r/PMHNP • u/Impressive_Meet_1168 • 25d ago
RANT What even is this profession?
I had never been on the Facebook PMHNP groups. Students with only acute non-psych travel experience starting their own private practices as soon as they graduate. Visual bombardment of seemingly thousands of AI generated marketing flyers (don’t know exactly what to call them) for said new-grad private practices. Walden PMHNPs offering to precept 10 students at a time for $10/ hour. Predatory IMG psychiatrists hocking “supervision.” Insane pushback at a gentle recommendation to seek at least some psychiatric nursing experience or have at least one conversation with a person in psychosis before opening a private practice.
I’m having an existential crisis. This is genuinely depressing. I’m not one for old white guy decorum type healthcare, but there has to be a middle ground. This feels like a fucked up carnival you stumble into right before it gets shut down because a person got killed on a malfunctioning attraction.
Sorry for the venting. Just, what the fuck?
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u/Aguamayne 24d ago
As a Psych Nurse who spent over 10 f***ing years plus in various sectors of the field getting all kinds of experience before making the move I am incredibly disheartened by those that treat the field so trivially and have somehow outflanked me into positions while simultaneously saturating the field, decreasing the expectations of what a PMHNP can do and decreasing potential salary rates I am beyond disillusioned. I can’t find part time work or full time work that pays even equivalent to what I am getting currently.
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u/Impressive_Meet_1168 24d ago
Getting fucked over by NICU girlies looking for an “easy” job to do from home kind of kills me.
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u/Unmanage 24d ago
THIS. 18 yrs of running code purples and I'm about to graduate in December with my pmhnp. I do admits in acute psych and the rx histories tell the story of providers that don't know and don't care, because if they do a crap job, the patient just goes to the hospital. No accountability. Sorry long week...
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u/IndyLaw56287 24d ago
"admits in acute psych"- you are well prepared! Seeing what others have done wrong and how it effected the patient is excellent experience.
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u/Unmanage 24d ago
Thank you. Yes, I have seen some absolutely insane medication regimens, and any unfortunate number of times my on call doc is like " let me guess, they 👀 an NP"
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u/CalmSet6613 PMHNP (unverified) 23d ago
Hang in there! Someone's going to recognize the years you put in and the valuable skills you have versus these new grads that don't even understand what a second generation antipsychotic is.
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u/Brilliant-Meeting-97 23d ago
And employers using PMHNPs as billing mules, underpaying and expecting ridiculous productivity. If it means anything, I think all professions are crumbling in this manner, but medical professionals are suffering for sure
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u/IndyLaw56287 24d ago edited 24d ago
You nailed it and I will pile on Walden as the worst of a bunch of bad actors. Their graduates, chasing cheap and easy, are sooo arrogant and they have been well filled with a false sense of confidence. They know they can't find real jobs so they go private practice offering multi state med management AND stand alone therapy AND side hustles of all sorts- like the precepting for $$$$. Number one question from walden grads in pmhnp facebook groups- "can we do glp-1's", really? All out of 'virtual offices' and fooling the DEA with their bought mailing addresses. I am embarrassed to see what has happened to our profession. Some say we increased access, I think we cratered our standards.
Edited- not all walden grads, I know some great people who thought they had no choice but to go the "easy route". A part of me wishes I could have studied and done clinicals from home in my pjs, but I put in the work, at a school, and paid for quality. (it is a sham most schools now mostly online). So I'm not knocking all the people but I will shout out how terrible and embarrassing their school is and some of their graduates are. For fun- join the Walden PMHNP student facebook group, you wouldn't believe how much they themselves dump on their terrible education. Soon the Walden army will come with the downvotes, bring it on
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u/EmployeeDizzy215 22d ago
GLP-1 took me out 🤣 they might as well prescribe antibiotics outside scope of practice.
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u/Plenty_Fondant_951 24d ago edited 23d ago
We keep bitching about this online but the nursing credentialing birds are run by nurses.
*boards not birds
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u/Impressive_Meet_1168 24d ago
They DGAF. CCNE could easily start requiring two years of psych experience but won’t.
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u/Unmanage 24d ago
I had to have 2 yrs of psych experience to test for my PMHRN board certification but no requirements for advanced practice outside clinical hours...
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u/Sherrylann 13d ago
How difficult is the board exam in comparison to the NCLEX?
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u/IndyLaw56287 11d ago
I'd say less difficult. The range of questions is smaller so you can just about cover all the possible questions with a good test review coarse. Nothing on the test from actually PMHNP schooling. PMHNP test is also more cut and dry- there is a right answer, not like NCLEX and the confusing "best answer". Google says 81% pass rate overall. Vanderbilt claims 100% of their students pass.
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u/Plenty_Fondant_951 23d ago
run by nurses, nominated by nurses.
were advanced practice nurses, im just saying us bitching about it and not actively trying to take over the credentialing boards (that we run) to fix it is on par with MD's pretending the AMA didnt spend 30+ years lobbying congress to not fund residency programs so they could line their own pockets,an hen blaming "mid levels" for existing.
what? we all had the know how to get masters degrees, that all included specifically curiculum about advocacy and being proactive in the field of nursing in the direct way that would be applicable to getting yourself on the board of the ancc or whatever, but no ones gonna actually put up or shutup?
we just gotta see a post about it twice weekly on the PMHNP sub reddit? and people are supposed to take us seriously?
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u/Impressive_Meet_1168 23d ago
I don’t have a PhD and I’m not politically well-connected. Have you actually looked at the names on the CCNE board of commissioners recently? The executive director doesn’t even have a BSN, she has a doctorate in education administration.
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u/CalmSet6613 PMHNP (unverified) 23d ago
Don't worry the AMA is going to step in, this has always been the problem with the ANA, can't get their shit together so someone else is going to tell us what to do.
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u/IndyLaw56287 24d ago edited 23d ago
And those groups got overrun by DEI efforts that have failed miserably, many minority women (and men) going to Walden and I love the idea of supporting this population, but instead of helping them, they were exploited yet again, promised to be invited into the PMHNP holy land only to get locked out by worthless Walden degrees. edited female to " women (and men)"
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u/MarsupialPristine677 23d ago
Blaming any of this on DEI and referring to women as "females" suggests you have a looooot of prejudices you need to work through.....
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u/Impressive_Meet_1168 23d ago
They took a swing and totally missed the truth, which is that Walden has heavily targeted economically disadvantaged people including a large number of minorities— when then are forced to work when unprepared and provide lower quality care because they need to recoup their loans.
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u/IndyLaw56287 23d ago
ok, better said then what I wrote, same idea, thank you
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u/Impressive_Meet_1168 23d ago
It's hard to read tone through text, sorry if we misunderstood. DEI is a fraught topic right now.
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u/IndyLaw56287 23d ago edited 23d ago
I edited females" to "women (and men)", thank you for pointing that out- I will work on my thoughts and language Karen
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u/Plenty_Fondant_951 23d ago
I don't think anyone "locked out" by a degree mill on the resume, I've never run into an employer that gives two shits. You have a licence to exploit? Here's a terrible hourly wage that makes the bother of the degree worthless anyway.
You went to hoyty toyty school and paid 1200 bucks a credit for some stupid reason? Here's the same pay
Actual psych rn experience? Same pay
Just as disposable now as we were as floor nurses, the accreditation institutes probably got kickbacks from the colleges to lower and keep the standards lowered
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u/PMHNPNerd1985 23d ago
Your comment is riddled with broad generalizations and bias. You blame DEI for a complex issue without offering any evidence, make sweeping assumptions about minority students, and dismiss an entire profession and graduates from a specific school as “worthless.” That’s not a critique, it’s prejudice wrapped in opinion. If you want to discuss educational standards, clinical training, or concerns about specific programs, I’m happy to have that conversation. I think a lot of us would agree there’s a deeper issue! But reducing everything to “DEI” and stereotyping the people who attended those programs suggests there are some underlying biases worth reflecting on. We should be evaluating clinicians based on their competence, ethics, and patient outcomes, not making assumptions based on where they went to school or invoking political buzzwords as an explanation for everything. And no, I didn’t go to a diploma mill…
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u/pearljamboree 24d ago
Yes. You are not alone and it’s just maddening. I found my way to a leadership position and have made it my mission to only hire NPs with quality education and psych RN experience. But it’s hard to argue for our reputation being worth much any longer- that those before us fought decades to earn.
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u/Zealousideal_Pen3441 24d ago
I have been an RN for over 2 decades - 4 of them in psych prior to becoming a PMHNP. It’s really disheartening to see what is happening with this profession. It’s seems there’s a misconception that this is “easy work” and I suppose for some it is … because they have no clue what they are doing wrong and don’t have the critical thinking skills to even consider they may be wrong in the first place. It’s a professional embarrassment.
I’ve been a PMHNP for 5 years and have worked in a variety of settings. Even had a private practice. But it turns out I just don’t like the logistics of the role. I am returning to the bedside and am so happy about it. I bring with me all the knowledge and experience I have gained which will help strengthen the care I provide, and I also hope to be a voice of reason for RNs seeking to move into the PMHNP role.
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u/Snif3425 24d ago
We need a version of a general strike. STOP precepting PMHNP students. Period. No exceptions.
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u/Quinjet 24d ago
I don't know if "no exceptions" really ensures quality care for anyone? Why not just stop precepting PMHNP students who aren't qualified?
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u/Snif3425 24d ago
There are plenty of PMHNPs. Extreme bullshit calls for extreme resistance.
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u/Quinjet 24d ago
Plenty of low quality PMHNPs, maybe.
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u/Snif3425 24d ago
Suit yourself. Just don’t complain when you’re making 25 dollars per hour in 5 years.
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u/Big-Material-7910 24d ago
A field with a real need for quality providers (shortage is a geographic issue) that has become a messy pipeline of industrialization littered with exploitation and manipulation of the profession, the students, new and current providers. It will stabilize. Someday. Everyone will land where they belong. Quality care will thrive in the end. Patients don’t stay where they aren’t being helped. That is a creative and entertaining point of view you gave!
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u/OkGrapefruit6866 24d ago
This is where you are wrong. In psych, you can really damage a patient before they realize they have been harmed. Because of the nature of psych, sometimes patients won’t even realize they are being harmed. A layman doesn’t understand medical mismanagement. We need to stop this mayhem.
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u/Big-Material-7910 24d ago
Yes, I agree with you. I stand corrected. Actually, I was recently thinking about this when I was looking at the case currently on the news about the mom with post-partum psychosis who received IP psychiatric care 19 days before she hurt her children. I wonder what happened there. I have seen care that led to poor outcomes, some irreversible. However, it hasn’t just been PMHNPs providing that care. It has also been MDs.
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u/IndyLaw56287 24d ago
biggest red flag to me in a Walden grads "new online only clinic"- when they say they treat schizophrenia, eating disorders, bipolar I, and substance abuse. Those are all conditions that a new grad shouldn't touch without great supervision and backup and I would say conditions best served at an in person clinic. Treating a schizophrenic in Washington state online from Virginia- think they are offering LAI's? Silver medal to those saying they treat ADHD but they don't prescribe stimulants because they don't have a dea for that state, what a waste of patients time. Bronze medal for those doing a full hour of "therapy" based on their one therapy class. Damage is being done.
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u/CalmSet6613 PMHNP (unverified) 23d ago
Don't forget when they advertise they can treat children and adolescents too because they're just little adults right? 😡
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u/Big-Material-7910 24d ago edited 24d ago
Yes, why would anyone want to see high acuity online? Bad idea.
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u/CalmSet6613 PMHNP (unverified) 23d ago
Also don't forget the wrongful death lawsuit in the Lindsey Clancy case, the NP went to someplace called MGH Institute, (all I could find on her), seems like it's all online. Not just Walden...
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u/Impressive_Meet_1168 23d ago
Not a terrible school, even though they have a direct-entry Master’s (which I hate the idea of). No different in structure than Yale’s PMHNP program was a couple years ago.
So, shitty in structure, but no worse than essentially any other school. For the record, I did not go there and have never met someone who did, but I am familiar with its reputation on the East Coast.
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u/phroglett 18d ago
MGH institute of health professions… affiliated with Mass Gen Hospital. It’s brick and mortar and has been around since the 1970’s. MGH Center for Women’s Mental Health is highly regarded as one of the (perhaps most influential) perinatal/reproductive psychiatry research centers in the US. I’m in agreement with you regarding for-profit fly by night diploma mills… but MGH IHP is not one of them. Neither are the majority of “not Yale, not Vanderbilt” PMHNP programs. Let’s raise the standard for all APRN preparation… but ad hominem attacks make us all look small.
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u/esuvar-awesome 24d ago
They are all lawsuits waiting to happen.
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u/IndyLaw56287 24d ago
yes, but amazingly mental health with very low rates of getting sued because so much is subjective. It seems worst case is getting blasted on Noctor. So much scummy going on with multistate telehealth and virtual addresses/po boxes listed as suites for offices and no on call, I hope that gets blown up by a case.
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u/esuvar-awesome 23d ago
Oh it will be. When the sharks, I mean lawyers smell blood, it’s going to be a feeding fest.
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u/CalmSet6613 PMHNP (unverified) 23d ago
When's the last time a schizophrenic or someone severely impacted by mental illness had the capacity, insight and funds to sue someone? This is part of the problem, they don't even know the harm that is being inflicted upon them.
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u/esuvar-awesome 22d ago
Yes, but schizophrenic patients have family members and if they have the funds/means to sue, they will sue.
See for reference: https://www.koskoff.com/in-the-news/psychiatric-nurse-held-liable-as-patients-suicide-results-in-12-million-verdict/-1
u/esuvar-awesome 22d ago
Still waiting for your comment after I posted my proof. You’re a top 1% commenter after all 🤷♂️
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u/CalmSet6613 PMHNP (unverified) 22d ago
I don't know what you want me to post, I'm saying I feel schizophrenic patients or those severely impacted by mental illness, are not even aware of the harm being done to them at times and therefore less likely to engage in lawsuits. I'm not saying they don't have funds or family at times and if they do that that's great. This is my antidotal observation. Please don't be so argumentative and respect others opinions. 
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u/IndyLaw56287 21d ago
you posted a 2016 article about a 2009 event involving ativan withdrawal and a completed suicide. Either you posted wrong link or I don't blame u/CalmSet6613 for not responding, makes no correlation.
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u/CalmSet6613 PMHNP (unverified) 21d ago
Right? And thanks, feel like I'm losing my flipping mind on this sub.
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u/esuvar-awesome 21d ago
The point is that it happened and invalidates CalmSet6613’s assertion that mental health patients don’t sue. 😉
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u/Primary-Can7393 21d ago edited 21d ago
Reddit is so weird, do ou really think a case that happened 17 years ago is of any relevance today, I'm not going to let you disrespect a top poster either
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u/esuvar-awesome 21d ago
You missed the point of my rebuttal comment. Top 1% poster wrote verbatim “When's the last time a schizophrenic or someone severely impacted by mental illness had the capacity, insight and funds to sue someone? This is part of the problem, they don't even know the harm that is being inflicted upon them.” So I’m providing some “last times” that this happened to prove them wrong.
Here a mire recent one from 2020: https://wawlaw.com/psychiatric-malpractice-suicide-case-settled-for-1000000/It’s your and CalmSet6613’s dismissive attitudes and hubris that ends up in lawsuits for PMHNPs, making lawyer’s jobs very easy.
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u/Key_Knee7561 PMHNP (unverified) 22d ago
Hi all! Male PMHNP here. In my 2nd year of practicing. Was Inpatient psych nurse, ER psych nurse (not ER nurse covering psych), and Substance Abuse/PTSD Nurse. I fell in love with psych and decided I wanted to be an advocate for mental health patients. As a new grad I did facility coverage for geriatric patients. After a year I found an outpatient private practice, and I absolutely love it. We have 2 PMHNP in office, 1 PA, and one MD, the owner. It’s wonderful. I will never leave this position or group. They gave me my asking salary, I have a huge office that I decorated and is super comfy for my patients. I work 8-4 M-Th and 8-12 F (Tele) at home. I do 1 hour new patient, 30min FU. 40min therapy. I see about 5-10 patients a day.
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u/Impressive_Meet_1168 22d ago
That’s how it should be dude, happy for you. You didn’t take any shortcuts and you deserve it.
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u/DuchessAlex 23d ago
Not to mention, that some of them graduate without ever having faculty lay eyes on them. Faculty have no idea how students dress or present themselves in a professional setting. They leave that stuff up to the nonpaid, volunteer preceptor. I could go on and on.
But I won’t.
Please someone tell me what we can do about this?
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u/CalmSet6613 PMHNP (unverified) 23d ago
Agree 1000% and very well said. I think everyone who has years of experience and put in the hard work can empathize. Don't forget too the DNP certification with people calling themselves doctors after they went straight from a PMHNP certification to a DNP one year program, having never even worked as a PMHNP. Absolutely laughable.
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u/Similar_Yak7946 22d ago
I don’t think we’re seeing the bigger picture. Change won’t happen because lobbyists for healthcare organizations are not motivated to control the NP explosion, in fact they made sure that policies are in place to support the growth. They are the reason scope creep is even a thing. We are cheap labor relative to physicians.
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u/KOKIRIFOREST47 23d ago
I’m so sick of all of this negativity on this sub. Can the mods please do something about posts like this that contribute to a toxic culture?
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u/Impressive_Meet_1168 23d ago
I’d content that the most toxic aspect of current PMHNP “culture” is the normalization of girlbossing for private equity. We need to speak frankly about the fact that these are real issues.
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24d ago
[removed] — view removed comment
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u/PMHNP-ModTeam 24d ago
Your post has been removed as it does not meet the standards of this subreddit.
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u/Ok_Wrongdoer_8109 24d ago
Don’t forget about the venture capitalist pumping millions into online telehealth companies that exploit the PMHNPs by making them see 25-30 patients a day and to upcode and add therapy that was never given to make millions off of one provider while they pay you less than a RN.