Snowranger19

Way back when I became an RN, my school highly encouraged everyone to get at-least 1 year of medical experience before going into psych. I don't think this is completely neccesarily, but I can think of many times it served me well through my psych RN career. Even in psych, you will have medical issues to deal with (emergencies, wound care, detox, IVs) and I worked with many psych-only nurses that were VERY uncomfortable. Psych is also a hard specialty that gets underappreciated. We don't have all the medical procedures and tasks that other RNs do... but we typically have higher patient loads and they can be very draining. In my ED days, I could have 4 patients needing constant monitoring and IV changes, wound care and I would be running back and forth. Psych you may have 10 patients; one psychotic, one on suicide watch, one needing detox/CIWA checks every hour, etc. Psych documentation also is a lot heavier and narrative/conversation focused (if done correctly). I have also seen an increase in acuity in psych patients/inpatient over the past few years. Addictions also typically falls under psych, which is very hard. Also, as a PMHNP that takes NP students, most of the PMHNP students are get are actually from other specialties wanting to be a Psych NP for various reasons. I'd love to have an experienced Psych RN as a PMHNP student!

Is there a reason it needs to be observed? Is this for MAT or ASAP requirements? Our set up is just a restroom with no sink water. There is dye added to the toilet and they are instructed not to flush. UDS cups have a temperature strip that must be valid. They put all their items in a locker before going in and have to pat themselves down to show everything is empty. I don't see a benefit to observed samples if you are not doing chain of custody (and even then?). Feel like this is an old, outdated practice in medicine and is mainly used in corrections.

What would becoming an MD do for you that additional training/education as an NP wouldn't? That is a lot of extra cost, training, and "starting over". There is always CME, additional certifications, etc. that you could do if it really is about having more knowledge. Your pay is very low... it is below what I made when I was an NP resident with the VA. Are you sure its not just your current position/job that is making you feel this way?

100% this. Please do not go into psych just because the pay is better. Even if you end up landing a super-easy gig, its still a lot more patient interaction than medical visits. There are also lots of no-shows, medication non-compliance, crisis intervention, etc. I hear often that other NPs are jealous that we get longer appointment times, but honestly sometimes 30 minutes is not even enough when someone is off their meds, using substances, suicidal, doesn't have money for medications, and wants to talk about their relationship issues.

I worked inpatient throughout my PMHNP program, including clinicals. Have you spoken to your employer? My work set me up with some clinical rotations there and allowed me to use PTO to take days off while still staying "full-time" on the unit. They also were great for networking and would introduce me to others because they knew I was looking for opportunities. In the end though, it depends on you and how well you think you will do juggling both. Practicum was a lot for me and I know I couldn't have done 40 hours a week inpatient + school + practicum but there were others that were doing that!!

PMHNP, Psych Nurse for 12 yearsish. First "job" was a VA Residency for 1 year. 80k for 1 year. Lots of experience, PGY-1 Certificate. Full federal benefits. Second job was an MAT clinic. 123k a year + incentives and bonuses. Averaged out to around 140kish. Full hospital benefits. (P Northwest USA) Third/current job is psychiatry outpatient for a privately owned business. Full benefits. 170k + bonus structure on productivity. (P Northwest USA)

I never understood the people that list RN and APRN. Nursing "leaders" also hilarious to me. Sometimes they have so many credentials it takes a minute to even see what they actually are. And if they have an MBA or other non-nursing degree, they usually list it also.

I found a lot of USMLE things helpful. I have been told that is taboo by some other NPs but I found a lot of the material for medical students was very helpful.. YouTube was a great resource for me also. I would watch videos about USMLE preparation, explanations about MOAs, etc. It is also a nice break from constant reading/studying.

Working in psychiatry as an RN could give you a "taste" of what being a PMHNP would be like but also not really. You'd see the patients and the medications, kind of the overview. But being a NP is very different than being an RN. Most NPs do provide some therapy, but it is usually attached to medication management. In my experience, most employers would rather hire social workers or therapists to do therapy as we generate more revenue (and there is a big need) doing medication management. There are some out there that do primarily therapy but they are few from what I have seen. Have you considered doing RN Case Management? Many community mental health centers/providers have RNs on staff that help patients with things like getting connected to care, appointments, refills, crisis calls, etc. It sounds like you may really enjoy that based on what you are describing.

I asked this question at 34. I was working with an NP in the ED who was encouraging me to start NP school. I will repeat her answer... "How old will you be in 3 years if you go to NP school? How old would you be if you didn't?"

This is my opinion.. I was a Psych Nurse for about 12 years before obtaining my PMHNP... I do believe that RN experience offers valuable experience for the PMHNP. Not only in dealing with patients but also the knowledge of medications, procedures, and processes that come with being a psychiatric nurse. I ran groups, took crisis calls, did a lot of case management, safety planning, restraints, etc. that helped and continue to help me as a NP. In school, it was a boost up for sure. I already knew most of the psych medications, their classes, doses, and a general understanding of how they worked. It was not necessary, but it was a leg-up. I also had a general working knowledge of common side-effects, why patients don't like certain medications, etc. from working so long in the field. I have experience with seeing these things first-hand versus studying/reading about them. It doesn't make me better than the NPs without it but it does add to my practice. I could say the same about residency. I did a PGY-1 Residency after NP school. It was extremely valuable and I learned a ton. I saw/did things that NPs don't even do... but it expanded my knowledge. Should residency be required? I am not sure. But do I feel it made me a better NP? Definitely. TL:Dr It is my opinion that RN experience does prepare you to be a better NP but is not required or the only factor.

You are required to practice within your scope despite most (all?) states having only one APRN "License". There is no law saying that a PMHNP could not manage hypertension or a WHNP manage Bipolar disorder. The issue would come into play if something happened, or a mistake was made; what in your training made you feel you were prepared to assume care of this patient? All that said, I have seen PA's and NP's working in areas that were not their specialty but were around for other tasks. Such as an FNP on the psych unit there to perform H&Ps, manage medical medications, etc. That could be their goal as well as you seeing less acute psychiatric patients. A psychiatrist on site sounds now, but how available would they be for you? If you get a "stable follow-up" that is no longer stable, off their meds, and suicidal how comfortable will you be managing that on your own? These are the questions I would ask myself.

I really hate all the letters behind my name. I try to get away with listing as little as possible because I find it just confuses patients. My current employer likes to use MSN, APRN, PMHNP-BC and I can't tell you how many conversations I have with patients (and co-workers) about what it all means. I really wish we could just standardize: Snow, NP or Even Snow, PMHNP (can we drop the -BC since everyone has to have it to practice?)

If the patient is a bartender, is it possible he is being drug-tested or having an issue due to taking a stimulant? Not sure what medication he is on (I would assume some stimulant) but I have had patients with concerns about work due to random drug testing or an addiction issue occurring. I agree with others, talk to the patient about WHY and I would also ask why the letter is being requested and by whom. I would share I don't have enough information to be comfortable writing such a letter unless I knew specifics and even then, the letter may not say what they want it to say. -Snow

Hey all , I am currently considering a move to Austin, Tx. I have been offered a position with American Travelers and they have a few contracts in the area. I am considering taking a contract just as a way to help me with relocation but do not really plan to continue to travel. Is this a bad idea? Thnx! Landon