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I can't agree more with Fullglass. Your first job can really set the tone in your career. My first job out of FNP school was in a GI clinic that did not know what to do with new grads but they had extensive experience with training NPs so I had an amazing experience with a few hiccups that were fixable and required me to advocate for my patients through my training. Years later I am now in a Family Medicine department at the same hospital, and I heavily rely on the training from my G.I. years and wish that the new grad NPs in my department had a similar intense training that I received because they're just left to figure it out and find anyone that can help them even though they know I'm here but now a per diem basis . I now primarily focus my time on my private practice.

That is appalling! I heard the one professor that made the program worth the strife returned back to only teaching medical students as soon as my class graduated.

Your experience sounds incredible. I guess a question to ask yourself is how much in the patient's health journey do you want to be/feel most useful in the patient's well-being journey. For me, I knew the listening, advising, and teaching which encompasses many fields, but the ordering of labs/imaging/procedures and prescribing (non-pharm and pharm) were also important to me as a type of one-stop shop for many things. Plus these really interest me on personal interest level as well. I've met incredible therapists that have made radical changes with patients, so it depends where you see yourself as most helpful and called.

Hi QEOLAdvocate! I'm probably the last person that would be helpful in this, but it might give perspective. I am in my early 40s. I've been an FNP for nearly a decade and then I went back for my PMHNP and graduated last Summer. Like you , I have been interested in psychology and psychiatry. Actually I was planning to switch from my FNP program to the PMHNP but then I thought it would be better for me to have a more abroad understanding of nursing/medicine and then maybe later on I would specialize. So I did and that decision worked for my circumstances. Anyway, when I graduated from my FNP program, my first job was in G.I.. for several years and it was amazing and many mental health issues came up during that time, which is probably why it was so interesting to see the gut-brain health connection and then due to hours and obligations. I switched to a family medicine department and that was wonderful too because it was(still is) more expansive and I saw many more mental health related issues in a more direct capacity. So my PMHNP program was primarily focused on the medications and that was quite defeating and demoralizing at times. It was important though because with this education I've seen (and corrected) in such a short time how devastating poor medication treatment can be in not doing the basic checking of labs, not considering how psychiatric meds impact overall physical health, and the precipitating events, etc. With that being said, I have my own private practice that is flourishing. All visits are psychotherapy I don't do only med-checks ; it's part of the overall visit and the wonderful thing about this combination is I can work in real time on the psychotherapy which is the primary reason for visit and adjust meds (if applicable) as well. Everyone gets homework and we meet regularly and it's a very close communication and follow up system since I take a very small amount of clients at a time as the patient-puppy mill experience is not what we're about. Also, many of my clients have underwent medical trauma as well as severe trauma in their own lives and are drawn to the more holistic-nursing approach. I incorporate nutraceuticals and dietary lifestyle recommendations that goes along with it. The individuals that see me like the one-stop-shop type aspect of it as it is inclusive and I do reach out to therapists to bridge care/connect them to therapists since I have a wide network (ex I'll suggest trauma therapists -I'm working on that training) and I recommend a nutritionists, acupuncture , OT, gastroenterologists, among others that specialize in areas beyond my scope of practice. On an interesting note, I do work on G.I. issues at to a certain capacity in my practice because they often come up as many with trauma and other mental health issues suffer from significant G.I. disturbances, but at times are brushed off in primary care /their specialist visits . I seriously thought about going back for License mental health clinician (LMHC) or PhD in psychology for a time . Who knows where life will take us but for now my children are small and the last program was tough on all of us while working. Much of what I've learned is through CEUs and CMEs during and after my PMHNP program. And my clients are thriving and I do have an intense practice to be honest, but it is so rewarding. All to say supporting clients on their healing journey can look many different positive and effective ways. , a formal education and foundation as a therapist is wonderful and I have mostly therapist friends that I speak with which is helpful. With your experience and skill set, the sky is the limit. And there is so much to learn out there and it might seem overwhelming, but by posting this question you have done something incredibly powerful for your future endeavors. Because you care your patients will have the opportunity to thrive. Hope this answered your question.

Hi WestTXRNtoNP I am (hopefully) finishing this semester and can say that some of my classmates ONLY had telemed clinicals with this program. 100%! And they are thriving. It seems that the thing JHU care about like the ANCC is the supervised clinical hours so if you were on the moon, telemed, or in a submarine is fine so long as you were supervised. Also, your clinical hours must be >51% with a PMHNP and the rest could be with a therapist. They want to ensure that you know the meds and are comfortable with prescribing PRN.

Hi city_FNP, I worked and it was awful and many of my classmates went to part-time. I think the fall semester it's doable just challenging but then it gets tricky with the clinical rotations as that will be your priority. I wouldn't recommend working >20 hrs if you are caring for your family/loved ones while doing this program.

These answers are incredible! I do want to add from the perspective of witnessing a classmate who is a close growing go through this similar turmoil in decision making. I had a classmate who joined my class (BSN-MSN) after delaying school coursework mid -program in order to gain more nursing experience for an additional year. Classmate is brilliant and engaged; ended up graduating with us and went onto work in the ED for about two years. The last year. Had the itch to go to medical school. Fast forward about six years now that classmate is finishing up third year of medical school. My classmate is extremely happy of the choice and thankful for the RN and NP experience as well. Keep in mind classmate is a male and he plans to go onto residency then fellowship and has time. He hopes to find a wife along this journey but is in no rush. Some may say you can buy time with fertility treatment there are no guarantees in anyway. everyone's comments above illustrated some really great points for potentially improving your current situation. I've had the struggle between MD vs NP. The MD longing for similar reasons in terms of the trainings but as a 'seasoned' FNP and now finishing up my PMHNP certificate and doing this all while being a mother to two small children , wife, seeing amazing patients in an academic setting's chaotic safety net hospital primary care clinic-developing our department's group classes with key and untraditional stakeholders- in the purgatory data collecting stage for my paper (expected publication 2025), building my private practice, developing homeschool curriculum, planning for having our last child, while taking additional courses in integrative medicine I can say that I am satisfied with my choice in these circumstances. And I hope it displays some of the many opportunities NPs have. I must say even today the MD longing occurs with diminishing fervor (it comes in smaller less frequent waves and intensity). Plus I told myself there is always the PhD much later if the itch won't scratch. Also, I work 'part time' but if I worked full-time officially, I would make about $140,000 a year according to my salary statement in an academic setting on the East Coast are you in a southern state? Is your pay typical for your area?. as soon as I complete my PMHNP program this Summer, I'm going full throttle with my private practice and decreasing my hospital job hours as I've been an FNP (worked in GI for years and completed a fellowship- my first love; and transitioned to primary care due to schedule flexibility for family/personal) for several years and am incorporating everything I've learned to go into my integrative medicine practice that is telehealth and in person (I have secured two offices locations, clearance (legal and admin). Are there ways to optimize your current situation? The comments about the significance of continuing education is critical to be a knowledgeable practitioner. I've taken so many courses and my library is filled is several medical texts and even USMLE reviews which helped me understand more. In my clinic I'm the primary person that see the physicians in the clinic and hospitaland their children as I give comprehensive care just like ALL the NPs in my clinic but we all have different interests and skills . The physicians ask me about GI related matters for their patients. It's what you do with the time you have. Plus another benefit of being an NP is you can transition to other specialties more easily. The learning and financial opportunities for both avenues are potentially limitless and the satisfaction you gain is immeasurable in the right conditions. All to say , I totally feel where you're coming from and I have no advice either way, but I must say even doing this one year PMHNP program with small children being the type of mother and wife that I am and want to be (involved/engaged and will homeschool this Autumn) has been very challenging and extremely draining and I could not imagine this experience going through the medical school/residency route for years . we're all built different and we all have different strengths and when push comes to shove I'm sure you can make it work either way just plan as best as you can for the reality you choose. Plus in life you can always change your path. Good luck to you ?!

Hi Jac_f, Unfortunately, we are in so many large group discussions that I do not remember which classmates mentioned that they were at a remote-only sites; but the program provides a list of placements that include remote-only options. Please keep in mind that some of the sites may be outdated. Could you network with your prior nursing program to see if they could help connect you with alumni that has a telemed only practice? That may be a potential resource to save you a potential headache. One good thing about attaining your MD RN license is that if you are having trouble finding a remote clinical site, the program has stronger local connections and could help with securing a MD telemed site. I am licensed in my home state, a neighboring state, MD and DC. I wouldn't go as overboard as I did but I like to have back up plans but having another state RN license broadens your remote clinical site opportunities. Also, my clinical site does some telemed and the preceptor has told me I could join via telemed. It seems more of a comfort for you and the preceptor. Sending you a smooth transition! Hi city_FNP, BSN, MSN, RN, NP, I am wrapping up the second semester so I don't know the grad rates or anyone ahead of my program and their job prospects.

Hi @ Jac_f They offer telemed remote clinicals. Is there any way you can secure your own telemed clinical through networking to save yourself the headache. You may want to ask if there are any international restrictions (I wouldn't) or just get a VPN. This program should be doable abroad.

Hello all! I am in crunch time in the last two weeks of the semester but thought I'd quickly check in on this feed. This program's main weaknesses are: 1. the lack of assistance with the clinical placement 2. merging the PMHNP w/DNP students so less attention for us Cert students. 3. last minute policy changes for testing and delayed responses from some professors and admin. I knew where my placements would be prior to starting this program from networking. It is possible yet unnecessarily hard to find a placement. Even with my predetermined placement, it was a bit difficult getting administrators to respond quickly to move the process along. I am not going to sugar coat it but the placement experience is ridiculously excruciatingly difficult and nearly caused some of my classmates to drop the program in the 2nd semester but at the last minute (literally day of and in one case week after start of Spring semester) it ended up working out and they are flourishing with their sites. Knowing all I know, I would still choose the program and with all its flaws as I don't know the other options plus if you have a good small group of classmates to lean on it becomes bearable. Plus they have a physician professor that is worth the cost of tuition and frustration as she is incredible. The main strengths so far: -the professors and instructors overall do seem to care and try to meet you where you are. -the quality of the lectures (but they are just the beginning of learning so don't expect too much) -the ranking of the program -online convenience. -3 semesters and done -there's probably more but I have to get back to my assignments. Good luck!

@FNP to PMHNP : regarding textbooks no recs as they are undergoing a review. @FNP to PMHNP : great question! I wish I quit my job because it is really challenging to do this program while working regular hours and taking care of a young family. @fnptopmhnp : the interview was like a conversation. just asking what your interests are, reason for applying (I said the ranking, quality of faculty and program and the shorter length). they're practical and no what students do best which are ones with a specific goal(s). @Mergirlc, MSN, RN : excellent question. oh this program! I have an incredible physician professor that makes the rest of the program amazing despite lack of communication from some or transparency from others. I hear so many non-JHUers complain about their NP programs too but I expected more interactive learning. this was their first year of bridging the PMHNP cert and DNP program and it's been a challenge. Good luck! I'll update at the end of the semester if I remember but this program is extremely INTENSE and time is limited for all of my classmates as well. if you review the material I suggested you should be entering with a leg up. Ciao

I have no textbooks in mind. Plus the program seems to be in transition and they might change what we're currently using. I stand by my earlier recommendations.

I would speak to your boss about adjusting your schedule for the next three months even if it means decreasing your salary (ex. work 3 days per week seeing 11 pts per day and then SLOWLY ramp upwards such as adding an addtl pt per week) and if that is not on the table I would consider looking for telemed jobs (if you must work) if your classmates or professional networks can't help. The point of working is to help patients while meeting your goals. If it is one-sided or no-sided, it doesn't sound like a good or viable deal, and your body may be telling you that this is not a good setup. My first NP job was in GI and it was intimidating. I stayed for 18 months (completed a fellowship, became pregnant after trying with my first child and only a few weeks maternity leave) and I regretted it. I adored most of my colleagues and learned so much but the cost was something that I should not have paid for now knowing my vision and goals in life. find out your vision and goals and what is the exact cost (incl how long) you are willing to pay before making any decisions. Sometimes resetting expectations with this articulated plan may make the work not seem so bad or make apparent that your current path is a dead-end. I wish you and yours luck!

My biggest regret was not reviewing some of the material (even though I bought dozens of books regarding Psych) months in advance of the program with the goal to prepare ?. I would recommend reviewing the the 1.) ANA's PMHNP Review and resource manual and if you're really ambitious getting started with the corresponding 2.) APEA PMHNP questions a little at a time. like 1 question a day in tutor mode just for learning. other than that enjoy your time because the reading is ALOT! but if I did these things it probably wouldn't have been so intense. another two books I wish I read the Spring and Summer before I started would be Dr. Jonathan Heldt's 3.) "Memorable Psychopharmacology" and 4.) "Memorable Psychiatry" the corresponding videos are excellent. again, I wouldn't drive myself insane to "prepare" but reading a little bit each week will help get you on the ground running. I cannot emphasize enough how amazing the professors are and they tie this information well. good luck! C

Hi FNP to PMHNP, I love this program so far. The professors are surprisingly compassionate. I knew they would be brilliant so that wasn't an issue that crossed my mind as well as the quality and intensity of this program. This program is like drinking water from a fire hydrant but if there's ever an issue, the professors make it known that they care and will work with you to come up with a remediation plan if need be. I found a small group of classmates and we text each other and encourage each other daily. Of course not everything is perfect but I must say I'm surprised that despite all the work how happy I am in this program. It is high yield information taught by NPs, an MD and a Psychologist within their own expertise. It's so refreshing. another benefit is that if you work, you set up your schedule on when to complete items within the due date. They should have me in the commercials for this glowing review haha. I wish you luck wherever you go. I'll try to update my thoughts at the end of the semester if I remember or receive a reminder message. Good luck! C