Hello to all lovely -hard working -nurses. I have been a nurse for almost 20 years and 99% of my work experience is mental health nursing. I really am passionate about mental health and love to be a psych nurse. However, in the recent years things are changing. I am exhausted trying to advocate for patient in psych wards, when everything is about money, and filling beds rather then patient care. With that intro, I have been thinking alot about going back to school and getting my Psych-NP degree, so maybe I can have more autonomy with patient. These are my concern and worries; I have been away from school for ever, what if I can't keep up with the pressure of school, and all the new changes?
I am in a small town with no university around, can I find an online program that is supportive and no too expensive? would they see me as qualify ? (I have AA in nursing, and BA in psychology, and a solid resume with strong psych nursing experience)
Is there any other ways to be in mental health and actually have the chance to make a different ??? ANY advise, and feedback would bee deeply appreciate. I still have 15 more year before I get to retire so I MUST turn my career path around before I hate everything about what I do ... Thanks for taking the time to read.
TheOldGuy. This board has helped me ask for and get more money in my locums jobs. A locums psychiatrist makes $120 HR average. I am up to $78 HR. The 80 percent formula would have me at $96. Still a ways to go.
At a moonlighting job I took (mostly to network), I asked for 80/hour on med checks only and paid (hourly) travel. This way I'm not wasting my time on the road. I was going to ask for more per hour, but it's a 1.75 hour travel there so I wanted to guarantee I got that instead of measly mileage. Give a little, take a lot. They require 30 minute med checks which I find excessive. They didn't want to budge on that so I shot them down to 20 minutes. With most billed at 99213 and on Medicaid the company only makes about $7/ hour when I work, however, they actually go in the hole paying my travel. They ended profiting off their grossly underpaid therapists. I do some infrequent evaluations which they'd make about $40 off of.
Neither the pay nor networking has really been worthy time.
Aside from the money aspect I believe that those states which have independent practice expand upon the attractiveness of this option (Psych NP). This is especially the case when one considers that a one to two year additional time investment can yield FNP certification and the ability to have an integrated practice which also deals with the many basic physiological/Axis III issues faced by your clients. Furthermore, additional training/certification can be obtained in areas such as cognitive behavioral training which can further augment your ability to have a positive (non drug based) impact on your patients and their lives.
Aside from the money aspect I believe that those states which have independent practice expand upon the attractiveness of this option (Psych NP). This is especially the case when one considers that a one to two year additional time investment can yield FNP certification and the ability to have an integrated practice which also deals with the many basic physiological/Axis III issues faced by your clients. Furthermore, additional training/certification can be obtained in areas such as cognitive behavioral training which can further augment your ability to have a positive (non drug based) impact on your patients and their lives.
Or you can remain a specialist (psychopharm), do one thing really well, see more patients, and of course make more money. Let the therapists have their CBT.
There are opportunities to specialize as noted by above posts. My foundation and expertise is in clinical formulations. On my resume I stress psychopharmacology and diagnosing since that is where the jobs are. I plan to get CBT training because it can be easily integrated into psychopharmacology. I am not specializing but I do have areas of expertise based on my jobs. I am not especially interested in medical except sometimes, in particular cases.
Hey @psychguy was it hard to find your first job and did you have to relocate?
It was a hidden gem. I was entertaining community mental health, which I didn't want, private practice (which I kind of wanted and still do), and the VA whose salary was atrocious. I had a chance to speak with the CMO of my organization, and we both responded to well to each other. He ended up telling a friend of mine "I've got to have that guy" and I told my wife "here's our dream job."
I did relocate to take a position in the region I work in and later relocated again to get closer to the office. But I knew jobs were here so when I was in training I flocked to my region to wait search for an opening.
Hey can you all give me the pros and cons on being a Pmhnp in Ga I just got accepted into a program and need some guidance. I got accepted into an Fnp program as well. Thanks
There are opportunities to specialize as noted by above posts. My foundation and expertise is in clinical formulations. On my resume I stress psychopharmacology and diagnosing since that is where the jobs are. I plan to get CBT training because it can be easily integrated into psychopharmacology. I am not specializing but I do have areas of expertise based on my jobs. I am not especially interested in medical except sometimes, in particular cases.
I'd like to have the family cert but ONLY for personal gain, i.e. treating myself and family and that's still only doable to a full degree if this were an independent state. I'm in a collab. pract. state, however, I function independently. We really just give what the board needs to hear, and I'm left to my own devices. Self/family treatment is now a violation of any regulation here, and I know when I'm out of my league, but I've prescribed a few things in the family when warranted. I do not want to do any of the gyneo or repro medicine training that FNP requires so there's a >95% chance I'll never follow through with it. I also don't want to lose income and free time to something that has no true benefit. Mostly, I'm a bit of a prepper and I find the idea of being able to do whatever I want medically to be a great appeal.
I've entertained the idea of a CBT cert, but I understand you have to video sessions and follow the manual to a "T" so the heck with that. I also am not interested enough in therapy. I'd wager that many of the leadership and self-improvement books that I read, because I enjoy that genre, have taught me far more about CBT-related skills than any academic training.
Pros and cons are very individualized and stress is relative.
Pros to PHMNP for me:
I work independently in my own office with no influence. My only restrictions are state regulations. I control my environment, schedule, and income. I don't have to touch people and my patients aren't hacking their lungs out, puking up their guts, crying, or oozing anything. I make a lot of money. If I worked 50 hours per week I'd make kn excess of 200k. At 40/hours, I get pretty close to it. My productivity bonuses exceed anything I made as a RN, and my salary alone rocks. I hated being a RN, and the nexus to what I did as a murse is quite limited.
Cons:
Although I work independently, I am in a collaborative state so I have a paper collaborator and cannot "write" Schedule II scripts although I effectively prescribe them. I cannot really "do" anything but psychiatry. I'm also not a doctor but know I'd be a **** good one. Another con for me is having to explain what a NP is and wince when I'm called doctor. I neither want to explain it again, and I don't want to mislead either.
Stressors:
By the days end I'm tired of typing, looking at a computer, and sitting down. I find that I slow down around 4pm and leave at 6pm. I work four 10 hour days, by choice, but I cannot seem to managey Friday time to engage in family activity, hobby, or other manliness. I get up, get a haircut, and the days seems to end abruptly. Another stress includes child patients. I really don't care if they're ADHD or not although I diagnose it and treat it daily. When I was a kid, you just got dragged to the office, and the principal wore your fanny out with a paddle. Although kids did the same stuff, they got the impudence beaten out of them and we were better off for it. I also HATE bad parents. I get that single parents have limitations, but I think some parents need to be pushed out my third story office window. I'm also not a fan of judges and DHS sending kids in for treatment. I value my time too much to sit in front of his honor explaining why he should stick it in his ear. I also detest adult ADHD and people saying "my bipolar." We haven't, as a company, yet catered to patient satisfaction, but I think that direction for healthcare is the way of the lemming. Have you seen the crap PCPs are having to do? It's no wonder they refer our everything now.
The last person I ever arrested before jumping to healthcare had just shot up an apartment complex and was thought to be holding his female cousin hostage. He was. Without warrant, due to exigent circumstances, I went into that apartment and pulled him out. The new prosecutor said in response that I didn't know what I was doing and needed to learn something. This occurred on my actual last night (day) of planned work. What I told him was to make his case work and that the one thing I had learned was that Jack muffin politicians need to suck it up and let the workers work (cops, nurses, social workers, you name it). It was a slam dunk case for him, but he went back into private defense later.
I am very work-oriented hard charger. I devote to it and to some degree my careers have also been my hobby. I loved LE, and I love outpatient psych. I am ever so grateful I have an autonomous job where I'm doing something that both interests me and matters. I am blessed, and my aim is to direct that blessing to the benefit of others. It may just take a two by four to the forehead approach to do it.
Well for me the major motivation to wanting to also obtain my FNP is the ability to hopefully relocate to Kauai. Really, living in the islands is perhaps the primary reason (other than eating, supporting my family,and owing about 60K in student loans) that I became a nurse. My calculation is that IF, I can obtain a Psych NP/FNP combination in an independent practice state (such as Hawaii) that I can eke out some sort of existence (and be able to swim, snorkel and hike on some of my off days things I truly enjoy). Also, I would like to offer a "night shift" niche considering that although there are only about 60K permanent residents on Kauai, there are about a million visitors each year. Thus, if I ran a lower cost clinic that was available 24/7 perhaps even making home/condo visits (obviously working in conjunction with other practitioners since I don't want to work more than about four 12 hour shifts per week) I hypothesize that there might be a "niche" for my concept/services. I don't expect to enjoy being an NP, but I aspire to despise it less than my current job in a midsize surgical/trauma ICU.
Well for me the major motivation to wanting to also obtain my FNP is the ability to hopefully relocate to Kauai. Really, living in the islands is perhaps the primary reason (other than eating, supporting my family,and owing about 60K in student loans) that I became a nurse. My calculation is that IF, I can obtain a Psych NP/FNP combination in an independent practice state (such as Hawaii) that I can eke out some sort of existence (and be able to swim, snorkel and hike on some of my off days things I truly enjoy). Also, I would like to offer a "night shift" niche considering that although there are only about 60K permanent residents on Kauai, there are about a million visitors each year. Thus, if I ran a lower cost clinic that was available 24/7 perhaps even making home/condo visits (obviously working in conjunction with other practitioners since I don't want to work more than about four 12 hour shifts per week) I hypothesize that there might be a "niche" for my concept/services. I don't expect to enjoy being an NP, but I aspire to despise it less than my current job in a midsize surgical/trauma ICU.
I think you could do a concierge practice and make a decent living in HI.
PG2018
1,413 Posts
At a moonlighting job I took (mostly to network), I asked for 80/hour on med checks only and paid (hourly) travel. This way I'm not wasting my time on the road. I was going to ask for more per hour, but it's a 1.75 hour travel there so I wanted to guarantee I got that instead of measly mileage. Give a little, take a lot. They require 30 minute med checks which I find excessive. They didn't want to budge on that so I shot them down to 20 minutes. With most billed at 99213 and on Medicaid the company only makes about $7/ hour when I work, however, they actually go in the hole paying my travel. They ended profiting off their grossly underpaid therapists. I do some infrequent evaluations which they'd make about $40 off of.
Neither the pay nor networking has really been worthy time.