PMHNP- One concern

[AppliedBehaviorAddiction]

Hello, I am new here- so I will give some background. I recently graduated with my bachelors in Communication Sciences and Disorders. I was sure throughout my undergrad experience that I wanted to be a medical SLP. I loved learning neurology, anatomy, dysphagia/TBI/stroke, etc. Then, in my last semester my mother unfortunately passed away and due to that experience- I have developed a big interest in going into psychiatric medicine. This has led me to strongly consider becoming a PMHNP. I have poured over tons of forums and posts about it and it is a profession that greatly interests me. I would have to take my pre-reqs for that and I want to apply for DE programs after that. After my research, I have one concern, and it is going to sound really stupid: hours.

Don't get me wrong, I have no problem really draining myself to get my degree. I am a very hard worker and have the capacity to pull off such a program in under 5 years. There seems to be a battle going on between people saying that you must have RN experience to be an NP and those who do not believe that. I understand both sides of the argument and I don't want another thread on it. However, if I were to get some RN experience after my program, I would be 28-29 years old. I don't fear blood, needles, patient's problems (I currently work with kids with autism and am looking into working as a mental health tech under RN supervision at a hospital right now), any of that. But at that age, doing 12 hour shifts, or overnights genuinely scares me. At that point, it would be reasonable to think that I would be about ready to start a family with my partner who I have been with for a very long time. If I could work days, there would be no problem- but I hear about these rotations where people are always on call and their schedule can never be predicted, and one week they are doing 12 hour shifts, the next week they are doing nights. I know as a new graduate, I could not be that picky and I am afraid of completing my degree and then being forced to take on those shifts. Again, I know it is hard work and I am more than willing to put that in- but would there be any hope of getting day shifts as a new graduate as either a PMHNP or an RN, while I just get experience and then move into being an NP? I guess I could just use some insight into what it is really like out there before I drop some serious money on a program.

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[d2305]

First you have to take the prerequisites for a RN program.

 

[Boatswain2PA]

Getting through RN program will likely require some nights.

Depending on location and specialty, you will most likely be able to find new RN grad jobs that are day only.

Clinical rotations for NP programs can consist of as little as shadowing your friend for 4-5 hours a day, two days a week in their outpatient clinic.

 

[762513]

Hello, I am new here- so I will give some background. I recently graduated with my bachelors in Communication Sciences and Disorders. I was sure throughout my undergrad experience that I wanted to be a medical SLP. I loved learning neurology, anatomy, dysphagia/TBI/stroke, etc. Then, in my last semester my mother unfortunately passed away and due to that experience- I have developed a big interest in going into psychiatric medicine. This has led me to strongly consider becoming a PMHNP. I have poured over tons of forums and posts about it and it is a profession that greatly interests me. I would have to take my pre-reqs for that and I want to apply for DE programs after that. After my research, I have one concern, and it is going to sound really stupid: hours.

Don't get me wrong, I have no problem really draining myself to get my degree. I am a very hard worker and have the capacity to pull off such a program in under 5 years. There seems to be a battle going on between people saying that you must have RN experience to be an NP and those who do not believe that. I understand both sides of the argument and I don't want another thread on it. However, if I were to get some RN experience after my program, I would be 28-29 years old. I don't fear blood, needles, patient's problems (I currently work with kids with autism and am looking into working as a mental health tech under RN supervision at a hospital right now), any of that. But at that age, doing 12 hour shifts, or overnights genuinely scares me. At that point, it would be reasonable to think that I would be about ready to start a family with my partner who I have been with for a very long time. If I could work days, there would be no problem- but I hear about these rotations where people are always on call and their schedule can never be predicted, and one week they are doing 12 hour shifts, the next week they are doing nights. I know as a new graduate, I could not be that picky and I am afraid of completing my degree and then being forced to take on those shifts. Again, I know it is hard work and I am more than willing to put that in- but would there be any hope of getting day shifts as a new graduate as either a PMHNP or an RN, while I just get experience and then move into being an NP? I guess I could just use some insight into what it is really like out there before I drop some serious money on a program.

Getting through RN program will likely require some nights.

Depending on location and specialty, you will most likely be able to find new RN grad jobs that are day only.

Clinical rotations for NP programs can consist of as little as shadowing your friend for 4-5 hours a day, two days a week in their outpatient clinic.

Please don’t listen to Boatswain2PA, he’s not a RN or a NP, doesn’t know what he’s talking about, and shouldn’t be giving advice.

No RN school education will require any night rotations. You may possibly have a PM clinical here or there, but no straight night shifts. When you become an RN simply choose a job that closes at 7 pm. There are thousands of examples. Clinics, urgent cares, etc. You can make it work with some foresight. You may miss the “joys” of inpatient nursing, but you’ll have a normal life schedule which is important. Get a few years experience and then do your research and make sure you pick and well established NP program with a good reputation. Generally, a public college may be your best bet, although there are good private programs too. Ask for advice from NP’s as you start making your plans. Good luck.

 

[pamac]

Getting through RN program will likely require some nights.

Depending on location and specialty, you will most likely be able to find new RN grad jobs that are day only.

Clinical rotations for NP programs can consist of as little as shadowing your friend for 4-5 hours a day, two days a week in their outpatient clinic.

LOL! Nope. Not even under the best of circumstances. 10 hours per week would take you a couple years of just the clinic portion. As a new grad I made $60,000 more than my buddy’s sibling, who was a psyche Pa working more hours than I did.

I guess NPs could graduate with the minimum amount of hours, most of us have more. I had well over double of my programs minimum hours. I also had literally over 10 job offers upon graduating. My FNP friends have done just fine with their job market, but it’s quite a bit tighter. I don’t know any that don’t find decent jobs after graduating. On top of our NP training, almost all of us have at least 4 years of nursing experience behind us, unlike the armies of Pa new grads, who mostly pepper their resumes with things like mission trips to go perform substandard care in third world countries (but it’s better than nothing, right?). Or they are candy stripers, or work the front desk at the doctors office, or are scribes for physicians. LOL! There you go! A scribe would be some of the best health care experience you’ll see these days at PA school.

Oh, and night shifts are a dime a dozen. I always had an easy time finding nurses that wanted to make $11,000 more to work nights. Anyone saying otherwise obviously doesn’t know what they are talking about. You know why they train at nights? Because that’s the time when the other nurses aren’t so bogged down with minutia that they can actually have time to teach. If you want a new nurse to fail, you train them during days, which has almost a 75 percent higher attrition rate for new RNs.

 

[762513]

LOL! Nope. Not even under the best of circumstances. 10 hours per week would take you a couple years of just the clinic portion. As a new grad I made $60,000 more than my buddy’s sibling, who was a psyche Pa working more hours than I did.

I guess NPs could graduate with the minimum amount of hours, most of us have more. I had well over double of my programs minimum hours. I also had literally over 10 job offers upon graduating. My FNP friends have done just fine with their job market, but it’s quite a bit tighter. I don’t know any that don’t find decent jobs after graduating. On top of our NP training, almost all of us have at least 4 years of nursing experience behind us, unlike the armies of Pa new grads, who mostly pepper their resumes with things like mission trips to go perform substandard care in third world countries (but it’s better than nothing, right?). Or they are candy stripers, or work the front desk at the doctors office, or are scribes for physicians. LOL! There you go! A scribe would be some of the best health care experience you’ll see these days at PA school.

Oh, and night shifts are a dime a dozen. I always had an easy time finding nurses that wanted to make $11,000 more to work nights. Anyone saying otherwise obviously doesn’t know what they are talking about. You know why they train at nights? Because that’s the time when the other nurses aren’t so bogged down with minutia that they can actually have time to teach. If you want a new nurse to fail, you train them during days, which has almost a 75 percent higher attrition rate for new RNs.

You should really just ignore Botswain2PA. He’s trying to start a flame war.

 

[Boatswain2PA]

4-5 hours a day, two days a week equals 500 hours a year. The minimum standard for NP programs is 500 clinical hours.

There are many who only meet the minimum standard.

 

[762513]

4-5 hours a day, two days a week equals 500 hours a year. The minimum standard for NP programs is 500 clinical hours.

There are many who only meet the minimum standard.

Except 2 years year round including summer semesters would make a 6 semester NP program, really 7, because the first semester is always non clinical. You don’t know what you’re talking about. Stop.

 

[pamac]

I think 600 hours is the minimum, but regardless, the boat always takes the minimum, and then applies that minimum as broadly as possible so as to disparage every NP. I have well over the minimum hours required. I think I’m fairly typical in that regard. How much high level HCE does the typical PA student, (or even boatswain) have? Was he a nurse? That’s pretty much the gold standard for pre PA HCE, and yet very few Pre PAs have that background. Almost all of them are CNAs or EMT Bs, or scribes. Thats a point that he conveniently leaves out. That’s right, you can go from candy striper, and then with one year of class, and one year of clinical, you can all of a sudden be a PA.

See how that works? Painting with a broad brush doesn’t tell the whole story, but it’s the way that boatswain prefaces all of his arguments.

 

[762513]

I think 600 hours is the minimum, but regardless, the boat always takes the minimum, and then applies that minimum as broadly as possible so as to disparage every NP. I have well over the minimum hours required. I think I’m fairly typical in that regard. How much high level HCE does the typical PA student, (or even boatswain) have? Was he a nurse? That’s pretty much the gold standard for pre PA HCE, and yet very few Pre PAs have that background. Almost all of them are CNAs or EMT Bs, or scribes. Thats a point that he conveniently leaves out. That’s right, you can go from candy striper, and then with one year of class, and one year of clinical, you can all of a sudden be a PA.

See how that works? Painting with a broad brush doesn’t tell the whole story, but it’s the way that boatswain prefaces all of his arguments.

It’s not just that, this guy attacks NP’s as a whole while demonstrating he has very little knowledge of the education required. The worst part is posters coming here looking for advice will probably listen to someone who isn’t qualified to give it.

 

[pamac]

It’s not just that, this guy attacks NP’s as a whole while demonstrating he has very little knowledge of the education required. The worst part is posters coming here looking for advice will probably listen to someone who isn’t qualified to give it.

Its even better than that. In the case of psyche, you wouldn't want to go see a PA vs a psyche NP. Under the best of circumstances, even if a PA program requires a psyche rotation beyond it just being an elective, you still would be seeing someone who only spent a few weeks training in it. If NP's are substandard, then heaven help you if you were to see a PA, because their immersion in psyche comes across clearly as an afterthought. Thats why most places are hesitant to use them, and pay them less than NP's. Since PA programs are no longer heavy on pre PA healthcare experience, you are not likely getting someone who worked in healthcare in a high responsibility role, let alone in the role of a psyche nurse.

 

[Boatswain2PA]

I had over 20,000 hours of HCE as a medic before I retired from the military and went to pa school.

The minimum clinical hours for PAs is 2500, including structured rotations in FM, IM, EM, surg, peds, women's health, and cardiology, with end of rotation testing at end of each rotation.

The minimum clinical hours for NP is 500 hours with no real requirements for structure. I have seen MANY NP students who get their 500 hours just doing 4-5 hours a day for a couple of days a week....a very poor environment for training.

I am not suggesting every NP did/does the minimum, but some do. Same with PAs....many of us do much more training than that, but some do the minimum.

It is this minimum which sets the STANDARD. Every NP has 500 clinical hours. Every PA had 2500 hours. Every NP was a nurse for at least a day before NP program.

One of my classmates works in psych. She knew she wanted to do psych, so had several psych heavy rotations including one of her inpatient rotations, and then did peds psych. Those two rotations alone likely gave her as many clinical psych hours than most psych NPs receive in training.

 

[pamac]

You went to PA school, not medical school. I think that bears noting for the sake of clarity. Don't want anyone mistaking you for a physician.

20,000 working as a medic around homogeneous and relatively healthy military population of prime age and physical standards, and maybe some situations on humanitarian crisis', and still essentially non formalized education (unfortunately those certifications don't have a civilian analogue outside of the service....maybe EMT-B, right?) isn't even the norm among your peers. Most PA students now don't even have one quarter of that kind of HCE, so your point is moot. I do consider that respectable, and probably very interesting service, but its certainly a bit different than the general population with very specific treatment oversight and benchmarks.

You have no idea how many clinical hours the average psyche NP trains in, so you can suggest that your peer in psyche did more in her two brief rotations, but you would be speculating. Just because she is a PA, she somehow has superpowers in her brief elective psyche immersions?

This is the most important point I'd like to make, but I'm sure you will skip past it because its more convenient for you to cherry pick past the points that are hard for you to rebut, but lets use that last case of your peer, and clearly list her as the extreme exception, because that is probably the case. Using your logic, since a PA can complete a PA program having never had a psyche rotation, then that MUST mean that most PAs in psyche have NO rotations in psyche. That's YOUR logic I'm using to suggest that, because that is the same kind of broad brush you paint all NPs with. For you, most NPs went to degree mills, performed the minimum amount of clinical hours, and did their rotations with their friends... and you push this ad nauseum. Its comical at this point. But its also a non issue overall. NPs are doing just fine.

 

[Boatswain2PA]

You went to PA school, not medical school. I think that bears noting for the sake of clarity. Don't want anyone mistaking you for a physician.

Thank you. I was distracted several times writing that.

The rest of your post shows your lunacy. I spent 20 years doing SAR.

I think your bias prevents much logic. The point I was making was that every PA has a broad medical education, and can somewhat specialize in school (as I did in EM, and my classmate did with psych). I know I had more clinical ED hours than any ENP program requires, plus surgery, IM, peds, cardiology, women's health, etc.

 

[pamac]

So were you an EMTb or a paramedic for those 20 years? And you have to admit that your HCE puts you in the top 1% of typical PA program applicants. But yes, you danced by the point I said that you would dance by, which is that if we want to go by minimums, and paint that minimum as the norm, then we could say that a PA in psyche probably has no rotations in psyche prior to entering the workforce to do that. Thats with using YOUR logic.

 

[Boatswain2PA]

So were you an EMTb or a paramedic for those 20 years? And you have to admit that your HCE puts you in the top 1% of typical PA program applicants. But yes, you danced by the point I said that you would dance by, which is that if we want to go by minimums, and paint that minimum as the norm, then we could say that a PA in psyche probably has no rotations in psyche prior to entering the workforce to do that. Thats with using YOUR logic.

Sure, some/many/most PAs working in psych likely had no dedicated psych rotation hours in the PA program, although every PA has psych classroom education and formal testing for certification.

The flip side of that is psych NPs have virtually no medical training in their NP schooling.

 

[pamac]

I had plenty.

 

[pamac]

Besides, I was a nurse for quite a while. That's part of the difference. You go show up to PA school alongside folks with no HCE to speak of. Part of the gargantuan task ahead of PA faculty is to get all of you, with your various backgrounds, all to be on the same page. Then you get 3 semesters of class, and 3 semesters of rotations.

 

[762513]

Thank you. I was distracted several times writing that.

The rest of your post shows your lunacy. I spent 20 years doing SAR.

I think your bias prevents much logic. The point I was making was that every PA has a broad medical education, and can somewhat specialize in school (as I did in EM, and my classmate did with psych). I know I had more clinical ED hours than any ENP program requires, plus surgery, IM, peds, cardiology, women's health, etc.

As an ex army medic I know the types of patients you overwhelmingly cared for in the military. No hepatitis care. No pancreatitis. No end state COPD or heart failure. While you became very good in ortho and sports related injuries, we both know it didn’t provide you a broad base for medicine, with the occassional massive trauma, and your patients were essentially healthy young people, with rare exceptions. In real medicine, it’s the opposite.

You’re again wrong that NP schools don’t have structured requirements for clinical rotations. I had to have certain hours in different patient populations and settings. I don’t give advice to PA students about PA school because I don’t know enough about that occupation to give advice. You clearly shouldn’t be giving advice to prospective NP students because you don’t know enough to be qualified to do that.

 

[Marsdgrove33133]

Hello, I am new here- so I will give some background. I recently graduated with my bachelors in Communication Sciences and Disorders. I was sure throughout my undergrad experience that I wanted to be a medical SLP. I loved learning neurology, anatomy, dysphagia/TBI/stroke, etc. Then, in my last semester my mother unfortunately passed away and due to that experience- I have developed a big interest in going into psychiatric medicine. This has led me to strongly consider becoming a PMHNP. I have poured over tons of forums and posts about it and it is a profession that greatly interests me. I would have to take my pre-reqs for that and I want to apply for DE programs after that. After my research, I have one concern, and it is going to sound really stupid: hours.

Don't get me wrong, I have no problem really draining myself to get my degree. I am a very hard worker and have the capacity to pull off such a program in under 5 years. There seems to be a battle going on between people saying that you must have RN experience to be an NP and those who do not believe that. I understand both sides of the argument and I don't want another thread on it. However, if I were to get some RN experience after my program, I would be 28-29 years old. I don't fear blood, needles, patient's problems (I currently work with kids with autism and am looking into working as a mental health tech under RN supervision at a hospital right now), any of that. But at that age, doing 12 hour shifts, or overnights genuinely scares me. At that point, it would be reasonable to think that I would be about ready to start a family with my partner who I have been with for a very long time. If I could work days, there would be no problem- but I hear about these rotations where people are always on call and their schedule can never be predicted, and one week they are doing 12 hour shifts, the next week they are doing nights. I know as a new graduate, I could not be that picky and I am afraid of completing my degree and then being forced to take on those shifts. Again, I know it is hard work and I am more than willing to put that in- but would there be any hope of getting day shifts as a new graduate as either a PMHNP or an RN, while I just get experience and then move into being an NP? I guess I could just use some insight into what it is really like out there before I drop some serious money on a program.

I'm a Psych RN/BSN and I will be done in April 2020 with my NP in Psych. I have 8 years of RN psych experience before applying to school. However, I know some RN's with one or two years of experience that were accepted to my program. Unfortunately, the need for PMHNP is in such high demand that schools are accepting RN's with little experience. Honestly, RN to NP is like comparing apples to oranges. Yeah, they are both fruits but different, if you get what I mean. The only thing I would consider when thinking about NP vs PA is that the NP can stand alone in 21 states. The only reason why NP's CAN'T stand alone in the state of Florida is due to bills voted on in Florida's legislature, always included PAs in it. PA's will never be able to stand alone. They will always be stuck with a supervising physician. Also, the amount of money compared too PA's is not even funny. I know so many PMHNP who make 140k to 150K a year, working 4 days a week in an outpatient setting. Again, someone is going to say something about this but it's true. If you work in the psych world, its common knowledge. I worked all up and down the state of Florida and I have not heard of or even seen PAs working in Psych. I am sure there are many PAs out there in the specialty though, somewhere. I might even get one knucklehead to bash me about making a statement like this also, lol. But that is up to you to decide. For the money and freedom, I will choose PMHNP. If you don't want any experience and spend 2 years in a PA program then choose PA. Good luck!

 

[pamac]

21 states or more have what the AANP considers to be the optimum level of autonomy, which is no requirement for supervision/collaboration whatsoever from day one of practice, having the board of nursing practice full regulatory control over the states NPs exclusively through that board, and full prescribing privileges of scheduled medication (among other items). That’s a really high bar. In several other states where progress was mired down, NPs have settled for incremental progress, including state provisions to allow independent practice after a set amount of time under collaboration/partnering with a physician. Other states allow independence, but have physician board members on the BON panel, or have NPs answer to the board of medicine for oversight of the profession. So while full progress has been made in at least 21 states, considerable progress has also been made in more states than even the most progressive states. That level of progress still exceeds what PAs have been able to obtain. For better or worse, this is the reality, and lends toward a professional advantage on that front. I anticipate we will see even more ground gained over the next 5-10 years, especially once California becomes an NP free practice state.

I’d echo what was said above.... PMHNP is a good way to go, and my starting wage in a lower cost of living region was above $140k. I work 4 days per week. I certainly can’t seriously even entertain all the job offers that come at me, not to mention the other professional opportunities afforded through part time or PRN gigs. At the same time, the money doesn’t come at you unless you are there to show up for it, and while it’s nice to be in demand, the market does have a ceiling for NPs, it’s just typically higher than for most nonphysician providers. I like to say that psychiatrists have potential to make Yacht and second home money, NPs have the potential to make wakeboard boat and RV money (and have to work pretty hard to even get that). Bosses are excited to have me come to work for them, but part of that excitement is because I make at least half as much as some psychiatrists. If I were to push my luck and ask for too much, they would happily show me the door and move on with their search for a provider, and not give it a second thought. I may be rich for a nurse, but I’m poor for a provider when you compare me to a doctor. And if you don’t like dealing with psychiatric patients, that extra money will not make up for how you feel every Monday morning knowing the next 4 days belong to them.