Psych nurse practitioner - page 5

I just got accepted into a psych nurse practitioner program....However, I now have a second thought on accepting it after talking to a couple of PA and MD. I was told that unless I have some sort of... Read More

  1. by   zenman
    I was in an independent practice state working in a hospital. I did involuntary commitments for up to 7 days all the time (ED admits) without consulting anybody. After that the psychiatrists had to sign the papers for commitments to the state hospital if we thought the patient was still a danger to themselves or others, otherwise they would be discharged within that 7 day period. And I was usually the one writing up the commitment papers for the psychiatrist to sign. Fortunately, the psychiatrist had to go to court. Not something I wanted to do. Another thing you need to consider is that you may be more valuable in an independent practice state. Many of the physicians were hacked off at my medical director because they had to sign off on all the orders made by PAs. My med director didn't have to do a thing with my work...and she loved it. And I was hired over another psychiatrist.

    Now I'm in a state where NPs have to have a collaborating physician. I'm working for the military so that's a moot point but I've made up my mind to head straight back to an independent practice state as soon as this gig is over. It's just so much less hassle.
  2. by   harmonizer
    Please note that the laws about involuntary commitments & forced treatments differ from states to states, even among independent practice states. Zenman, I think you talked about emergency involuntary commitment only. There is another procedure called "court-ordered treatment" for chronically mentally ill people in outpatient settings/non-emergency purpose. The step must be renewed and initiated by a psychiatrist only.

    I don't like that almost all independent practice states are either freezing cold in the winter or covered by deserts.
    When will the good ol'southern states & California with excellent and hospital weather turn into independent practice states for NPs, hopefully by next decade?
    Last edit by harmonizer on Jan 1, '13
  3. by   nurse*sunshine
    There is a reason you will see more jobs listed for FNPs than PMHNPs. A greater portion of the US population is treated for chronic medical conditions than chronic mental health conditions. Greatest demand is not determined by the amount of practice opportunities.
    I have found job listings all over the US with very good salaries for both FNPs and PMHNPs. I researched your claim about salaries and found several sources that listed the average salary for PMHNPs as higher than FNPs but nothing to support your claim.

  4. by   Miss PsychNP
    I agree nurse*sunshine. I have worked in Ohio, Missouri, Arkansas, Oregon, New Mexico, West Virginia, Tennessee and now Maryland as a Psych NP and made a very good living. I am now certified as a FNP and the offers were quite by 20k less than what I make now. One company offered more only after they realized I was an adult psych turned family psych add fnp. Then and only then they offer more money....but it was still less than what I make now working only as a Psych NP. My advise to the person having second thoughts is to do what you love. I love working in psych and it wasnt the money that attracted me into the field...but it certainly hasnt hurt either!
  5. by   myelin
    Wow, this thread is full of really interesting comments and info. Miss PsychNP, what prompted you to earn the FNP cert on top of psych? Did you get sick of psych or was is that you wanted to address both the physical and mental health circumstances of your patients? I'm curious because I think I might eventually want to add FNP on as well (I'm on the FPMHNP track now). Do you find maintaining both licensures difficult? Thanks!
  6. by   Miss PsychNP
    I initially wanted to obtained both certifications but went ahead with the adult psych, then earned the family psych to finish with the fnp. I have always loved integrated treatment (medicine) and found out of necessity that I had to learn how medications prescribed for physical health conditions can affect psychotropic medications.
    No...I would never get 'sick' of psych. It is really my calling. I think you need to have a strong understanding of either even if you choose to work in only one field. As a Psych NP, I have encountered a patients in my appts with medical crises that could easily go unchecked like a child diagnosed with ADHD and Disruptive Disorder of which she had neither, but instead suffered from convergence insufficiency resulting in her inability to read (no even the pcp picked that one up) so I referred her to an opthamologist.
    No it is not difficult to maintain both certifications. I work 3 days as a psych np and 1 day as a fnp. Once I finish developing an integrated clinic, I will split two days to provide patients an opportunity to have primary care services. In Maryland, I cant work as both at the same time and must specify how I split the time (weird).
    Adding FNP is not for everyone...I choose to work with undeserve populations so having two certifications to provide primary physical health and mental health allow me provide services to those with limited access to care.
    Good luck with your studies!
  7. by   kris_10
    I'm not even a nurse yet, but I work for a psychiatrist and when I mentioned that I was interested in becoming a psych NP, they actually already said they would hire me if I become one, because the demand is so great! The waiting lists for psychiatric treatment stretch out for months, and I'm not even in an 'underserved' area.
  8. by   myelin
    Thank you Miss PsychNP for the reply. What you're doing sounds exactly like what I'd hope to achieve at some point in my career, though I plan on working as a psych NP only for several years (pay down my loans, etc.) before going back to become a FNP as well.

    Hey ReInventor, I'm curious. What part of the country are you in (or if you're willing to share, what state)?
  9. by   Miss PsychNP
    You will be just fine in your studies as you are asking the right questions. I was fortunate as I worked for a university hospital system that paid most of my initial training for BSN, MSN. National Health Services Corp paid for the rest! (Post-Masters, DNP) , so no loans for me. Depending on where you want to work, you may want to consider the Corp. The money is tax free and it can pay your debt down fast. 4 years 120,000. I had a great experience, moved around the country and seen some cool places...not the horror stories you might of heard.
  10. by   myelin
    Thank you so much for the support and advice, Miss PsychNP! I know I'm fairly early in my studies to be thinking this far ahead, but I can't help it. It sounds like I should relax, because there seem to be plenty of jobs that pay well and many options for loan repayment. Plus, after having a positive conversation with some classmates ahead of me in the MSN program (there is, apparently, work for per diem/part-time RNs in the bay area, afterall), I'm not as concerned about having absolutely gigantic loans to pay back (they will hopefully just be sort of gigantic, haha!) It sounds like I will be able to work part-time as a RN during the PMHNP portion of my program.
  11. by   Miss PsychNP
    You will definitely be able to work.
  12. by   FLMurseRN
    This (Psych NP) is what I want to do ultimately. Please feel free to continue this thread.
  13. by   Ellen NP
    I can initiate involuntary commitments, lead an ACT team, etc. I cannot administer ECT...only physicians can do so. I grew up in California but like the cold New England winters. Portland, ME is pretty liberal although the state leadership currently is embarrassing. We can practice and prescribe independently according to state law. A number of facilities still will require physician supervision although the other physicians all have supervisors, too. I independently admit patients to one of our three attending psychiatrists. The residents have the same limitations on their admissions. In fact, the outpatient attendings in our organization do not even have admitting privileges. They have to send patients from their office to the ED or (occasionally)for direct admission by me, a PA, or a resident.

    I think that you really have to look at each position and each organization as well as the state laws when choosing where to practice.

    If you want to do primary care then go with the FNP. You'll be able to do a lot of uncomplicated mental health and there's actually a new certification in mental health for pedi and FNP's. It's offered through NAPNAP. If you really want to do psychiatry then the PMHNP is the way to go. I initially trained as a pedi NP but missed psychiatry and went back for my PMHNP. Since I work on the consultation liaison service and cover the inpt med-gero-psych unit I still get to do lots of medicine. I definitely need my medical experience in this job.