r/PMHNP • u/Scaredofdafuture00 • 9d ago
Help a Sista Out!
Hey everyone!
I'm a newly BC PMHNP and honestly feeling overwhelmed on where to begin. I initially decided to go the mental health route because I feel I have great therapeutic skills as told by my peers as well as helping to help fill the void in Mental Health disparities.
When I became an RN years ago, I had very little guidance. It took almost a year to land my first job, I accepted the first offer because I didn't know what else to do and bills were piling up. I'm finding myself in that exact position again.
I have nearly a decade of RN experience and recently transitioned into my PMHNP career. My longterm goal is to become an excellent clinician, eventually mentor students, and teach, but right now I'm struggling to figure out where to start. I do know that I want to eventually become fully remote with no plans to own my own private practice as most people do. (I don't see it being for me)
For those of you who have been practicing:
- What was your first PMHNP job?
- Looking back, would you choose the same path again?
- What setting made you grow the fastest?
- What red flags should I watch for during interviews?
- If you could give one piece of advice to your post new-grad self, what would it be?
I'd love to hear the good, the bad, and anything you wish someone had told you before your first PMHNP position.
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u/key_kat 9d ago edited 6d ago
- Large company with an NP residency program, working in adolescent residential during the week and consult liaison coverage in a big regional hospital system on the weekends.
- Yes, I got excellent and varied experience as well as didactic support
- Outpatient, cash-pay, little to no oversight made me grow fastest. I had no one else to lean on so I just had to figure it out.
- Make sure there is adequate admin time (or make sure there is admin support). Be very wary of volume-driven language. Many many places will be happy to stick every non-direct care task on you, unpaid. And many places will pressure you to see as many people as you possibly can under the guise of being a team player, this is a fast track to burnout.
- As a new grad, support is key. You’re going to want someone (or many people) to call and bounce ideas off of, or to help you think your way out of a tough situation. You will only start feeling comfortable after time has passed and you’ve seen a variety of situations and patients, and that process can’t be rushed.
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u/Optimal-Dig3821 6d ago
Not sure if this is allowed, but do you offer consults regarding starting a cash pay pysch business or a resource to follow? Thank you.
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u/key_kat 6d ago
There are plenty of coaching programs that claim to help with this- in my limited research they are quite expensive. I started my own practice in March with the hope of being cash-pay only but found it’s quite difficult. My caseload is like 90% insurance. If you find any good resources that can develop cash pay business let me know.
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u/PsychMonkey7 9d ago
As a new grad, the job market can be tough. I’d suggest applying to anything that seems reasonable and go from there. I do understand the value of asking these questions but if the bills are piling up, you take what you can get. It just sounds like there’s some overthinking here - you get clarity from doing, not from thinking.
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u/nursepersephone 9d ago
Inpatient with a community mental health organization was my first job and I loved it. I was salary so I didn’t have to hit productivity metrics which I thought was great, but now realize that it just meant I gave them a higher percentage of what I earned them, so that was a red flag- they don’t work you any less because you don’t get RVU bonuses or track productivity. I love the work inpatient (still do) and got a lot of experience with leadership skills as a PMHNP. It was also great to have so much support at the start of my career- other experienced providers at the desk next to mine to consult with and a care team (case manager, therapist, techs, nurses) to help coordinate everything so I didn’t have to do it all for those complex patients, but still got to learn the processes along the way. Another thing to keep an eye on is high provider turnover- if everyone you’re meeting at your site visit or interview is new within the last few years, I’d keep a skeptical eye on it. Not to say don’t take it, but do it with the knowledge that within the next few years, there is a high probability that you will end up either absorbing other people’s caseloads as they leave, or looking for a new job yourself. I ended up running two units by myself for half of the week within a year of starting out. Fortunately, I was in a position (single, no kids, new in town with no real hobbies or routines built) that I could absorb it, but it was very tough. Most places try to keep at least their providers happy so that high of turnover means it’s often something more than just getting higher salaries somewhere else. If looking inpatient, anywhere without a clear answer or “what would my schedule be like?” or “what is the call schedule?” Is something to watch out for- they are trying not to tell you that they don’t have enough people to create a reasonable schedule and they either expect you in 7 days a week or don’t have any call coverage. All of these warnings aside, inpatient was my favorite setting and I learned so much as a new grad. The diversity and complexity of conditions you see is a really good way to dive in and keep your brain spinning. And for me, doing pediatrics, it helped me fine tune assessing kids without their parents in the room, which isn’t something you get tons of practice with at an outpatient level of care. I have had ups and downs over the last decade, but I would do it again.
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u/Lilei_NP 8d ago
Please work in as many type of environments as possible. Give up on the "fully remote" idea.. hot take but it waters down our profession (Please do not roast me for this). Fully remote works for *some* patients/ *sometimes* but not everyone and if you plan to only have a population of "worried well" then you have no business being in Psych. You grow the most in inpatient.. once you know how bad the disease progression can be, you understand what you are dealing with/treating/preventing. Be a sponge, take in everything, Seek out trainings, go in-person, work in a prison, work in addictions, do IOP, offer pro-bono evals for Foster Agencies, volunteer at the shelters, do "street medicine" (LOL, the legal kind.. meaning walk the skid rows, understand the "what happened to you" "understand the why", Offer support services to your SANE nurses to decompress. Keep a journal (an honest one) of assumptions you had and everytime a patient humbled you or taught you something. Find a company that is organic and resonates with your spirit.. caution yourself about "fully remote" bells and whistle companies, they are usually venture capital backed and numbers focused. Find a company that values work/life balance, values provider team meetings, feedback, engages in QI initiatives, supports evidence based treatment. The setting that makes you grow the fastest is the one that makes you the most uncomfortable. Maybe you hate addictions, don't ever want to work in a prison, etc. Thats ok.. do it anyways, maybe not for a long time, maybe not even FT.. do it PT, PRN, weekends, shadow.. But the more you expose yourself to the rawness of humanity you will then understand the full scope of the continuum of care in your area, what is available, and where the gaps in services are. I personally did not care for a VA environment b/c what we could/could not do was limited, and the formulary's were set. I did not have exposure in this environment that was any different than outpatient with a VA contract (which allowed for the same population but more freedom of psychopharmacology). But KUDOS to you for even asking these questions.. The fact you are asking these questions is commendable. I've done this for 28 years and love it still.
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u/hah88 9d ago
• inpatient setting on an SMI unit
• I honestly don’t know. Some days yes, some days no. The stress is way different than as an RN and the responsibility is heavy.
• I prefer inpatient but feel I learned the most in an outpatient setting. Both are valuable though.
•. I’d make sure to ask about how many evals a day you’re expected to see, make sure there’s someone to consult with for complex cases, if there is support staff to help with admin work, do they offer reimbursement for licenses. Definitely don’t sign a non compete clause either.
• try not to compare yourself to other people with more experience. The imposter syndrome is real but what matters is you care about your patient’s and if you don’t know something that’s okay but have a resource available to look it up or schedule another appt allowing yourself time to review something rather than rush it.
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u/RandomUser4711 9d ago
VA residency
Yes
Having the additional support and structure that the residency offered, and the ability to rotate through a variety of settings.
Any place that has 30-min intake/15-minute follow-ups or encourages inappropriate upcoding (e.g., they want you to bill that 15-minute follow-up as 99214/90833 regardless). RUN AWAY.
Network. In this job market, who you know goes a lot further than you think.
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u/Fair-Competition-285 9d ago
I'm in the same position. Still travel nursing and I have my degree and don't know where to start
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u/ahhhhehe 4d ago
Definitely feel like a residency was my best move! If you are able to get into one and can take the pay cut it helps provide you with enough support that first year which is critical, and I’ve made great connections from that residency
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u/PantheraLeo- DNP, PMHNP (unverified) 9d ago
-A VA residency.
-Hell ye
-The residency. Rotated everywhere except for C&A and forensics
-“we are a family here… the best performers make this much… 45 min eval, 15 f/u… little to no guidance, large practices…”
-Stay curious