SDStudent1

I am a PMHNP, I am MSN with cert. In no way do I regret not getting my DNP. From my experience, most of the extra classes where low value adds anyways. I have had no career constraints occur because I lack a DNP, and I have no plans as of now to go back and get it. I think if you have a buring desire to teach, then sure it might be a good idea to spend the extra 2 years to get the DNP. Outside of that, I do not think it is a worth while investment. I think the best option would be to get the MSN + PMHNP cert first. Then if you find that the career you want requires a DNP, then go back and get it after you have settled into the DNP role. But adding another 2 years of lost NP income, and experience, just to get a DNP does not seem like a wise decision to me. In my personal opinion, the DNP is overall a waste of time. But if you want to teach, the gate keepers require it. That is the only real scenerio I would recommned getting your DNP. Otherwise, I wouldnt consider it. Just added cost and time without equivalent added value. Just my two cents.

I couldn't agree more. I really like the PA education pipeline. Less fluff, more focus on the hard sciences one needs as a foundation. NP has unfortunately become a money grab of higher education. Long term I think this will dilute the quality of providers and hurt the trust in the profession overall. I am a NP and I am a little concerned when I personally have to see another NP rather than an MD or DO, or even a PA, because I know what a joke the NP education can be depending on where you go. In my experience, there are many high quality NPs out there, and they all held themselves to a higher standard than their NP programs did. If you just meet the standards of your program, you will generally be an incompetent Provider. Today I would say the biggest barriers to becoming an NP are time, effort, and money, rather than fitness for the actual profession. If you ever find, or start, a group advocating for change here I would enthusiastically sign up.

I think you will do fine. In those classes, the resources used is what helped me the most. For Path, I HIGHLY HIGHLY HIGHLY recommend "Pathoma". I cant stress that one enough haha. Makes incredibly difficult concepts incredibly easy to understand. You will end up knowing more than anyone in your class who worked in med-surg if you use that resource, by a long shot. For pharm, Lippincott I thought was helpful. Never really found a good resource for health assessment that made it any easier for me there. I also HIGHLY recommend "Anki" spaced repitition flashcards. Essentially you make the flashcards and it shows them to you in spaced intervals that gradually increase the better you know the material. Helps you to focus more on the stuff you struggle with while showing you stuff you know well less often. I thought it made studying very efficient, learn more in less time. But to answer your question, Yes. I think you will do fine. I spent a lot of time up front studying HOW to study and researching the most effective study methods and I think that helped more than any medsurg experience ever would.

Short answer is No, you having med-surg will have very little, if any, effect on your job prospects once you graduate. Longer answer is that people with Med-surg experience will have an easier time during the general nursing courses in the beginning, but once you are through that it will all be equal. I think the more psych specific work you do the better. You have plenty of things you will needed to learn in Psych in the 3 yrs of experience you want to get in school. I think focusing on being a well rounded nurse will likely come at the detriment of you being a well rounded Psych NP. I had only worked in Psych prior to starting Psych NP Program, did really good on the advanced Patho / pharm / health assessment, and was very grateful for my psych experiences once I got deeper into the program. You employer will not care if you had med-surg experience. But they will be impressed by how much experience you have in psych. You prospects for employment are more dependent on the location you are applying. I live in Cali and was offered 3 good paying jobs before I even graduated. My advice would be to focus on getting experience in the field you want to work. But I do understand why this would of concern for you as it was a concern of mine when I began my program. I do agree with what was said above. Probably the most important thing you can do is focus on getting the highest quality clinicals in your program as possible. Don't take the easiest ones like some of my classmates did. They all regretted afterwards. Hope this helps, good luck in your program.

I am sorry for the delay. I am just now seeing this. I didn't use pre-made decks during nursing school or my NP Program. I feel what the information each professor is looking for you to know is so individual that wasn't a good idea (for me at least). I do remember looking for some and none really seemed to fit my needs at the time. I use anki for other things as well that I think using shared deck was useful. For example, I am learning spanish and there are some really good shared decks for that

A friend Of mine got an inpatient job at a local hospital starting at $211,000. This is in the San Diego area otherwise I know of several offering $160,00 with full benefits.

Socal: $48 with benefits | $59 per diem. More with differentials. Probably another 5 -7 in differentials if on nights . Depends on where you work though. I worked for county an the pay was half of what I got in hospital locked unit

Both seem extremely interesting areas for entirely different reasons. Thank you very much for taking the time to answer.

Just memorize the high yield information provided by the movies One Flew Over the Cuckoo's Nest, Shutter Island and 12 monkeys (in that order exactly) and you should be good to go.

Regarding the DSM, thats a good way to conceptualize the ability to subspecialize in the PMHNP profession. I would not have thought to put it that way. I feel like the deeper I get into my PMHNP program the more I hear about interesting niche roles I would never had considered. For example, I think one PMHNP one here was talking about incorporating horse therapy or something like that into her practice. Although that is not something I would be interested in doing, it's interesting to know what is possible. I guess I should have titled this subspecialties / Niche roles / unique modalities within PMHNP ?

Would you mind describing what a typical day for a Forensic PMHNP would look like, what you found interesting about it and how it differs from working on something like a Psychiatric ICU (where I work now as a Psych RN) ? Forensics seems very interesting to me but unfortunately, I wont be able to do a clinical rotation in forensics as part of my PMHNP program. I am currently in clinicals at a hospital who supplies Psychiatrist/PMHNP to a large local prison in the area but, despite my best efforts, they will not let me do a rotation there. Also, what about LTC makes it lucrative and what do you mean when you say it is very flexible ? I only ask because I would not have guessed that was the case but I have heard the same thing from other people posting on here. When I started my PMHNP program I wanted to work Pediatric Psych and was terrified of Geriatric because of how medically complicated they are. I am now most of the way through the program and have completely switched. I have not interest in doing pediatric psych but found that I actually enjoyed working in geriatrics. Thank you very much for the info

Again, I will have to respectfully disagree. And again, I would use the cell phone as an example. The “Brick” cell phone was discontinued within a few years of its creation, but I am willing to bet you have a far more advanced and capable version of it in your pocket right now. Just because a first-generation version of a technology did not become mainstream does not mean that is the end of the story. In fact, in the case of Mcsleepy I would argue the opposite. It actually did receive FDA approval to autonomously provide anesthesia in a live surgery. I don’t think it is a stretch to worry about that fact if my job revolved around providing anesthesia. The general trend with technology advancements is that initially it augments and later it replaces. Most likely, AI and Robotics would initially be used to automate the mundane and repetitive tasks and then at some point would entirely replace the Anesthesiologist/CRNA. I would further argue that the technology currently exists to do so. It is more of an implementation problem at this point. The reason Mcsleepy failed is because a closed loop feedback system is very rigid and rule based which is inadequate to handle the complexities of providing anesthesia. With the advances in machine learning, that limitation is no longer present. This NCIB article says as much, stating “hand dexterity” is likely the only thing that may not be able to be automated “at this time”. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903534/ I do agree with you that it is not only a technical matter but a political one as well. But I also feel the politics of it become decidedly less complicated when there is substantial financial incentive, which would be the case if Mcsleepy 5.0 proves to be cheaper with as good if not better outcomes. It wouldn’t matter how strong a single special interest lobbying group was, it would not be as strong as all the member who would profit from it. I am not arguing that I know for a fact that it will occur within a given time frame. I am only arguing that the OP has a very legitimate concern given the interest in automating anesthesia, when coupled with the technological advances that have already occurred. I feel the only thing that can be said for certain is that Robotics and AI will drastically change a CRNA job description. Whether that is primarily augmentation or complete replacement I don’t think you nor I can say for certain. (That being said, I am definitely rooting for you to be right about the cyborg technology assimilation ?) "We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don't let yourself be lulled into inaction." - Bill Gates

I feel like the horses in the 1800's told each other the same thing. They thought they had job security because the horse and buggy would always require a "horse component". Excluding the horse power comparison in cars, that turned out not to be true ?. But on a serious note, I would respectfully disagree. In nursing school I briefly considered CRNA and ruled it out shortly thereafter when I read an article about "Mcsleepy, the automated anesthesiologist" which started being used live in surgeries back in 2008. Personally, I believe it's only a matter of time until it doesn't require a human component and I think it's next to impossible to say with any degree of certainty that it wont happen within your career timeframe. Use cell phones for example. Moores law (which states the number of transistors in a dense integrated circuit doubles about every two years) took the cell phone from a brick in 1993 to me being able to use my Galaxy Note 4 in virtual reality goggles too see a panoramic view of mars (as seen from the mars rover). I don't think anyone could have predicted how quickly the technology progression would happen and what changes would occur as a result. There are tons of articles out there about jobs that are more likely to be automated vs those that aren't. The general trend I see is that jobs that rely heavily on interacting with (conscious) people seem to be the hardest to automate at this point. Long answer short, I don't think anyone could answer your questions with any degree of certainty but I would be worried about the fact that they are already trying to automate anesthesiologist / CRNA.

What sub-specializations are available for PMHNP. The ones I can think of off the top of my head include ............ Forensics / Correction Telepsychiatry Perinatal Psychiatry Addiction LTC Geriatric Pediatric Private Practice I am curious if anyone could offer some insight into what all is available to someone certified as a PMHNP. Thanks

It was a somewhat hard choice for me. I enjoyed working at ACT and really liked the autonomy. There was two main reasons. First, we had a really good program direct that moved up in the company and he replacement was unethical and incompetent. She was fired, about 6 months after I left, for both of those reasons. Second, my overall plan was always to get well rounded psychiatric experience under my belt before going to Psych NP program (which I am finishing up now). Having experience in the ACT program as well as at an Inpatient locked unit has been EXTREMELY useful every step of the way in my PMHNP program. So, either way, I am very happy with the fact I got some experience working in a ACT program and feel I am better for it. I keep in touch with my previous coworkers at the ACT program and would certainly consider going back as a prescriber if the opportunity presented itself (minus the terrible program director ?)

I worked at an ACT program for about 1 yr before moving to an Inpatient setting. I thought it was a really good model for how to treat mental illness. It not only treated the illness itself, but also the aggravating factors that may be contributing to it. Where I was at, we has nurses, Psychiatrist, Social workers, Housing specialist, Employment specialist, and Peer Support. I feel like I had much more autonomy working at an ACT program when compared to inpatient setting. A typical day....... 0800: morning meeting where we go over each patient one by one, decide what needs to be done for them, see the last time they where contacted to see if someone should check in with them During the Day: Tasks include seeing Pt that live close and walk in. Driving to Pt home to give them their bubble packs and do quick psych assessments. Also give LAI if they are due. Often take Pt to medical appointments if they have one. Also, if we have Pt on something like Clozaril, we may take them to Labs if they aren't able to transport themselves. End of Day: If you have some Pt that live on your way home we would leave a little bit early and do that on our drive home. I can only speak for the one I worked at so I am not sure how similar or different they may be. For me it was a very good experience. It was my first job as a new grad nurse. I will tell you, people seem to be pretty curious when this is on your resume. I think it more has to do with it being somewhat of a unique place to work. I get asked about it quite a bit. There where a few occasions that got a little sketchy but overall I really enjoyed it. learned a ton, got to know each one of my patients better than I would if I had worked anywhere else, and actually feel like I did some good. If you want to prepare yourself for it, I would get the books 1) Memorable Psychiatry 2) Memorable Psychopharmocology 3) Medication fact book for Psychitric Practice (these are the ones I am using in my PMHNP program right now). I think if you read #1 & 2 and kept #3 on you to look up any meds you arent familiar with you would be set. If you have any other questions let be know. I will answer them the best I can.

Thank you for the suggestion. I just got in the mail and it looks like it will be a good resource

Thank you very much for your response. You gave me a lot to think about. I went back and forth on going to Med school vs NP route and ultimately choose PMHNP for a number of reasons. That being said I don't plan on stopping there. I am still fairly young so Med school wouldn't be out of the question. I guess the way I look at right now is there is nothing stopping me from getting as much as I can out of self studying from recommended resources used in med school (First Aide, Sketchymicro/pharm, Pathoma etc.). I am doing this in my NP program and studying well beyond what is expected of me to try to make up areas I feel I am weak in. I understand that would in no way be equivalent, but its the best I can do without going $300,000 in debt. In my mind, PMHNP is a fulfilling career that I feel I would enjoy and would provide an income that allow me to pursue other interest as well. Thats the plan at least, but like I said I am keeping an open mind because anything could happen and I am sure I have not considered a lot.

The reason for this post is that I will be starting a "Physical Assessment and diagnosis" course next semester. For those who have previously taken this course, was there any resources (books, websites, etc) that helped them during it? I find that there are plenty on Patho and Pharm but cant find much in this area. Also, was there any specific technique that helped you during this course?

I am trying to keep an open mind to where my career may take me. I enjoy learning & working in psych (and science in general) so working as a PMHNP and research are both very appealing to me. Although I don't want to teach at this point in my life, I would like to at least have the option in the future. Several Psychiatrists I work with round on patients in the hospital, participate in research studies being conducted by the hospital and have small private practices on their own. As of right now I'd like to do something similar but am keeping an open mind to things that I may not know about or be considering given my lack of experience in the field. I am more or less am asking in the above question if those with experience view my tentative plans are realist and/or worth while to pursue.

ECHO ECHO ECHO echo echo echo..........Crickets

I reluctantly agree with you guys lol. I don't really have any interest in working as a FNP, I just wanted the certification and knowledge that comes with it. To be honest, I didn't give much thought to reimbursement rates and education cost. Seems like the return on investment would make it not ideal. So, if its not something I plan on actually utilizing, it seems my time would be better served focusing on something else. I appreciate you guys giving me a dose of reality.

Neuro Guy, Thats a good point, I have been doing some more research and found a few that are more 'psych geared'. Also I may take another look at some of the psychology programs that have specializations in cognitive, behavioral or systems neuroscience. If I may ask, I am assuming you are a PMHNP with a degree in Neuroscience as well. How have you used this education combo ? What setting do you work in ? Did you find it beneficial ? Did you education make you uniquely suited to work in a particular area ? Thank you for taking the time to answer

I mean no disrespect, I am not talking about you in particular. Just offering my 2 cents. From my experience, I find that in psych your level of boredom is directly related to what kind of nurse you are. There are a lot of people who see the profession as glorified babysitters and stay in the nursing station, see the patients the minimum amount of time, chart and then go home. On the flip side you have those who hate charting because it takes away from their time to interact with the patient, learn how to communicate, and de-escalate. Charting is important for your job, interaction is important for your patient. The nurse can choose to interact or not. For example, I have a patient that the last time he was in he got me really good with a headbutt. That was a while back. Today, if he starts to escalate I am able to calm him down because he trust me and I have good rapport with him. That didn't happen from me staying in the nursing station being bored. That took a lot of time and effort to develop. My advice would be if you are bored, then you most likely aren't doing it right. You should be honest with yourself and decide if you are suited to work in psych. Nursing is a huge field and there is no sense to stick to a career you are not meant to be in. Psych can be an emotional roller coaster that not many people are cut out. Doesn't mean anything is wrong with you as a person (probably means you are the normal one in fact lol). Just means it might be worth it to move on to something else.

Understood, I am not trying to be over optimistic about the profession. Many improvements need to be made, especially in education and quality variations of NP programs. There should be less fluff and more hard science courses (like PA programs). I guess I was just trying to make the point that NPs have a role to play in the healthcare system. Just like MDs, Nurses, Physical therapists and Nurse assistants. I will be sure to come back and update this post when I lose that optimism in the future LOL : )