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post-masters PMHNP what job to take in the meantime

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by kelseykelsey4 kelseykelsey4 (Member)

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Hi all of my nursing experience has been in a PICU. I just graduated in May from an acute care pediatric nurse practitioner program and my clinical rotations were in a PICU, pediatric cardiac ICU, a pediatric stepdown unit and a pediatric neurosurgical outpatient clinic.

I am actually thinking of getting my post-masters certificate in PMHNP. I like the hours/schedule, pay, being able to provide therapy and medication management.

However in the meantime should I just take a job in a PICU? Or should I take a job on an inpatient psychiatric unit? I would not be able to do any of the therapy part (which is what I am actually interested in). It would only be medical management. I would still have the crappy inpatient schedule and pay. I am not really sure what to do. I like the idea of being an outpatient PMHNP which I can't do yet without the post-masters certificate. But in the meantime I like the idea of being a PICU provider more than an inpatient psychiatric medical NP.

Thanks for your advice.

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Naturally I am going to suggest getting extensive experience in Psych before getting a PMHNP.  For one thing, you may feel very differently about therapy after you truly see it in action.

PMHNP's in my neck of the woods do relatively little therapy. There just isn't enough money in it. You set aside an hour for a patient, they don't show up, you can't bill, and office lights don't stay on.

Unless they own their own practice, then they can do as they see fit.

I have done a little of everything in psych, but honestly I am very glad to be mostly done with therapy. So few patients have any desire to make changes.

I would not want my first day on the job in Psych to be with a prescription pad.

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Part II. The so called money in Psych is in seeing 3 and 4 patients an hour.

These types of posts very much worry me. Call me old fashioned.

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TheMoonisMyLantern has 12 years experience as a ADN, LPN, RN and specializes in Mental health, substance abuse, geriatrics, PCU.

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3 hours ago, Oldmahubbard said:

Part II. The so called money in Psych is in seeing 3 and 4 patients an hour.

These types of posts very much worry me. Call me old fashioned.

The new thing is to be a PMHNP with no psych experience apparently. 

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Why not work in the role you were just trained? When I think of post-graduate certificate ....... I would have the expectation that students would be proficient in the role in which they are coming.   Make some money for a year or two and then decide your path.   

Congrats on Graduating !

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PMHNP Man has 7 years experience as a MSN, APRN, NP and specializes in Psychiatry.

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On 6/22/2019 at 8:30 PM, kelseykelsey4 said:

Hi all of my nursing experience has been in a PICU. I just graduated in May from an acute care pediatric nurse practitioner program and my clinical rotations were in a PICU, pediatric cardiac ICU, a pediatric stepdown unit and a pediatric neurosurgical outpatient clinic.

I am actually thinking of getting my post-masters certificate in PMHNP. I like the hours/schedule, pay, being able to provide therapy and medication management.

However in the meantime should I just take a job in a PICU? Or should I take a job on an inpatient psychiatric unit? I would not be able to do any of the therapy part (which is what I am actually interested in). It would only be medical management. I would still have the crappy inpatient schedule and pay. I am not really sure what to do. I like the idea of being an outpatient PMHNP which I can't do yet without the post-masters certificate. But in the meantime I like the idea of being a PICU provider more than an inpatient psychiatric medical NP.

Thanks for your advice.

So a few of things....

1. Some insurance panels won't credential you for psych patients as an acute care person or FNP or even a PA. 

2. As a PMHNP, you probably won't be doing any therapy. If you know some that do, they're outliers. You won't be qualified albeit credentialed for therapy as a PMHNP.

3. Psych meds are nuanced and heavily "off label" something you haven't learned about. 

4. You'd probably be poorly effective at a psych job until you're trained for it. I can't think of anyone I know who'd hire you, and that's something I've been involved with as well. 

 

Yes, this is the lifestyle specialty.

It sounds like you should stick to the PICU for now. That's obviously a niche that must be fun for someone! I've never seen a PICU, lol. 

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No insurance company will credential you unless you are a PMHNP.

As a PMHNP you are theoretically credentialed on paper to do therapy, but you have had so little training as to be laughable. You will quickly see how over your head you are, without extensive experience.

Many, if not most of your patients have an an agenda, and will tell you falsehoods. Some will believe their own lies, but lies they are. 

Example The patient hasn't slept a wink in many years.

The pool will be 6 feet deep but you are only 5'6". You will have to know how to swim, or you will be very quickly eaten alive,

You do love to write stimulants and benzo's, right?

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myoglobin has 11 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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Here's my counterpoints:

1. My SO has been PMHNP since 2016 with no previous psych experience. She had three job offers before she even graduated and has had few issues as a telepsych provider. She gives out benzos to clients about as often as I get affection, which is to say one client, one time on a good month.  

2.  I have no psych experience save for "being the Baker Act guy" at our hospital the rest of my 11 years is mostly ICU/neuro trauma. I have the social skills of Rain man without Dustin Hoffman's good looks. I have three offers and I haven't even applied (in all fairness my SO is hawking me for jobs even though I'm in no hurry).   

3. In a perfect world you might get some psych. experience while you were in school. I tried, but no one would hire me since all my experience was in ICU (ironic that three people have given me job offers as PMHNP and I haven't even graduated).  It is espeically hard to get this experience since you will need part time or better yet PRN and usually as a "new hire" you need to be full time (otherwise the orientation doesn't make finaincial sense for the organization).  You might work as a NP in some capacity for an outpatient clinic. The site where I do my clinical pays many of the students who are FNP's to "see patients (my school will not allow this so for me it isn't/wasn't an option). However, even if you worked at an outpatient clinic as an RN it could be considered relevant experience.  

4.  Another argument for "getting your certification now" is that you should "get it while you can".  I know a Master's level RN who as her ACNP, FNP, PMHNP all because she took the boards in the 1990's (or maybe early 2000's I'm not certain) when you could sit for them without having to do extensive clinical hours (and basically several more years of school). In five or ten years you might need a DNP and or more clinical hours so getting the certifications now may pay off in the long run (or not).  

Edited by myoglobin
correction

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