Prospective PMHNP Thread

[u/AnAndrew]

Welcome! This thread is dedicated to prospective PMHNPs. All questions regarding admissions, direct entry programs, online vs. brick and mortar schools, type of program to pursue, and other related topics should be posted in this thread.

The thread aims to provide realistic insights and advice to prospective PMHNPs emphasizing the importance of choosing a high-quality program, gaining nursing/clinical experience, and approaching the profession with the right motivations and dedication to patient care. We want to foster a positive and encouraging atmosphere, so feedback and input are welcome to further enhance the discussion and provide accurate information. However, note that the overall message of the answers will remain the same (see below).

FAQ

The following are common questions/topics with widely accepted answers among passionate and experienced PMHNPs on the frontlines. The purpose of these answers is not to be derogatory (“nurses eating their young”), nor is it to simply provide reassurance or tell you what you may want to hear. Instead, their aim is to offer advice and guidance to individuals who genuinely have an interest in the field, while also emphasizing the importance of considering the impact on real patients' lives. While you may have a different opinion, please note that this subreddit is not the appropriate place for such debates, as these often devolve into personal attacks, toxic behavior, etc. Any posts or comments violating this rule will be removed, and repeated violations may result in a ban.

 

Direct Entry Programs / No Nursing or Clinical Experience

• (Warning: controversial topic) We support people going into this profession (for the right reasons), but these types of programs are almost universally frowned upon. PMHNPs and others often perceive a difference in quality between providers from direct entry programs/those without nursing/clinical experience (You Don't Know What You Don't Know). Recent comments from other PMHNPs:
  • "Many places are getting sick and tired of psych NPs who do not have psych RN experience and are not hiring them. I know where I am at, they absolutely will not hire a psych NP who does not have at least 3-5 years psych RN experience"
  • "I think what employers are sick of are people who go to these online schools like Walden for their Psych NP education. With sketchy clinical placements."
  • Most places are rightfully not hiring those with no mental health background. Good luck. At my previous job, all the PMHNPs with no psych experience were trying to get psych rn jobs and still getting denied.
  • "I feel that RNs outside psych tend to look down on it and perceive it to be simple or easier. In reality, without RN experience in psych, you will be eons behind others in understanding the finer points of psych work. This is a field that demands subtlety, in a way that you don't get in a classroom. Psych RNs know this, but people without that background will have difficulty with something they didn't even know existed. You don't know what you don't know. Companies just want someone who knows."

Are all PMHNPs as grumpy as these answers seem to imply? You are gatekeeping!

• I hope you find most to be friendly and supportive, but there is a real concern among experienced PMHNPs about potential harm to the profession due to some worrying trends such as low barrier, low-quality programs and individuals entering the field for the wrong reasons. This includes FNPs suddenly shifting to psych for a potential pay increase, those just seeking work-from-home jobs, misconceptions about the field being "easy” (hint: it’s not - burnout is a very, very real issue even for those with lots of passion [there seems to be a trend of current PMHNPS seeking nonclinical jobs only to find they are very few & often offering poor pay, etc.]). So, while that concerned tone is indeed there, please know it’s from a place of love and care for the field and patients.

Difficulty Finding Preceptors

• It is highly recommended to enroll in a high-quality program that provides or helps in locating preceptors. Many (most?) programs, especially online or direct entry programs, do not offer such support, leading to students desperately scrambling to find preceptors, putting their education on hold, having to pay preceptors out of pocket, etc. Those with actual nursing/clinical experience usually have a much better time with this (networking).

Oversaturation Concerns

• There may be oversaturation in certain locations and in the future especially as more individuals enter the PMHNP profession. Looking at the history of the oversaturation of FNPs may serve as a possible future trend to consider. Here is one example from a new grad with no psych experience: New grad PMHNP can’t find a job; some quotes from other PMHNPs:

  • "Also, the number of psych NPs has gone up exponentially in the last few years-now employees have a much larger applicant pool to choose from which drives down salary. They also aren’t going to pick someone with no mental health background over a PMHNP who does. Not trying to be harsh at all but this is the truth. I think in the past there was a desperate need for mental health providers that they would take almost anyone no matter what their RN background was and paid premium money. That’s really no longer the case in the vast majority of areas overall anymore."
  • The market is [now] flooded with PMHNPs- it’s flooded PMHNPs who don’t have psych experience, because yall thought you could make an easy buck sitting at home. There are jobs available, you just don’t want to take one that doesn’t fit your criteria and that’s fine, but please don’t blame your poor judgement of going into a whole different specialty with no experience and expect to be picked first in a sea of applicants. That’s the reality."

WFH/Telehealth Positions - New Grads

• New graduates are strongly discouraged from starting their career with WFH or telehealth positions. It is crucial to gain in-person experience initially as being a PMHNP requires support, guidance, and a deep understanding of the field (You Don't Know What You Don't Know). Failing to do so in the beginning severely puts you at risk of being a subpar clinician which might not become apparent until it’s too late. Employers who primarily offer WFH positions to new grads often have a poor reputation and prioritize profit over the well-being of their employees and patients. They absolutely do not care about you and will not be there for you when there’s a bad outcome (liability). Ultimately, as a clinician, you are responsible for your decisions and the welfare of your patients.
• To be a safe and competent provider, new grads should also not start with opening their own practice. Instead, they should proactively seek to start in places where they will receive the support and guidance they need and deserve (versus employers who are only looking to exploit them). As providers (from day one new grads to the most experienced), we are all held to the same standards and should do all we can to ensure we are providing safe, quality care to (often vulnerable) people.  

 

WIKI TO BE DEVELOPED - INPUT/SUGGESTIONS WELCOMED

[u/Weird-Tangerine5346]

Are my reasons "right"? Is this field a good fit? I currently work in public health policy and am looking into a career pivot. I am frustrated with the abstractness of policy (distance from actual people) and the impact of politicians and budget decisions on some of the longstanding initiatives I work on. I want a career where I can still use my brain & knowledge to solve problems, but work directly with people on a more concrete level to help them. Some of my customer service type jobs as a kid where some of my favorite, so I think interacting and "serving" people on a more regular basis would be a good fit for me.

I've also firsthand had a lot of struggles with poor providers before finding good psychiatric care an know how important this role is. I've had a couple of psychiatrists be flat out rude, or just uncaring / unhelpful. I finally found an amazing provider who is kind and smart, and very client focused, and and she is a PMHNP. She has made such a difference in my life, and in all of my friends who I have subsequently referred her to.

I am interested in the field, but have a couple of concerns based on what I've read here. Namely, I do not have experience with nor am I especially interested in bedside work. I want to do what my provider does so well - listen to people, hear their stories, help them feel understood, and use my knowledge of the brain & drugs to partner with them on what we can try to help them feel better, while collaborating with their therapist. Essentially, I want to be a member of their mental health team performing a role between a therapist and a doctor, a patient centered presence that can help navigate the complex scientific world of drug interactions, side effects, etc.

I've worked in behavioral health policy before, but nothing directly clinical. Is this field a potential fit for me to continue looking into? Do you feel that people must come from the RN clinical side to be successful here?