmacy job market back then (and prior) was like PMHNPs a few years ago. She got multiple high-paying job offers within 15-mile radius with sign-on bonuses from retail pharmacies. These retail pharmacies were begging her to work.

Over time people caught wind of the "lucrative career", Pharm associations kept touting "huge pharmacist shortage," and schools with low standards started popping up everywhere graduating thousands of PharmDs. The upshot is that nowadays new grads lucky to get a job as a pharmD after shelling out $200k tuition. PharmDs work in crappy environments for pay that's lower than RNs with associate degree. Many are talking about going to Alaska to get their first job. Pharmacists are dime a dozen and easily replaceable, and many older pharmacists are basically forced out so companies can replace them with cheap new grads.

The future NPs have to look forward to as we follow the same path!

Psychnursehopeful, ASN, RN · Jul 3, 2021

Super saturated. Even rural positions. There are so many diploma mills pooping out crappy graduates. RN to MSN or RN to DNP.

The nurses with 5-10 years of bedside experience in their specialty will probably still have some demand.

umbdude, MSN, APRN · Jul 3, 2021

On 6/29/2021 at 9:47 PM, Yao Jiang said:

Hello everyone,

I am currently a retail pharmacist and I am seriously considering saving up and switching careers with PMHNP as my final goal. I live in New York and just have a couple of questions on the job market and the work culture. I see myself graduating and getting credentialed as a PMHNP in the next 6 years. How difficult is it currently to find a job as a new grad in this market, especially if I don't plan on staying at the bedside for long? Would clinical rotations from school be enough? What other opportunities are there to make myself more competitive? Do you get paid for charting time if you are an hourly employee? How do companies treat call outs? Do they call the patients to reschedule their appointment or do you end up getting the other practitioner's patients for the day? Do they pay you extra if you end up going over your normal scheduled work hours in cases like that?

While I would greatly appreciate any feedback from any PMHNPs currently practicing in the NYC area, I am happy to hear all your thoughts! Thank you in advance!

I'm a PMHNP. Like another poster said, this specialty is the fastest growing specialty so who knows what the job market will be like in 6 years. In the current job market, it's not hard to find a job, but it is not easy to find a good job (there are many crappy jobs out there). It might be harder or you might have fewer options as a new-grad PMHNP if you don't have some psych experience. You can make yourself more competitive by working in a psych hospital (not as a pharmacist but as a tech or RN) to make yourself more competitive for school and jobs, and going to a reputable program does help a bit.

In terms of lifestyle, it really depends on the job. In outpatient, PMHNPs could see anywhere between 2 to 4 patients an hour for follow up. Typically a salaried job will provide about an hour of charting/administrative time per 8-hr day. If you're paid fee-for-service, you won't get paid anything unless you see patients (I.e. no paid administrative time).

The pay structure of a PMHNP is really quite different from a pharmacist or RN. I've never heard of getting overtime pay as a NP. For example, in one of my part-time jobs I get paid by the hour but I do not get over-time pay (I chart pretty quick and have admin time, so I don't work much OT anyway). The other job I get paid based on what insurance companies pay me. If an employer wants you to take calls on the weekend or overnights, the terms, pay, conditions are usually negotiated and agreed upon prior to signing the employment contract (you should always get paid for doing these).

The first intake appointment is usually scheduled by someone else, and after that you typically schedule follow up yourself (which is a good thing) unless the pt calls front desk requesting an earlier appt. If you call out sick, usually there's a front desk person who will call patients on your schedule to cancel and reschedule (though that's not the case for all companies). You are ultimately responsible for patients. If you call out consecutive days and you have acute patients who need coverage, you are ultimately responsible for finding someone to cover for you.

I think if you're passionate in psychiatry, go for it 100%. Your pharm background will be valuable to patients and colleagues.