Therapist or PMHNP?

[heythere]

I know this question has been asked a few times, but I am looking for fresh perspectives. I am a senior at university, and I know I want to pursue a career in mental health. I am interested in becoming a therapist or PMHNP (I'm going to choose one or the other though. It would be a waste of time to get both degrees). I'm just not sure which route to pursue? I love people, but I am pretty introverted in the sense that I get exhausted in overstimulating environments. I would really like to work outpatient where I have my own office that I can see clients in because I think I can preserve my energy in that kind of setting, enabling me to be the best clinician I can be.

I am concerned about the therapy route because of how unstable the field is. They don't make very much money. This isn't a huge deal to me, but it is pretty disheartening to go through a graduate program and 2 years of licensing to make $40k a year when an ADN can make more. It can be hard to find a job, too. I have done my due diligence and spoken with therapists and LPC interns, and the sense I get is: Yes, this field can be financially stressful, but it can get better. On the flip side, I am hearing about the anticipated glut of PMHNPs. Does this claim have any grounding to it?

I also am interested in having prescriptive authority. I took a Chemical Dependency class, and we went in depth on how drugs work in the brain, detox, and basic psychopharmacology. I LOVED it! Science is something that takes longer for me to wrap my head around, though. I took A&P I and did well, but I did have to study a lot. If I did go the PMHNP route, I would still be interested in doing therapy eventually. I have seen some PMHNP's continue their education so they can practice therapy. I understand insurance companies won't cover this, but I like the idea of one day at least having the option to do therapy.

All of this being said, I have looked into direct entry programs. I know they are highly controversial. I just don't see myself being an RN. I think very highly of RNs, and I would love to do the job if I could, but my introverted/easily overstimulated nature is not conducive to the environment RNs work in. I hope this makes sense. I truly want to be a well-educated clinician. I don't want to just skip the RN portion because I am ignorant to the value of having RN experience. Is it possible to be a well-trained clinician without that experience? Because I don't see myself as an RN, could this be indicative that I shouldn't consider the field at all?

All of that aside, I am concerned about the price tag. It makes me extremely nervous to think about taking out loans as big as I would need for a direct entry program. Is it possible to pay those loans off without a significant chunk taken out of your income? At that point, would I still be financially better off than a mental health therapist?

Thank you so much for opinions and perspectives. Please know my heart is in the right place.

[NurseNotRatched, ADN, BSN, CNA]

Congratulations on your senior year of college. I am a 2nd year graduate student in an MSN program for psychiatric mental health nurse practitioner (May 2019).

The route you take ultimately depends on a combination of how much money you want to make or how much therapy you'd like to incorporate in your professional career. PMHNPs utilize both non-pharmaceutical psychotherapeutic modalities as well as medication to treat people. Upon finishing a psych NP program, you operate in BOTH roles as a therapist and a prescribing clinician; however, the focus of the PMHNP and how you get the MOST out of your degree financially is medication management. You cannot bill for both medication management and psychotherapy at the same time so you essentially have to choose...and unfortunately, meds pay more so that is basically what you'll end up doing 95% of the time. In my outpatient clinical site, the PMHNP sees the patients for med management and initial consults and the patient then has to schedule separate appointments to see one of the therapists in the office. Some of my school faculty have their own practices and offer therapy modalities but they are seasoned, make their own schedules, and offer therapy sessions on certain days or through telepsych. They have also mastered billing and coding.

If you want to keep your options open and want to do therapy with the option of being able to prescribe and do not mind making less money, I would go with a psych mental health NP program. As far as cost is concerned, state university programs offer the best in tuition but there are reasonably priced pmhnp programs available considering we've been told the *minimum* starting pay for new grad pmhnps should be no less than $110,000 per year.

[Guest936851]

On 10/23/2018 at 2:14 PM, txgal27 said:

On the flip side, I am hearing about the anticipated glut of PMHNPs. Does this claim have any grounding to it?

All of this being said, I have looked into direct entry programs. I know they are highly controversial. I just don't see myself being an RN. I think very highly of RNs, and I would love to do the job if I could, but my introverted/easily overstimulated nature is not conducive to the environment RNs work in. I hope this makes sense. I truly want to be a well-educated clinician. I don't want to just skip the RN portion because I am ignorant to the value of having RN experience. Is it possible to be a well-trained clinician without that experience? Because I don't see myself as an RN, could this be indicative that I shouldn't consider the field at all?

I'm just going to be frank. When I was in my BSN program w/o any RN experience, my view of direct-entry programs was a lot more favorable. I had a similar attitude toward floor nursing.

However, having now worked as a psych RN for some time, I wouldn't recommend entering a PMHNP program without at least some floor experience (preferably in psych).

Is it possible to be a "well-trained clinician" without RN experience. I'm not here to say it's impossible. But, when someone calls you up in the middle of the night asking for authorization to give chemical restraints to a patient, do you really think you know what it is you're ordering without having been on the floor and seen many patients that need to be restrained and been hands-on involved in the restraint process?

Let me give a simpler example. Many of the psychiatrists at my current facility are in the habit of ordering ODT tabs such as Zydis for psychotic patients. Theoretical wisdom says that ODTs are often better because they prevent cheeking and promote rapid absorption. The trouble is that many of my patients are A) So confused and disorganized that they cannot be instructed to let a tablet dissolve on their tongue so they swallow it anyway and B) The tabs dissolve too slowly because they don't drink enough water throughout the day.

It would be much simpler to just prescribe a standard tab form and have the nurses check for cheeking. Why do the psychiatrists continue to prescribe the ODT forms so often? My sense is because they don't actually know what's happening on the floor.

If there is one advantage advanced practice nurses should have over physicians (new physicians in particular) it should be experiential or phenomenological knowledge of the patient and health care world gained through experience as an RN.

As for a glut. I won't really answer that. But, I will say that the more programs there are that have low entry barriers with no experience required the higher the chance that there will be a glut. And worse, there's a chance that it could ruin the reputation of the profession in general.

[Hany Sabban]

On 1/23/2019 at 11:07 AM, NurseNotRatched said:

Congratulations on your senior year of college. I am a 2nd year graduate student in an MSN program for psychiatric mental health nurse practitioner (May 2019).

The route you take ultimately depends on a combination of how much money you want to make or how much therapy you'd like to incorporate in your professional career. PMHNPs utilize both non-pharmaceutical psychotherapeutic modalities as well as medication to treat people. Upon finishing a psych NP program, you operate in BOTH roles as a therapist and a prescribing clinician; however, the focus of the PMHNP and how you get the MOST out of your degree financially is medication management. You cannot bill for both medication management and psychotherapy at the same time so you essentially have to choose...and unfortunately, meds pay more so that is basically what you'll end up doing 95% of the time. In my outpatient clinical site, the PMHNP sees the patients for med management and initial consults and the patient then has to schedule separate appointments to see one of the therapists in the office. Some of my school faculty have their own practices and offer therapy modalities but they are seasoned, make their own schedules, and offer therapy sessions on certain days or through telepsych. They have also mastered billing and coding.

If you want to keep your options open and want to do therapy with the option of being able to prescribe and do not mind making less money, I would go with a psych mental health NP program. As far as cost is concerned, state university programs offer the best in tuition but there are reasonably priced pmhnp programs available considering we've been told the *minimum* starting pay for new grad pmhnps should be no less than $110,000 per year.

Hi, I am considering BSN- PMHNP at UNCW or Chapel Hill. I am waiting for approval. Do you think UNCW support PMHNP students with clinical placement?

Thank you.