Any Psych Nurse Practitioner's out there?

psychrnoklahoma · Apr 12, 2014

I am not a Psychiatric Nurse Practitioner, but I have researched it on here and on the internet. I have applied to two schools this fall for PMHNP. Psychiatry as a NP isn't near as popular as a Family Nurse Practitioner. There are far more nurses that apply for FNP than PMHNP. I can't really speak in regards to a typical day, but I'm sure it largely entails medication management. Compensation is every bit as good as FNP, even better in some areas. There is currently a high demand for PMHNP's. For example, in Oklahoma where I live, there are at least 15 or so openings combined in the Tulsa/OKC areas, and this is just on one job search site. I think you will love it and have made a good choice. Good luck and anymore questions let me know! Hopefully you get some responses from actual PMHNP's for even more insight.

mtsteelhorse · Apr 12, 2014

I will hopefully be starting a program soon as PMHNP. There is a huge demand! A typical day depends on the setting. I encourage you to shadow someone to get a feel for what the career entails. In a private clinic a typical day consisted of patient visits with some therapy and medication management. Intake visits take longer and the NP I shadowed checked vitals, etc. I loved it! Anyhow, I've put this off far too long and hope to start next month if accepted. I'm 53 and just gearing up for grad school. You are wise to choose this path over LCSW, at least IMO. Compensation ranges from lower end ($85K to $150K from what I've seen). There is no shortage of positions. Trust me, I wouldn't be taking this path if there weren't a demand. I looked into counseling, which I truly love, but the compensation for investment did not appeal to me. Good luck!

HealingThoughts · Apr 12, 2014

Thanks @mtsteelhorse and psychrnoklahoma! Yes, I do think this is a smart career choice. While I'm a little bummed I wasted some time in a counseling program, at least the courses I took will be applicable. Most of the people I knew who went LPC or MSW are now very unsatisfied with their pay and employment prospects. Also they have to do an incredible amount of "internship hours" before they can even start to practice. Most of those unpaid! I love psychology it's always been a huge interest of mine. I wish I'd know about PMHNP much sooner.

While I know PMHNP's mostly do med management. I understand there is the opportunity to branch out into other areas, if you are driven enough.

I know of at least one person who is a licensed counselor who is now looking into Accelerated MSN programs. She plans to continue to perform counseling services in addition to med management.

I am nervous about my age and the coursework load. I wish I'd done this earlier in my life. The adviser I spoke to here though was very supportive of my choice. She said it was a smart move in her opinion.

mtsteelhorse · Apr 12, 2014

You are just a pup! I turned 53 recently. Woulda, coulda, shoulda is my mantra! Just do it now...you have LOTS of time to work in your field. How long for your BSN program??

TheOldGuy · Apr 12, 2014

If you're really interested.....

Psych nursing is not well respected in the nursing world (I am not saying this to insult people but this is what I've seen). Just like many cultures, there is something of a hierarchy and the most respected tend to be ED/ICU nurses. SNF nurses tend to be at the bottom and Psych nurses are just a bit above them. Again, I am not trying to be disrespectful. My RN experience includes SNF, Home Health, Tele, ED, ICU - and psych. Each area has its own challenges. RN compensation kinda follows - worst paid tends to be SNF and psych.

Work your tail off in the BSN program - learn as much as you can. On graduation, get some experience working in a medical unit so you understand medical issues. Most psych patients have significant medical co-morbidities and it is important to understand them, the meds they will take for them and the side effects associated with those meds. Many people who have only had nursing experience in psych nursing don't really have solid medical backgrounds and it hurts them. Many psychiatrists don't either by the way! I worked in tele, ER and ICU and it really helped. Psych patients are often pretty good at faking symptoms, its important to know what those signs and symptoms are to rule out real vs faked problems. Coordinating with the pt's PCPs is a lot easier if you speak the language. The psychiatrists that I work with often come to me with medical questions and it helps establish credibility.

Find an NP program that has more coursework in the "hard stuff". I recommend the University of North Dakota even though the program is about 15 units more than most MSNs. You will take twice as much patho, 3 times as much pharmacology there. Go to grad school while you are working as a nurse. Again, try to work in a medical unit. You will learn and understand advanced pathophysiology, advanced assessment and pharmacology a whole lot better if you have chances to practice everyday. Your ability to read and understand labs and their real life significance will improve greatly. Becoming familiar with those meds and interactions takes time.

A typical day for me means seeing anywhere from 8-15 pts. These might be a combination of new patients requiring complete workups, "quick" med checks and annuals. I review lab work and respond to the zillions of little problems eg insurance company issues.

Compensation is ok - but not what it should be. Expect to see roughly 1/2 of what an MD makes. This is not fair or right and I expect it to improve, but that is what I've seen. The market is good and I think it will be for some time.

I love working as a psych NP. It is a real rush to come up with the right "cocktail" that really makes a difference for someone who has been seeing psychiatrists for 25 yrs with little success. At the same time, prepare yourself for patients that will successfully commit suicide despite your very best efforts...

Hope this helps!

TheDude77 · Apr 13, 2014

TheOldGuy said:
If you're really interested.....
Psych nursing is not well respected in the nursing world (I am not saying this to insult people but this is what I've seen). Just like many cultures, there is something of a hierarchy and the most respected tend to be ED/ICU nurses. SNF nurses tend to be at the bottom and Psych nurses are just a bit above them. Again, I am not trying to be disrespectful. My RN experience includes SNF, Home Health, Tele, ED, ICU - and psych. Each area has its own challenges. RN compensation kinda follows - worst paid tends to be SNF and psych.
Work your tail off in the BSN program - learn as much as you can. On graduation, get some experience working in a medical unit so you understand medical issues. Most psych patients have significant medical co-morbidities and it is important to understand them, the meds they will take for them and the side effects associated with those meds. Many people who have only had nursing experience in psych nursing don't really have solid medical backgrounds and it hurts them. Many psychiatrists don't either by the way! I worked in tele, ER and ICU and it really helped. Psych patients are often pretty good at faking symptoms, its important to know what those signs and symptoms are to rule out real vs faked problems. Coordinating with the pt's PCPs is a lot easier if you speak the language. The psychiatrists that I work with often come to me with medical questions and it helps establish credibility.
Find an NP program that has more coursework in the "hard stuff". I recommend the University of North Dakota even though the program is about 15 units more than most MSNs. You will take twice as much patho, 3 times as much pharmacology there. Go to grad school while you are working as a nurse. Again, try to work in a medical unit. You will learn and understand advanced pathophysiology, advanced assessment and pharmacology a whole lot better if you have chances to practice everyday. Your ability to read and understand labs and their real life significance will improve greatly. Becoming familiar with those meds and interactions takes time.
A typical day for me means seeing anywhere from 8-15 pts. These might be a combination of new patients requiring complete workups, "quick" med checks and annuals. I review lab work and respond to the zillions of little problems eg insurance company issues.
Compensation is OK - but not what it should be. Expect to see roughly 1/2 of what an MD makes. This is not fair or right and I expect it to improve, but that is what I've seen. The market is good and I think it will be for some time.
I love working as a psych NP. It is a real rush to come up with the right "cocktail" that really makes a difference for someone who has been seeing psychiatrists for 25 yrs with little success. At the same time, prepare yourself for patients that will successfully commit suicide despite your very best efforts...
Hope this helps!

I agree with everything he said, besides the compensation part. I think this has to do a lot with locale. In my area there are hardly and PMHNP's and the ones that do practice in outpatient settings as well as hospitals are raking 80% of what the Psychiatrists are making.

HealingThoughts · Apr 13, 2014

Thanks for the information! For what it's worth LPC's and LCSW's usually have heavy caseloads as well. They are pretty low on the hierarchy despite many years of school & training. Not too mention the 3,000 hours of supervised (and usually unpaid) hours they must take. So after a Bachelors, then a 60-credit hour masters, on top of the supervised hours.. it's almost as much work as going the PMHNP track (at least in my opinion).

So for me the PMNHP decision just makes good sense. I do like the suggestion of gaining medical experience.. since it's where I'd be weakest. I think that's a very wise bit of advice!

Trauma Columnist · Apr 13, 2014

Moved to pre NP forum for more answers. Good luck.

EatYourVeggies · Apr 13, 2014

Quote
RN compensation kinda follows - worst paid tends to be SNF and psych.

From what I have heard it seems that RNs that work in psych get paid the same as RNs on other units, but I am not sure about RNS at SNF. I just accepted a position at a behavioral health hospital and my starting rate is more than all of my classmates who are starting in ICU, ED, Home Health, Med-Surg, etc. that I know of. I do agree that people respect psych nurses less which is a shame I feel like we experience the same stigma as our patients : / Even before nursing school my goal has been to become a PMHNP and I'm hoping that I will eventually reach that goal : )

TheDude77 · Apr 13, 2014

EatYourVeggies said:
From what I have heard it seems that RNs that work in psych get paid the same as RNs on other units, but I am not sure about RNS at SNF. I just accepted a position at a behavioral health hospital and my starting rate is more than all of my classmates who are starting in ICU, ED, Home Health, Med-Surg, etc. that I know of. I do agree that people respect psych nurses less which is a shame I feel like we experience the same stigma as our patients : / Even before nursing school my goal has been to become a PMHNP and I'm hoping that I will eventually reach that goal : )

My base hrly rate is higher than my fellow graduates base hrly rate on med/surg

Carlyjo · Apr 18, 2014

I am writing this in honesty because I feel like everyone considering becoming a PMHNP should be aware:

I am a PMHNP and graduated Fall 2012. I would like to know where PMHNP are earning 80% of what a psychiatrist earns??? I can tell you in my area of the country, that is not happening. Furthermore, it took me 4 months to find a job after passing my ANCC exam. I started about $80,000 and so did the rest of my classmates, including those who moved to take jobs all over the country. Some states have higher salaries but this correlates to the cost of living. What if you cannot find a job for a few months after graduation? Will you be happy accepting $70,000-80,000 a year, while relocating to get that? Many new grad NPs have problems finding employment. There is definitely an oversaturation of PMHNP in many areas of the country. Also, foreign residents are jumping at the chance to match in psychiatry because this specialty is one that foreign residents can be confident of getting into the US( I am not even going to get started on this issue). Even in the independent states, I think a psychiatrist must supervise a PMHNP for certain reimbursement. Unfortunately, a PMHNP cannot replace a psychiatrist.

That being said, I know 2 PMHNPs who make six figures but they did not make this until they had over 5 years of experience. Their job also requires massive on-call. These same NPs had a good relationship with a psychiatrist who helped advocate for their salary. The average salary for a PMHNP is $95,000 a year and this includes locum rates. Yes, some make higher but most make lower and this average comes from jobs that do not include benefits. Locum rates are good for Psych NP, but I still have children at home and cannot be bounced around.

I plan on returning for my DNP/FNP and I wish that I had gone the FNP route in the first place. A FNP can fit themselves into many roles. Some states still allow FNP to replace PMHNP. I had several FNPs tell me this but I did not listen to them. Reimbursement by Medicaid/Medicare is generally no higher for FNP versus PMHNP. FNP can see more patients a day than PMHNP, and bring a practice more money. Many people will never seek mental health treatment, but all people will have to see a medical provider. Some of the best places for FNP are pain management and dermatology. FNPs in these areas do make six figures.

I love psych, and if you really want to be a PMHNP I do not want to discourage. If you go FNP you could always go back for PMHNP and be very marketable. I do believe everyone that is considering this area of specialization needs to have a realistic view of what the job market is like. Severe oversaturation has occurred in my area. The wild rumor of riches as a PMHNP are not true. If you are willing to relocate, you probably will find a job. Schools also want to promote their programs, most are not honest concerning the job market or salary. Please be aware that searches on indeed also include locum and recruiters where a job may not exist or an employer may have hired several recruiters to market for the same job.

I am a graduate of a great school with an excellent reputation and network. I had to take loans because I was not in a financial position to do otherwise. I have 15 years of psychiatric nursing experience, and my hourly wage as a RN was high. I had to go PRN during school, and my PRN rate was even higher. After my loan payment, I make no more money that I did as a staff RN. This was a severe let down after all of the hard work I put in to get my MSN.