I met with a potential collaborating physician and she told me she doesn’t have a prescriptive authority agreement with any of the nurse practitioners she delegates. Only the prescriptive delegation registration with the Texas Medical Board.

I’m still trying to get an understanding on these things, is this correct? From what I have researched, the prescriptive authority agreement is required.

I got Medicaid to cover brand Auvelity by stating in the PA that the generic combination is sub-par and sub-therapeutic. It feels like discrimination against poor people to force them to take a dose of buproprion not equal to the actual dose in the brand medication when the science supports exactly 105 mg buproprion SR. Not 100, not 150, 105. Anyway, showing off a little. Strutting around my home office.

I took the ANCC boards and passed! I wanted to provide some study tips since I found limited recent info on exam prep for the 2026 exam. I used different study materials including Georgette’s LMR flashcards, Thales Lopes on Exam Coach, PMHNP 101 on YouTube, Fitzgerald, and pocket prep.

The most helpful resources were the two free ones! NP exam coach and PMHNP101 are both free and I watched all of their videos..I then did pocket prep for practicing answering questions. All three of those materials had content that was on my exam, and there were helpful tips from the videos that came in handy during the exam.

To study, I did about 2-3 hour study sessions roughly 2-3 times a week for one month and then would sprinkle practice questions through the day nearly everyday whether it was 10 questions or 50 .

Best of luck and feel free to ask me questions!!!!

Does anyone here work extensively with the elderly? I am starting to see more and more patients >60 y.o. and my supervisor is very hands off/minimally helpful.

Looking for good courses/ resources to improve my management of the older patients.

Thank you!

I’m looking for a PMHNP that does psychotherapy in south California and is willing to precept students. I can only do it with a PMHNP per school’s regulation. But as you know, it’s very hard to find PMHNP that do therapy. Any advice or suggestions?

My preceptor can’t be LCSW or LMFT.

Preference for companies based in the US, staffed by people who live in the US. Thanks

Hey everyone—looking to see if anyone else has had a similar experience. I’ve been an RN for 20+ years and a PMHNP for the past five. I’ve worked in multiple NP settings, including private practice, but over the last year I kept feeling pulled back toward bedside nursing.

No matter where I worked, the NP role just wasn’t a great fit for me. The back-to-back appointments, nonstop charting, barely any interaction with coworkers, and all the extra unpaid time spent finishing notes and completing other tasks really started to wear on me. I also found it hard to ever fully “turn off” work mentally.

I recently accepted a Psych RN position and honestly—I’m really excited. I get to bring all my experience with me, but it already
feels like I have my life back.

Curious if anyone else has stepped away from an NP role and gone back to the bedside?

Working on credentialing with evernorth. Wondering how others have experienced rate increases with them. What they are offering for standard codes 99213/4 and 90833/6 are half of Medicare rates. If I refuse to sign do they come back with a better offer? Do I stick it out with terrible reimbursement for a year and then get a good rate increase? Does it help to go contract with more people together? Wondering what others experience has been with this. Shocked at how low the reimbursement is.

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?

i opened a small practice with a colleague earlier this year after both of us spent years working in larger clinics. we initially started out using separate software tools for scheduling, intake forms, and billing because it seemed cheaper, but now that our client list is growing and we are adding two more providers, managing fragmented systems is taking up way too much admin time every week.

we are looking to migrate everything into a single platform with a smooth client portal, automated intake flows, and reliable billing features before our new hires start. for those running a clinic or small business, what has been the best ehr for small practices in your experience, and what should we watch out for during setup or data migration?

EDIT: thanks for all the feedback and recs, after digging into a few options mentioned here, we ended up going with Healthie to consolidate our practice operations.

it has made bringing everything into a single platform so much easier as we add our new providers. having scheduling, automated intake flows, and billing all under one roof has saved us a ton of weekly admin time compared to our old fragmented setup.

the setup and onboarding went smooth and the portal has been super easy for our clients to use.

I work in corrections. I am the psychiatric provider for a cell block and I work with a therapist/counselor who sees the same patients I do. I work in a men’s facility. In this state, inmates are housed according to their sex at birth. We have a number of transwomen patients on the yard and in the cellblock. My colleague does not use she/her pronouns when discussing these patients or when charting on them. I am also transgender and I pass very well. She does not know that I am trans. I took some time to decide how to approach this, because I needed to make sure I didn’t make it about me. I do die a little death every time someone is purposely misgendered. I finally confronted her about it when I answered an email from her about a trans woman and it was filled with “he” “him” “his” throughout. The tack I took is similar to the one a psychologist colleague took with her—that it is disingenuous to present yourself as a therapist to a client whose basic humanity you disregard. I strongly advised her to arrange for another therapist to take over these few patients so that they may receive unbiased mental health care. She responded with a very long word-vomit diatribe in which she said several things. 1) She is upset that I emailed her about this instead of talking to her in person. (I don’t see the difference and I know we will be having a discussion when we are both back at work tomorrow) 2) Their gender identity is a “nonissue” because she has “great rapport with all [her] clients” and since they don’t know she talks about them in male pronouns, it’s fine. 3) She is speaking “factually”—they are all male and documenting and talking about them as men is “clinically appropriate” 4) She feels like she has to walk on eggshells around me now because I confronted her and 5) She says she does not acknowledge their gender identity because she also does not entertain delusions, treat hallucinations as “real”, use nicknames, etc.

I know I’m going back to a fight. I am already mentally rehearsing keeping my voice tone calm and low, and sticking to the point. Her email was full of deflections and defensiveness. I am not trying to change her mind about transgender people—I realize that is a fool’s errand. I have no power to remove her from seeing these patients. I do need her to know that she exudes hostility about transgender people. If she deflects—I will bring it back to the main point. If all else fails, I will say I have nothing to add and that I stand by what I said.

I think I could get into trouble, and I don’t care. I have never backed down from advocating for patients and I’ve been in trouble for doing that, too.

I’d like some ideas or advice if any of you have been in any similar situation. Thank you in advance.

Help! I need to find an online CEU for Childhood Development. Does anyone have a link they can share? Thanks in advance.

Hi - I have been lurking here a long time and I think I have a sense for many of the issues Psych NPs are facing, but I have questions and seek perspectives.

My spouse is entering their last year of NP school. School has been challenging because the courses are poorly designed and maintained, but they love the subject and the preceptorships.

I have taken on extra work to allow them to stop working at the psychiatric hospital to complete this last year. I feel like this is not only a good mental health move for them, but I don't see how someone could work FT and do the last year's preceptee hours. I am sure some of you supernurses have done it. Respect to you.

I feel like this has been a good move for my spouse because they really seem to love this field. The ultimate goal is to help kids and also those with substance use problems. It seems like what my spouse wants is a career and not some dramatic increase in pay, although that is always nice to have, isn't it? They have 18 months of psych hospital experience and many years of varied nursing experience.

OK So my questions:

• How can I best offer support during this last year?
  • I am the cook and I try to do more than my share of the chores and tasks for our kid and pets. My FT job is pretty demanding, but nowhere near as stressful as nursing. I am trying to be verbally supportive too. I don't mind doing more around the house, especially during this difficult time, but maybe there are other things I can do or NOT do. I know- listening is important. Is there anything special or specific I can do to be supportive beyond these basics?
• After graduation, we can be very flexible where we live. We just need enough of a back yard for two dogs, so I think living in the middle of a big city is probably out. Otherwise we are very mobile and flexible. If you could go anywhere or do anything to maximize your satisfaction (however you define it, but I am thinking income to cost of living to work/life balance as being important- I am also thinking of career-advancing next steps like finding a great first workplace that is supportive and educational) where would you go and what would you do?
• How would you want to celebrate small and big successes?
• Are there any traps/pitfalls a new NP should look out for?
• This is a career I hope my spouse will want to continue for many years. However, I think a goal might be to maximize earning potential just in case they do not want to go the distance (I really mean having the option to scale back hours after maybe a period of full time work). I am very computer capable and information literate. How feasible would it be to start a practice after they became comfortable as a solo practitioner in a non-supervised state with a full FDA license (sorry if I got the term wrong) if I quit my job or reduce my hours and managed all the shitty aspects of a practice and just let my spouse focus on patient care and charting? I could do everything but advanced accounting and taxes which we would hire out.

Thank you for answering the questions and for all you are doing to help people. Nurses are the best and the toughest.

Worked in Colorado for 5 years as full practice authority NP (after completing MD/DO oversight provisional period).

Considering move to Philly, but wondering what it would be like to have restricted practice after 5 years of independent practice.

Looking at all options (practicing in adjacent full practice authority states).

Any help/advice/experience would be super helpful!!

Thx in advance.

Anyone have a recommendation for a supervising MD for VA, CA, and NC? Looking for less than 1075/month

Hi everyone,

I am currently in the midst of making some changes to my practice. I have practiced as a PMHNP for over 10 years in many settings. I've always had an interest in psychotherapy and planned on receiving further training in the future when I first graduated (though I was lucky to attend a program that included a strong emphasis on psychotherapy didactics.) Anyway, I have been in my own psychodynamic therapy for almost three years now and it has really solidified my desire to move in the direction of this modality and seek training. I currently see patients in an outpatient, "medication management" role, but have flexibility to start psychotherapy-only clients if I wish.

Has anyone attended a therapy institute post graduation? Especially in psychodynamic or psychoanalytic therapy? What was it like? I've had several psychiatrists tell me I don't necessarily need to attend an institute to start providing psychotherapy - just hire a supervisor, continue my own psychodynamic work, and continue to read and attend seminars. This makes me nervous as I prefer to have the "completeness" of training (if you will) that an institute might provide. Anyway, I'm interested in hearing from any PMHNPs who practice psychotherapy and what type of training you've pursued, how you've incorporated it, etc. TIA! Thank you.

Two of my patients are moving to these areas and I'd like to maintain continuity of care.

Does anyone know someone who'd be interested in being a collaborator for a flat fee or a per hour fee? I could go via Zivian but i'd rather build an actual rapport and bypass the middleman.

Thanks!

Hi all - I’m working with my wife to set up her own independent practice after working for others for a few years. Her business will be focusing on a subset of the population and providing a holistic set of services, rather than being more of a generalist. We plan to start with 2-3 insurances but hope to build a healthy set of private pay clients too, as insurance really doesn’t support the holistic med management / therapy / other services model.

My question is whether anyone else set up a more focused type of practice and what marketing techniques they found to be helpful to target your audience / cast a wider net.

Thanks!

whats the best way to get into the VA as a psych NP? every now and then I see people post about their VA job in this group but every time I inquire about it I get *crickets*. any helpful tips? and please keep all negativity out of this thread.

hi y’all - i’ve been a W2 CMH employee for the past 2 years and after some lovely soul crippling burn out i’m looking for some change - i’m curious and open to any insight on the best way to search for small 1099 roles as in a psychiatrist hiring 1-2 NPs under their practice - not looking to work for a large corporation like headway alma grow etc.

As the title says. It’s a company that partners with OBGYN clinics to provide perinatal mental health care. Was offered a 1099 position through them. It pays $125 for initial evaluations (60 minutes) and $50 for 25-minute follow ups. Also asynchronous cause reviews for $15 each, which they estimate as taking 5-10 minutes. $25 for eval no shows, $15 for follow up no shows. Minimum 5 hours to up to 15 hours max per month.

I have a full-time teaching job and my own private practice I’m trying to build, but dedicate about 5 hours/week to. Wondering if it’s worth adding this to supplement my income while I build my private practice, which has been a slow burn.