TheOldGuy

Between the two, I'd probably suggest in-patient - mostly so you would know what happens in that setting. However, I would suggest getting experience outside of psych - especially as a new RN. My experience in the ED, ICU and Tele have made a tremendous difference in building my knowledge base. Our patients have numerous co-morbidities and having a more solid medical background will help you build credibility with your physician colleagues.

How do the politics affect me? Ever hear the phrase "the tail wagging the dog"? I felt the program I attended prepared me extremely well.

Wow. Please, I intend no disrespect, but I can't help but express my shock that it is possible to become an NP without having anatomy and physiology without a lab component. This is the sort of thing that challenges our credibility when it comes to full practice authority. If I may ask, what schools did you attend for your RN and NP programs? If you would prefer not to say, I understand....

There is likely a range of quality in distance learning programs just as there is in brick and mortar programs. I earned my MSN in the PMHNP program at the University of North Dakota - outstanding program. I felt very well prepared to practice. The program was rigorous and required a great deal of self-discipline.

I'm a psych NP. I love what I do. I hate the politics of nonprofits. I work M-F 8-5 with no call.

You're welcome jmnurse.... Pursuing an FNP is not a bad choice - it will build on the experience and knowledge you have. In primary care you will see a lot of psych...I'd recommend the Master Psychopharmacologist program through the Neuroscience Education Institute (neiglobal.com) after you've taken the basic pharmacology course in your FNP program. You can always add a post NP certificate in psych - if you find you're still interested......

Congrats on your DNP! You're right - the issue really is outcomes. Another good indicator of the quality of care provided by NPs is the marked difference in malpractice claim frequency - which is present in both states that have some sort of collaboration agreement as well as the growing number of states where NPs have independent practice authority.

While it is true that the author/owner of the page did not cite any sources, everything that is stated is pretty much dead on - at the same time, I don't disagree with those who state that medical school is more rigorous. However, the page does not discuss rigor of education, only years of study and outcomes.

No idea - try calling them....

Hi JM, I'm glad it helped! Your post points out one of the MAJOR problems in nursing: you're working as a psych clinical instructor but you're worried that you may not have enough experience in psych to do a PMHNP program! We are in such a rush to get students into nursing programs even though we don't have faculty who have the training and background to really prepare and teach them.... You really should get some in-patient psych nursing experience - part time perhaps. One of the jobs I had while I was going to grad school was on the mobile assessment team with a local psychiatric hospital. I would go to EDs in area hospitals and evaluate patients for involuntary holds. It was great experience and helped with diagnostic reason and decision making. As nurses we don't make decisions - we assess and inform so someone else can make a decision which we implement. One of the changes in role to an NP involves learning how to make a decision - its not easy! I know you're busy in teaching and working in MS/O but some part time psych experience would be good. I worked 8 shifts a week in 3 different jobs while I was in school to try to get everything in !!

Some people might disagree with me on this but I don't care! :) I would strongly suggest that if you want to be an NP in psych you should get some solid medical nursing experience eg Med Surg, ED or ICU. Always remember that psych diagnoses are rule out diagnoses and we need to always consider other medical differentials. Most of our patients have significant medical co-morbidities involving medications or treatments that may impact or complicate psychiatric treatment. Psychiatry is sometimes plagued by the not knowing what you don't know syndrome. Our physician colleagues have all had basic rotations in all areas of medicine. Nursing school experience is NOT adequate. In addition, many psych patients may not even have a PCP and you have to be capable of recognizing and possibly diagnosing or treating a wide range of medical issues. After graduating from nursing school, I looked at my jobs in nursing as a sort of residency. I worked in a variety of areas ranging from inpatient psych to med surg to ED to cardiac and respiratory ICU. I worked full time while I went to grad school, told all the docs I worked with that I was in an NP program and asked them to treat me like a med student - they were more than accommodating and I was regularly humiliated! But I learned a ton. I am a much better NP for it and am compensated accordingly.

Been there too.... Sometimes we have to remember what it means to be a nurse...... Great job!

I started at about $135. Be willing to take several part time positions. As you gain experience you can make a better case for higher pay. Leverage pay at one part time position to the others. Then look for full time work. I worked full time and part time - lol!

You're always in a stronger position before you say yes. $85 per hour isn't bad. That's over $170k per yr. I would take that and later look to earn that or more with benefits.

Why wouldn't it? You have to think like a doc and not like a nurse re salary. You also have to be willing to walk. I have been offered much lower compensation a number of times - I just said "thanks but no thanks". I am good at what I do and will not accept low pay. If you are good and you know what you want and are willing to walk if you don't get it then you will be more successful when it comes to increasing your compensation.

Outpatient clinic. Psych. Of course they have "set amounts" - but they don't mean anything unless you let them. How can you be "aggressive" if you're afraid? If you are clinically strong and have high productivity then you have value. If you are clinically weak with average or low productivity then you are easily replaced. I have the highest productivity of all providers (MDs/NPs/PAs) in the clinic.

California 3 1/2 yrs Salary: $220k - 40 hrs/week Benefits: 3 wks PTO, 1 wk CME, 401k w/match, insurance, 10 holidays Tips: Forget what other NPs are making. Have high productivity. Know how much you are generating in revenue. Negotiate based on what MDs are getting paid - start with 85% of MD pay.

Yes I do get upset. I am not a physician extender or midlevel provider. I am a nurse practitioner. Terms such as physician extender and midlevel are used by physicians to maintain a caste system, their power and compensation. How we are referred to is important. Labels do matter. If you disagree just use the N word and see how well it goes over....

Between $95 to $140 per hour.

Don't mean to argue PsychGuy but I do have to disagree with a few points. When I mentioned lower claims, I was referring to states where NPs have full practice authority. The data is clear - lots of studies. NP provided care is as good as or better than MD provided care in primary care settings. You can disagree and that's fine but outcomes refers to quality not number of patients seen. One of the reasons that MD care is not rated as high, is that they don't take the time to listen to patients - which means they don't pick up on symptoms - which means they may misdiagnose and consequently improperly treat. That said, I have the highest productivity in my clinic which is mostly staffed by MDs. We all see the same sorts of patients - no difference in severity of symptoms/treatment etc. I don't do anything "less critical" than my physician colleagues do. However, I do order more lab tests than they do. The most common reason I hear from them as to why they don't order more labs is that they don't want the liability associated with reviewing labs and possibly missing something or improperly treating. I use every tool I can because I want to provide the highest quality care that I can. On the other hand, many of my MD colleagues don't use all the tools available and just as they don't always do a good job listening and consequently miss symptoms, they may miss more objective indicators. I recently got a new patient with a hx of schizoaffective DO and IVDA who was recently seen by an MD psychiatrist. The MD increased his antipsychotic to address confusion, paranoia and agitation. I ordered labs including NH3. NH3 was significantly elevated and I started him on lactulose - guess what - symptoms improved...... NPs do tend to consult more - our MD colleagues tend to consult less - which I have seen results in more missed diagnoses. Unfortunately, egos sometimes get in the way of practicing good medicine. Finally, new providers whether MD or NP are not as efficient - no big revelation there. Over time, we all get better, and faster - the key is not to get sloppy and not take the time needed to provide high quality health care. Peace

Nothing to worry about here Pro. The only unintended consequences will affect our physician colleagues who want to hire NPs for $55 per hour, bill at $200 per hour and pocket the difference. Its a business model that practice management consultants are selling heavily..... The reality is that there is a staggering level of demand for health care provider services that the medical community is trying to maintain a monopoly on. As the NP role matures and scope of practice laws expand, compensation and opportunities for NPs will rise - unless we fail to limit the explosive growth of marginal quality NP programs that are mass producing poorly educated and trained NPs with virtually no nursing experience.... My 2 cents.....

Thank you for your support of my comments but I've got to disagree with you on a couple of items: 1. I do not feel that the NP model is superior. I do believe that NP programs need more rigor. I believe that NPs who also have years of nursing experience are able to effectively leverage that experience with additional education and training to provide high quality care with outcomes equivalent to or better than our physician colleagues in some areas - not all. 2. I do not believe physicians will become outdated by any stretch....I do believe that there will be increased focus on specialty areas eg surgery, neurology, etc where NPs have essentially no training. Please do not turn this into an anti-physician blog - the OP was asking views about equal pay for equal work. My comments were directed specifically at this question. The key here is the "equal work" part!

So..... 1. Many of the responses indicating MDs deserve more are not written by NPs. 2. If you are not familiar with how billing works then please don't pontificate. 3. If you are not an NP then please don't pontificate. 4. The issue is not pay as a function of number of years of schooling - consider PhDs vs MDs. 5. The issue is basic economics - supply vs demand. MDs have been working really hard at limiting the number of new docs. They keep the supply low while demand has surged. Consequently earnings have grown tremendously. Nursing in all its wisdom (NOT!) have exploded the number of nursing schools and NP programs. This will increase supply which in turn will decrease wages. 6. MD earnings in specialties eg plastic surgery, cardiac surgery, neurosurgery and orthopedic surgery are through the roof. That's ok - they have the specialized training and skills to justify it. 7. Many of the responses in favor of NPs earning less seem to indicate that the quality of the job done is somehow lower than that provided by MDs. The question asks about equal pay for equal work. If I am doing EXACTLY the same job, seeing EXACTLY the same patients, with equivalent or better productivity, providing care that is EQUAL TO or BETTER THAN that provided by my physician colleagues, then I should earn the same amount of pay. If I'm not doing the same work, then I don't deserve the same pay. In my field and practice setting, I do the same work, have better outcomes and the highest productivity in the facility. 8. Decades of research indicates that NP care is equal to or better than MD care. Malpractice claims are orders of magnitude lower for NPs compared to MDs - in states where full practice authority is present. So...why are nurses here attacking nurses? BTW, I am a big proponent of increasing the rigor of NP programs....but keep in mind that the NP model was originally based on the premise that you had experienced nurses who obtained advanced education and training to teach them what they needed to know in order to provide high quality care - diagnosing and treating. I know there are many NPs who do not have years of nursing experience who have "made it" but I know that because of my med surg, tele, ED and ICU nursing experience, I am a much stronger provider, and am considered to be equivalent to an MD in knowledge and ability by the medical director of our facility. When you add up years of experience and training in both undergraduate, employment and graduate level education, NPs are pretty darn close to MDs - who have 2 years of didactic in medical school and 2 years of clinicals before starting residency.

Please do not work for $90k unless it is part time. I make about what PsychGuy makes and I think we're very much underpaid when compared to our physician colleagues. Income should be at least 80% of what MDs are paid since Medicare reimburses at 85%.

I've been doing telepsych independently for a little over a year. I do it on top of my day job for a little extra cash. There are a number of companies that have put together secure software, EHR, etc. They handle lining up the patients and billing. And yes, I CAN see pts while they are sitting at home on their laptops. My plan is to continue to see pts this way and in a few years retire to someplace nice with a sandy beach and work part-time.....