How stressful is Psych NP?

[contemplating2005]

currently work in an office clinic and see a lot of psych patients. A lot of times drug seekers and med management. I would imagine denying them their meds can cause them some issues. I was a psych major in college so always had an interest in psych. Now given the opportunities and potential of psych NP I am wondering how stressful is the job and you could give me a day in the life.

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[pamac]

Heres a perspective to consider. No matter what kind of provider you are, you may regularly have to present people with tough choices. Even easy choices that are presented to difficult people can be just as difficult. And patients with psyche issues are treated by all sorts of providers, not just psych. Those who are in the psychiatric patient population tend to have more medical issues than folks that don’t have psyche issues, so folks in other practices also get their turn to handle psyche patients... maybe even on a more consistent basis. The patient may see their primary care provider monthly for physical issues, and yet only see their paychiatrist or psyche NP for a less than an hour per year total for all their psyche med management after you add up all their 20 minute visits. There are folks that you see more frequently, but most people that have to be told “no” all the time, (especially the ones that would be your biggest headaches to treat), also tend to be the folks that decide to move on in search of someone that will tell them “yes”. If they try to make your life complicated beyond what you feel is reasonable, you cut them loose with a referral to another provider... or you just let them know that you can’t see them anymore...whichever you feel you can risk. But you don’t have to subject yourself to abuse.

Another thing to try to do is put yourself in the mind of a provider. Providers, in turn, try to maintain the perspective that they are there to treat people that are sick, and when you are sick, you might act in ways you otherwise wouldn’t. That realization doesn’t mean people get to heap abuse on the provider, but it does mean that many providers will try their best to be sympathetic to people that are having a bad day. I’ve found that even folks who are behaving poorly due 100% to them choosing to behave that way, rather than compelled by their state of mind, will still be easier to handle.

 

[contemplating2005]

Heres a perspective to consider. No matter what kind of provider you are, you may regularly have to present people with tough choices. Even easy choices that are presented to difficult people can be just as difficult. And patients with psyche issues are treated by all sorts of providers, not just psych. Those who are in the psychiatric patient population tend to have more medical issues than folks that don’t have psyche issues, so folks in other practices also get their turn to handle psyche patients... maybe even on a more consistent basis. The patient may see their primary care provider monthly for physical issues, and yet only see their paychiatrist or psyche NP for a less than an hour per year total for all their psyche med management after you add up all their 20 minute visits. There are folks that you see more frequently, but most people that have to be told “no” all the time, (especially the ones that would be your biggest headaches to treat), also tend to be the folks that decide to move on in search of someone that will tell them “yes”. If they try to make your life complicated beyond what you feel is reasonable, you cut them loose with a referral to another provider... or you just let them know that you can’t see them anymore...whichever you feel you can risk. But you don’t have to subject yourself to abuse.

Another thing to try to do is put yourself in the mind of a provider. Providers, in turn, try to maintain the perspective that they are there to treat people that are sick, and when you are sick, you might act in ways you otherwise wouldn’t. That realization doesn’t mean people get to heap abuse on the provider, but it does mean that many providers will try their best to be sympathetic to people that are having a bad day. I’ve found that even folks who are behaving poorly due 100% to them choosing to behave that way, rather than compelled by their state of mind, will still be easier to handle.

how many years as a RN do you recommend before going to NP school?

 

[Jewels86]

how many years as a RN do you recommend before going to NP school?

Five. That's when I began to feel confident. From what I gathered from the allnurses.com website, NP's begin their full patient load immediately. I'm a former ER nurse for both grownup and peds ED that now works med-surg/tele. Even that transition made me realize how much there is to learn. I may do psych NP just to get on with my life and not MD/DO. Even with studying for MCAT, all my pre-meds, etc., I learned a lot. After studying all of this plus years of experience, I still believe there is tons more to learn. So, five years should be the minimum one works as a RN before NP school. I feel it'll save me headaches later on. Best wishes!!

 

[pamac]

Before going to NP school? I’d say get into NP school as soon as possible. I wish I had started sooner myself instead of plodding away working in my BSN (which I didn’t have to do because there are options where I could have gone from my ADN to NP). There’s nothing magic about working as a nurse. If you want to pick up knowlege as an RN, you just have to open your eyes and pay attention to what’s going on around you. The problem with waiting too long is that you just get complacent and get to the point where you feel burnt out, and that’s not the time you want to be starting your NP journey, you want the groundwork in place to be finishing up by the time that point hits you. It all comes down to motivation... if you have it, then you don’t need to languish doing bedside patient care as an RN for half a decade before you start school. That puts you at at least 7 years before you are done with NP school and looking for a job. That’s where I’m at roughly and that’s not necessary. I don’t mind my pathway or the time it took me because everything is paid for by someone else, and I have a life, but it’s not necessary.

A good analogy is the way I study for nursing academic courses. I could save myself a lot energy by slowly plodding along and taking off small bites, but I have enough going on that a lot of the time I tend to have to put school projects off until the week before hey are due. Then I cram and get it all in before the deadline (nursing material is tons easier considering I’ve taken courses like organic chemistry and biochemistry, and other very demanding courses alongside very smart people). So nursing stuff just doesn’t require the same kind of finesse. That’s similar to the folks who don’t need to take 5 years laboring in something they really don’t want to be doing if they show up to learn and make the most of every opportunity in front of them.

 

[contemplating2005]

I am under the impression that 1 or 2 years of NP experience beats out 5 years of RN experience with no NP experience. I think there is much more advantages to get it done faster. You get out sooner getting more experience, in return more money and negotiating power, life gets in the way, you become complacent. Just find a good provider relationship with someone that will help you.

 

[pamac]

So I mentioned this to you before, but I think it bears repeating for he benefit of others to think on....

I’d rather become an NP as soon as possible so that I can be an NP with 7 years of experience vs waiting 5 years to go to Np school, and then going to NP school for 2 years, and at the end of the same 7 years, just graduating and being a new grad NP. Nobody who gives you that advice has YOUR best interests in mind. Nor are they going to cough up almost $400k in lost income that you would have missed out on by waiting 5 YEARS(!) and working as an RN before you apply to NP school (and won’t become an NP for 7 whole years or more). Sorry, but forget that, because it’s utter nonsense.

You are going to be an Np, not a nurse. The roles are different, and while they build upon each other, there’s nothing about changing bed pans and answering call lightsyear after year that will translate well to being a provider. There are much more efficient ways to gain knowlege, and languishing as an RN when you don’t want to will not give you the most bang for your buck unless you are so lazy that you need to gain knowlege by the osmosis of going to work 3 shifts per week for 5 years rather than picking up a book and studying. Like I said, my only regret might be hat I didn’t start my NP journey the moment I graduated from ADN nursing school, and instead I got my BSN.

Nursing is a decent career, if that’s what you want to do for your whole career. If you don’t, then keep moving as fast as you can through it. Make your own magic in life by moving towards your goal. If someone needs 5 years to grasp concepts that you can grasp in less time, leave them to their own needs and disregard.

 

[Moki1984]

I am not a provider, BUT I have worked in psych for 7 years in various positions and I work alongside NPs and PAs here. Yes, of course it is stressful and of course we see a lot of med seeking patients. We have an entire unit dedicated to dual diagnosis and sometimes they make you want to cry, but you have to remember they are here because they are unstable. If they were your average person, they wouldn't be locked behind these doors.

I should mention we are a mostly inpatient hospital with a lot of IVC patients (involuntary commitment). Not that outpatient doesn't have stress, they do, but my population are the ones deemed unsafe towards themselves or others currently.

People have to learn how to say no, when they have every excuse in the world and rationalization for why they need X amount of drugs and why their pain management clinic gave them everything they asked for....you have to be the bad guy/gal that refuses them their happy pills and redirects them towards a better quality of life. Easier said than done. My favorite NP jokes all the time when she sees me, who is upset with me today? lol she knows. Patients either love her or hate her because she is a straight shooter who will not give into demands and will not discharge them until they are ready. I greatly prefer our stronger providers that don't give into every demand. Patients will never change their cycles if you hand them everything they ask for , sometimes they need us to be honest with them (in a gentle way, show them some heart).

It is a rewarding field, but it is hard sometimes. I am not even a provider and last week I had to close my office and take a 10 minute "calm down session" after being berated by a patient who went off meds and to put it nicely, is really flipping mean and has a mouth of a sailor. If you can't handle someone cussing you out while in a psychotic state or a drug seeker throwing a chair telling you to "f***** discharge me or I will ruin you and buy the entire hospital you f***** b***" , pick a different field lol.

Again, I am in a lock-down inpatient facility so we see a lot of aggression. I am used to it at this point, I grin when I see the new staff that get nervous or jolted when a PT has a code. Oh the RNs in training doing clinical rounds here, so amusing. I seen one run once lol

Just giving my perspective as you asked

 

[AnnoyedByFreud]

I am under the impression that 1 or 2 years of NP experience beats out 5 years of RN experience with no NP experience. I think there is much more advantages to get it done faster. You get out sooner getting more experience, in return more money and negotiating power, life gets in the way, you become complacent. Just find a good provider relationship with someone that will help you.

I have found this to be extremely true, granted I had minimal RN experience before attending NP school. There's no question that NP experience outweighs RN experience by a landslide. So it make sense to pursue the NP license sooner rather than later, for the above variety of reasons. Just make sure your first NP job will support/foster you and you're on your way. Find some great mentors. Heck, I even learn what not do from some of the terrible docs/nps/pas I've worked with.

And to get back to the OP, I think it's actually easier for psychiatric professionals to say 'no' because we get useful training for how to do it. Learning about therapy, transference, counter-transference, boundaries, etc, is a large part of the training. PCPs do not get this training, and for that reason I think they actually have a harder time saying no and maintaining boundaries compared with a psychiatrist. Of course I've met plenty of pushover psychiatrists too, I mean how else would I have inherited all those patients on 2+ benzos and stimulants back in the days of outpatient?