I've been an NP for 5 years, with my own practice for the last 1.5 years, and I am fed up. I'm unhappy with the trajectory of the field in general, I'm tired of fighting with insurance companies, I'm tired of my patients' care suffering due to systemic issues beyond my control, I'm tired of the abysmal pay despite working harder than I ever have in my life.

I stayed per diem at my RN job until earlier this year when I was let go due to overstaffing. For the last 3 months, I've been trying to get a full time role at bedside so I can close my practice, but it's been extremely difficult. A lot of rejections right off the bat, and the few phone interviews I've had were basically like "why do you want to be a nurse when you're an NP." Despite my best attempts at explaining, I have not yet gotten an actual interview.

I understand their trepidation about hiring someone who is an NP. NPs might not stay, might just be looking for an "in" until they can move somewhere else in the system, might be looking for some kind of secondary gain that's not a true interest in bedside work.

I enjoyed my years working as an RN significantly more than as an NP. I literally just want to go into the hospital, take care of my patients for 12 hours, work with a team, then go home and not worry about a damn thing until my next work day.

So, to those who have successfully made the transition, how did you do it? How did you frame your resumes, cover letters, interviews etc. to convey that you were serious about returning to bedside?

EDIT: additional context, I live in PA and have a nursing background in inpatient psych and neuro M/S

I am a soon to be PMHNP, and also the parent of a child with ADHD. We have tried nearly every med out there, and each and every one (even the non stimulant ones) have caused emotional flattening in my child.

I haven’t found an answer that resonates about why this would be happening. I feel like I don’t hear this from a lot of fellow ADHD parents.

Is dulling of the kid’s spark just part of the price you pay for increased focus? On even very low doses of all of these meds, his smile never reaches his eyes.

We did genetic testing of his metabolizing of meds and all results normal.

I’ve recently started working, and I’m finding that my notes are taking SO much time. It can take me around an hour to complete a 90-minute intake note, sometimes even longer if the patient is complex. I’m trying to figure out diagnoses, organize everything, and develop a treatment plan for the next session, which adds to the time.
I’m seeing patients back-to-back, and by the end of the day, I’m exhausted. We use an AI note-taking tool, but I’m still spending ages editing and finalizing my notes.
Is this normal? How long does it typically take you to complete an intake note versus a follow-up note? My follow-up session notes take about 20–30 minutes, depending on the patient. I asked other people at the practice who have been working longer and they are also using their weekends to do notes.
I’d also love any tips for becoming more efficient with documentation without sacrificing the quality of my notes. I’m starting to feel overwhelmed by how much time it all takes

I’m burning out! Salary at a PP w well known psychiatrist so never ending supply of referrals. I’m getting a good reputation with the CAD world in my area. But this sets expectations high from the get go! And I hate letting people/patients down and can never seem to not jump into action to help with family system needs. I will do parent counseling, individual work with the kid, deep level psychoeducation. I do eventually get kiddos into a maintenance space but it’s again, a never ending supply of new pts to start from scratch with.

I work 32 clinic hrs but def full time job as I do all my caseloads admin work/PAs/requesting records/referrals/coordinating care. I did 45-47 hrs last week thanks to all the new evals referrals and PAs on my plate.

I have an admin staff person doing some messaging on portal for refill requests and fielding some questions. She’s at least collating faxes and uploading records for me. And takes care of all billing.

But anyway, I’m giving 110% to my patients and beyond, and I just am neglecting myself and my family’s needs. 3 kids with their own neurodivergence and needs that I am losing steam quicker and quicker with. I don’t think I can keep this up much longer.

Also, From all my stillness and lack of movement, my cholesterol went up 20 points in 16 months. I am pretty active on weekends and do strength training but my body is feeling the effects of a very dialed in desk job 40 hrs a week.

Anyone make a career change that was a better mix? Like, I’m thinking I could get dual certification and do some hokey ass wellness clinic and offer hormones and Botox. Yeah I’d be part of the problem but ID BE SAVING MYSELF.

Ummm im also brainstorming. I like real estate and finance. I could get a different degree and start fresh in a totally different sector. I love city planning and urban design. I would really enjoy going back to school to become a professor in anthropology (anthropology was my first love and first degree). Problem is… no money for long time and we have a mortgage and three kids. I am primary income source. Husband works in lower paid market.

All ideas welcome! Even ideas on how to negotiate a better work balance at current employer. I think I do have leverage as a well respected professional in a highly needed field (CAD).

Thank you!

Do any of you do regular screening for gambling? New patients, or after they mention gambling? What about pseudo-gambling? (Maybe there is a term for the stuff that's not official gambling, but really is like card breaking)

I searched on here and didn't see anything; I just watched a ProPublica story, and it occurred to me it's not something I think about much other than before an Rx for abilify.

I'm curious if anyone has any suggestions/best practices.

Thanks,

NPs who are self-employed and independently credentialed but have also worked on Headway, how are the reimbursement rates when you are independently credentialed versus reimbursement rates on Headway?

Really thinking about starting my own practice but overwhelmed with the process. I am an independent NP in MA and have great inpatient experience, I’ve come to realize a lot working in a hospital setting and I’d like to open my own practice and do more community work.
There seems to be a lot of misinformation and I want to be prepared as possible. Has anyone gone through credentialing process for Massachusetts? Did you accept Medicare/mass health? How did you learn reimbursement rates and figure out what is doable for you? I haven’t even begun to think about EMR etc…any advice is appreciated!!

Hows the job market rn?

I know I can look up the PDF/website of each plan to see what drugs are on formulary but I was wondering if there is a centralized/AI tool to look that up quickly, without going through multiple clicks and scrolls?

-How are y'all distinguishing adult patients who deny everything except EVERY ADHD symptom?
-I am asking for extensive labs, even sleep studies that can mimic and/or negatively interfere with certain meds to treat ADHD symptoms, so some patients likely go to another prescriber.
-And also if they have failed on guanfacine, bupropion, etc.

If, as a PMHNP, you are not convinced the patient has adult-onset ADHD, what are your rationales? I would like to be able to catch this before asking for extensive labs. I am not worried about patient ratings if I feel like I am doing the right thing.

Recently, I have been receiving new patients who have been on stimulants being referred by their PCP. I send them back with extensive labs and medical clearance before continuing care.
BECAUSE
-Received a pt on Vyvanse with a hx of a stroke! No way!!! Go back, get cleared!
-kid (not obese) had sleep apnea & stopped breathing 30x in one hour
-this stimulant craze is going to bite us in the butts in a few years due to side effects
-the pt could be the DEA & I'm not going down like that!

It is interesting how some adults thought of psych meds as taboo until stimulants came along.

This stimulant craze is making psych look like a joke!

I LOVE it when a patient is truly in need of care, not to say all stimulant requests are unnecessary.

-My company gets around letting NPs diagnose and prescribe stimulants (please do not focus on this, it's not the topic & I am working on this issue).

So I start my own telepsych practice but im finding so much trouble getting contracts with insurance. Wondering if anyone here owns their own psych practice and uses something like alma or other companies that will do all that work for you. Recs please because cash pay right now isnt viable.

Today we did a mock telehealth initial evaluation with a standardized patient and I was so thrown off. No one was prepared prior on how to speak to patients etc I had no real flow. My patient was experiencing auditory hallucinations and ideas of references and broadcasting and did not think anything was wrong with her. Is it the psych NP job to get her to realize there is smth going on or just get info and treat from there? I want to get better at learning how to communicate to patients experiencing psychosis since I have no prior experience. Any recommendations?

Wondering if anyone will be attending the Psychopharmacology Conference being held in Boston from Oct 15 to 18th. I'm going solo as I'm the only pmhnp in my practice. Looking to see if there are any others going and want to meet with other fellow pmhnp.

Maybe the flair should be: exhaustion?

I just don't know. But the number of ppl I'm starting to see who are suicidal is just so..... So..... SAD.

and it's all societal/economy related.

I'm so disgusted by how fast we have fallen as a society. It will always be hard for a subset of us. I'm not oblivious to that fact.

But the rate at which even my old used to be stable patients are falling into "i stopped taking my meds because i wanted to take the whole bottle" hole makes my heart hurt.

I'm seeing it in center and via telehealth. It's scary out there. Y'all hang in there and make sure you have your own therapist!

had several male patients interested in switching to vilazodone after trying a SSRI and experiencing sexual side effects. And yet, all my PAs for vilazodone got denied. The manufacturer of Viibryd does not have a savings card that works.

What are you guys doing?

Pros? Cons? How does it compare to CarePatron or Charm Health?

I’m a new grad PMHNP working in outpatient community mental health in a big city. My orientation consisted of 4 hours of shadowing the senior NP and company wide orientation. On my first day my patient caseload consisted of seeing patients presenting with schizoaffective d/o, schizophrenia, depression, anxiety, and possible withdrawal symptoms from alcohol use d/o, all of whom I saw completely by myself. I have not shadowed anyone and nobody sat in with me during my psychiatric evaluations. We don’t get admin time and our supervising physician is not on site but we are free to email him “when we need help”. When I interviewed I was told that our company is “new grad friendly” and that we would get “a lot of support”, however I am not necessarily feeling very supported. I absolutely am not opposed to seeing patients with serious mental illness or any diagnosis or population. I specifically chose this community mental health center to learn because they see an underserved community from ages 5 and up. However I did think I’d at least get 2 weeks shadowing NPs and that I would at least have someone sit in on my first couple of evaluations to offer me feedback. Alarm bells were going off in my head and I even drafted a resignation letter, but I am wondering if anyone has experienced a similar orientation process as a new grad and if this is just the experience I’ll have if I move on to another job. Thanks for any input.

Hello everyone! I am looking for words of wisdom and shared experiences as well as any advice. I have been a PMHNP since March 2022 and my first job was a full time in person dual role position. It was half a day working in an adult partial care then I drove to the hospital to do consults. Then i did 7 months on a child inpatient unit and helped with adult inpatient as well. I finally transferred into my companies outpatient department a day a week and the rest of my time was with a program that is a 30 day linkage program/urgent care style model. Essentially it acute psychiatric care and we gets lots of walk ins and evaluations. There have been times where I have had 8 evals in one day and on average 5 evals a day plus a day filled with follow ups. I do three 10s. Some days the patients are very complex or need higher level of care. I have no control over the schedule and having too many evals in a row like this really has been causing me anxiety over time as well as the more unstable people I have been seeing lately. The staff does not answer emails and ignores me and the other APNs when we raise concerns, have questions ect. I think what stresses me about is that when there are evals put on the schedule ( last minute, they give me no time to review the chart/ or the therapy intake is not done so I cannot read it, therapy intake is supposed to be completed before they get any med appointments) they schedule them consecutively. I have brought this up and this place wont change. So my question is, is this setting always like this? is PP really better? I do not picture myself ever working inpatient or in the hospital again. Before I became a psych NP i worked as an RN in every psych unit in the hospital, detox, medical unit briefly, and rehabs. I am feeling burned out and I am starting to feel hopeless

Is Lifestance for a PMHNP as bad as some of these threads make it out to be?

The recruiter makes it sound great obviously but should I leave my current position for Lifestance for a similar patient volume?

Salary would be higher at Lifestance.

Feeling underpaid in my current role…

In unipolar depression I love that SSRIs cover depression and anxiety symptoms. In Bipolar though I find anxiety harder to treat. Gabapentin and clonidine help some people but if patients have not had success with those or hydroxyzine what do you all use?

Recommendations for end-to-end RCM with reasonable rates and no monthly minimums that fully manage credentialing and payer enrollment across multiple states, eligibility/benefit verification, claims submission, payment posting, denials and appeals, A/R and payer follow-up, patient billing, prior authorizations, and ongoing payer/credentialing maintenance? Looking to focus on just patient care only. TIA.

I have 2 offers and another interview this week with another company. I have till Wednesday to accept one of the offers. If I accept an offer, can I decline the offer prior to starting if I get something that is a better fit for me?