Really on the fence about pursing MSN...

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Hi all! I have been an RN for 5+ years, and after about 4 years of serious contemplation, I am now really considering pursuing my MSN and becoming a Psych NP. I have no doubts it would be beneficial for my life personally, and I originally started my nursing career with intentions to become a practitioner. I already have my plan for school and there shouldn't be too many problems executing it.

However, I am a bit of a curmudgeon with the current healthcare system (shocker), and I know the creation of the PMHNP role is to prescribe/adjust meds (revolving door type patient care) to help address the deficit of MDs pursuing a psychiatric residency. Which I believe, like all things, there are pros and cons to. My personal beliefs tend to stray against this, and I could see myself getting easily morally worn if this is primarily what I'd be doing. I'm not sure if it's worth in it that case. I did meet a PMHNP last year though and when I asked her, she held the same beliefs as me but had a different perception: "It's still primarily Rx focused, but at least I can come in and try to take them from 6 meds to 3, see what's really working and use a new approach, etc.". I praise her positive outlook, but not sure how long my cynical butt would see things that way. Like many, I see most treatment we're doing in Western medicine as bandaids, not getting to the real issue. All in all though, I strongly believe I would be an effective PMHNP, and I'd love to teach academic nursing as well. The program I'm looking at is respected and affordable, about 30K. At the worst if I get tired within a few years, I could pay back my education, and then go full-time teaching (which I know I enjoy). I also know a lot of nurses that got fatigued very quickly at the RN level, but going to graduate school really helped renewed their spirits and appreciate the nursing profession more - that sounds nice...

Finally, a lot of days I think about sacking nursing completely and finally opening my own coffee shop/cafe or working part-time selling my homemade soap, being a yoga instructor, and working at a library. :bored: Sigh...

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Specializes in NICU.

What is your question?

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More dialogue, I suppose. If I had to choose a question, it would be do current PMHNP find their work fulfilling, what are the pros and cons for them, etc.

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Specializes in CVICU, MICU, Burn ICU.

I don't have any wise words, but I do appreciate your perspective and thoughtfulness. I am on the cusp of grad school myself for FNP and I struggle with a lot of the same thoughts you expressed. And for me, I'm NOT in a place where I am feeling burnt out on bedside nursing. I actually love it and I love my current job situation. But I'm the age where I have to fish or cut bait on the NP thing. I also aspire to move back home in the not-too-distant future -- which means I will have to leave the job I love here -- and I've been around awhile to know that I may have a very hard time finding such an ideal situation as a bedside RN. But then how will it be finding a job as an NP? Sometimes I just feel like I'm too old to take crap or work in an environment that challenges my ethics by the very paradigm it operates under. But I also know I can't affect change in a place I refuse to go to.

We are ALL such babes in modern medicine. There is so much we don't know and still need to discover. One hundred years from now people will be appalled at some of the stuff we do today. Evidence Based Practice is the guiding force of advanced practice nursing --- and that doesn't mean there aren't better ways and it does limit practice, but in a nursing world where there is no such thing as a "standard" preparation/training of the NP, we have to start somewhere and EBP is currently the firmest foundation.

How that would effect a PMHNP who is pharma-shy --- I do not know. For FNP, I plan on modeling my practice after the pharma-conservative/ integrative-minded physicians and NP's who inspire me to move forward despite the very imperfect waters we are all swimming in.

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Cheesepizza - I'm not a PMHNP but my understanding is that Psych NPs often work in jobs where they are just prescribing with 15 minute patient visits all day long. But there are other options for PMHNPs where the NP is not just doing meds. I read about one NP in Seattle that works with hospital inpatients making sure that their psych meds work while they're inpatient and consulting with their physicians. Other options are working in inpatient Psych facilities or addiction/comorbidity treatment centers, the VA, working with a collection of nursing homes being the psych provider for all the residents.

The other thing is that while PMHNPs are qualified to do "talk-therapy" most don't, mainly because it isn't the most lucrative and many PMHNPs aren't excited to do it. But you may be one who wants to include talk therapy because it may give you more satisfaction.

So, my point is that you should be able to find or create a job that is NOT just prescribing/adjusting meds in a revolving door situation. You may not get that job as a newly graduated/licensed NP but after you get experience you may be able to find or craft the perfect job. Perhaps you can work, for example, inpatient with three-12 hour shifts a week and then start your own practice one day a week. You can build your own practice over time. (In some states, you may be able to do this independently, in others you may need to affiliate with an MD/DO).

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Specializes in Family Nurse Practitioner.

Overall regardless of the setting, unless you open your own practice and are willing to work for reduced reimbursement to do therapy, the role of a PMHNP is medication management only. Something to consider about becoming a NP now is that the market in many areas is becoming saturated, opportunities as well as salaries are reduced and will likely only get worse. I'm not sure teaching as a plan B is any more secure now with masses of DNPs who are graduating, looking for a non-patient care position and have the credentials to teach. That would actually be an interesting topic.

Have you considered a MSN in social work? They work in the same settings and are paid to do therapy, group therapy and non-med treatments such as EMDR.

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Specializes in Tele, ICU, Staff Development.

You could make a difference with your values.

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Your responses and the time you took to write them are all very appreciated.

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Specializes in NP, ICU, ED, Pre-op.

I really think you should shadow someone who is already doing this....It would definately give you a better understanding of what you will be doing prior to officially entering a program. I feel your heart is in the right place as this population is very vulnerable and NEEDS providers that will listen, treat, and guide correctly! GOOD LUCK

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