pro_student_2010

not that unusually i suppose but i know a pnp who works in a clinic strictly devoted to nocturnal enuresis.

hello and welcome! i actually share similar career aspirations and questions as you do. i also know from my own experience that the answer to your question is not 100% black and white. basically though, to achieve the type of practice you are looking for (combined psychiatry and family practice) you really would need credentials in both areas. that holds true if you pursue your md or np. there are just a handful of combined psychiatry-family medicine residencies across the country which provide eligibility for dual board certifications. graduates of these programs generally provide the type of care you are describing. this type of practice would also be possible as a nurse practitioner yet would still require dual specialization. you are correct that this would nearly double the amount of schooling required. since there are no combined np programs for psych and family practice (to the best of my knowledge and personal research) you ought to pursue your msn with one specialty and either practice for a bit to gain some experience or return to school immediately for a post-master's certificate in the other specialty. though it may not be what you want to hear, that really is the only way to be a competent and qualified clinician in any two clinical specialties. yes, there would be some overlap. in an fnp program, mental health should be discussed but psychotherapy and psychopharmacology are generally considered outside the scope of practice for an fnp. similarly, in a pmhnp program, physical assessment and illnesses will be covered yet it would certainly be beyond the scope of practice to treat purely physical ailments such as dm, htn, etc... if it helps, bear in mind that 3-4 years of np school (or i could even name at least one school that could cut that down to 2 years total) would still take much less time than 4 years med school + 5 years combo residency all for a very similar scope of practice and knowledge base (the most glaring exception being that family medicine could include catching babies whereas an fnp is only allowed to do pre- and post-natal care + well baby care, and i suppose "catch" in an emergency just like any rn). hope that answers you question without too much discouragement.

Adult nurse practitioners are able to treat adults including older adult (aka geros). If you wanted to practice as a geriatric nurse practitioner you certainly could do so with you ANP. The ANCC also has instituted a mechanism by which ACNPs, ANPs, and FNPs can become certified as GNPs. You would need 2000 clinical practice hours with older adults and 75 education hours in gerontological topics (the have a specific breakdown). Having you initial certification as an ANP would also give you much more flexibility if you ever decide to try something else or want to move around a bit. It might also be more attractive to employers although geriatirc clinicians might be high demand in your area.

In general terms, WHNP should be trained and able to do primary care (for women obviously, not that a cold would be different based on gender). That's what's supposed to set WHNPs and CNMs apart, the fact that the NP can also manage primary care concerns other than reproductive related issues. Practically, though it comes down to what your state says you can/cant do. If you're in a state that's not explicit on the APRN specialties (which many are not) then you should be able to do primary care. Obviously, you should not be seeing any male patients unless you are also an ANP or FNP but I would run it past the BON just to be sure. Also, ask yourself how comfortable you will feel with the primary care you would provided. There's a huge difference between being qualified and being able.

Hello and welcome, Sounds like you are off to a great start! There's a huge need for mental health service providers right now and having the prescriptive ability that comes along with the NP would be a huge asset. Many schools are now offering direct entry MSN and all of those you listed are respectable programs. Personally, I'm partial to UCSF, Yale, and UPenn but there are many other excellent schools. UCSF has more of an emphasis on underserved populations especially with mental health. Substance issues and homeless mental health are among their strong suits. They emphasize psychotherapy too which seems like it's something you would desire training in (some programs are more exclusive to either medication management or psychotherapy but a few are balanced). UPenn is also a top-notch program with a similar urban emphasis. While there is plenty of support for underserved populations, there is also more diversity at UPenn with an abundance of practice types and styles in which you can do your clinical work. The faculty are excellent and there is a lot of collaboration with the Psychiatry department from the school of medicine. Yale is another top-notch program. I particularly love their RN year (heavy on the sciences if that's something you're into). A very balanced psych program with plenty of pharmaco- and psychotherapy involved. One of the faculty members (Sandra Talley) is one of the pioneers for the ability of PMHNPs to prescribe. There's a lot of theoretical psych integrated into the curriculum which I think you'd enjoy considering you were looking into a PhD in clinical psych. All these schools have very good research opportunities from students (Yale I know requires a scholarly project and UPenn really loves to get student in with faculty on research). Your experience will really help land you a spot at the program of your choice, especially the research experience, presentations, and TA. The clinical experience you gained from being involved in research will also make a big impression for admissions. Having a strong GPA with honors, tons or wonderful experience, and assuming you can pull off a competitive GRE score (I wouldn't worry about taking the subject test, just the general) and you should have your choice of any of the schools you listed. Prereqs. are a tricky issue because some school don't require any (Yale), some require very few (UPenn has two admissions options depending on what you have), and some require everything. In terms of volunteering/getting "clinical" experience, I wouldn't worry about it with you previous experience. If it's something you want to do, then go for it! But if it's just to look good, I would say you don't need it. For example, I worked in an inpatient psychiatric facility after getting my BS and I spent more time educating other staff than learning from them. It was good to see things from the inside so to speak and I did get in good with the DON who was a Yale alum but other than that, didn't boost my changes for admission. Coming from psych into nursing and moving through to PMHNP there will be a much of med/surg type nursing that you will learn and probably never use (and more you will use rarely). Some of the better programs realize this and streamline the RN portion with the understanding that you're going to be leaving the program as an APRN and likely never do bedside nursing. Something I would look into when evaluating potential grad programs. Best of luck!

Has anyone obtained advanced certification in public health (through ANCC unless there is another certifying organization I don't know of)? It seems to me that there is more ambiguity between public health nursing and advanced public health nursing. For those of you with either certification and/or advanced education (MSN or MPH) in public health nursing, did your added credentials get you farther in the field? Were you able to get higher level positions or have more responsibilities? In general, does an MSN or an MPH seem to be more beneficial? Would any of you consider the advanced certification now that its available with an MPH and not just an MSN?

nps (including fnps) certainly can and do work in school settings although this depends greatly on location and school system. a least a few public school systems across the country actually have primary care clinics within the school itself. these are often in underserved and/or low-income areas where kids are much less likely to get routine medical care otherwise. i know new york and connecticut both have these school-based primary care clinics. this is obviously a growing trend. there is an article in pediatrics on the topic (if you can get access to it through your school i would highly recommend giving it a read). i also know of several primary care clinics that arrange "clinic days" at schools for the same purpose. virtually all the jobs i've seen for school nurse practitioners do not show a preference for pnps vs. fnps which would be good news for you.

Personally, I would say go for the MPA since you are already on that track. It's never going to hurt to have more education and especially with the current state of healthcare and healthcare reform efforts, an MPA might actually be a huge asset even if you work solely as a clinician. Getting your MPA will also give you some more time to better define your career goals. Before pursing an MSN it would be wise to have a strong idea of exactly what you want to do in healthcare (what specific function/role do you want to fill, what type of patient population would you want to work with, is direct clinical care really where you fit into the healthcare arena). Our current Secretary of Health and Human Services has her MPA and has spent much of her political career advocating for health-related issues. While it might not always seem like it, at 23 you do have a bit of time to pursue your career. Just my but having both an MPA and MSN as a nurse practitioner would give your many vary strong career options and you could easily be done before you're 30.

While the above poster is correct, they Family PMHNP is intended to cover mental health over the whole lifespan, some programs do not view it the same way. You want to be cautious that the school you attend shares your view. Some programs train you as a child/adolescent PMHNP will some added emphasis on family therapy and involvement and some programs train you equally across all ages.

UT-Arlington also has a ENP program that is fairly good. Graduates are certified as FNPs in order to cover them from birth to death. Programs vary in how they prepare students. Some really only arrange your clinicals in ERs or more acute settings but otherwise not any different. The better programs actually offer some modification of whatever base program you would be certified in (ACNP, FNP, etc...) to prepare you for the unique nature of emergency care. Since you said your goal was to work in a level I trauma center I would think that the more specialize training you can get related to emergency medicine would be advantageous. And yes, all ENP programs really do is pad your resume, your certification will be the same as any other FNP or ACNP but hopefully your program will give you more specific didactics and clinicals that will better prepare you for the ER.

PNPs and FNPs often receive some discussion in their programs about mental health issues and treatment however it is generally considered outside their scope of practice to treat mental illness independently. It is important for primary care NPs to be able to recognize signs of mental illness in order to make appropriate referals and to have some familiarity with treatment of mental disorders (both psychotherapy and pharmacotherapy) since they will inevitable have clients either in therapy or on meds. If your goal is to be a mental health provider, however, you should really be trained as a mental health provider. In nursing that would mean either a PMHCNS or PMHNP. As to the differences between the two, it really all depends on your state's definition of the roles, the practice you eventually work in, and the program you were trained in. For example, in some states CNSs cannot prescribe medications but they can in others whereas NPs usually can prescribe but cannot provide psychotherapy. Some practices will hire an NP to basically only do med checks while others will utilize the whole scope of practice. Some training programs differ in they preparation one receives based on the role (CNS or NP). You mentioned apprehension about prescribing psych meds but also realize that it might be helpful and necessary. It your fear comes more from a lack of experience, obviously that's something that can be alleviated with training and experience. It would not hurt to be trained on prescribing medication but not necessarily make that part of your practice. My advice: look into the state(s) you think you'd like to practice in and how they define and regulate NPs and CNSs. Then talk to some mental health providers or look at job descriptions to get a sense of how the practice environment is for each role (sometimes they are interchangeable and sometimes they are night and day). Finally, with a better sense of what your options would look like upon graduation, start evaluating programs on how they fit with your ideal practice allowing some wiggle room for future changes. Good luck!