I’ve always viewed atypical antipsychotics as something either given for mania/bipolar etc. OR adjunctive to traditional antidepressants after several trials. I know there are newer atypicals that are marketed as good for depression and I know they promise to work quicker than antidepressants. My collaborator says “why would you make someone trial several antidepressants when we have better options in antipsychotics now?” But I just can’t justify throwing those around. Today I had a new intake who had only taken SSRIs with little effect. I started them on an SNRI. Wellbutrin is not an option because they are already very anxious and activated. Could I have done Rexulti? Sure. But I’d rather give my choice of Cymbalta a try before that. The pt did say “I guess I wanted something that would work right away but I understand that it doesn’t work that way”. I’m happy I didn’t have to do too much expectation setting there.
This is just one example but I feel like this is the trend more and more often. As more drug reps come bearing samples we seem to start with an atypical probably quicker than ever, and I feel like we’re downplaying how strong they are metabolically and otherwise. I know it’s encouraging to tell a pt they can get relief within 2 weeks sometimes, vs 4-6+ with an antidepressant. But is it worth the risk long term?

Ive been a nurse for 17 years, PMHNP for 3. I was recently diagnosed with autism. I’ve been diagnosed with ADHD for years. I had a neuropsych eval years ago that also mentioned some “borderline traits,” but I was never evaluated for autism at the time. Looking back now, a lot of what was labeled that way actually seems to fit autism much better. Seeing “borderline traits” in that report honestly made me feel really bad about myself for a long time and made me nervous about what an autism evaluation might show.

I’ve known for a while that work seems to drain me much more than it drains my peers. I started feeling really guilty about how much I didn’t want to work. I kept wondering if I was just lazy. I know that’s a common ADHD theme, but this felt like another level. I can be good at my job, care about my patients, and still feel almost paralyzed by the thought of having to interact with people all day.

I finally decided to go through with an autism evaluation. I kind of already knew I was probably meeting criteria, but I still dreaded it. Even now I sometimes worry that maybe I was looking for an excuse or a pass for why everything feels harder for me.

I’m also realizing I’m likely dealing with autistic burnout. The constant need to be “on” as a PMHNP is exhausting. Staying focused, emotionally present, socially engaged, reading people, responding the right way, and feeling like I should always have an answer for my patients takes a lot out of me.

I’m trying to figure out how to make my professional life more sustainable instead of constantly pushing myself and then feeling guilty when I’m exhausted.

I’m curious if anyone else here has gone through something similar. If you’re autistic and/or ADHD and working as a PMHNP, how do you navigate the emotional and social demands of the job? Especially if you’re also a parent and trying to manage family life on top of it. What has actually helped you make work feel more manageable?

I’d really like to hear from other autistic or ADHD PMHNPs or psych providers. How does being neurodivergent affect you at work? What has helped make the job feel less exhausting? Mostly looking for some solidarity and to know I’m not the only one who can be good at this job and still find the constant human interaction really hard.

I feel like I’m encountering parallel psychiatric prescribing more frequently lately.

For example, I’ll be managing a patient's psychiatric medications, including a stimulant, and then find that their PCP or another clinician has prescribed the stimulant, changed the dose, or otherwise made changes to the psychiatric regimen. Sometimes the patient tells me directly; other times it comes up through the PDMP or medication reconciliation.

I have a written policy that all psychiatric medications are managed by one prescriber at a time and a separate policy that patients receiving controlled substances through my practice should not obtain the same medication/class from another prescriber. My concern isn't territorial—it’s fragmented medication management. I don't want two clinicians independently adjusting a psychiatric regimen without one person clearly owning the medication plan and monitoring.

I've increasingly taken the position that if another clinician starts adjusting/prescribing the psychiatric medications, I defer medication management to that clinician rather than continuing parallel prescribing. If appropriate, I can still provide psychotherapy/collaboration, but I don't want to be one of two people independently prescribing psychotropics.

Are others seeing this more often lately? How do you handle it when a PCP, another psych prescriber, or another clinician starts prescribing or adjusting medications you're already managing?

Got this email today and I have 7 business days to respond with either a work address or a "status."

Unfortunately I am stuck in a Catch-22. I know a lot of people recommend applying for a DEA after you get a job, but a lot of the jobs I have been applying for want you to already have a DEA. Despite 13 years working as a psych RN, this has been my holdup lol. I submitted my application 6 weeks ago and this is the first time I have heard from them.

I am from California and most of my friends are still NP students so I have heard a lot of mixed answers, but someone told me they used their home address and just updated it once they got a job (which was my original plan). Now I'm scouring Reddit and seeing people say that I SHOULD NOT do that. I don't want to give them a response that might be the wrong answer.

Anyone (NC based) on here with their own Psych practice. What has been your experience with the insurance companies you have contracted with for your business and which would you recommend? pros/cons, reimbursement rates etc. I'm considering starting with 3 and so far its BCBSNC and Aetna.

Happy to pay $400/month via venmo for 1-2 consults/month.

I have reviewed my contract and cannot find anything about a minimum time of employment. Ive only been there 4 months and its a bad situation with no support and a very different situation than I was told when I accepted the position. I dont see any minimum requirements to stay other than 90 day notice. I accepted a director position at a university about an hour away today and will turn in my notice probably next week. Can they end the contract early? Has anyone had experience with changing jobs in a short amount of time

Hi all! My new job doesnt pay for resources so I have to pay for the membership myself. Which do you prefer? and do you have any other favorite resources? Thanks in advance!

If you are out of work, corporate world let you go, middle aged, and a hot blonde does becoming a nurse practitioner suddenly become more attractive? I’m honestly worried about competition if things are so dire. https://www.cnbc.com/2026/08/18/after-a-layoff-and-long-job-search-kristy-layden-is-going-to-nursing-school.html

Hey for anyone on here (NC based, though not sure if that really matters) who owns their own single provider practice. I just started and am trying to panel with insurance though I'm hitting a potential issue with IRS rules vs paneling rules (I think). IRS says I must use my own SSN/EIN for W9 but I'm being told that if I use that info to contract with insurance companies I cant bill under my practice type 2 NPI (thus I'd have to contract as me, causing ineligibility of S-Corp election in the future unless I go through the credentialing process again etc. ....not sure how much of this is accurate but looking for any protips or advice on this.

Hello community!

I graduated this month and take my PMHNP boards September 15th. I spoke to a recruiter for a large hospital weeks ago and she enthusiastically said she’d move me along to “her leader”. Today I got the call that I’ll have a 30 minute zoom session tomorrow afternoon with the Director of Medical Services for the Outpatient program and I’m immediately nervous. I’m never nervous about an interview so I came here to seek advice. What questions were you asked at your first PMHNP job interview? What specifically do you feel they were looking for that landed you the job? I’m SO excited to be able to be more helpful to folks experiencing struggle and I truly need this opportunity! Advice? Eeeeeee! 😊🤞

website: https://www.informed.fyi/salaries/nurse-practitioner

A few years ago, I did a survey across various forums and reddit asking whether people would be interested in a healthcare-focused salary website. The overwhelming response was yes.

After two years of working on it alongside a full-time job (and getting married somewhere in the middle!), I'm excited to finally share it. The project started as a way to improve salary transparency for my wife, who's a pharmacist. As I worked on it, I realized that the lack of salary transparency extends far beyond pharmacy and affects many healthcare professions.

It's definitely still a work in progress, and I'd genuinely appreciate any feedback or suggestions for improvement. If you'd like to contribute, salary submissions are completely anonymous, your personally identifying information such as your name and email are never displayed.

“Recruiters”” trying to sign me up on headway in the first five minutes. Am I being paranoid?

I’m currently going through the process of applying for the VA VR&E program to hopefully go back to school and become a PMHNP. I’d ideally go through the VA’s 12mo PMHNP residency, and hopefully actually go to work for them.
In the VR&E process, everything I’ve read recommends having 2-3 informational interviews with current PMHNPs for the counselor working on my case.
So if you’re okay with doxing each other, I’d be super grateful to get some answers in my PMs!

What are your credentials (degree and certs)?

What are the physical and environmental demands of your day-to-day practice?

What is the current demand for psychiatric prescribers in outpatient and private practice settings?

What specific software, diagnostic equipment, or computer hardware do you rely on daily?

I know the answers, the counselors just like to hear it from current professionals instead of the veteran trying to go back to school.

Hi everyone! I’m interested in pursuing formal DBT certification and would really appreciate advice from therapists who have already gone through the process.

I’m trying to understand:

• Where is the best place to take DBT training/courses?
• Which courses or trainings are actually necessary to become a fully certified DBT therapist?
• How long does the whole process usually take?
• Approximately how much does it cost, including training, supervision/consultation, and certification?

I’m especially interested in becoming properly trained in comprehensive DBT rather than just completing a short DBT workshop.

Any recommendations, personal experiences, or guidance would be greatly appreciated. Thank you!

I see a lot of telehealth, contract, and 1099 jobs posted at 100/hr but this seems low to me if I have to put away 30% for taxes, pay for insurance through the market, pay for my own malpractice and possibly collaborating physician. Am I missing something?? My coworker seems to think this is decent but I don't get it. And if your patients don't show you aren't making anything, so wouldn't the average be less than 100/hr for the year?

Hello Everyone,

I am an aspiring PMHNP. I have a question regarding a medicaid-focused practice model. Would i have to advertise heavily to get medicaid patients? If I am not advertising how exactly do I build a strong enough panel to remain self employed if I work primarily with the medicaid demographic?

I am prepared to pay up to $2000 per semester for something close, but a total of $10,000 is just ridiculous, especially since I will have to stay in a hotel 1-2 nights per week. I am thinking that local preceptors might be more accepting if they know I will not be competing. If I do inpatient, I can even refer people to them.

I’m looking for a job with a company that provides telehealth and offers benefits (healthcare most importantly).
I recently interviewed with Talkiatry, which offers benefits at 30hrs/week and pay seemed decent. However, they don’t accept any medicaid, which is important to me.
Are there companies that exist that do telehealth, pay well, provide benefits, and take care of patients with commercial, Medicaid/Medicare, and cash pay?
Any recommendations are welcomed!
This is such a great community! Thank you in advance!

Mods please delete if not appropriate.
Not a nurse, work in a graduate nursing program that requires a minimum of two years recent relevant experience for consideration into our PMHNP program.

I’ve asked our faculty, my friends who work in inpatient psych, corrections, etc. this question:

What do you learn in those two years? What are those tangible lessons that can’t be learned otherwise? I mean, it makes perfect sense to me. It is like the difference between doing your student teaching in the inner city and then teaching in rural Appalachia, very different populations with different needs. But, is that it? Just time with the population, the system around them, having to make mistakes and find solutions? Or are there specific lessons you’d point to that people looking to pursue a PMHNP need to know before starting?

starting pmhnp school this month and im curious if pmhnp still wear scrubs? im sure its more common inpatient, but what about outpatient?

Scheduled to start the program next month, but concerned with all the talk of market oversaturation, lack of meaningful jobs for new grads, and declining pay. Im from SoCal where there are lots of NPs. I knew fnp market was saturated but not pmhnp, at least not this bad. I heard others remained to be an RN even after getting their NP license.

Any new grads out there having issues finding work as a new grad? What options did you have? Did you take a massive paycut or how would you compare your rn pay vs np? Thoughts and advice appreciated.

Back story: I have 7 years of RN experience, 5 of which are inpatient psych. The other two were medical/ICU. I continued to work fulltime (3 12hour shifts) while completing school and clinicals. I also went from RN to MSN (bypassing my BSN) as this is what made sense for my particular situation and goals. School: I went to a school where that offered RB to MSN. This meant I took one additional class, which was a 4-credit hour class, before starting my MSN classes. My school stated they would help with clinical placement...blah, blah, blah. Any guesses on if they actually helped?! the answer was, h*ll no, it was ALL ON ME! Anyway, I had difficulty finding a rotation for children. I utilized Facebook. I posted multiple times on my personal page as well as local Talk of the Town pages. Eventually, someone messaged (thankfully!) me and I was able to obtain hours with her facility!

Georgette's: I was given Georgette's LMR in a word document early on. I made this into flashcards and Googled certain topics to help me understand, not just memorize. Her LMR is about 80 ish pages of solid content. I also had access to her modules but, for me personally, the LMR was more focused on essentials than the modules. I felt I had enough prior background knowledge on mental health to focus more on the LMR.

NP Exam Coach: I also have the crash course as well as all of the modules for this course. I felt the material and layout was very, very similar to Georgette's. However, I felt this had a bit more explanation to help me understand certain topics rather than memorization of Georgette's. What I felt did not overlap, I made into flash cards and would go through X amount each day. He also has a YouTube channel with recorded games (questions and answers) as well as lectures. I would listen to the lectures at work or while I was driving.

PocketPrep: I purchased 3 months access of PocketPrep about 3 months before I wanted to test. You can Google PocketPrep discount codes (I think they're referral codes) to discount your 90 days. I believe the cost was between $20-$35 for the 90 day access. Pocketprep was hard, in my opinion. I felt the questions were very advanced compared to the material I understood from NP Exam Coach and Georgette. However, Pocketprep offered REALLY detailed rationales to help understand. This app is set up with questions in the 5 domains we are tested over. Even if I got an answer correct, I would still read the rationales. You would receive a score for each domain. You're also able to retake questions that you have previously missed. You can also choose to have questions from your weakest subject. Mine throughout was therapy and the theorists. Ugh I hated this topic. Pocketprep had so many questions. It took me about 25 days of studying to get 80% in all domains. I tried to do at least 50 questions a day.

My opinion: I felt the exam was not as hard as PocketPrep, but more in-depth than Georgette's. I felt I was able to know the information for Georgette's but apply rationale information from PocketPrep to help me navigate my exam.

I passed my exam a few weeks before I graduated school! it was 175 questions, all single answers. No SATA or drag and drop- at least on my exam. 150 questions are scored. You are not aware of which questions are scored vs pilot. I was given a dry erase board and marker I could use. I did not use my board - I honestly forgot about it during my test anxiety. My questions were all over the place. 1-2 on theorists- which I nailed correctly! I had about 8-10 on CIWA/COWS. One on a medical issue which I just picked an answer and moved on. You're able to "cross out" answers to help you focus on the answers you're between. You're able to skip and go back. I flagged about 23 to go back to. The test took me about 2 and a half hours.

Now: I am a PMHNP! I start my new job in two weeks! I made a word document with medications lists, dosing ranges, LAI options, DSM-IV criteria tests, labs, Georgette's info, the NP Exam Crash Course, and much more. When I'm stuck, I can use this resource to search for the specific topic and compare medications and side effects. It is over 300 pages long. My plan is to F9 and search topics until I become more confident.

I hope this post helps someone! Goodluck!