Torn between two decisions, advice appreciated.

[thekid]

Hi all,

I'm an RN with licenses in Hawaii and Arizona. I never worked med/surg and was hired into hospice when I graduated many years ago. Due to some burnout issues, I went on nurse hiatus but was reinstated in 2011. Without any recent clinical experience, I was hired into a case management job and I enjoyed certain aspects of it, mostly the autonomy and working from home. I did medical and then later worked strictly with the behavioral health population. I love everything about psych nursing, I've never worked in a hospital in psych but was familiar with a lot of it because case managers were directly involved with admissions, medication management (which I loved) and discharge/follow up. The main challenge of course being that our population was not compliant with treatment so I felt like I was more a clerical personal assistant than a nurse. I have thought about applying to the psych hospitals in Hawaii where I have lived for 10 years, but it's hard to get a foot in the door, and also because I had a gap in employment, and am a A.A.S. nurse (no BSN), I'm up against a lot of obstacles.

I've often considered studying for my master's and working as a psy NP . I seem to have a knack for the medications and anything psy related, and had a decent insight into community nursing as a case manager.

Being 44 years old, with no savings, an 8 year old in Hawaii, I feel like my choices are a bit limited. Of course I wonder if I'm too old to pursue a master's and would that be tough for my 8 year old. His father and I are not together and while his father is helpful with child raising, he is based in Hawaii and he has never really taken my nurse work seriously, in other words I've always tried to find nurse work that works around his schedule. I feel life passing by and have decided that if this is something I really want to pursue, that I need to do it soon.

What I lack on resume experience, again I make up for with an intuitive knowledge for psy disorders and management. I've often felt like I have not worked up to my potential academically and professionally, but then again with a young son, priorities in life change.

I've considered getting licensed in other states and to attempt travel psych nursing (inpatient) but I know that may require me to leave the state. My other family lives in Arizona and there are a lot of psychiatric hospitals , and even with my lack of experience inpatient, some of the recruiters have acknowledged that case management would be considered an asset. Potentially, I could build up experience in Arizona then look into travel assignments.

I want to remain flexible with options to accommodate my son.

But the voice in me from my 20's keeps saying that if I wanted to be a psy NP, then go for it. Financially I cannot afford it so I would have to apply for loans. I imagine it would take three years of academic work and then I would be a newb NP . I don't know where I'd go to school (Hawaii does not have a psy NP program, only general NP). And I don't know where I would work after I graduated. It is very hard to consider leaving the island because it is just as important as any career.

Are the online NP programs reputable, would it be possible to remain here and complete an online program?

Or should I focus on gaining more "resume" experience by working as a psy RN inpatient (although I really felt I learned a LOT with case management because we were in the field alone ). I'm not new to crisis intervention or deescalating patients. I understand milieu in hospitals, I know what a COWS assessment is, how to score for suicide/harm to self to direct a one on one, I have done med passes as an LPN in nursing homes, as I mentioned as a case manager I spent a lot of time in psych hospitals here so I'm not new to it, unfortunately hospital staff often views case managers as the go to when stable housing cannot be found or a pt is noncompliant with treatment. I've seen both sides and I understand the insurance side as well , having working in medical case management/ UM.

Personality wise, I'm confident in what I know but I respect the experience of others. I felt frustration when I didn't agree with a treatment plan or a doctor's change in medications. I work very well by myself and have always enjoyed the creative problem solving "overall" planning for pts. I quickly pick up on the gaps and barriers in healthcare and prefer working towards long term solutions . Although I spent time as an LPN in LTC, and I know how to task, "clinical" skills have never been my favorite part. I enjoy pt contact but am seeking a role that is more comprehensive, more autonomous, and possibly more authority (hate that word) . It's not so much that I want to write scripts as that I enjoy the entire management of care that can be customized for each person . A lower patient case load with more intense long term care is my ideal.

And I like to write :)

Wow, that's a lot, and I certainly don't anticipate an easy answer. I know the obstacles with where I live and being a mom, yet I'm not sure working to be a psy NP is the best choice. I've often heard psy RN's state that they enjoyed being an RN but they LOVED being a NP. I know it also comes down to a matter of deciding what is most important, and that's the tough part. I want the best life for my son but I don't want to pass by what may be something very satisfying.

Because of where I live (and love it) and lack of savings, I think the part that concerns me the most is, what if I earn the master's and don't enjoy the work? For many many years I felt that way as an RN, it was before I worked in psych and I never felt a pull towards ICU or ER . Hospice nursing was something I enjoyed because I agreed with the mission, but psy has been the only area that I've felt I was in the right place. I don't want to go into debt and find out psy NP is not how I imagined it would be (again just like when I became an RN) , then again I don't know if I would feel challenged enough working as a psy hospital RN (and that is in no way meant as if to sound that psy RN's are not as smart or important).

I've spent quite a lot of time looking into the role of the psy NP but I guess you just don't know if it's a fit until you are in the shoes.

Thank you, any input or words from the experienced are welcome. I know what I want in theory, but is it reality?

[Psychcns]

It strikes me on reading your post that you have these internal longings for more challenge and responsibility in psychiatric nursing and no support. Is there any way you can take some prerequisite courses and see if you like online learning. Do you have any psychiatry mentors? Are there psych np jobs? I think you want to do it. There are a lot of online psych np schools- you can do a search on this forum. Maybe the state schools in HI have options you have not considered. Do not spend a lot of money! It is reality once you start taking concrete steps. Best wishes!

[thekid]

Thank you for your encouragement :) I am glad that is is apparent from my post that I take the decision seriously and do enjoy being challenged, and yes, I have many obstacles. We have a general family NP program in Hawaii, I wonder how many nurses have gone this route then specialized in psych later (if that is possible). Not that I agree with it but I know of a lot of general practitioners who prescribe psychiatric medications .

Unfortunately I do not have any mentors and my previous psych case management experience did not leave me with many contacts/references because we worked independently . Admittedly we had a high turnover rate , the social workers would stick around but the RN's left within six months, not just because of the pay but because of the management. Surely other RN's have left positions due to poor management, but it's not the best thing to list on a resume .

Although psych nursing is my top interest, most of my clinical experience has been in long term care. I may try to pick up a few assignments in state so I can build references again. Once I'm out there in a job, I am excellent at networking and dropping a business card on the desk of medical directors, DON's , etc.

I enjoy the entire management of care, from initial assessment to complete/ongoing follow up, referral to community resources, etc. In that aspect I enjoyed case management but unfortunately our caseload was too high, the acuity was determined by the insurance company (and did not reflect accuracy at all, I often spent more time helping the "once a month" pts because many of them knew how to work us and work the system, then complain and switch case managers, or agencies. Of 40 people, I had two that I was fortunate enough to assist and get them stabilized on medications, get them to visit their GP to follow up on other health concerns, and enter the work force again. I was very happy. Many of the patients were in the CM program as a requirement to receive other state benefits, so they were noncompliant or missing in action. I had one guy who would show up once a month, collect his SS check, then disappear. I understand programs have imperfections, but I suggested to the company and the insurance company to consider hiring an intern or student at a lower wage to process the non-stop housing applications and to update the large stack of paper files in the office that were outdated by a few years. It was a big mess and I made many suggestions to the companies during IDT meetings, that is where I excel.. once I understand some of the process , I can see what needs to be fixed and have possible solutions .

I have been looking into online programs too, as I would be happy to take a few classes while I continued to work as an RN . I'm just not sure if online MSN/NP programs are reputable or considered satisfactory so that when it came time to look for a job, an employer would not consider a candidate who attended a brick and mortar school. I learn very well on my own, I have the discipline to study and research on my own and I would even try to challenge a few classes and see if I could test out of them, or at least receive credit for my field experience.

That standard "two years of recent experience" is the real bummer. I understand why the standard is there, but I'm able to pick up on things rather quickly, and despite the fact that most of my hands on clinical in long term care was years ago, I have worked a variety of facilities and am adaptable. My first job as a CNA and LPN was through a staffing agency in Arizona. I had zero experience but I was hired and sent to various facilities (and home care environments) around Arizona, when I tested and received my LPN license, my agency manager did not hesitate to send me right out to work as an LPN. It was scary but I did it.

Again thanks for your encouragement :) I need to start by updating my resume and focus on what I have done as a lifetime career as a nurse, despite their preferred requirement for two years of recent experience. The right manager will see the continuum of my experience in various settings and consider it an asset .

As far as psychiatric nursing, although I lack on paper the inpatient hospital experience, the right recruiter will see the strengths of having worked as a case manager . Community nursing really broadens one's resources and skills, perhaps as I work towards the psy NP role, I'll end up taking a position as a public health/community PNP as opposed to working in a hospital . :)