Psych-DNP

It's very much like a job interview. The candidates with nursing experience stand out most, as well as those who have been working with some sort of marginalized population (LGBTQ+, women's health, working in FQHC in Latinx area). Veterans are given a preference, but they only make up a small percentage of the applicants. The biggest thing is wanting to stay with the VA long term. If your goal is to complete the residency and leave it's probably not the right program. The needs of veterans doesn't always translate to what you would be doing in the community.

Residents are considered trainees NOT staff. My recommendation is to contact an HR specialist and ask them these questions.

Yes. Before you apply make sure you take a long pause and thing about two things 1) why do you want to work with Veterans and 2) why you want a career with the VA. The point of our residency is to prepare people for a long career serving our nation's Veterans. We have had people apply who do not want to work at the VA long term, which is fine, however, this might not be the program for them. More important talk about why you want to work with the Veteran population. They have a unique set of needs. We have had people apply who never mention Veterans at all in their personal statements.

The VA is moving towards a single application system where the candidate can fill it out and select which locations they would like to submit to. The barrier to that is not all of the programs start at the same time. The start times fluctuate by location because of academic partnerships the VA has with local universities. So the VA in X city partners with X university and that university starts on 7/1. The VA in Y city partners with Y university and the university starts on 10/1. The start dates are becoming more compressed with most starting over the Summer, but are still not perfectly in sync to the point where everyone across the country starts on the same day or even the same month. Residency directors are looking for a few things such as grades, what your recommendations letters look like, and most importantly, why you want to work with Veterans in the long term. The residency should be the first step in a career with the VA, not just a stepping stone to private practice or a community setting. In regards to competitiveness, the interest in residencies continues to grow and every year there are more candidates turned away at some sites. Sites that are in cities like San Francisco have more applicants than others because more people want to live there. If someone is flexible in where they want to live they can apply to them all. The applications are similar enough that it shouldn't take a person hours and hours to complete each one of them because you'll be using the same resume, the same recommendation letters, etc. Hope this helps.

Every station has different application deadlines depending on when they start during the year. For my station, you can apply before graduation, with the stipulation that you will graduate and be eligible to take your boards by the residency start date, July 1st.

Oh my! My program was 40 hours a week, with required times for multidisciplinary seminars and didactic sessions (10 hours every week). The MD residents don't even do 80 hours per week. However, they are covered by a union out here in California.

After graduating with my DNP I completed one of the PMHNP Residency programs at the VA (there are several: Boston, Sacramento, Salt Lake City, San Francisco, there are more that I can't remember, and more are being added every year). It was one of the best decisions I could have made to start my career. Each residency is a little different from what I understand and is determined by the site. It provided me with a year of on the job experience that was designed to give me exposure to multiple settings: multiple outpatient psych clinics, inpatient psych, psych emergency (to name a few); multiple patient populations within the VA: Transgender health, addiction programming; almost every setting I was in I was part of a multidisciplinary team of APNs, social workers, psychologists, and physicians; I was able to get a varied experience in prescribing, group psychotherapy, and individual psychotherapy; and there is a requirement for all sites to provide weekly didactic lectures. My VA had a wide range of topics from food/sugar addiction, benzo sparing alcohol withdrawal treatment, LGBTQ+ health, PTSD treatment, minority stress, (again this is just a few of the many topics); there are opportunities to teach with the university we are partnered with (e.g., one day presentations, or being a guest in a seminar on interview building skills). The amount of growth and knowledge I received in that one year alone. I am still learning so much. Every patient encounter is supervised and the the educators I had were adept at teaching learners. There are also some pretty great perks too, you can get medical and life insurance, 13 days of vacation, 13 sick days, 11 paid holidays. You won't get to participate dental, vision, or the retirement during residency. Three is a significant amount of free training available throughout the year. Did I make significantly less than I would have if I went to work for a psychiatrist in a private practice doing nothing but prescribing adderall and ativan? YES! Did I gain experience that far outweighed that? Also, YES! When I finished the residency and became staff I got a significant raise and access to the full benefits package the VA offers (which is huge!). There are residencies around the country, I think Mayo, Duke, Rush universities, and some community settings have them. The great thing about being at the VA is that if you graduate in one state you can still apply for a VA residency in any state because you only need one licence in any state. I graduated in Illinois, if I wanted to go to Mayo or Duke I would have to pass my boards, get my licence in IL, then apply for a licence by endorsement before I could start working. Depending on that state's board of nursing that can be a nightmare. Also, you can graduate and be eligible for licensure to start the VA residency. You then have 90 days to pass your boards and get your state license. This might be an unpopular opinion--residency should be a requirement for NPs. Especially in states where full practice authority is allowed. (But that might be a different post)

4000 hours? That's almost 80 hours per week! How did you survive?

That is the challenge. Even though you boarded fairly high, with needing to wait another 8 years to get to top out, you will still be making less than in the community. I am currently at the VA in another city and love working here. I am hoping to move to Sacramento and am interviewing for positions there both at the VA and working with a recruiter for a community placement. I got another offer that would pay me so much more, but I would only be doing med management all day, with limited resources on referrals, I'd have to give up my pension (I'm not fully vested yet), and lose my student loan repayment. Those things coupled with every community provider so far only wants to give like 2-3 weeks of PTO (to be used for both vacation and sick time). That's always the point where they lose me. I can't give up 8 weeks of PTO. I don't care how much money I make if I don't have time off to spend it. Glad you were able to find a gig that worked for you! Stay safe!

What did you board as?

After graduating with my DNP I completed one of the PMHNP Residency programs at the VA (there are several: Boston, Sacramento, Salt Lake City, San Francisco, there are more that I can't remember, and more are being added every year). It was one of the best decisions I could have made to start my career. Each residency is a little different from what I understand and is determined by the site. It provided me with a year of on the job experience that was designed to give me exposure to multiple settings: multiple outpatient psych clinics, inpatient psych, psych emergency (to name a few); multiple patient populations within the VA: Transgender health, addiction programming; almost every setting I was in I was part of a multidisciplinary team of APNs, social workers, psychologists, and physicians; I was able to get a varied experience in prescribing, group psychotherapy, and individual psychotherapy; and there is a requirement for all sites to provide weekly didactic lectures. My VA had a wide range of topics from food/sugar addiction, benzo sparing alcohol withdrawal treatment, LGBTQ+ health, PTSD treatment, minority stress, (again this is just a few of the many topics); there are opportunities to teach with the university we are partnered with (e.g., one day presentations, or being a guest in a seminar on interview building skills). The amount of growth and knowledge I received in that one year alone. I am still learning so much. There are also some pretty great perks too, you can get medical and life insurance, 13 days of vacation, 13 sick days, 11 paid holidays. You won't get to participate dental, vision, or the retirement during residency. There are residencies around the country, I think Mayo, Duke, Rush universities, and some community settings have them. The great thing about being at the VA is that if you graduate in one state you can still apply for a VA residency in any state because you only need one licence in any state. I graduated in Illinois, if I wanted to go to Mayo or Duke I would have to pass my boards, get my licence in IL, then apply for a licence by endorsement before I could start working. Depending on that state's board of nursing that can be a nightmare. Also, you can graduate and be eligible for licensure to start the VA residency. You then have 90 days to pass your boards and get your state license. After I completed the residency I applied for a staff position at the VA. You'll also see a lot of posts about the boarding process at the VA, yes it is a horrid. The residency was designed so that you have to complete certain objectives. If you have successfully completed the objectives, when you go to write your NPSB packet you will have met all criteria to be a Nurse III. Now I am a staff NP and faculty in the residency program, providing supervision to residents and graduate nursing students, which is a part of my work I never thought would be so rewarding. This will most likely be a very unpopular opinion--residency should be a requirement for NPs. Especially in states where full practice authority is allowed. (But that might be a different post) Good luck on this new chapter of your career!