RN or PMHNP?

[eventualnurse]

Hello,

I'm so glad this site was recommended to me, this is so helpful and I'm so excited to eventually join your ranks!

I am looking at nursing programs and have so many interests and aspirations - which it seems nursing can accommodate for - but I'm drowning in options and ideas and I don't know what's realistic and which step to take first. So, maybe some of you can offer a little advice. Bear with me please, there's a lot here and it's probably pretty naive, but that's where I'm starting from.

What I do know is that...

- I definitely want to be able to go abroad: maybe crisis/disaster relief, maybe to teach, as it seems like an ethical and helpful way to live abroad.

- ER, community nursing, correctional nursing and rural nursing appeal to me.

- I would like to be qualified enough to work in good hospitals in major cities, should I decide to come back and settle down in one.

- I'm really looking forward to working with the body but also believe very much in the inter-reliance of mental and physical health. I'm really interested in mental health, mindfulness, the de-stigmatization of mental illness, gender identity, women's health/reproductive health, and generally, social justice and equality.

- I know that I would also like to get my Masters in Oriental Medicine and Acupuncture (MSAOM).

So...

Option 1 is to go to Carrington for my ASN. It's a for-profit school with an accelerated RN program. It would be quickest and easiest but it's expensive and you just get an associates.

Option 2 is a direct entry Master's Program (I have a BA in International Relations) and I'm looking at a PMHNP program (Vanderbilt specifically).

I don't think I want to do strictly psych, and I think I want to start my nursing career working more with the body to get used to gross sights/smells/bodily functions, high stakes stress, and the intimacy of working with vulnerable patients. Also, I'm not interested in being fresh out of school and in a position of authority.

But, psych does seem really relevant and useful for everything I'm interested in, since some form of psychological trauma is almost always involved (disaster relief, forensic nursing, community, correctional, rural even...). Also, if/when I do eventually want to be in a position of authority, I think I would most like to be able to intervene in issues of mental health. It also seems like it would be a useful skill for teaching abroad as mental health is approached so differently all over the world and there is so much stigma attached to it. Also, I'm interested in how acupuncture and other holistic, gentler approaches can be applied to mental health (in conjunction with standard treatments).

So, I'm thinking that the skills learned as PMHNP might be useful to have, even if I don't want to come out of school and be a Psych NP. It also seems like a Masters is just a really good thing to have as a general resume requirement for upward career mobility and/or working in a good hospital in a big city.

But, is it even possible to work as a regular RN with a PMHNP? Are the skills I'm hoping to get from the program realistic? Are they actually applicable to the other fields or would the PMHNP education be mostly about prescribing meds? Would having an PMHNP make me a desirable RN and give me access to more hybrid positions or would I just be "over qualified" and the PMHNP irrelevant? Is it a plausible idea to maybe one day have my own small holistic practice as an RN/Pysch NP/MSAOM? Or is that just lofty and impractical? Also, I'm concerned that if/when I decide to really use the NP, say to teach psych nursing abroad, would it be possible that my work history wouldn't be specialized enough if I didn't use the NP in the standard way?

Since I know that I want to do the Master's in Acupuncture, it's a lot of schooling to do the associates RN, Master's in Acupuncture, and then an MSN (it seems like any Masters - not necessarily an NP - would eventually be almost necessary). Going back to school 3 times seems unappealing and daunting, not to mention expensive, so I'm thinking it might be useful to knock out the RN and MSN in one go with the PMHNP, but I don't know if my ideas and expectations are realistic.

If you got through all that, thank you! And thank you so, so much for any input you might have.

[OrganizedChaos, LVN]

Why don't you work as an RN for awhile & figure out what you want to do for sure then go from there. By the way, I've worked in corrections & love it! I have decided to continue my education to PMHNP in corrections

[twinkerrs]

I think you should start with an RN and see if you even like it. You sound kinda indecisive so maybe dipping your toes into nursi

[KatieMI, BSN, MSN, RN]

1). US PMHNP is generally useless beyond the borders of USA, Canada and maybe UK. Too many countries have extremely different approaches to the subject of mental health, to say the least.

2). If you want to go "Nurses Without Borders" or Peace Corps, your clinical and technical skills must be absolutely top notch. As well as you need to have skills of working alone, in the God only knows which condition and without flebothomist, xray guy and CRNA at your service, and no doctor to call in vicinity. One cannot develop all that in direct-entry MSN program without significant previous experience. Therefore, you might want to work as an RN for a while, and at place/position where you can develop independence, such as home care.

3). There are places in the USA preparing nurses to this sort of job. Eastern Kentucky University Rural Health FNP and Saginaw Valley State University (Michigan) FNP have strong rural/community health component and the latter one offers medical mission to Haiti as part of the program. I bet that there are more such places, and you can look where indian reservations, if there are any near you, get their community nurses. But you will need a BSN, and a solid one, to enter one of such programs because, as I mentioned, you might find yourself totally alone at work and still have to do it all and people in these programs know it too well.

[elkpark]

Yes, PMHNP curricula are primarily focused on prescribing medications; specifically, psychotropic medications.

PMHNP education would restrict you largely to working specifically in psychiatric settings and/or with psychiatric populations and would significantly restrict your opportunities to work as a "regular" RN outside of psychiatric settings.

Since you have listed a wide range of interests, you may be better off and have a wider range of opportunities (esp. in terms of working abroad) as a generalist RN with some reasonable amount of experience in both med-surg and psychiatric nursing. That would offer you more of the flexibility you appear to be seeking.

Best wishes for your journey.

[eventualnurse]

Hi all,

Thank you so much for your for time and thorough answers. This is really great. Thank you for the rural health and community nursing university recommendations, KatieMI. And the tip off on home-healthcare as a way to gain independence - I wouldn't have thought of that.

Literally every single person I've spoken to has said NO, don't do the PMHNP but for whatever reason I can't seem to shake it. I'm trying to be rational though. Elkpark, if I am able to work as an RN before I get my PMHNP, (the program I'm looking at offers the specialty NP courses in a part-time format, potentially giving me the time to work as an RN while in school for the NP) would that give me a little more experience to allow for more flexibility later down the line?

Thanks again.