PMHNP/PSYCH NP

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Hello All. Considering enrollment into a Psych NP program. Been a nurse for 14yrs 3yrs Med Surg , 8yrs acute hospital case management. 3yrs community health. Any advice is helpful. Pros and Cons. Inpatient or outpatient. I am thinking adult population. Thanks for your kind responses.

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Specializes in mental health / psychiatic nursing.

What is it that draws you to working in mental health as opposed to a different specialty? What is it that you are hoping to get from having your PMHNP in terms of knowledge or ability to care for patients?

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Specializes in Psych/Mental Health.

It's hard to define "pros and cons" because your pros might be my cons. In terms of settings, subspecialties, and age group, these are all personal preferences.

I would recommend getting some a bit of exposure in at least a couple psych settings to get a feel because there's such a variety of environments in which Psych NPs work.

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On 7/31/2019 at 11:44 PM, verene said:

What is it that draws you to working in mental health as opposed to a different specialty? What is it that you are hoping to get from having your PMHNP in terms of knowledge or ability to care for patients?

Thanks for your reply Verene. The fact that a large part of my nursing experience has been involved with care coordination, teaching , advocacy , and prevention, coupled with a masters degree in social work. I think this will be a great fit.

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Highly suggest you get psych experience. Real experience. Flesh eaters, testicle removers, feces eaters, patients who cut their wrists and throat etc until they pass out or die. It just may not be for you. I have seen so many psych NP students precept at my work only to quit their programs after being exposed to real psych. There eyes were so bugged out having no idea what they signed up for.

There is a very good reason psych nursing is the least popular field of nursing.

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6 hours ago, bryanleo9 said:

Highly suggest you get psych experience. Real experience. Flesh eaters, testicle removers, feces eaters, patients who cut their wrists and throat etc until they pass out or die. It just may not be for you. I have seen so many psych NP students precept at my work only to quit their programs after being exposed to real psych. There eyes were so bugged out having no idea what they signed up for.

There is a very good reason psych nursing is the least popular field of nursing.

Bryanleo, you make this sound terrifying, this sounds more like inpatient psych to me, aren't there several areas you can work in , eating disorders, geriatric, nursing homes, forensics ?.

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Specializes in Psychiatric and emergency nursing.
19 hours ago, Success2011 said:

Bryanleo, you make this sound terrifying, this sounds more like inpatient psych to me, aren't there several areas you can work in , eating disorders, geriatric, nursing homes, forensics ?.

While there are indeed multiple areas in psych to specialize if one chooses, I don't think Bryan has a terrible idea regarding needing some exposure to the sickest psychiatric patients prior to becoming a psych NP. And you have a good background but to be fair, these are all areas that could be applied to an NP with a med-surg focus as opposed to psych. What is it specifically that draws you to PMHNP when you don't seem to have any experience in that particular area?

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2 minutes ago, ThePsychWhisperer said:

While there are indeed multiple areas in psych to specialize if one chooses, I don't think Bryan has a terrible idea regarding needing some exposure to the sickest psychiatric patients prior to becoming a psych NP. And you have a good background but to be fair, these are all areas that could be applied to an NP with a med-surg focus as opposed to psych. What is it specifically that draws you to PMHNP when you don't seem to have any experience in that particular area?

PsychWhisperer, thanks for your response. Reasons 1. The Need 2. Job security-there are too many FNP. 3. Challenging myself-like i mentioned in my original post, I strongly believe my experience and education suits the role. So why not. MSN MSW RN CCM.

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Success2011,

So why not?! Right! I say do it! You are well qualified and your rationales are your own. You don’t need any other nurse (that’s probably hating) to question whyyyy you want to get into psych! I am a board Certified case manager, I worked in ICU, I started as a LPN (in high school!) in SNFs, I’ve worked in home health and hospice, I have a MSN in Education and I’ve been FT faculty etc etc! Now, in a few months I’ll be a PMHNP! You can do it and don’t need permission. I totally agree that being a FNP is not a good move. Not sure where you live in the world but geographically the east coast and west coast I find are very lucrative have high needs.

Nurses are always so territorial! To them: You can’t guard a specialty and DEFINITELY cannot guard the profession! I’ve seen the next generation of nurses! We should be advocating for one another and encouraging each other! We all know there’s a need for all types nurses, so who cares what you choose as long as you’re doing right by the patient themselves. Sorry had to vent a little. Good luck! I hope you are very successful in your new endeavors!

personally I like inpatient, mainly because I enjoy the challenge of fixing acute problems. Inpatient is still pretty fast paced depending on the provider. The NP I shadow sees 30-40 patients a day and the entire lifespan. She mostly does medication management, very little if any therapy. In school the focus is on therapeutic rehabilitation through several modalities. We had ONE psychopharmacology course and it was 4 weeks! Craziest thing I’ve ever experienced. I am one of four in my program that is not an NP with a MSN and everyone struggled in psychopharm. Many FNPs are going back for Psych because they found that the pay is more than there FNP salaries (pro) and the workload less (pro). For me a Con would be outpatient therapy sessions, I’m not a therapist and I don’t want to be. I believe I will do a residency to get my feet wet (there are several for psych vs FNP) and they are all inpatient. NP School is similar to RN school, they feed you fluff and stuff but the crux is on the job training. Any more questions feel free to reach out! I’d love to keep the convo going!

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1 minute ago, ARND said:

Success2011,

So why not?! Right! I say do it! You are well qualified and your rationales are your own. You don’t need any other nurse (that’s probably hating) to question whyyyy you want to get into psych! I am a board Certified case manager, I worked in ICU, I started as a LPN (in high school!) in SNFs, I’ve worked in home health and hospice, I have a MSN in Education and I’ve been FT faculty etc etc! Now, in a few months I’ll be a PMHNP! You can do it and don’t need permission. I totally agree that being a FNP is not a good move. Not sure where you live in the world but geographically the east coast and west coast I find are very lucrative and high needs.

Nurses are always so territorial! You can’t guard a specialty and DEFINITELY cannot guard the profession! I’ve seen the next generation of nurses! We should be advocating for one another and encouraging each other! We all know there’s a need for all types nurses, so who cares what you choose as long as you’re doing right by the patient themselves. Sorry had to vent a little. Good luck! I hope you are very successful in your new endeavors!

ARND, OMG, thanks so much for the motivation. You made my evening. BTW I am on the east coast. I see psych nurses on here been so harsh and inquisitive about us nurses, who were not previously active in the field and want to join in. There's so much need for mental health in many states. We should join hands to fight, advocate and help those impacted. I understand, they want us to know what's it's really like, but we should also at the same time share the pros and motivate those willing to join in.

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Absolutely! I am glad to help! When I worked case management inpatient psych I fell in love with the population and the need for true advocacy! While working I encouraged two RNs who were working on the unit with BSNs to go for their psych NP and they are in school now.

I do understand that some people are cut out for psych but some aren’t cut out for case management, nursing homes, ED, ICU, Education...it just how life is and those people won’t stay too long (burnout, bitter, jealous).... there’s one in every specialty! Lol

The psych description above with the eating feces etc. that does happen (had a 15 yr old last week defecating and smearing it on people). Unfortunately that’s because those patients aren’t stabilized (she was a ward of the state, in a residential facility, refusing meds). It’s sad when this happens. If unable to be stabilized they go to the state hospital (depending on the state) or jail. DOC is actually the largest mental health provider so there’s opportunities there as well. A small company that contracts for DOC entertained myself and peers at a dinner (very nice dinner) pretty much begging for any help (pt, ft, prn)! Kids, Women, Males are all incarcerated and need MH services. I was even shocked at the care the inmates receive, its pretty top notch! But for every unstable patient, there’s a clinic full of hundreds of stable, high functioning, productive patients that could be anyone from your boss to your child’s school principal! We get a variety of people in a variety of socioeconomic backgrounds that need help because no one is immune from mental illness! I guess the moral of the story is you’ll be fine and you’ll find your niche. Anything else you wanna know just ring!

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Specializes in Psychiatric and emergency nursing.
50 minutes ago, ARND said:

Success2011,

So why not?! Right! I say do it! You are well qualified and your rationales are your own. You don’t need any other nurse (that’s probably hating) to question whyyyy you want to get into psych! I am a board Certified case manager, I worked in ICU, I started as a LPN (in high school!) in SNFs, I’ve worked in home health and hospice, I have a MSN in Education and I’ve been FT faculty etc etc! Now, in a few months I’ll be a PMHNP! You can do it and don’t need permission. I totally agree that being a FNP is not a good move. Not sure where you live in the world but geographically the east coast and west coast I find are very lucrative have high needs.

Nurses are always so territorial! To them: You can’t guard a specialty and DEFINITELY cannot guard the profession! I’ve seen the next generation of nurses! We should be advocating for one another and encouraging each other! We all know there’s a need for all types nurses, so who cares what you choose as long as you’re doing right by the patient themselves. Sorry had to vent a little. Good luck! I hope you are very successful in your new endeavors!

personally I like inpatient, mainly because I enjoy the challenge of fixing acute problems. Inpatient is still pretty fast paced depending on the provider. The NP I shadow sees 30-40 patients a day and the entire lifespan. She mostly does medication management, very little if any therapy. In school the focus is on therapeutic rehabilitation through several modalities. We had ONE psychopharmacology course and it was 4 weeks! Craziest thing I’ve ever experienced. I am one of four in my program that is not an NP with a MSN and everyone struggled in psychopharm. Many FNPs are going back for Psych because they found that the pay is more than there FNP salaries (pro) and the workload less (pro). For me a Con would be outpatient therapy sessions, I’m not a therapist and I don’t want to be. I believe I will do a residency to get my feet wet (there are several for psych vs FNP) and they are all inpatient. NP School is similar to RN school, they feed you fluff and stuff but the crux is on the job training. Any more questions feel free to reach out! I’d love to keep the convo going!

Hating? You're precious. Hating on what exactly? I have a military and emergency medicine background, and outpatient and inpatient psychiatric experience. I see some of the sickest patients at their worst while working my main job at a community hospital, and do private practice medication management with brief narrative psychotherapy on weeks off from my inpatient gig. I am also dual board certified in emergency nursing and as a psychiatric nurse practitioner. I am only a few months from my doctorate, and will soon be the coordinating liaison between my psychiatric unit and my emergency department. But yes, I must surely be hating because the OP is younger or cuter or something similar, because that's all it could be, right? ?

Anywho, my original question wasn't meant to be a personal attack. I simply wanted to know what was drawing the OP towards psychiatry when s/he didn't mention any overt experience, and merely suggested that the OP get a little experience with some of the more acute patients before dropping thousands of dollars on a psychiatric nurse practitioner program before learning that's it's not going to be their niche. Psych is a wonderful field but it has some of the most emotionally exhausting patients. Unless one has a true love for the population, providers can get really burned out, really fast.

As for being territorial? Yep. But not the way you might imagine. There's enough mental illness to go around for all of us. What I am protective of is my patients, who deserve better than someone in it just for job security and a cushy desk job. I am not guarding the profession; instead, I am guarding vulnerable patients from those that get into this field for the wrong reasons. I do support those getting into mental health and will be a preceptor for a PMHNP student this fall, but I highly recommend a person getting their feet wet prior to plowing full steam ahead into the field and finding out it's not for them, which truly was the original gist of my response.

Finally, unlike some that believe everyone deserves a "Thata girl!" or a hearty encouraging pat on the back, my first priority is to advocate for my patients. Period.

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