NP/PMHNP Work Culture

Updated:   Published

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!

Specializes in oncology.
On 7/1/2021 at 11:11 PM, umbdude said:

You really don't know?

 

24 minutes ago, umbdude said:

You can make yourself more competitive by working in a psych hospital (not as a pharmacist

Okay, you (the patient are seeing someone for depression.....Who would you rather  treat you and actually provide some positive actions for your future"?.1) RN NP who says "get out more" or 2) NP / Rph who says "get out more and maybe take something to help your neurotransmitters." I go to a Psych MD for the RX.

I read about a lot  so-called compassionate nurses who want  to help another professional transit to a nursing profession. It must be just talk. In the last two days,  I have seen comments negating the possibility of a Rph  teaching in a NP Program without knowing anything about them besides they were working retail. and now this.

Up Vote Up Vote ×
Specializes in Psych/Mental Health.
7 minutes ago, londonflo said:

 

Okay, you (the patient are seeing someone for depression.....Who would you rather  treat you and actually provide some positive actions for your future"?.1) RN NP who says "get out more" or 2) NP / Rph who says "get out more and maybe take something to help your neurotransmitters." I go to a Psych MD for the RX.

I read about a lot  so-called compassionate nurses who want  to help another professional transit to a nursing profession. It must be just talk. In the last two days,  I have seen comments negating the possibility of a Rph  teaching in a NP Program without knowing anything about them besides they were working retail. and now this.

I'm not sure what you're trying to say. That I'm helping a pharmacist make a transition to psychiatric nursing? 

Up Vote Up Vote ×
Specializes in oncology.
27 minutes ago, umbdude said:

You can make yourself more competitive by working in a psych hospital (not as a pharmacist but as a tech or RN)

Review the last 25 posts from RNs going from acute medical/surgical to pysch NP. It is amazing. There is no requirement for experience in the area or really any RN experience. How many here say they just graduated and want to go onto to be a NP. Graduate entry programs to a NP, anyone? If you all want to curb the influx of non prepared or just plain job seekers from those truly wanting the profession and willing to go the extra mile, you need to get active with your local, state and accrediting agencies. Talking with a united voice might help (plus asking your national agencies to pay for advertising such as "what makes a NP" campaign. You won't, Walden will win $$ for their investors and you will all wonder what went wrong

Up Vote Up Vote ×
Specializes in Med-Surg/Tele/ER/Urgent Care.
8 hours ago, Psychnursehopeful said:

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. 

And then the Direct Entry NP programs where no RN experiences before becoming “advanced practice nurse “!

2
Up Vote Up Vote ×

I currently practice as a PMHNP and I would say your background as a pharmacist would make you so invaluable and would definitely make you more competitive compared to other new grads. Me and my fellow physician and NP colleagues rely so much on pharmacist input on patients. My last PMHNP job there was a long acting injectable clinic managed by pharmacists and they would collaborate with the PMHNPs and MDs on patient cases. When I worked as an inpatient psych nurse we had a pharmacist that specialized in psych sit in on biweekly rounds and give recommendations. You also want to keep in mind that with a lot of psych NP jobs you are being hired by physicians and with my previous RN experience I find that MDs tend to respect pharmacists over RNs, so youre pharmacy experience will be viewed favorable. Also I do therapy and medication management so yes, you can absolutely do both.

2
Up Vote Up Vote ×
Specializes in mental health / psychiatic nursing.

1) Finding a job will vary based on location, subspecialty, and setting. Right now I can't predict what the market will look like in 6 years. There is increasing saturation (which may be self-correcting as wages drop and/or psych gets the reputation of being "saturated" and/or people realize this isn't the field they want to work in) and there is also more money going into the mental health system in some places at least, which may increase job opportunities. 

2) Having relevant experience to the job you are applying for is important. That experience doesn't have to be psych nursing per se, but getting clinical rotations that help set you up for future practice (e.g. try to get things like community mental health where you see a little of everything for broad foundation, and/or a rotation in a specialty area that interests you), and also look at how your non-nursing experience ties into which ever job you are looking at. Pharmacy back ground may be less of a strength if you are looking for a position which is primarily therapy but could be a huge asset in working with a population which often have complicated medication regimens (e.g. clinic which provides mental health services for individuals with severe mental illness who are also receiving care for oncology or HIV/AIDS - the meds can get really complicated!).  I do think it is important to have exposure to working with mental health populations outside of clinicals alone, as some things can really only be learned through hours of exposure  - while psych RN experience is great, I also think that if you could work as a clinical psychiatric pharmacist and run groups or do a lot of patient education this would also be a reasonable background to get exposure.  I do think your pharmacy background in general will make you stand out in a good way. 

3) Charting time, call-outs, cross-coverage, and over-time pay are all going to vary based on employer. 

I work inpatient, I make a base salary for my contracted hours and am paid either straight time or overtime for hours worked in excess of this time (as defined by my contract). This means that for me -- face-to-face patient care, documentation, chart review, committee/work group hours, hearing preparation/testimony etc are all from the same pot of funds and aside from extra pay for extra time worked - there is no variability in pay for increased acuity/increased billing codes nor decreased for lots of time spent on non-billable tasks (e.g. documentation, collateral gathering, work-group projects). For vacations/scheduled absences we find our own coverage (which is usually pretty easy). In emergency situation -some will still find their own coverage, but it is acceptable to reach out to supervisor and/or Chief of Psychiatry and ask for assistance in finding coverage in emergency situation. One of the good things about working inpatient is that we have a lot of psychiatrists and PMHNPs and in a pinch critical needs will always be covered. 

Up Vote Up Vote ×
Specializes in mental health / psychiatic nursing.
On 7/3/2021 at 11:15 AM, londonflo said:

Review the last 25 posts from RNs going from acute medical/surgical to pysch NP. It is amazing. There is no requirement for experience in the area or really any RN experience. How many here say they just graduated and want to go onto to be a NP. Graduate entry programs to a NP, anyone? If you all want to curb the influx of non prepared or just plain job seekers from those truly wanting the profession and willing to go the extra mile, you need to get active with your local, state and accrediting agencies. Talking with a united voice might help (plus asking your national agencies to pay for advertising such as "what makes a NP" campaign. You won't, Walden will win $$ for their investors and you will all wonder what went wrong

I went through one of those accelerated/direct entry programs -- ABSN to PMHNP. I think there is some misunderstanding that those taking this route have no idea what they are getting into. Everyone in my ABSN cohort who was on the PMHNP path had some level of mental health background prior to entry into the program (e.g. CNA, counseling, research, etc), and both application process and entry standards were rigorous.  The program (unlike some of non-direct entry) also limited number of students accepted  typically taking ~5-6/year into ABSN continuing to PMHNP and ~5-6/year experienced RNs in to PMHNP.  Part of why so few applicants were admitted each year was/is so the program can guarantee vetted high quality clinical placements to every student and ensure that their students are well prepared to enter the work-force on graduation as competent practice-ready new-graduates. 

That being said - I would love to see someone actually do some research on the different schooling paths to PMHNP looking at direct-entry/non-direct entry, # years of nursing experience, # years relevant non-nursing experience, etc and actually take a look at the outcomes data.  To the best of my knowledge there is very little actual research that has been done on student background and impact on patient care outcomes and/or level of support needed by new-grad for safe practice and I'd love to be able to point to actual case exhibits and data in making policy changes, as I very much agree that standards for admission are variable, and the quality of new-graduates is all over the map with some highly ready to enter practice and others needing significant amounts of support, and a few who are down-right unsafe and incompetent.  The inconsistency in background and preparation also makes it more difficult to get hired - when one looks at a new-grad MD they know exactly what criteria has been met for that status and what can be reasonably expected of them if hired - with a new-grad (and sometimes even experienced) PMHNP it's a crap-shoot. 

2
Up Vote Up Vote ×
Specializes in Psychiatry.

Once again direct entry programs are NOT the problem. Those programs tend to be competitive and houses in top schools. They take students with traditional pre-med backgrounds and honestly if ALL NP programs were set up with the same entry standards and difficulty as direct entry programs our profession would be much better off.

 

Instead we have lots of online for profit programs with zero entry standards. No amount of nursing experience can overcome that. I'll take a direct entry graduate with 0 bedside experience as my NP over a 20 year veteran RN who graduated from Phoenix or Walden any day of the week.

2
Up Vote Up Vote ×

Nurses working regular hours do NOT make more $ than a NP or pharmacist in my area (unless picking up all kinds of extra shifts). Where do you live?

Up Vote Up Vote ×
On 7/8/2021 at 10:04 PM, verene said:

I work inpatient, I make a base salary for my contracted hours and am paid either straight time or overtime for hours worked in excess of this time (as defined by my contract). This means that for me -- face-to-face patient care, documentation, chart review, committee/work group hours, hearing preparation/testimony etc are all from the same pot of funds and aside from extra pay for extra time worked - there is no variability in pay for increased acuity/increased billing codes nor decreased for lots of time spent on non-billable tasks (e.g. documentation, collateral gathering, work-group projects). For vacations/scheduled absences we find our own coverage (which is usually pretty easy). In emergency situation -some will still find their own coverage, but it is acceptable to reach out to supervisor and/or Chief of Psychiatry and ask for assistance in finding coverage in emergency situation. One of the good things about working inpatient is that we have a lot of psychiatrists and PMHNPs and in a pinch critical needs will always be covered. 

I think I am leaning towards outpatient clinics currently, but would love to learn a little bit more about inpatient as well. Could you tell me a little more about your day to day other than working up patients, rounds, and medication management? You mentioned work group hours and testimonies, could you elaborate what those entail?

Thanks for all your responses so far, I really appreciate everyones input. I am learning a lot. To be honest, I am more interested in the therapy aspect of PMHNP (kind of regret not pursing career path as a therapist) , but want to use my medication knowledge as well so this looks like the best of both worlds for me. 

Up Vote Up Vote ×
On 7/1/2021 at 8:20 PM, Iamchasingdreams said:

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? 

pharmacy tech here in nyc and I would never in 1million years EVER be a pharmacist. they treat pharmacist so bad and they are so disrespected and devalued. It's one of those careers that looks amazing on the outside but its terrible. I have been a tech for 6 years and have gotten my bach in psych and am now starting my ABSN program. I never wanted to be a pharmacist but becoming a tech was a quick way to get some medical experience without having experience. I know many pharmacists that have left..one just quit last Tuesday she literally walked out during her shift. pharmacy is also very saturated now, for example, a tech I worked with just graduated she is making $40/hr as a new grad floater pharmacist. this is insane as here in nyc there are lpns making 40-45$/hr. and this is the going rate at retail chains for pharmacists now.

I am horrified the way "corporate" comes and speaks to pharmacists. we had a visit last week and the DM literally asked my PIC "how would you feel about getting a 30min lunch break?" smh bc as you know pharmacist in retail don't even get lunch breaks, although I heard one retailer started closing for an hour to give the staff a break.

pharmacy is a joke sorry but it is and the culprits are big pharma. they are so money hungry, as a tech I am over worked and underpaid but I didn't go to school for 4-6 years nor do I have a doctorate so I don't complain. but I feel so so bad for pharmacists.

Up Vote Up Vote ×
Specializes in Med-Surg/Tele/ER/Urgent Care.
On 7/8/2021 at 8:23 PM, verene said:

 I think there is some misunderstanding that those taking this route have no idea what they are getting into. Everyone in my ABSN cohort who was on the PMHNP path had some level of mental health background prior to entry into the program (e.g. CNA, counseling, research, etc), 

I taught the grad physical assessment course when local university started psych NP Program. One had been a labor & delivery nurse, has gone on to get PhD, teaching at same university and years later is head of psych NP Program. She works as FNP in urgent care and claims to have her private practice while continuing to teach full time. Another former undergrad student that also became  psych NP/DNP worked in cath lab as new grad. She is also teaching, works part time at acute care psych facility. One other did work in patient psych as new grad while pursuing psych NP/DNP and went straight to teaching. So while your cohort had some type of behavioral health background, many do not. I think they are lured when they learn the salaries for psych NPs

1
Up Vote Up Vote ×
+ Join the Discussion