Psych/Mental Health NP Questions

[WhoSholaza]

First post here and hope to get feedback from some of the regular members of the community.

I'm very interested in becoming a Psych/Mental Health NP. I realize a couple of different routes exist and each has its own nuances. One caveat is although I have a bachelor's degree in a science field, I am not already a nurse so I'd have to obtain RN credentials/pass the NCCLEX, etc. As such, my preference is to go through a direct-entry (DE) program where I could complete my education in a good 2,5-3 years.

1 - Do any of you have recommendations on direct-entry programs for psychiatric NP's? I have seen about 20 or so programs including some high profile ones such as Vanderbilt, Columbia, Yale, and UT-Austin as well as others which much less visibility such as Oregon Health Sciences Univ, Univ. of Southern Maine, etc. Is there any advantage to a more "well-known" (re: expensive/prestigious) program? My goals are to have the best theoretical, scientific, and clinical foundations - especially the latter.

2 - Specific to DE programs, do all of them grant you the ability to work as an RN should you chose to do so temporarily or while working on the masters portion of the degree? I ask as it seems some DE programs license you as an RN but only grant you an MSN while others, like the Yale program seem to grant both a BS & MSN. I readily admit I have little interest in bedside med-surg nursing but more job options, at least temporarily, are never a bad thing even if the market for new grad RN's is dismal.

3 - Any insight into residencies or extended (but paid) clinical training opportunities after graduation? I have not heard much about NP residencies but I think I would love the the chance to do one if possible.

4 - My long-term goals are to practice independently in one of the 18-20 or so states that grant this right. I've got a good business acumen after 10+ years working in an entirely different field. The cost/benefit/risk/reward for Psych NP's appears to be very good and I find that quite appealing. I'm looking to have a good work/life balance and this field seems to provide favorable circumstance for that. How realistic is it?

5 - I've volunteered in both regular outpatient clinics (general health) as well as mental health settings and know that I enjoy both areas. I realize the scope of practice for psych NP's is much smaller than FNP's but the pay/lifestyle/autonomy of Psych NP's seems much better. Is there any reason to not pursue a Psych NP degree and go for an FNP instead? I can be happy doing either I think but I would be happier with better-paying work, more autonomy, and control over my own would-be practice.

6 - I've considered PA but the lack of true independent practice and the educational focus outside of mental health make it far less appealing. I have zero interest in medical school.

Any comments, advice, and help would be greatly appreciated.

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[futurepsych0]

I would suggest you try allnurses.com as they will probably be able to answer your questions more adequately. I am not well versed in the NP profession but have been doing a lot of research as I recently decided to pursue that path. As for the independent practice, that is only applicable to certain states (to my knowledge AL, AZ, DC, IA, ID, ME, MT, NH, NM, OR, UT, WA, WY). Other states have legislation in the works (like New York's nurse modernization act) but the outcomes can go either way. I am not sure how accurate this site is but I found it to be pretty cool http://www.bartonassociates.com/nurse-practitioners/nurse-practitioner-scope-of-practice-laws/

PA is good in the sense that you can change your specialization more easily. At least in my state, if you want to change your area of practice you would have to go back to school. Both are great careers and I wish you luck on whatever path you decide to take.

 

[zenman]

I didn't do FNP because there was so much to learn about too much. I went strictly with psych. You can do a residency if you can find one but I'll bet your school will let you keep signing on for clinical for years if you keep paying them. You can then set up clinical to match whatever psych area you're interested in.

 

[WhoSholaza]

Futurepsych: Thanks for your comments. I think the horizontal flexibility of the PA profession is one of it's truly great qualities. I wonder if in the future going into specialty practice as a PA will require more credentialing or residency of some sort - probably to make it more "respectable" perhaps as with the DNP movement in nursing which is more about perception than more clinical training.

In any case, as I have both full independent practice and the ability to as an entrenpeur to determine my financial worth as definite goals, I think the PA role would probably not be the best fit for me.


Zenman: Appreciate the feedback. I don't want to downplay the breadth of psychological issues in any way. That said it strikes me as much more challenging to be competent in a such a broad area such as general practice as FNP's do - I'd rather be very good at a smaller subset of issues or at least populations. Regarding clinicals, I had no idea about that and certainly see it as an option, albeit a potentially expensive one depending on the school!

 

[pamac]

Futurepsych: Thanks for your comments. I think the horizontal flexibility of the PA profession is one of it's truly great qualities. I wonder if in the future going into specialty practice as a PA will require more credentialing or residency of some sort - probably to make it more "respectable" perhaps as with the DNP movement in nursing which is more about perception than more clinical training.

In any case, as I have both full independent practice and the ability to as an entrenpeur to determine my financial worth as definite goals, I think the PA role would probably not be the best fit for me.


Zenman: Appreciate the feedback. I don't want to downplay the breadth of psychological issues in any way. That said it strikes me as much more challenging to be competent in a such a broad area such as general practice as FNP's do - I'd rather be very good at a smaller subset of issues or at least populations. Regarding clinicals, I had no idea about that and certainly see it as an option, albeit a potentially expensive one depending on the school!

I think you are right about what the future holds for lateral movement for PAs, but thats just my guess.

One thing you may want to do is shadow. Decide if you want to be a nurse as well. I'm not a huge fan of direct entry NP programs, and there are some pitfalls to them as well if you don't finish the entire program....(if you dont finish the whole thing, you usually dont get the RN you got along the way). Thats cool that you want to be an entrepreneur, but I think you should probably be heavily grounded in healthcare before you will be successful at the business end of it. Its like going out and deciding to be a lobster boat captain on a whim. Its possible to do it, but how well do you think you'd do if you approached it just from the standopint of it being potentially lucrative?

 

[deleted6669]

regarding PAs- I think the long term reality will be required one year residencies and CAQ exams in every specialty outside of primary care (which is taught very well in pa school).

 

[AnnoyedByFreud]

I'm in a direct entry psych NP program at a "top" school. OP - unless you plan on taking time off to work as a RN between the RN and MSN training, then earning the BSN is a moot point. The likelihood that you will be able to work as a med surg floor nurse as a new grad and simultaneously continue on with the MSN is very low, because most hospital jobs for new grads require completion of a new grad program, which is pretty much full-time for 6 months or more. They also typically have new grads sign on for 2+ year contracts, since the cost of training is very expensive. You wouldn't be able to do that and start your MSN. For that reason, it makes more sense to look for RN work in other facilities, outpatient, per diem, etc. Fortunately, there appear to be quite a few jobs in behavioral health (my plan is to work as a psych RN part-time during the NP part of my program.)

I'm considering going back for the FNP licensure later on in my career, but I'm currently very pleased with my prospects and career plans in psych. Also, don't assume that lesser well-known schools are cheaper, almost all DE NP programs are expensive. OHSU is very expensive for out-of-state students, if I remember correctly. With your career goals (which are very similar to mine), I agree that psych NP makes a lot more sense than PA.

 

[dudestheman90]

If your set on psychiatry, u may want to consider psychiatric NP programs like annoyed freud said, since it's very specialized. There are also post-graduate NP residency programs you may want to consider, i don't know if there's 1 for psychiatry, but I think those programs will help you to fine tune and hone your skills. I'm leaning more towards Derm, family, or trauma/critical care. Good Luck!

 

[WhoSholaza]

Thanks for the helpful replies.

On a sidenote and regarding the PA angle: my anecdotal experience is that this profession is in for a massive influx of students/graduates. With so many people and career changers wanting in, I suspect that would make further credentialing an easier sell as a way of ostensibly "safeguarding" the profession and/or propping it up in the eyes of the public.

pamac: Your point about gaining experience and being grounded first is well-taken and one I agree with. It actually coincides with my own perspective both philosophically and practically. Spending a couple of years in a structured setting working with others would both grant needed experience as well as provide opportunities for quicker loan repayment via one of the "service for loan repayment" schemes out there such as NHSC. It is also pragmatic as one needs a certain amount of capital to fund a startup (marketing, equipment, and other typical costs) and such funds won't exactly be readily available after several years of NP school. Although everything I've read suggests a solo psych practice requires much less startup capital than say, a traditional primary-care clinic

AnnoyedbyFreud: You make a great point about RN work. My interest in bed-side nursing is nil. I'd approach RN work strictly from a sense of acquiring some small bit of income while in NP school to offset living expenses and minimize acquired non-school debt. So in that regard, psych RN work, wellness, tele-nursing/triage or anything else that's low(er) stress and pays decently would be appealing.

 

[dudestheman90]

k

 

[AnnoyedByFreud]

Yeah, I'm planning on working as a RN simply to offset costs. In my area, RNs make a ton of money (even outpatient), so it will be a very significant reduction in loans for me. However, working as a RN in a behavioral unit is very unlike bedside nursing. My friend who is a year ahead of me in the program is working in a behavioral unit and she does initial intakes and assessments. Once you get into out-patient/behavioural health, RN jobs are pretty different than typical floor nursing/med surg work, as far as I can tell.

I talked to a PA the other day who lamented his lack of psych training and basically said, "there's no way I could practice in psych without a huge learning curve, I only had two courses". I think PA is a great option for someone interested in em/surg or who is uncertain about their field of interest. However, if you know you want psych, then NP makes far more sense from a training perspective (and for other reasons that have been discussed ad nauseum on this forum).

If you want loan repayment, do consider applying to the nursing corps scholarship program. They pay all your tuition upfront and give you a stipend of ~1200/mo to live on. For each year of funding you have to work in an underserved site. There are a lot of qualifying sites in the psych specialty. You can also wait until you graduate and get a NP job at a site and get loan forgiveness after the fact, although I'm hearing that it's getting harder and harder to qualify. Going for the scholarship and getting the money upfront is the smarter move, in my opinion.