CuriousConundrum

Addressing the #2 and #4, you're right. It is more socially acceptable, but still not completely. I think that perception is even more regionally dependent. The psychological usually testing required preselects people who don't have the typical SMI. I'm not suggesting there isn't depression, anxiety, and PTSD or related disorders, perhaps more than in the non-first responder population, but I still don't see them openly getting treatment. I even tested out a similar market by affiliating with department chaplains and never had a single referral. Fast forward several years, I found myself staffing a VA hospital with young, hard charging OIF/OEF vets who also wanted to become cops and firemen many of which were drawing service connected disability for PTSD or MDD. Many of them I tried to discourage because I didn't deem it safe for their mental health trajectory. It was there I learned that the state north of me, doesn't conduct any psychological testing on officers. Boy, that was alarming. You sound to be in a population dense area, I'm thinking FDNY and NYPD off the top of my head, haha. Most of the US is rural, so outside those metro areas it would be hard to render a cops and firemen practice.

The stimulant drive and everyone suddenly having ADHD now is one of the reasons, about 30% really, of why I no longer enjoy my career. Also, therapists, who don't know anything about anything, are sending people to me "to get tested for ADHD." I don't do "testing." What the actual...?

I agree with this.

Yes! I've been doing that for a few years, but since I began working from home before anyone ever heard of COVID, my motivation to do any other work has lapsed. I love being here, alone, as I write this message waiting for my next Zoom person. I'm looking at a program called Functional Medicine Fast Track to develop a sort of turn key virtual health program. I'd gotten really interested in the American College of Lifestyle Medicine (ACLM) and was going to board certify with them. Then one day I decided their exam cost was too expensive, and they don't support the consumption of meat. Believe me, I know we can exist without it, but we have the teeth and digestion to support it, and the group encouraging people to live healthier lifestyles completely overlooks what most societies consider a staple part of every meal. (And as a lifter, I eat a lot of meat haha...and 4-5 servings of veges). The ACLM membership isn't very expensive and was cheaper around Black Friday. They have a new member series of monthly videos and a 5 hour nutrition CME that's enlightening if you haven't done much other nutrition stuff that are probably worth the $170 or so. They also have member interest groups, such as fitness, but I admittedly never sacrifice my free time to attend them. We should talk.

Until Instagram slipped me a nurse coach ad, I had never heard of a nurse coach, and I've never met anyone soliciting a nurse coach. Frankly, I've only met one person who had a life coach, and I actually had never heard of a life coach until I hired a home organizer to unpack my house after a move. That woman was also a life coach by self-title. We can be whatever we want, but selling others on the idea of paying us for our perceived knowledge base and title is a different animal. I don't think the nurse coach, based on the ads and curriculums I see, have the experience in any particular field sufficient enough to provide meaningful health services. They're not nutritionists, trainers, counselors, func med providers, and generally we don't see most RNs as being overly knowledgeable about chronic health problems unresolved by standard medical practices. However, if I could sell people on a training program to become alligator whisperers, I'd gladly do so, and I think the nurse coach groups are providing the same level of unnecessary product.

I'm in psych with similar thoughts. I'm not "stuck" to psych at all. I've spent the last year and a half learning about lifestyle medicine, nutrition, fitness training, and functional medicine (all with several certifications), and I'm really over the chronic disease model and prescriptions. I'd love to never talk about prescriptions again.

There won't be many here, but what would you do? What have you done? How many of you would leave mental health if you could maintain the same lifestyle? I have peers that wouldn't openly answer that question.

Having followed a similar path, we know that meds can be limiting to certain career paths as can the diagnoses. Talking is not necessarily a therapy and anyone can talk. Evidenced based psychotherapy programs such as CPT, PE, et al for PTSD are meaningful. Marketing and decorating your private practice office for public safety personnel could definitely be a niche, and there are some papers addressing your topic of interest. But by only working in this capacity, you would preselect a healthier than normal (with respect to psych) population and not grow in the experiences we unfortunately need. Most likely as a newb, you'd have to work for a group, and they'll have scheduling peons who put whatever they fill like putting on your schedule. It burns me up that an uneducated, inexperienced person dictates my day, but such is life. Outside of these concerns, you'd need a population density to support a practice. Where I grew up and wore many badges, there weren't enough public safety officials in 10 counties to support a psych practice. To make a living at this, you need access to a lot of sick people. If about 20% of a municipality will seek mental health services - at some point in life - even less of a percentage of uniformed guys will seek the same.

Just combine them and say APRN or something and move on. No one knows what the FNP means, and no one really cares that you (or any of us) has a master's degree.

Illegal? Probably not. Inadvisable, surely. Whoever gave their orders is still licensed, and you could follow them until doom's day. The license is the crux here, and the organizational policies really don't mean anything to anyone other than human resources. I wouldn't recommend it, but you could unless you have specific statutory verbiage in your state detailing otherwise.

Ironically, I make quite a bit less in psychiatry than I did ten years ago. The only reason I still do the job is because I can do it from home. This really outweighs anything else.

Autonomy. Flexibility. Compensation. Status within the organization. I don't really want to interact with management officials or support staff unnecessarily with a preference to work from home and have since before COVID, and I can do whatever I want between interviews. Compensation, primarily pay followed by retirement matching, is also important because I don't like this well enough to do it for less, and I want to live without having to overly concern myself with paying bills. Finally, I don't want to be expected to do anything outside of direct care, I.e. no committees, unnecessary meetings, peer reviews (I really hate those), calling people, and engaging in correspondence. I think of the VA as an example. The compensation was below competitive, the autonomy was non-existent, at the time there was limited flexibility although I was able to take advantage of a situation and craft my own hours, and the status was extremely low with no support from anyone. So if it sounds like I'm working for creature comforts, then yes, obviously. Why wouldn't anyone be selective? Many just aren't as blunt about it. #worktolive

Check out American College of Lifestyle Medicine. If you can segue a specialty change after this then cool. There is a faction of us, like you, who are gravely disenchanted with the traditional model of sick care and treating "stable" patients who are actually no better off. Ironically, I've been thinking about going to the local U. (not expensive) and getting a post master's FNP cert, more as a model of information than to change practices. I'm a PMHNP. In parallel, treating people who want to be healthy or healthier is very fun.

I had to describe, in detail, various perceived dimension of nursing practice and how I met those to come in as a NP III-5 or nurse III or whatever it was. A committee then reviewed those answers and my application details and weighed in on where they thought I would place. Ironically, I went to the VA to become involved in "systems and committees" so that I may begin to transition my practice to administration. But once I was there for a few months I realized I wanted no part of their systems or committees, LOL. Every in house RN that became a NP went to II. (I guess none of them were already some kind of III.) I'm not with the anti-autonomy VA anymore. I left 3.5 years later with a III-7. The IVs were department chairs or deputies that happened to some sort of nurse, and the only V was the head nurse for the hospital site - the title for which I can't remember.

How many patients in the psych hospital are admitted for "acute anxiety/depression?" I rounded on psych hospitals for many years, and the overwhelming majority of patients were seriously mentally ill with a good subset of those refractory to standard treatment regimens. And about 20% were homeless people making up stuff because they were hot or it was raining too much. Usually the people who were coming just anxious, I would discourage or refuse admission because the milieu will worsen that anxiety every time. Psych hospitals can be very austere and traumatizing places and also notoriously understaffed so de-escalation by unit staff is mostly academic. If you're on call, you'd be on the line to order an untold number of injections and PO interventions. I think you're probably under prepared. If you're working there already, and you're doing fine. Congrats.