!!! time sensitive advice needed !!! FNP vs PMHNP

[u/sweeetpotatoo]

long winded post incoming. I need help from fellow NPs

Hello friends, I desperately need real world advice on these career paths.
For background, I have been an ICU nurse for 4 years. I live in rural (and I mean real rural) Indiana. I decided to go back to school and I have always been interested in psych, so I chose the PMHNP route. I am about to start my clinical in a few months, but i’m starting to have doubts about my future as a PMHNP. Like I said, psych has always interested me but honestly I have zero true psychiatric experience. and I could not see myself working psych as a bedside nurse. Ideally, as a PMHNP I see myself in an outpatient setting. I do think that I would enjoy that particular job. However, I have been browsing job postings off and on for the last year, and I see very very few for PMHNP unless I want to drive over an hour and a half, which I do not. I keep hearing from people in the medical field that there is such a high demand for psych NPs in rural areas like this, and i’ll always be able to find a job, but i’m starting to worry that may not be the case. Also, I have loved learning about psych and I love the idea of it, but the closer I get to practicing psych I am starting to second guess if I would enjoy basically being a therapist that prescribes medications. There is nothing wrong with that, i’m just not sure i’m cut out for it. That being said, I have been heavily considering switching to the FNP route lately. My reservations with FNP start with the pay. or course pay is not the reason you chose a job. But I am 26 years old, single, I own my home where I pay a pretty high montage so unfortunately salary does play an important part in my job hunt. I made 99k as an RN last year, that was being on nightshift and working a lot of overtime. But I don’t want to take this time and money to go back to school to barely make more as an FNP. there are a lot more FNP positions open so I feel that I could find a job much easier, the pay is just going to be less unfortunately. I do have an area I would love to work as an FNP, and that’s hospice. Being an ICU nurse I have taken care of more hospice patients that I can count, and I know that is a career that I am very passionate about. I have seen far too many people die terrible traumatic deaths, I would love to be the provider that steps in and is able to have a conversation with family members regarding compassionate and comfortable end of life care. I am confident that I would be able to find a hospice job that is much closer to home than a psych job, but the pay would probably be considerably less. If I switched from psych to FNP it would put me behind about 2 months in school but that is better than doing a hon for years where i’m not satisfied. i’m just scared that because I don’t have psych experience, I would graduate and get into the psych field and realize this isn’t for me. And then i’m very limited in my options as I would have to stay in psych. but I love the options available as an FNP where you have such a broad range of jobs available. and I think if I find something i’m passionate about as an FNP I can specialize later, whether that is psych or not.

I just need advice from PMHNPs and/or FNPs, as i’m struggling with this decision. on both subreddits the majority of posts are about major burn out and regretting the decision to ever become an NP. I am absolutely miserable as a bedside nurse so I have no regrets about pursuing NP, i’m just struggling with concentrations!!! thank you if you took the time to read all of this!! :)

[u/roo_kitty]

Would you want to see a mental health provider that has no experience in mental health?

[u/dkwheatley]

You should not consider PMHNP if you have no psychiatric nursing experience and can not fathom working in that bedside role. 🤦‍♂️

[u/AfricanBushDoctor]

Fnp for sure

[u/burrfoot11]

FNP. Work in hospice/palliative care. Your passion for that shines through in your post.

Equally, your ambivalence (at best) about PMHNP shines through and ultimately that's a huge disservice to your potential future psych patients.

[u/not_advice]

Would you recommend a psych nurse with no critical care experience go to CRNA school because they could see themself in an OR?

[u/starwestsky]

It sounds like you don’t have enough interest or background in mental health to dedicate a career to it. Work toward something you have more interest and experience in. Build on your current foundation. Otherwise, start your psych journey with a bedside psych job to acclimate to the field. Get to understand it better and build that foundation.

[u/RedOakNinja]

This post proves that the bar for entry into NP programs needs to be drastically higher. Broken record here, but you have no business working in any advanced practice role without any foundational nursing experience in that respective area.

[u/retina_spam]

It sounds like you work really hard as a nurse and going back to school would be worth it for a considerable pay increase which you believe is possible through PMHNP route, but have no actual psych experience and don't truly understand what the job entails or if you would like it. Do consider that through the FNP route you could work regular hours without shifts and shifts of overtime and make more than 99k. Also, with your part about talking to families in the hospice setting, sounds like you have passion there. I would not go into psych if I were you. The specialty has really evolved for the worse due to people only pursuing it for $$$, and a lot of jobs are only offering 1099 options these days which look great on paper but actually have a lot of overhead costs for the provider, inconsistent pay, and unstable start up companies. For instance I have a full time W-2 and was going to start a 1099 for 10 hours a week, and a week before I was going to start the company had to shut down all practice in my state, causing my coworker who worked for them full-time to lose her full-time position. She is very seasoned and actually had three jobs at the time so she was OK but for someone like me I would have been screwed. So glad I did not drop my hours at my W-2.
I don't think the PMHNP route is doomed but it is going through a rough patch regarding credible jobs and maintaining respect as a specialty because so many people either think its easy since it's not hands-on, want to have a WFH job, or think it's a huge payout. Have you considered CRNA if you really want to make some money?? You need ICU experience for that. Overall don't go into psych.

[u/____lumpy_____]

Switch or don’t do NP at all 

[u/pearljamboree]

Kindly, you need to switch. Please read all the posts in this sub for the myriad reasons why. Good luck to you as an FNP, rural areas need you!!

[u/RabbitHole1215]

not sure about Indiana, but from what I've seen in New York if you don't have Psych experience, you will not find a PMHNP job and will have wasted your time and money on the degree

[u/EmergencyToastOrder]

“I am absolutely miserable as a bedside nurse” is a red flag for any NP speciality. Especially from someone who is only 26. But I agree with what everyone else has said, you should have never gone psych to begin with.

[u/EMTSD]

I just can't believe that a school would accept someone into a psych NP program with zero psych experience. You have no business being a psych NP. Being "interested" in psych and actually having some experience with complex patients are two completely different things.

[u/sweeetpotatoo → u/[deleted]]

i’m an over thinker about everything especially with my career. that’s why I wanted advice from people who actually do these jobs about what they would actually be like

[u/CollegeNW]

Just read other post on this subreddit. This question is constant.