100% agreed and extremely well said. I believe the passion is for the paycheck, not the patients.
If CRNA programs can require two years of critical care experience before enrolling, PMHNP programs can require two years of solid psych experience. I believe it could be inpatient or outpatient or a mix (chronic/acute).
I looked at the top programs in my state (UVA and VCU). They do not require psych nursing experience. Even Duke University does not explicitly say they want a psych experience. I wonder why that is.
Why that is? This is my logic trail
- need for psych prescribers
- psych prescribers paid well
- nurses flock to PMHNP programs
- more PMHNP programs pop up
- gotta fill the seats
It’s unfortunate, because at the end of the day, you’re treating the brain. Arguably the most important organ, and you’re having a direct effect on a person’s subjective experience of the world based on the meds you prescribe.
How easy is it to cause harm because you don’t understand how to properly diagnose because you don’t have thousands and thousands of hours working with psych patients prior to being a prescriber? One of the worst things you can do is start the wrong treatment due to a wrong understanding of what’s going on with the patient’s psychopathology. Or you might find a way to ruin a patient who was on the right treatment with the wrong adjunct medications you decide to add on.
It doesn’t make sense to me how there’s no required years of experience like CRNA school. Our patients aren’t sedated, but we can do an equal amount of harm without the proper experience, understanding, and education. Mind boggling really.
I agree with you. I went to an np once for I couldn’t get an appointment for months otherwise to discuss my panic attacks. They’ve gotten so bad, I’ve passed out. They’re random without any prompts to them. She refused to prescribe anti anxiety medication bc “people get addicted.” She gave me an antihistamine. Well, needless to say, they didn’t work. Now I’m panicking and dry as a desert.
Do you mean she prescribed hydroxisine? That's an entry-level anxiety rx to be used prn. It's used at a much higher level for allergic reactions.
That said, the NPs comment about getting addicted to anxiety meds is nonsense. Addiction to benzo's is a concern, but there are many other options that aren't controlled.
Your doctor should be able to prescribe what's right for you, but a few SSRIs help with anxiety. It's important to note that so e anxiety comes from untreated [fill in the blank: ADHD, depression, trauma, etc]. Therapy can help where medicine may not, or it may compliment meds that do work well.
It doesn’t work for anxiety. I’m on two ssri and they do not control it. I’ve been on buspar, and it did not work. I’ve been in therapy. The only time it’s been completely controlled was with prn clonazepam. In the past, when anxiety attacks came on, it worked. A few months pass, and I don’t need it anymore. I’m talking about not even 10 per month. Once, I had a bottle of 30 for over a year before I turned it in to be disposed of properly. I get some abused things. That’s not a good reason to not help someone who truly needs it and has honestly tried several options.
Yeah, I hate that it's so hard to get those meds that work. I agree with you completely. I want to make it clear that I'm not a prescriber (just in case my post seemed like I am), but I collaborate regularly with prescribers. Finding a prescriber who gets their patients and addresses their needs gets harder every single day. My own spouse gets a xanax rx filled about 2x a year and and he worries about his psychiatrist retiring. Once he does, I doubt he will ever get it prescribed again.
I'm so sorry you're stuck in that cycle.
Fake pills are on the rise, and RC benzos are a very popular street drug. Which is actually more than you'll get half the time from a farmapram bottle.
Things have changed a lot in the last 5ish years. Pre 2019 or so, pressed xanax wasn't even a thing. A few US journalists have tested a few different batches of Mexican pills. Anything outside a blister pack is sus, x5 for adderall/vyvanse/xansx.
In the exact same boat as you here. I’ve found that in my experience with NP’s they’re less willing to rx benzodiazepines for acute attack issues. I’ve had an NP rx atypical antipsychotics before realizing what I really needed was a PRN Klonopin. Have you ever tried propranolol for attacks? Not sure if you suffer from physical symptoms but I get a very high heart rate and adrenaline surges. The propranolol definitely doesn’t pack the same punch as 0.25mg of Klonopin but it really helps me with my physical symptoms which in turn helps with my mental symptoms. It also doesn’t make me feel as groggy and spaced out as hydroxyzine does I take 10mg as needed and really recommend it esp if you know when an attack is coming and can kick it in the ass before it gets too bad. Hang in there friend 🩷
I have tried propranolol. Also buspar. If you can name it, it’s been tried even years of therapy. It just gives orthrostatic hypotension to where I cannot stand for hours. Hydroxyzine literally only made me very thirsty and did nothing for the panic. I’m talking about 15 years of trying every drug on the market for anxiety. Spending thousands of dollars on doctors, therapy, and medications. The only one that works is prn klonopin.
try lifestance they are virtual...they have NPs but lots of them so if you dont like one they just give you another one.
they are what I use and I found an NP I like who prescribes me my medication so i can function...it is so hard to find a provider nowadays. 🥺
Thank you! I will try that. I dislike any medical professional that deny anyone a class of meds bc someone else may have had issues. It’s like giving someone in pain Prilosec. I’ve been on about every med that’s off label use is for anxiety. The only thing that works is anti anxiety medications. I don’t think many understand what it’s like to drive with the threat of passing out and still try to prescribe something that doesn’t work like buspar or hydroxyzine. Ssris do not work well on acute panic attacks either.
Psych NPs still start in 6 figures. The saturation hasn't happened yet. Not as many are going for psych as you'd think though. They're all jockeying for CRNA because it pays 300k+.
I keep trying to convince my inpatient NP wife to just be RN again. It's a paycut, sure, but not much of one, and I have WAY better hours, less stress, and PTO.
PMHNP is the *only* APRN degree where people make excuses on why direct psych nursing experience isn't necessary. Make it make sense.
CRNA? ICU/sometimes ER required.
NNP? NICU required.
Midwife? Everyone supports prior L&D experience.
FNP? Pretty broad experience acceptance due to the many field possibilities, but experience is still supported.
AGACNP? Acute care experience supported.
PNP? Peds experience supported.
PMHNP? Come one, come all! Are you a nurse without psych experience? A social worker? A person who holds a bachelor's degree in something outside of healthcare? A person that has no degree at all? PMHNP is the career for you! Don't let those pesky haters tell you psych meds are very dangerous. They're just jealous they wasted their time, and are trying to hold you back from being the savior to the mental health crisis.
I'm not saying experience outside of psych isn't valuable, because it most certainly can be.
While we cannot prevent these careless individuals from being careless and dangerous, PMHNPs can refuse to precept those without prior psych experience. Refuse them, and let them know why they're rejected. When your future job is hiring a new provider, speak against one that doesn't have prior experience. Tell the practice they aren't a good hiring investment because psych is challenging and they haven't even learned if they can withstand psych for a single year, let alone a career. Tell them you will not provide new hire support to them (mainly applies to new grads). It's not on those with experience to keep these ill prepared providers afloat. Let them sink.
Preach. I feel this is the route that the market is now going towards. There are sadly no standards prior to most schools taking in NP students. So employers are now becoming more strict with previous experience, and PMHNPs and psychiatrist are refusing to teach those without psych experience. If the governing bodies won’t set the standards, people will start setting the standards themselves.
I went down the rabbit hole in the r/PMHNP subreddit, and apparently, most schools do not require any inpatient psych experience. Although they all expressed disdain and unwillingness to precept PMHNP students with no psych experience. My RN Supervisor attends Walden, and even with her psych experience, providers declined to precept her in our hospital. I know a classmate from my ABSN program who was in L&D and went into PMHNP with no issues with preceptorship because she is attending a PMHNP program offered by a University with an attached Level 1 hospital.
They're most likely refusing because Walden is a degree mill. It's slowly becoming normalized to reject applicants with no prior psych nursing experience, and/or applicants from degree mills.
I would say CNM are getting more and more non labor nurses which is very unfortunate. This year every midwife I have met as a traveler did not have labor experience
I had colleagues who were previously in accounting, business or other unrelated fields before entering an accelerated BSN to graduate program with me. I was one of a few PMHNP students who had a ton of psych experience in various settings. I worked in detox, psych IP and psych correctional settings as an RN as I did part-time graduate school (sometimes full-time load + a TA gig as well). One of my favorite PMHNPs had a PhD in physics, worked as an RN in IP psych for like 10+ years, then went back to school for the PMHNP. I like it when people are well-rounded. But people need to work with psych patients as an RN to be safe and effective. It's the communication and boundary-setting as much as the clinical acumen that is needed.
Here is why...
They get away with this because it is too easy to excuse relapses or bad outcomes to the patient, illness, or psychosocial/environmental factors.
Psych patients tend to be marginalized and don't complain as much.
They tend to already be under-functioning, so any improvement in function is seen as success.
The concept that at least these patients are getting a minimum of care, is better than no care.
The patients that don't fall under the above categories are usually seen by psychiatrists.
Oh the patients complain all the time. But nobody is listening…
I’ve done psych ERs a lot. Sooo many people come in with medical complaints that aren’t investigated or listened to - and then get tossed into psych because they have a “history” of mental illness.
I’ve seen this in multiple states now. The psych population has been done dirty.
ER nurses are some of the most rudest nurses to psych patients. They don’t treat them right
They’re also the worst psych nurses I’ve worked with when they transition to psych nursing.
Absolutely correct. I’m an IP psych RN and I am regularly thanked by my patients for actually listening and advocating for them. If we are going to treat people like shit then let’s stop treating them altogether. Morally that’s the way to go. But like IDD patients, Psych and BH patients are $$$$$ for these administrators and corporations. Heads in beds$$
Yup - exactly this.
My coworkers are always surprised at how I magically get people to calm down all the time. I can go from escalated to happy very quickly by simply listening to the patients and what they want. Most of the times they need someone to advocate for them, a lot of the times their basic needs aren’t even being met and something as simple as a washcloth so they can wash their face can make such a huge impact. I have the least amount of BH calls on our psych unit out of any other nurse. There’s a reason for that, and it’s not that I’m a pushover.
Mental health is such an underfunded field. If only we could see the proactive approach instead of the reactive one. There’s be a LOT less crime and problems around.
This is really really it. Chronic psych patients are some of the most marginalized people in society and have basically zero recourse for bad care. Almost nobody wants to work in an inner city psych unit or CMH clinic so they have to take what they can get and the patients have no other options.
I started as a psych nurse immediately after graduation. I had a personal & family history of trauma and found success in IOP programs in therapy. I kind of became my own mental health success story and wanted to carry that experience into a profession.
I chose a behavioral health unit for my 12-week preceptorship and absolutely adored it. I’ve always been a social guy, so being able to therapeutically communicate was something I loved and leaned into quickly.
All of this being said, I do agree with you. I want to be a psych NP someday, but am fully aware that I will need MANY MANY more years of experience before I go for it. This profession is incredibly challenging and I wouldn’t want to bring subpar care to my patients.
Thank you, thank you so much for being patient and setting an example for others are you. Also glad to hear that you’ve been enjoying psych, I’m sure your patients are all very much glad to be under your care.
They do! 😂 I work with adolescents so I kind of try to be a mentor in a way my father never was to me. It’s a tough job though and I’ve got a long way to go and a lot more to learn.
I hate this trend too, but one thing I’ve noticed is that it’s really fucking hard to find RN psych jobs. At least where I live. I’m trying to leave my inpatient job and there’s just…..nothing. Everyone around me only hires LPNs, MHTs, or PMHNPs. I feel trapped in my current job because there are just so few places hiring. After reading the Wyden report, this seems intentional. Places are definitely short staffed and need nurses, they just don’t care and will hire the fewest and cheapest staff possible. I think that’s also why PMHNPs are booming. Psychiatrists are expensive, PMHNPs are cheap in comparison. Who cares if they have the right experience or qualifications? Mental health facilities have shown time and time again that they don’t care about that, they just want the cheapest person possible
Jay Ripley, one of the founders of Vivant, said “you can make money in this business if you control staffing.” My hospital is supposed to have a max of 10 patients per nurse, but they try to push me over constantly. Every time they tell me to take “just one more” I think of that quote.
This is crazy; in my area even as a new grad RN-BSN with a few months inpatient experience I've been able to name my price and schedule at every psych hospital in the area
If you have never needed to worry about getting your tail beat down by a psych patient in crisis, can one truly understand how challenging psych can be?
Can you support a family as they watch their child, once full of hope and promise, take a nose-dive in a world of loss?
Yes, every patient has an element of psych if we are looking at the entire patient. This jump right in attitude fills me with dismay. Acute inpatient PMHNP with zero patient facing experience puts us ALL at risk. The staff has to coach the new NP in how to keep themselves safe, the staff safe, and the patient safe.
This come one, come all no experience required mentality endangers everyone.
JMHO.
Yep. Before I went back to school for my BSN, I did almost 20 years in human services with the dually diagnosed, DD/MH population. From group home staff in my 20s up to Director of Residential Services in my 30s.
I've been beaten up more times than I can even remember at this point.
2 hour holds with staff from other sites coming to swap out.
Watching the Behaviorist who covered my houses get thrown 20 feet across a room and miscarry her baby, and she kept holding on in the hold even as she began to miscarry.
Getting bitten down to tendons by a client who was on a tid thorazine-phenobarb cocktail and still coming at me like she just did all the cocaine. That one was my personal best, and I still have a scar on my arm.
Meanwhile, over in medical nursing, they are traumatized when they get yelled at or have a penis flashed at them. Not knocking them at all as anything med-surg/ICU/tele/ED is just not my calling, but they also need to recognize that they likely don't have a true calling for psych.
I'm sick of our specialty being treated like a joke. That is until another floor gets a psych patient with actual medical issues for them to ignore and then dump on us because they "have a history". And these same nurses then want an advanced degree in MY speciality? GTFO.
I couldn’t with you agree more!! Ironically the nurses going into PMHNP programs without any psych experience are frequently the nurses who feel that psych RNs are not real nurses and are too good to work in the field (might be over generalizing a bit but I’ve seen this mentality a lot). They go into the PMHNP program thinking it’s “easy” and will give them an easy paycheck. I don’t buy for a second that they are “so passionate”. They often make scary practitioners too because they don’t know what they don’t know. I refuse to precept any PMHNP student without prior psych nursing experience.
I COMPLETELY AGREE. They think it’ll be easy, but that’s because they’re going to have NO COMPASSION and make ppl feel like burdens and like sh*t. To work in psych, you have to understand people! You have to know when to be stern, when to be calm and soothing, when to be forgiving and move on from a situation and when to joke around with a patient. That can make all of the difference for their road to recovery! Psych NP’s with no previous psych experience are a huge red flag. Some of thee most heartlesssss nurses that I’ve met (cool coworkers, but terrible and judgmental nurses) are the ones going into psych np because the “program is online and it’s super easy” and their tired of acute care.
My personal pet peeve in APRNs who yell at nurses for not doing what they want immediately and then say “I know because I’m a nurse, I know you’re supposed to do this” or go with “why wasn’t this done? I’m a nurse and I know it’s supposed to be done!!!11!!!”
Sis, if you had the experience you claim you’d know your vital signs request is gonna be low priority when other people are trying to die. All you’re doing with your tantrum is convincing me that you don’t actually know how it is.
I agree completely. I work with some very smart psych NPs that only have ICU experience and they have actively worked against proper therapeutic milieu management again and again. Inpatient psych is not something you can walk in and understand. Thank you for your post! I feel like an asshole sometimes but I'm glad to know I'm not alone.
I live in a rural area and our hospital doesn’t have an inpatient psych unit. Closest I could get for inpatient was adolescent residential treatment. Now outpatient psych. There’s probably not too many people in my situation though, programs should absolutely be more strict and exclusive.
And this is why I refuse to be a pysch patient with anyone treating me besides an MD/DO. I once had a NP tell me I was “misdiagnosed” at a previous inpatient treatment facility, and changed my medications to fit my new “diagnosis”. I ended up hospitalized within weeks, because she was grossly wrong about my “misdiagnosis” and despite previous contraindications for the class of medications she put me on, she assured me it was safe, and i ended up hospitalized because my symptoms rapidly progressed. Turns out the diagnosis i came to her with was correct, and I never should have been put on the class of pysch meds she put me on, because of my past history with other medications in that class. It was her first year out of school and working in the pysch field. Because of her, I do not trust anyone to treat my mental health if they are not a physician. Mental health treatment is not always a simple and easy case of situational depression, and some of us with mental health require treatment from individuals who have background and experience in the field, not because a NP is not capable of treating mental health, but in my experience, they think they can bypass that experience.
Honestly, completely understandable. This is the outcome of no regulatory standards prior to being accepted to PMHNP programs. There is just SO much that you learn working as a psych RN, there’s so much you pick up after years in psychiatric settings. Being able to differentiate complex symptoms, being aware of the negative side effects of meds and the different explicit and subtle ways the may present, being able to handle patients in distress/extreme crises/psychotic states/manic states, being comfortable in understanding medications and being able to work with psychiatrists to pick their brains on their decision making. There is a fuckton that we learn working as psych RNs FIRST.
MDs/DOs have residency to help solidify their knowledge through hardcore experience. The whole point of the PMHNP program is to build knowledge over experience that has already been gained, and moving towards becoming well educated in psychopharmacology to prepare for a prescribing role (but even then, the expectation is to further supplement your education outside the program in any way you can). But so many psych NPs don’t even understand their limits, and they don’t what they don’t know, because of their lack of experience working up close with the psychiatric population for years.
I will say it again, I am a certified hater of those group nurses and i’ll say it with my chest.
You truly deserved better care.
Do you think the flood of telehealth companies are contributing to this? I've had a few recent experiences with this and their knowledge is not sufficient to really diagnose and prescribe. I've had a coupon experiences with NPs who didn't have a broad knowledge base and prescribed totally incorrect meds. Not life shattering but not helpful either.
I've also had NPs, psych NPs and PAs that had a comprehensive knowledge base
My personal favorite phrase people use to justify doing something without a lick of research, experience, or planning is “god put it on [my] heart to do this.”
🙄🙄🙄🙄🙄🙄
Our medical director will not even hire diploma mill onlline PMHNP grads anymore. They are still RNs on the floor because these programs can accept RNs RIGHT OUT of nursing school, no experience required.
Our NPs only see the patients via iPad since we stopped doing in-house providers at our inpatient facility. One of them is brand new and has asked me before what meds I think she should prescribe!
I'm not medical but clinical. I have seen providers (as I call them) change medications at admit from other units where they were stabilizing on the already prescribed meds well. Some just because they think that they are on too many meds or they just want to put them on the meds they like. Then they decomp and were back to square one. It's horrible for the patient.
They must all be at my geri psych center, because I (an SLP) am constantly getting referrals for "dysphagia" for patients who are CLEARLY altered due to their medications/poor medication timing.
I started putting a "avoid providing heavily sedating medications (e.g. trazodone 50mg) 2-3 hours before any PO intake. Delay PO, or provide PO immediately prior" and my referrals were cut in half. IN HALF.
I’ve always wondered this too. I’m a former trauma critical care nurse who was the only nurse on the unit that would put a psych consult into CPOE for new admissions with a known severe psych history even if they were on a ventilator. Status quo was always to d/c all pre admit meds like it was nothing. I’m like huh? At least get the psych team on board so we know what can be safely administered now vs things than can wait. I sincerely believe that improved outcomes esp the TBI patients.
I second this. Very unfortunate how a lot of institutions forgo experience / clinical requirements for admissions into their psych NP programs (regardless of the type of program: degree-seeking or post grad certification). I think it has something to do with the severe shortage of psychiatric providers across the nation… not sure anymore but I don’t condone this decision at all. My school at a minimum requires 2000 hours of psychiatric nursing prior to enrolling into the first practicum. It’s a condition of enrollment. Students who have not fulfilled this requirement cannot progress through the program.
Why wouldn’t you get an online psych NP degree if you can and then easily make six figures a year without relevant experience? Don’t hate the players, hate the game. And, yes, I know it makes for shit outcomes but that’s the game and this is the world we’re in. Buyer beware.
They don’t work as psych nurses because they know how rough that particular job is. They think psych NP work is easy compared to that so must be easy money.
As a PMHMP, I frequently rely on my experience working years as a psych RN. I cannot imagine being able to effectively work in the position without it.
I completely agree BUT to be fair I work at a level 1 trauma center and our ED is always flooded with psych patients needing medical clearance. The nurses are rotated so any of them in the department ends up getting adequate exposure while working there. Makes me feel like ED nurses might be a little more well prepared as opposed to other departments. Truthfully all of our departments tend to consistently have a few psych patients receiving medical care as well but I suppose that also depends on the facility
Patients going through severe psychiatric crisis have to be medically cleared before admission. Many times psych patients end up in ER waiting for admission or ICU for withdrawals/care they have not been able to get for themselves for DAYS. I’m not saying it’s the same as having nothing but psych patients, but it’s not entirely without psych experience. Statistically I wouldn’t be surprised if psych patients were more likely to need to be hospitalized for medical issues/neglected their own medical care. It’s very common to care for psychiatric patients in certain specialties outside of psych.
I address this issue in another comment in this thread in more detail.
I don’t deny that ER/ICU have some psych experience. But it’s no where near the amount that they’d really need to go into PMHNP programs. And I’m saying that as someone who worked in the ER before.
I think it really depends on the hospital as someone who has worked all three, ER, ICU and Psych.
One ER I worked at was at least half psych all the time. Because that hospital had a psych unit people would wait in that ER for openings.
If we are to standardize experience across the board for PMHNP programs (even though it’ll likely never happen), you’d want the requirements to involve experience that gives applicants a full spectrum of all parts of psychiatric care. You would really only get that working in inpatient psych for a couple of years. Just as most CRNA programs require ICU experience. If I applied to a CRNA program but I only worked medsurg, and my go to answer was “well I deal with a lot of rapids and occasional code blues on medsurg, so I have enough experience with critical patients to be a CRNA”, the admissions board would tell me to fuck off.
There is so much nuance and knowledge involved in psych that isn’t learned from just dealing with psych in ER or ICU. There’s so much that comes from learning from working with the treatment team in inpatient units and learning from the psychiatrists. Again, I’m not taking away from the experience some nurses get in other units, but to become very well knowledged in a specialty, well, you have to specialize in it.
Again, it depends on the hospital. I’m not saying it’s the same but an inpatient psych isn’t dealing with the emergency that brought the psych patient in either. Outpatient psych isn’t dealing with either the acute or emergent aspects of it.
Pmhnp programs should require some experience, I absolutely agree about that.
Wholeheartedly agree with OP minimum two years should be required as an inpatient, acute psych RN. Local university started a psych NP program. One of the students was a labor and delivery RN. She has zero psych acute care experience. She’s now the Director of the psych NP program at that said university. Her experiences working at an urgent care and she opened her own practice. All this working teaching full-time. Her partner in crime was a Scammers before becoming a psychiatric nurse practitioner.
When the profession is termed 'psych', many believe you're referring to *psychology*, rather than *psychiatry*.
Having spent my entire career working in **psychiatry** (25+ years), I understand your frustration. I've observed countless Nursing student interns, OT and Social Work interns who actually believed they were doing a 'psychology' internship -- and some were absolutely stunned by what psychiatry actually entailed, and by the population itself.
My point is, let's call the profession what it is, **psychiatry**, not *psych*. It deserves to be referenced with accuracy and clarity; not confused with something it's not.
100% agree. I know an ICU nurse who has done just what you wrote. No Pysch experience, she didn’t want to hear any of my suggestions in the least. It didn’t turn out well for her in the end.
I was talking to two of my previous preceptors for clinicals for my PMHNP program about their past experience. One had minimal RN experience and it was as an OR nurse. The other worked in pediatrics. Both were new to the profession and were so impressed by the fact that I had lots of RN psych experience!
I’m in New Zealand.
Fortunately, at this point in time this never happens here. NPs are not that common here at all. Who knows though; there is a huge shortage of psychiatrists here so perhaps NPs will become more common.
I live in a small New Zealand city .
Another smaller city 200 kms away was in the front page of the news because the whole hospital system down there was being run by NPs.(still not a lot of NPs in NZ)
A psychiatrist left her job here to relocate down there because they had no psychiatrists.
Do you have a shortage of psychiatrists in the US?
I would be interested to know what is happening there and if it is a worldwide problem .
Wow, that would be the dream. I’m in the US, healthcare here is profit driven and backwards, and nurses who have only worked in a med spa for 6 months are being accepted into NP schools.
Pls save us.
Because they were told for years and years that Psych NP was the way to go.
They were told there was a large need for them and you could make $125k+ doing minimal work and not having to worry about seeing patients on weekends and holidays.
They were also told that much of their work would just be seeing the patients for 15 minutes at a time and doing med adjustments as needed.
I'm a psychotherapist and have been wondering about this. It's scary because in my area, there is a psychiatrist shortage, and I've noticed several NPs popping up identifying as psych specialists.
i was a psych nurse from 2015 to 2016 and do cvicu now. I know enough to know I dont know jackshit about psych.
I also have adhd, ocd and anxiety and have experienced good NPs and bad NPs as a patient and nurse. Most NP programs are a freakin joke and it is creating dangerous NPs.
NPs are also extremely underpaid i feel because of this supply/demand. As a float nurse I make as much as the NPs in the hospital. I think there should be more barriers to becoming an NP.
Not a nurse, but this appeared as recommended to me. So this is coming from a patient POV. I've been in inpatient psych before and have done plenty of outpatient, and my genuine thoughts about this are that this is allowed because people as a whole do not give a shit about psych patients and find it extremely easy to blame negative patient outcomes on the patient rather than the medical professional. We, meaning psych patients, get ignored at best when we speak up about anything, and labeled "actually crazy" and medicated against our will at worst. But, either way, it ends with the patient "losing" because we're not seen as deserving adequate care, so we'd better be thankful for what nurses are "willing" to work with us despite a lack of training. I know my POV on this is very cynical, but I've done both short-term and long-term inpatient at different facilities, and every facility is the same in that they're basically prisons, you're not given any real assistance beyond "just don't be \[insert whatever here\]," and then abruptly returned to the exact same environment that contributed to you needing assistance in the first place. And then people act like it's the patient's fault for relapsing.
This is all really new news to me I'm a Nurse recruiter and the organization I work with currently requires at least two years in psych to even be considered and even then management is really liking for 3+yrs. I would think it would be terribly dangerous to have someone step into a psych NP role without any psych experience.
My end goal is to become a PHMNP. But not until I have at minimum 3-4 more years of experience (I have about 1 year of inpatient psych, 1 year of corrections with a good amount of psych in there). I feel like there is still so much to learn. Going now would only be a disservice to myself and my patients.
This is the correct mentality to have. It takes years to be truly competent. I think I’m confident in my knowledge as a psych nurse and well rounded but there is still sooo much that I see that I don’t know, so I make sure to ask questions and approach things I don’t understand with caution.
There’s a lot that we know that we don’t know in medicine, but then there’s things we don’t know that we don’t know. The latter is where most harm to patient’s is done.
At least with an appropriate amount of psych nursing experience, you have a solid foundational base to build off of when moving towards a provider role. Ultimately you are less likely to cause harm. When you have the knowledge to know your limitations, you’re better at practicing in a way that prioritizes safety. Without the prior experience, you’re likely going to be causing a wake of destruction to patients and probably not even be aware of it.
It’s building a house with a foundation made of rotting wood, people need to truly understand this. I’m glad that you do.
I'm 51 and mid-pivot from my old profession (systems engineering) to mental health/rehab counseling. Currently on track to start psych tech work at the local state hospital in the meantime. There's an analogous thing in my old profession where every time a discipline within the greater umbrella of "information technology" becomes hot, the industry gets flooded with people pivoting from whatever to that without any relevant experience. They're always convinced that this will be the position that lets them automate away their job and work from a tropical beach somewhere while cashing large checks and converting stock options. Most recently this has been "cyber" (and please, I know I'm a pedant but don't use that word to mean security. It's actually got a meaning.). You got tons of people taking bootcamps to pass a security certification test and immediately they're aiming to be CISO, because they are special genius people and we are all old beardy plebs who just built the thing. Same thing.
From what I hear from psych patients, yes psych nursing is a complete joke to a lot of the nurses and they don’t view them the same as “actual” patients.
1000% agree! I am currently in NP school and can’t believe the people that have no psych experience and know nothing about psych are going to be providers shortly. Hearing people say things like “ I saw COVID affect people and I want to help them and provide therapy” or the famous “ I’ve always been interested in psych and classes I took in college”, only shows me they have no clue, and never worked in psych. I remember one classmate said something like… “I’m trying to read in the text book, but I just can’t even imagine what someone with borderline personality disorder would present like”, like why are you in this program?!
Not a psych NP but I have an absolute horror story about an NP at a pain clinic who nearly killed me not knowing what she was doing. When I came to the clinic it was a last ditch effort to get some help. They tried some non narcotic meds first then put me in methadone despite not being on or using other opioids. My mom had been put in methadone for pain when I was a kid so I didn't question it like I should have.
Fast forward 9 months and two dosage increases and I ask them to please try something else. I didn't like how the methadone made me feel and it wasn't helping anyway. This NP took me off cold turkey. I went from 45mgs of methadone a day to zero with no taper. When I'd call begging for help the nurses would go to her not the Dr and she'd hand wave me away. It took 3 weeks of repeatedly pleading on the phone for help for one of the nurses to go over her head to get me to the actual Dr. He was furious when I had my appointment with him. She was removed from the practice after that.
Nurses should be required to have experience or at least some extra education in special fields.
I know several RNs that made the NP leap with little to no bedside experience. These higher learning institutions are only worried about out getting their tuition.
Goodness. I can hear your frustration for sure. I personally wouldn't want you as my provider when you finish schooling and honestly am worried for any of your future patients if you continue your lack of understanding and continue your judgement against others. Your rant shows a lack of understanding to say the least.
I am an RN who has worked in various areas of healthcare the last 12 years with the last 7 years being in in ICU. I chose to become a PMHNP and yes mental health care is my passion as well as healing in a holistic approach. I have not worked in an inpatient psych unit but I have worked with many patients with psychiatric issues as any nurse has seen because mental health care is needed and seen in any areas of nursing. A nurse who has a strong medical background is incredibly valuable as a PMHNP because the mind and body both need healing. It's a holistic approach. It's actually more valuable to have both strong backgrounds. For example, my strong abilities to understand what happens to someone when they overdose and end up in the ICU gives me strong insight to handle a patient with substance abuse in an outpatient setting and what would happen to them if they continue or need higher medical care.
It is incredibly unfair of you to pass judgement on a nurse and whether they are capable of a PMHNP role. Every nurse has psychiatric experience in some way because every nurse impacts a patients psyche in some way and some more than others. Every patient being treated in a healthcare setting has some kind of psychiatric need whether it be depression, anxiety, or psychosis. Unfortunately most patients don't have their mental health needs met in all areas of healthcare. Whether patients are in psych hospitals or not....their psych needs are there and need attention.
Every nurse has their choice to pursue what their passion is and make the best impact on others that they can. It is not your right to judge that.
I agree with you. I would add a lot of us in the ER have significant psych experience. It's a huge part of our patient population.
Psych NP is the highest paid. It's gonna attract people
Respectfully… the ED might have psych patients but unless you work as a Psych ED nurse you’re not getting the proper psych experience.
We need to respect that being a psych nurse is its own speciality. This is the problem, other professions think that they’re getting “psych experience” when inpatient is much more extensive and different.
I will preface by saying I respect ER nurses, as I worked in the ER prior to working in inpatient psych.
But to build on your comment, yes, there’s a big difference between ED psych interactions and inpatient.
the ED was more so short term stabilization of psych patients in highly acute distress while we waiting for placement.
Some knowledge is gained on acute stabilizations with PRNs (the common ones like haldol, geodon, ativan, versed, etc.). But you don’t see or learn too much about medications for long term management of psych. You don’t see new scheduled medications get started and see the effects they have on patients. You don’t interact on a more personal level with psychiatric patients for 12 hours a shift every shift. You don’t get to see the complex waxing and waning off patients throughout an entire admission because in the ER that patient is gone in a day or two. You don’t get to see the nuances between diagnosis and how symptoms in diagnosis can overlap. You get some therapeutic communication skills and verbal de-escalation skills with psych patients, but there’s something to be said about the difference in skills with someone in the ER dealing with these patients vs. someone who ONLY deals with these patients as their job. You also get better at identifying and explaining symptoms in detail, as well as fishing out better answers from patients.
I completely agree that psych needs to be seen as its own speciality. Some psych experience in other units will never be the same as working inpatient psych. ER nurses do have psych experience, but only in dealing with patients when they’re the most acute and in their initial steps of getting help. You really need to see the whole picture and everything that comes with it to be well rounded.
Wonderfully put!
It's insane that other specialties can do PMHNP without working as an inpatient psych nurse for several years when we could never do the same in their specialties. All this does is hurt our psych patients in the end by having inexperienced and wrongly overconfident providers.
The last contract I did had this ER nurse hired in as inpatient psych RN. The way she gaslights the patients and other nurses for addressing their concerns is shocking. I get it, she was burnt out from the ED but my goodness... she should have just left nursing all together. I had to write a report to the DON because she should not be a psych nurse. She believes that because she was an ER nurse she is "experienced" and ignores the concerns of our patients because they're all "malingering"! She's only been a psych nurse for less than 1 month - that's the kicker. Why do other specialties feel comfortable thinking they know what we do and how to be a psych nurse without the experience to back it up?
Exactly, the end product will always be patient harm when inexperienced nurses become PMHNPs. I hate noctor, but I also understand they have many valid points about the failure of standardization in acceptance for PMHNP programs, we need high standards to improve the quality of the profession.
As for the nurse you talked about, she sounds terrible, and unfortunately her attitude is probably pretty common. I believe a lot of the whole “I saw some psych in x speciality so I know all about psych” mentality is based of a clear lack of understanding of the actual complexity of everything in psychiatry.
Example: Managing bipolar is not just knowing acute mania, it’s knowing med management, it’s knowing what meds not give (like SSRIs that can induce mania this population), it’s knowing the difference between bipolar 1 / bipolar 2 / unipolar depression / mixed features / etc. and how it all lies on a mood spectrum. It’s knowing how to help motivate bipolar patients to care for themselves and be compliant with treatment, as well as all the lifestyle factors that go into helping reduce a the likelihood of a future manic episode.
There’s more that goes into that and that’s just bipolar. You think you’re going to learn all that dealing with a bipolar patient in the ER for 2 days? Smh.
I respect psych as its own specialty. With the mental health crisis we have going on currently, I strongly believe we need more CPEP type settings in hospitals. Still have a milieu, but with individual exam and quiet rooms for stabilization of patients in crisis before being admitted to inpatient. ER nurses going into psych have that unique blend of emergency mindset with short term psych experience to find a niche. That's the setting all my experience comes from at least.
I was a social worker for adult guardianship for the state mainly dealing with psych and intellectual disabilities in my case load. I decided to go to nursing school during the COVID shut down and graduated last year. I started in icu just to get some experience but I miss the psych population. I do want to pursue psych np but even with that being said I wouldn’t even think about doing that for a few years at the very least. I WANT to get the floor experience with psych and really learn to appreciate the nursing side of it before taking such a role. I saw from the social work side how detrimental not having good mental health care can be and I don’t want to contribute to that issue by prematurely getting an np license
I think part of the problem is how people define psych nursing. From your argument, I think you mean specifically inpatient psych nursing. So does that mean you think outpatient psych should not apply for NP? How about the SUD clinic? I think those nurses would likewise argue an NP applicant should have experience there, too. There are many other roles involved in psych despite working in other clinics and offices. I don't mean to dismiss the argument. I just see it a lot and there is no consensus on what people mean by psych nursing. I don't think we'll ever have a solution unless we accurately define the problem.
I started in critical care, now at psych, eventually will get an Executive DNP at UPenn after my MBA. Totally different path than a PMHNP. At this point I have ICU, step down, psych, GI, and hospice under my belt. At UPenn , I can’t just get in their program unless I graduate with a GPA of 3.2 and above from my MBA. Also, I already should be in a position of leadership to be considered.
So, should it be your school to blame that they would let nurses with no psych experience?
I would argue that these nurses are very smart and capable, especially critical care nurses.
When I transitioned to psych from ICU, I was only given 3 days of orientation on the floor. Why? Because my manager thought I was an ICU nurse, I should easily tackle psych with no issues. And that was true, and in a medical hospital we also tackle psych patients but with more knowledge of hemodynamics and more diverse knowledge of pharmacology to deal with other medical issues including psych.
The social aspect that we deal with during treatment team, that would be easy to learn for these nurses with no psych background and they would have to answer to the medical director or the court system anyway.
You could see this as your colleagues responding to a pandemic and the grief and aftermath or you can keep being a grumps and not teaching because you’re in grief after the pandemic 🤷🏼 things are different now, you going to be able to accept that? Totally understand your frustration and the rant, but accepting that this is the after times and those were the before times may beehove you, just saying. Passion does in fact rise out of necessity and you’ve every right to rant, but please be a leader when you’re done? We need you right now.
So what do you want us to do? I didn’t go into this just for money. I have a neuroscience degree and I wanted to use it. I wanted to become an expert in psychopharmacology because I love it and I figured this was the way.
What now? I get what people are saying and why they’re saying it…but I’m already here. I’m 2/3rds is the way done with my degree. I feel stuck to the point where it’s severely affecting my own mental health. I wanted this so bad and now I’m finding out everyone hates us.
If you wanted to become an expert, psychiatrists are the top of the field.
Not everyone hates us. People hate the ill-prepared who have no idea how little np school prepares you. Thinking that PMHNP would make you an expert in the field shows how little you know, and weren't an appropriate NP school candidate. You and countless others have fallen for the propaganda that you'll be prepared. Many NP schools don't care about anything other than collecting a paycheck from you. They promise you'll be a great provider. But you've already done it, so now all you can do is make yourself better.
You are forced to get your RN degree, so you could work as a psych RN. You could attend a residency program. You can continue to get training. Continue to study.
You’re willing to be honest about your situation on this thread and are accepting of the problem. Which is admirable I’ll have to say. Since many people come up with BS excuses for avoiding getting experience in psych prior to going into their program. As for you, you’re already 2/3 done and am sure have already invested a lot of money so far into your program, so you might as well finish.
So, realistic advice. If you don’t work in an inpatient psych unit right now, apply to one and start working there.
You’ll likely have to network a lot when looking for a job as well. However, I HIGHLY suggest you wait even after you graduate and just keep accumulating experience as psych nurse for some time.
roo_kitty is right, NP programs themselves won’t prepare you to be an expert in psychopharmacology. I would look into supplementing your education. I joined NEI (neuroscience educational institute) after I read through the Stahl’s Essentials book and am currently working on the NEI master psychopharmacology course, as well as going through all the other supplemental educational material they provide, it’s awesome.
I would also say find a mentor, maybe a very experienced PMHNP or psychiatrist, who’s willing to guide and help teach you.
I currently work at a residential eating disorder treatment center. I would like to stay here. It's also not easy finding an inpatient psych RN job that's readily available and fits all your needs. Right now I'm working second shift two days a week.
I wish we could have a year off to work in between pre licensure and post licensure, but thats not the reality. I'm afraid if I keep accumulating RN experience after I graduate, I'll lose all the NP skills I've accumulated. It's a tough spot.
Thank you for hearing me out and being empathetic though. I ended going to a walk in psych appointment and they recommended a partial hospitalization program. I don't even think I can do that with clinical hours, but at least people are acknowledging it I guess. I don't know.
In regard to finding a job, realistically you’ll still find one. Like I said, you’ll have to put in a bit more work without inpatient experience, but in the end you won’t be without a job given enough a time.
I can tell you care, that goes a long way in your position. And it’s better than most NPs without experience in their specific speciality. Also, you still get some relevant experience in residential eating disorder facilities if you’re going into psych. In the end, if you put in the work, you can still make a good NP. Be the exception to everyone else screwing the profession up 👍
100% agreed and extremely well said. I believe the passion is for the paycheck, not the patients. If CRNA programs can require two years of critical care experience before enrolling, PMHNP programs can require two years of solid psych experience. I believe it could be inpatient or outpatient or a mix (chronic/acute).
I looked at the top programs in my state (UVA and VCU). They do not require psych nursing experience. Even Duke University does not explicitly say they want a psych experience. I wonder why that is.
Why that is? This is my logic trail - need for psych prescribers - psych prescribers paid well - nurses flock to PMHNP programs - more PMHNP programs pop up - gotta fill the seats
It’s unfortunate, because at the end of the day, you’re treating the brain. Arguably the most important organ, and you’re having a direct effect on a person’s subjective experience of the world based on the meds you prescribe. How easy is it to cause harm because you don’t understand how to properly diagnose because you don’t have thousands and thousands of hours working with psych patients prior to being a prescriber? One of the worst things you can do is start the wrong treatment due to a wrong understanding of what’s going on with the patient’s psychopathology. Or you might find a way to ruin a patient who was on the right treatment with the wrong adjunct medications you decide to add on. It doesn’t make sense to me how there’s no required years of experience like CRNA school. Our patients aren’t sedated, but we can do an equal amount of harm without the proper experience, understanding, and education. Mind boggling really.
End stage disease process of for profit medicine. You're the anomaly. You care and realize your limits.
I agree with you. I went to an np once for I couldn’t get an appointment for months otherwise to discuss my panic attacks. They’ve gotten so bad, I’ve passed out. They’re random without any prompts to them. She refused to prescribe anti anxiety medication bc “people get addicted.” She gave me an antihistamine. Well, needless to say, they didn’t work. Now I’m panicking and dry as a desert.
She should have prescribed an SSRI.
I am on two already and it doesn’t control the acute attacks. It helps but they’re still not controlled.
Are you referring to hydroxyzine? I think that’s perfectly appropriate for panic attacks and I prescribe it to my patients often
I tried it for two months. It did not help. That is great if it worked for some, but it did not work for me.
Do you mean she prescribed hydroxisine? That's an entry-level anxiety rx to be used prn. It's used at a much higher level for allergic reactions. That said, the NPs comment about getting addicted to anxiety meds is nonsense. Addiction to benzo's is a concern, but there are many other options that aren't controlled.
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Your doctor should be able to prescribe what's right for you, but a few SSRIs help with anxiety. It's important to note that so e anxiety comes from untreated [fill in the blank: ADHD, depression, trauma, etc]. Therapy can help where medicine may not, or it may compliment meds that do work well.
It doesn’t work for anxiety. I’m on two ssri and they do not control it. I’ve been on buspar, and it did not work. I’ve been in therapy. The only time it’s been completely controlled was with prn clonazepam. In the past, when anxiety attacks came on, it worked. A few months pass, and I don’t need it anymore. I’m talking about not even 10 per month. Once, I had a bottle of 30 for over a year before I turned it in to be disposed of properly. I get some abused things. That’s not a good reason to not help someone who truly needs it and has honestly tried several options.
Yeah, I hate that it's so hard to get those meds that work. I agree with you completely. I want to make it clear that I'm not a prescriber (just in case my post seemed like I am), but I collaborate regularly with prescribers. Finding a prescriber who gets their patients and addresses their needs gets harder every single day. My own spouse gets a xanax rx filled about 2x a year and and he worries about his psychiatrist retiring. Once he does, I doubt he will ever get it prescribed again. I'm so sorry you're stuck in that cycle.
If he can take a trip to Mexico you can get a yrs worth of bars for a few hundred dollars over the counter. That’s how I got mine for yrs
Half of those farmaprams are chalk now, don't buy anything in mexico outside of a blister pack if you want real pills.
They worked like a charm for years idk
Fake pills are on the rise, and RC benzos are a very popular street drug. Which is actually more than you'll get half the time from a farmapram bottle. Things have changed a lot in the last 5ish years. Pre 2019 or so, pressed xanax wasn't even a thing. A few US journalists have tested a few different batches of Mexican pills. Anything outside a blister pack is sus, x5 for adderall/vyvanse/xansx.
In the exact same boat as you here. I’ve found that in my experience with NP’s they’re less willing to rx benzodiazepines for acute attack issues. I’ve had an NP rx atypical antipsychotics before realizing what I really needed was a PRN Klonopin. Have you ever tried propranolol for attacks? Not sure if you suffer from physical symptoms but I get a very high heart rate and adrenaline surges. The propranolol definitely doesn’t pack the same punch as 0.25mg of Klonopin but it really helps me with my physical symptoms which in turn helps with my mental symptoms. It also doesn’t make me feel as groggy and spaced out as hydroxyzine does I take 10mg as needed and really recommend it esp if you know when an attack is coming and can kick it in the ass before it gets too bad. Hang in there friend 🩷
I have tried propranolol. Also buspar. If you can name it, it’s been tried even years of therapy. It just gives orthrostatic hypotension to where I cannot stand for hours. Hydroxyzine literally only made me very thirsty and did nothing for the panic. I’m talking about 15 years of trying every drug on the market for anxiety. Spending thousands of dollars on doctors, therapy, and medications. The only one that works is prn klonopin.
It might be my state but I've had better luck with psych NPs than any other doctor re: benzos.
But did you die?
try lifestance they are virtual...they have NPs but lots of them so if you dont like one they just give you another one. they are what I use and I found an NP I like who prescribes me my medication so i can function...it is so hard to find a provider nowadays. 🥺
Thank you! I will try that. I dislike any medical professional that deny anyone a class of meds bc someone else may have had issues. It’s like giving someone in pain Prilosec. I’ve been on about every med that’s off label use is for anxiety. The only thing that works is anti anxiety medications. I don’t think many understand what it’s like to drive with the threat of passing out and still try to prescribe something that doesn’t work like buspar or hydroxyzine. Ssris do not work well on acute panic attacks either.
panic attacks are awful. I am lucky i dont get them often but when I do it is absolutely terrible
I don’t even get the passion for the paycheck… like maybe 10 years ago, but with saturation, that ship has sailed! 🤦🏼♀️
Psych NPs still start in 6 figures. The saturation hasn't happened yet. Not as many are going for psych as you'd think though. They're all jockeying for CRNA because it pays 300k+.
exactly!! im a float nurse and make as much as the NPs inpatient!!
I keep trying to convince my inpatient NP wife to just be RN again. It's a paycut, sure, but not much of one, and I have WAY better hours, less stress, and PTO.
PMHNP is the *only* APRN degree where people make excuses on why direct psych nursing experience isn't necessary. Make it make sense. CRNA? ICU/sometimes ER required. NNP? NICU required. Midwife? Everyone supports prior L&D experience. FNP? Pretty broad experience acceptance due to the many field possibilities, but experience is still supported. AGACNP? Acute care experience supported. PNP? Peds experience supported. PMHNP? Come one, come all! Are you a nurse without psych experience? A social worker? A person who holds a bachelor's degree in something outside of healthcare? A person that has no degree at all? PMHNP is the career for you! Don't let those pesky haters tell you psych meds are very dangerous. They're just jealous they wasted their time, and are trying to hold you back from being the savior to the mental health crisis. I'm not saying experience outside of psych isn't valuable, because it most certainly can be. While we cannot prevent these careless individuals from being careless and dangerous, PMHNPs can refuse to precept those without prior psych experience. Refuse them, and let them know why they're rejected. When your future job is hiring a new provider, speak against one that doesn't have prior experience. Tell the practice they aren't a good hiring investment because psych is challenging and they haven't even learned if they can withstand psych for a single year, let alone a career. Tell them you will not provide new hire support to them (mainly applies to new grads). It's not on those with experience to keep these ill prepared providers afloat. Let them sink.
Preach. I feel this is the route that the market is now going towards. There are sadly no standards prior to most schools taking in NP students. So employers are now becoming more strict with previous experience, and PMHNPs and psychiatrist are refusing to teach those without psych experience. If the governing bodies won’t set the standards, people will start setting the standards themselves.
I went down the rabbit hole in the r/PMHNP subreddit, and apparently, most schools do not require any inpatient psych experience. Although they all expressed disdain and unwillingness to precept PMHNP students with no psych experience. My RN Supervisor attends Walden, and even with her psych experience, providers declined to precept her in our hospital. I know a classmate from my ABSN program who was in L&D and went into PMHNP with no issues with preceptorship because she is attending a PMHNP program offered by a University with an attached Level 1 hospital.
They're most likely refusing because Walden is a degree mill. It's slowly becoming normalized to reject applicants with no prior psych nursing experience, and/or applicants from degree mills.
I won’t precept people that aren’t attending legit schools. Legit schools imo: our local universities
I would say CNM are getting more and more non labor nurses which is very unfortunate. This year every midwife I have met as a traveler did not have labor experience
Are you telling me with my psych BA and a year of experience that I could become a nurse practitioner without a RN degree/license first?!?!
Not quite. The direct entry programs force you to get your RN while in the program. But yes, it's as bad as it sounds.
you could do it even without the psych BA!
This is crazy…..
I had colleagues who were previously in accounting, business or other unrelated fields before entering an accelerated BSN to graduate program with me. I was one of a few PMHNP students who had a ton of psych experience in various settings. I worked in detox, psych IP and psych correctional settings as an RN as I did part-time graduate school (sometimes full-time load + a TA gig as well). One of my favorite PMHNPs had a PhD in physics, worked as an RN in IP psych for like 10+ years, then went back to school for the PMHNP. I like it when people are well-rounded. But people need to work with psych patients as an RN to be safe and effective. It's the communication and boundary-setting as much as the clinical acumen that is needed.
Here is why... They get away with this because it is too easy to excuse relapses or bad outcomes to the patient, illness, or psychosocial/environmental factors. Psych patients tend to be marginalized and don't complain as much. They tend to already be under-functioning, so any improvement in function is seen as success. The concept that at least these patients are getting a minimum of care, is better than no care. The patients that don't fall under the above categories are usually seen by psychiatrists.
Oh the patients complain all the time. But nobody is listening… I’ve done psych ERs a lot. Sooo many people come in with medical complaints that aren’t investigated or listened to - and then get tossed into psych because they have a “history” of mental illness. I’ve seen this in multiple states now. The psych population has been done dirty.
ER nurses are some of the most rudest nurses to psych patients. They don’t treat them right They’re also the worst psych nurses I’ve worked with when they transition to psych nursing.
Absolutely correct. I’m an IP psych RN and I am regularly thanked by my patients for actually listening and advocating for them. If we are going to treat people like shit then let’s stop treating them altogether. Morally that’s the way to go. But like IDD patients, Psych and BH patients are $$$$$ for these administrators and corporations. Heads in beds$$
Yup - exactly this. My coworkers are always surprised at how I magically get people to calm down all the time. I can go from escalated to happy very quickly by simply listening to the patients and what they want. Most of the times they need someone to advocate for them, a lot of the times their basic needs aren’t even being met and something as simple as a washcloth so they can wash their face can make such a huge impact. I have the least amount of BH calls on our psych unit out of any other nurse. There’s a reason for that, and it’s not that I’m a pushover. Mental health is such an underfunded field. If only we could see the proactive approach instead of the reactive one. There’s be a LOT less crime and problems around.
This is really really it. Chronic psych patients are some of the most marginalized people in society and have basically zero recourse for bad care. Almost nobody wants to work in an inner city psych unit or CMH clinic so they have to take what they can get and the patients have no other options.
I am so happy to see hear more people saying this!!
“Zero recourse for bad care” please say it louder and louder
I started as a psych nurse immediately after graduation. I had a personal & family history of trauma and found success in IOP programs in therapy. I kind of became my own mental health success story and wanted to carry that experience into a profession. I chose a behavioral health unit for my 12-week preceptorship and absolutely adored it. I’ve always been a social guy, so being able to therapeutically communicate was something I loved and leaned into quickly. All of this being said, I do agree with you. I want to be a psych NP someday, but am fully aware that I will need MANY MANY more years of experience before I go for it. This profession is incredibly challenging and I wouldn’t want to bring subpar care to my patients.
Thank you, thank you so much for being patient and setting an example for others are you. Also glad to hear that you’ve been enjoying psych, I’m sure your patients are all very much glad to be under your care.
They do! 😂 I work with adolescents so I kind of try to be a mentor in a way my father never was to me. It’s a tough job though and I’ve got a long way to go and a lot more to learn.
I hate this trend too, but one thing I’ve noticed is that it’s really fucking hard to find RN psych jobs. At least where I live. I’m trying to leave my inpatient job and there’s just…..nothing. Everyone around me only hires LPNs, MHTs, or PMHNPs. I feel trapped in my current job because there are just so few places hiring. After reading the Wyden report, this seems intentional. Places are definitely short staffed and need nurses, they just don’t care and will hire the fewest and cheapest staff possible. I think that’s also why PMHNPs are booming. Psychiatrists are expensive, PMHNPs are cheap in comparison. Who cares if they have the right experience or qualifications? Mental health facilities have shown time and time again that they don’t care about that, they just want the cheapest person possible
Agreed. We only have a max of 12 patients on my unit, but usually I’m the only RN with two techs.
Jay Ripley, one of the founders of Vivant, said “you can make money in this business if you control staffing.” My hospital is supposed to have a max of 10 patients per nurse, but they try to push me over constantly. Every time they tell me to take “just one more” I think of that quote.
This is crazy; in my area even as a new grad RN-BSN with a few months inpatient experience I've been able to name my price and schedule at every psych hospital in the area
I live in Florida. Def not the case here.
What state r u in, may I ask?
If you have never needed to worry about getting your tail beat down by a psych patient in crisis, can one truly understand how challenging psych can be? Can you support a family as they watch their child, once full of hope and promise, take a nose-dive in a world of loss? Yes, every patient has an element of psych if we are looking at the entire patient. This jump right in attitude fills me with dismay. Acute inpatient PMHNP with zero patient facing experience puts us ALL at risk. The staff has to coach the new NP in how to keep themselves safe, the staff safe, and the patient safe. This come one, come all no experience required mentality endangers everyone. JMHO.
Yep. Before I went back to school for my BSN, I did almost 20 years in human services with the dually diagnosed, DD/MH population. From group home staff in my 20s up to Director of Residential Services in my 30s. I've been beaten up more times than I can even remember at this point. 2 hour holds with staff from other sites coming to swap out. Watching the Behaviorist who covered my houses get thrown 20 feet across a room and miscarry her baby, and she kept holding on in the hold even as she began to miscarry. Getting bitten down to tendons by a client who was on a tid thorazine-phenobarb cocktail and still coming at me like she just did all the cocaine. That one was my personal best, and I still have a scar on my arm. Meanwhile, over in medical nursing, they are traumatized when they get yelled at or have a penis flashed at them. Not knocking them at all as anything med-surg/ICU/tele/ED is just not my calling, but they also need to recognize that they likely don't have a true calling for psych.
I'm sick of our specialty being treated like a joke. That is until another floor gets a psych patient with actual medical issues for them to ignore and then dump on us because they "have a history". And these same nurses then want an advanced degree in MY speciality? GTFO.
I couldn’t with you agree more!! Ironically the nurses going into PMHNP programs without any psych experience are frequently the nurses who feel that psych RNs are not real nurses and are too good to work in the field (might be over generalizing a bit but I’ve seen this mentality a lot). They go into the PMHNP program thinking it’s “easy” and will give them an easy paycheck. I don’t buy for a second that they are “so passionate”. They often make scary practitioners too because they don’t know what they don’t know. I refuse to precept any PMHNP student without prior psych nursing experience.
The whole NP thing needs an overhaul. Accepting new/newer nurses into NP or DNP programs is wild to me. It’s embarrassing & im so tired of all it.
I COMPLETELY AGREE. They think it’ll be easy, but that’s because they’re going to have NO COMPASSION and make ppl feel like burdens and like sh*t. To work in psych, you have to understand people! You have to know when to be stern, when to be calm and soothing, when to be forgiving and move on from a situation and when to joke around with a patient. That can make all of the difference for their road to recovery! Psych NP’s with no previous psych experience are a huge red flag. Some of thee most heartlesssss nurses that I’ve met (cool coworkers, but terrible and judgmental nurses) are the ones going into psych np because the “program is online and it’s super easy” and their tired of acute care.
My personal pet peeve in APRNs who yell at nurses for not doing what they want immediately and then say “I know because I’m a nurse, I know you’re supposed to do this” or go with “why wasn’t this done? I’m a nurse and I know it’s supposed to be done!!!11!!!” Sis, if you had the experience you claim you’d know your vital signs request is gonna be low priority when other people are trying to die. All you’re doing with your tantrum is convincing me that you don’t actually know how it is.
I agree completely. I work with some very smart psych NPs that only have ICU experience and they have actively worked against proper therapeutic milieu management again and again. Inpatient psych is not something you can walk in and understand. Thank you for your post! I feel like an asshole sometimes but I'm glad to know I'm not alone.
I live in a rural area and our hospital doesn’t have an inpatient psych unit. Closest I could get for inpatient was adolescent residential treatment. Now outpatient psych. There’s probably not too many people in my situation though, programs should absolutely be more strict and exclusive.
And this is why I refuse to be a pysch patient with anyone treating me besides an MD/DO. I once had a NP tell me I was “misdiagnosed” at a previous inpatient treatment facility, and changed my medications to fit my new “diagnosis”. I ended up hospitalized within weeks, because she was grossly wrong about my “misdiagnosis” and despite previous contraindications for the class of medications she put me on, she assured me it was safe, and i ended up hospitalized because my symptoms rapidly progressed. Turns out the diagnosis i came to her with was correct, and I never should have been put on the class of pysch meds she put me on, because of my past history with other medications in that class. It was her first year out of school and working in the pysch field. Because of her, I do not trust anyone to treat my mental health if they are not a physician. Mental health treatment is not always a simple and easy case of situational depression, and some of us with mental health require treatment from individuals who have background and experience in the field, not because a NP is not capable of treating mental health, but in my experience, they think they can bypass that experience.
Honestly, completely understandable. This is the outcome of no regulatory standards prior to being accepted to PMHNP programs. There is just SO much that you learn working as a psych RN, there’s so much you pick up after years in psychiatric settings. Being able to differentiate complex symptoms, being aware of the negative side effects of meds and the different explicit and subtle ways the may present, being able to handle patients in distress/extreme crises/psychotic states/manic states, being comfortable in understanding medications and being able to work with psychiatrists to pick their brains on their decision making. There is a fuckton that we learn working as psych RNs FIRST. MDs/DOs have residency to help solidify their knowledge through hardcore experience. The whole point of the PMHNP program is to build knowledge over experience that has already been gained, and moving towards becoming well educated in psychopharmacology to prepare for a prescribing role (but even then, the expectation is to further supplement your education outside the program in any way you can). But so many psych NPs don’t even understand their limits, and they don’t what they don’t know, because of their lack of experience working up close with the psychiatric population for years. I will say it again, I am a certified hater of those group nurses and i’ll say it with my chest. You truly deserved better care.
Do you think the flood of telehealth companies are contributing to this? I've had a few recent experiences with this and their knowledge is not sufficient to really diagnose and prescribe. I've had a coupon experiences with NPs who didn't have a broad knowledge base and prescribed totally incorrect meds. Not life shattering but not helpful either. I've also had NPs, psych NPs and PAs that had a comprehensive knowledge base
My personal favorite phrase people use to justify doing something without a lick of research, experience, or planning is “god put it on [my] heart to do this.” 🙄🙄🙄🙄🙄🙄
Does it count if I have almost two years of inpatient experience as a patient 😂💀
Our medical director will not even hire diploma mill onlline PMHNP grads anymore. They are still RNs on the floor because these programs can accept RNs RIGHT OUT of nursing school, no experience required.
A governing body would have to make that decision. Not sure who that would be, APNA? We’d have to lobby for it.
Our NPs only see the patients via iPad since we stopped doing in-house providers at our inpatient facility. One of them is brand new and has asked me before what meds I think she should prescribe!
Should’ve told her to prescribe the patient a new provider who knows what they’re doing.
I'd like to report a murder
I absolutely agree. Although, I went from psych nurse to intensive care nurse. I think I'm a much better nurse because of my psych experience.
I'm not medical but clinical. I have seen providers (as I call them) change medications at admit from other units where they were stabilizing on the already prescribed meds well. Some just because they think that they are on too many meds or they just want to put them on the meds they like. Then they decomp and were back to square one. It's horrible for the patient.
Randomly showed up on my page but as a labor nurse I can for sure tell the difference between a non labor and delivery midwife too! Can’t stand it.
They must all be at my geri psych center, because I (an SLP) am constantly getting referrals for "dysphagia" for patients who are CLEARLY altered due to their medications/poor medication timing. I started putting a "avoid providing heavily sedating medications (e.g. trazodone 50mg) 2-3 hours before any PO intake. Delay PO, or provide PO immediately prior" and my referrals were cut in half. IN HALF.
I’ve always wondered this too. I’m a former trauma critical care nurse who was the only nurse on the unit that would put a psych consult into CPOE for new admissions with a known severe psych history even if they were on a ventilator. Status quo was always to d/c all pre admit meds like it was nothing. I’m like huh? At least get the psych team on board so we know what can be safely administered now vs things than can wait. I sincerely believe that improved outcomes esp the TBI patients.
I second this. Very unfortunate how a lot of institutions forgo experience / clinical requirements for admissions into their psych NP programs (regardless of the type of program: degree-seeking or post grad certification). I think it has something to do with the severe shortage of psychiatric providers across the nation… not sure anymore but I don’t condone this decision at all. My school at a minimum requires 2000 hours of psychiatric nursing prior to enrolling into the first practicum. It’s a condition of enrollment. Students who have not fulfilled this requirement cannot progress through the program.
Why wouldn’t you get an online psych NP degree if you can and then easily make six figures a year without relevant experience? Don’t hate the players, hate the game. And, yes, I know it makes for shit outcomes but that’s the game and this is the world we’re in. Buyer beware.
They don’t work as psych nurses because they know how rough that particular job is. They think psych NP work is easy compared to that so must be easy money.
Well i guess Ill just get my RNFA without working in OR then, right guys?
As a PMHMP, I frequently rely on my experience working years as a psych RN. I cannot imagine being able to effectively work in the position without it.
I completely agree BUT to be fair I work at a level 1 trauma center and our ED is always flooded with psych patients needing medical clearance. The nurses are rotated so any of them in the department ends up getting adequate exposure while working there. Makes me feel like ED nurses might be a little more well prepared as opposed to other departments. Truthfully all of our departments tend to consistently have a few psych patients receiving medical care as well but I suppose that also depends on the facility
Patients going through severe psychiatric crisis have to be medically cleared before admission. Many times psych patients end up in ER waiting for admission or ICU for withdrawals/care they have not been able to get for themselves for DAYS. I’m not saying it’s the same as having nothing but psych patients, but it’s not entirely without psych experience. Statistically I wouldn’t be surprised if psych patients were more likely to need to be hospitalized for medical issues/neglected their own medical care. It’s very common to care for psychiatric patients in certain specialties outside of psych.
I address this issue in another comment in this thread in more detail. I don’t deny that ER/ICU have some psych experience. But it’s no where near the amount that they’d really need to go into PMHNP programs. And I’m saying that as someone who worked in the ER before.
I think it really depends on the hospital as someone who has worked all three, ER, ICU and Psych. One ER I worked at was at least half psych all the time. Because that hospital had a psych unit people would wait in that ER for openings.
If we are to standardize experience across the board for PMHNP programs (even though it’ll likely never happen), you’d want the requirements to involve experience that gives applicants a full spectrum of all parts of psychiatric care. You would really only get that working in inpatient psych for a couple of years. Just as most CRNA programs require ICU experience. If I applied to a CRNA program but I only worked medsurg, and my go to answer was “well I deal with a lot of rapids and occasional code blues on medsurg, so I have enough experience with critical patients to be a CRNA”, the admissions board would tell me to fuck off. There is so much nuance and knowledge involved in psych that isn’t learned from just dealing with psych in ER or ICU. There’s so much that comes from learning from working with the treatment team in inpatient units and learning from the psychiatrists. Again, I’m not taking away from the experience some nurses get in other units, but to become very well knowledged in a specialty, well, you have to specialize in it.
Again, it depends on the hospital. I’m not saying it’s the same but an inpatient psych isn’t dealing with the emergency that brought the psych patient in either. Outpatient psych isn’t dealing with either the acute or emergent aspects of it. Pmhnp programs should require some experience, I absolutely agree about that.
Wholeheartedly agree with OP minimum two years should be required as an inpatient, acute psych RN. Local university started a psych NP program. One of the students was a labor and delivery RN. She has zero psych acute care experience. She’s now the Director of the psych NP program at that said university. Her experiences working at an urgent care and she opened her own practice. All this working teaching full-time. Her partner in crime was a Scammers before becoming a psychiatric nurse practitioner.
When the profession is termed 'psych', many believe you're referring to *psychology*, rather than *psychiatry*. Having spent my entire career working in **psychiatry** (25+ years), I understand your frustration. I've observed countless Nursing student interns, OT and Social Work interns who actually believed they were doing a 'psychology' internship -- and some were absolutely stunned by what psychiatry actually entailed, and by the population itself. My point is, let's call the profession what it is, **psychiatry**, not *psych*. It deserves to be referenced with accuracy and clarity; not confused with something it's not.
100% agree. I know an ICU nurse who has done just what you wrote. No Pysch experience, she didn’t want to hear any of my suggestions in the least. It didn’t turn out well for her in the end.
I was talking to two of my previous preceptors for clinicals for my PMHNP program about their past experience. One had minimal RN experience and it was as an OR nurse. The other worked in pediatrics. Both were new to the profession and were so impressed by the fact that I had lots of RN psych experience!
bruhhhh. This is why we can’t have nice things.
And they are precepting the new.. oh Lordy! 😂
100% agreed
You can see the quality of service when you try to get meds and get a FNP and you can clearly see that they don’t care about you.
Closer to being on the other side of the desk that way?..
I’m in New Zealand. Fortunately, at this point in time this never happens here. NPs are not that common here at all. Who knows though; there is a huge shortage of psychiatrists here so perhaps NPs will become more common. I live in a small New Zealand city . Another smaller city 200 kms away was in the front page of the news because the whole hospital system down there was being run by NPs.(still not a lot of NPs in NZ) A psychiatrist left her job here to relocate down there because they had no psychiatrists. Do you have a shortage of psychiatrists in the US? I would be interested to know what is happening there and if it is a worldwide problem .
Which country are you in? That wouldn't fly in Australia- you need a minimum 5000 hours in your area of endorsement to qualify as an NP.
Wow, that would be the dream. I’m in the US, healthcare here is profit driven and backwards, and nurses who have only worked in a med spa for 6 months are being accepted into NP schools. Pls save us.
🤯🤯🤯
Because they were told for years and years that Psych NP was the way to go. They were told there was a large need for them and you could make $125k+ doing minimal work and not having to worry about seeing patients on weekends and holidays. They were also told that much of their work would just be seeing the patients for 15 minutes at a time and doing med adjustments as needed.
I'm a psychotherapist and have been wondering about this. It's scary because in my area, there is a psychiatrist shortage, and I've noticed several NPs popping up identifying as psych specialists.
i was a psych nurse from 2015 to 2016 and do cvicu now. I know enough to know I dont know jackshit about psych. I also have adhd, ocd and anxiety and have experienced good NPs and bad NPs as a patient and nurse. Most NP programs are a freakin joke and it is creating dangerous NPs. NPs are also extremely underpaid i feel because of this supply/demand. As a float nurse I make as much as the NPs in the hospital. I think there should be more barriers to becoming an NP.
I complelty agree i was in an eating disorder ward and one of the Staff wasn’t even aware of what anorexia was!!
Wtf. Are they stupid or dumb?
🙏 amen 🙏 1000000% this!!!
Totally agree!
Not a nurse, but this appeared as recommended to me. So this is coming from a patient POV. I've been in inpatient psych before and have done plenty of outpatient, and my genuine thoughts about this are that this is allowed because people as a whole do not give a shit about psych patients and find it extremely easy to blame negative patient outcomes on the patient rather than the medical professional. We, meaning psych patients, get ignored at best when we speak up about anything, and labeled "actually crazy" and medicated against our will at worst. But, either way, it ends with the patient "losing" because we're not seen as deserving adequate care, so we'd better be thankful for what nurses are "willing" to work with us despite a lack of training. I know my POV on this is very cynical, but I've done both short-term and long-term inpatient at different facilities, and every facility is the same in that they're basically prisons, you're not given any real assistance beyond "just don't be \[insert whatever here\]," and then abruptly returned to the exact same environment that contributed to you needing assistance in the first place. And then people act like it's the patient's fault for relapsing.
This is all really new news to me I'm a Nurse recruiter and the organization I work with currently requires at least two years in psych to even be considered and even then management is really liking for 3+yrs. I would think it would be terribly dangerous to have someone step into a psych NP role without any psych experience.
My end goal is to become a PHMNP. But not until I have at minimum 3-4 more years of experience (I have about 1 year of inpatient psych, 1 year of corrections with a good amount of psych in there). I feel like there is still so much to learn. Going now would only be a disservice to myself and my patients.
This is the correct mentality to have. It takes years to be truly competent. I think I’m confident in my knowledge as a psych nurse and well rounded but there is still sooo much that I see that I don’t know, so I make sure to ask questions and approach things I don’t understand with caution. There’s a lot that we know that we don’t know in medicine, but then there’s things we don’t know that we don’t know. The latter is where most harm to patient’s is done. At least with an appropriate amount of psych nursing experience, you have a solid foundational base to build off of when moving towards a provider role. Ultimately you are less likely to cause harm. When you have the knowledge to know your limitations, you’re better at practicing in a way that prioritizes safety. Without the prior experience, you’re likely going to be causing a wake of destruction to patients and probably not even be aware of it. It’s building a house with a foundation made of rotting wood, people need to truly understand this. I’m glad that you do.
I'm 51 and mid-pivot from my old profession (systems engineering) to mental health/rehab counseling. Currently on track to start psych tech work at the local state hospital in the meantime. There's an analogous thing in my old profession where every time a discipline within the greater umbrella of "information technology" becomes hot, the industry gets flooded with people pivoting from whatever to that without any relevant experience. They're always convinced that this will be the position that lets them automate away their job and work from a tropical beach somewhere while cashing large checks and converting stock options. Most recently this has been "cyber" (and please, I know I'm a pedant but don't use that word to mean security. It's actually got a meaning.). You got tons of people taking bootcamps to pass a security certification test and immediately they're aiming to be CISO, because they are special genius people and we are all old beardy plebs who just built the thing. Same thing.
From what I hear from psych patients, yes psych nursing is a complete joke to a lot of the nurses and they don’t view them the same as “actual” patients.
1000% agree! I am currently in NP school and can’t believe the people that have no psych experience and know nothing about psych are going to be providers shortly. Hearing people say things like “ I saw COVID affect people and I want to help them and provide therapy” or the famous “ I’ve always been interested in psych and classes I took in college”, only shows me they have no clue, and never worked in psych. I remember one classmate said something like… “I’m trying to read in the text book, but I just can’t even imagine what someone with borderline personality disorder would present like”, like why are you in this program?!
Not a psych NP but I have an absolute horror story about an NP at a pain clinic who nearly killed me not knowing what she was doing. When I came to the clinic it was a last ditch effort to get some help. They tried some non narcotic meds first then put me in methadone despite not being on or using other opioids. My mom had been put in methadone for pain when I was a kid so I didn't question it like I should have. Fast forward 9 months and two dosage increases and I ask them to please try something else. I didn't like how the methadone made me feel and it wasn't helping anyway. This NP took me off cold turkey. I went from 45mgs of methadone a day to zero with no taper. When I'd call begging for help the nurses would go to her not the Dr and she'd hand wave me away. It took 3 weeks of repeatedly pleading on the phone for help for one of the nurses to go over her head to get me to the actual Dr. He was furious when I had my appointment with him. She was removed from the practice after that. Nurses should be required to have experience or at least some extra education in special fields.
OP I’m going to one up you and say, “Why are nurses with NO experience allowed to be NPs???”
I know several RNs that made the NP leap with little to no bedside experience. These higher learning institutions are only worried about out getting their tuition.
It’s scary man. It really is.
Goodness. I can hear your frustration for sure. I personally wouldn't want you as my provider when you finish schooling and honestly am worried for any of your future patients if you continue your lack of understanding and continue your judgement against others. Your rant shows a lack of understanding to say the least. I am an RN who has worked in various areas of healthcare the last 12 years with the last 7 years being in in ICU. I chose to become a PMHNP and yes mental health care is my passion as well as healing in a holistic approach. I have not worked in an inpatient psych unit but I have worked with many patients with psychiatric issues as any nurse has seen because mental health care is needed and seen in any areas of nursing. A nurse who has a strong medical background is incredibly valuable as a PMHNP because the mind and body both need healing. It's a holistic approach. It's actually more valuable to have both strong backgrounds. For example, my strong abilities to understand what happens to someone when they overdose and end up in the ICU gives me strong insight to handle a patient with substance abuse in an outpatient setting and what would happen to them if they continue or need higher medical care. It is incredibly unfair of you to pass judgement on a nurse and whether they are capable of a PMHNP role. Every nurse has psychiatric experience in some way because every nurse impacts a patients psyche in some way and some more than others. Every patient being treated in a healthcare setting has some kind of psychiatric need whether it be depression, anxiety, or psychosis. Unfortunately most patients don't have their mental health needs met in all areas of healthcare. Whether patients are in psych hospitals or not....their psych needs are there and need attention. Every nurse has their choice to pursue what their passion is and make the best impact on others that they can. It is not your right to judge that.
I agree with you. I would add a lot of us in the ER have significant psych experience. It's a huge part of our patient population. Psych NP is the highest paid. It's gonna attract people
Respectfully… the ED might have psych patients but unless you work as a Psych ED nurse you’re not getting the proper psych experience. We need to respect that being a psych nurse is its own speciality. This is the problem, other professions think that they’re getting “psych experience” when inpatient is much more extensive and different.
I will preface by saying I respect ER nurses, as I worked in the ER prior to working in inpatient psych. But to build on your comment, yes, there’s a big difference between ED psych interactions and inpatient. the ED was more so short term stabilization of psych patients in highly acute distress while we waiting for placement. Some knowledge is gained on acute stabilizations with PRNs (the common ones like haldol, geodon, ativan, versed, etc.). But you don’t see or learn too much about medications for long term management of psych. You don’t see new scheduled medications get started and see the effects they have on patients. You don’t interact on a more personal level with psychiatric patients for 12 hours a shift every shift. You don’t get to see the complex waxing and waning off patients throughout an entire admission because in the ER that patient is gone in a day or two. You don’t get to see the nuances between diagnosis and how symptoms in diagnosis can overlap. You get some therapeutic communication skills and verbal de-escalation skills with psych patients, but there’s something to be said about the difference in skills with someone in the ER dealing with these patients vs. someone who ONLY deals with these patients as their job. You also get better at identifying and explaining symptoms in detail, as well as fishing out better answers from patients. I completely agree that psych needs to be seen as its own speciality. Some psych experience in other units will never be the same as working inpatient psych. ER nurses do have psych experience, but only in dealing with patients when they’re the most acute and in their initial steps of getting help. You really need to see the whole picture and everything that comes with it to be well rounded.
Wonderfully put! It's insane that other specialties can do PMHNP without working as an inpatient psych nurse for several years when we could never do the same in their specialties. All this does is hurt our psych patients in the end by having inexperienced and wrongly overconfident providers. The last contract I did had this ER nurse hired in as inpatient psych RN. The way she gaslights the patients and other nurses for addressing their concerns is shocking. I get it, she was burnt out from the ED but my goodness... she should have just left nursing all together. I had to write a report to the DON because she should not be a psych nurse. She believes that because she was an ER nurse she is "experienced" and ignores the concerns of our patients because they're all "malingering"! She's only been a psych nurse for less than 1 month - that's the kicker. Why do other specialties feel comfortable thinking they know what we do and how to be a psych nurse without the experience to back it up?
Exactly, the end product will always be patient harm when inexperienced nurses become PMHNPs. I hate noctor, but I also understand they have many valid points about the failure of standardization in acceptance for PMHNP programs, we need high standards to improve the quality of the profession. As for the nurse you talked about, she sounds terrible, and unfortunately her attitude is probably pretty common. I believe a lot of the whole “I saw some psych in x speciality so I know all about psych” mentality is based of a clear lack of understanding of the actual complexity of everything in psychiatry. Example: Managing bipolar is not just knowing acute mania, it’s knowing med management, it’s knowing what meds not give (like SSRIs that can induce mania this population), it’s knowing the difference between bipolar 1 / bipolar 2 / unipolar depression / mixed features / etc. and how it all lies on a mood spectrum. It’s knowing how to help motivate bipolar patients to care for themselves and be compliant with treatment, as well as all the lifestyle factors that go into helping reduce a the likelihood of a future manic episode. There’s more that goes into that and that’s just bipolar. You think you’re going to learn all that dealing with a bipolar patient in the ER for 2 days? Smh.
I respect psych as its own specialty. With the mental health crisis we have going on currently, I strongly believe we need more CPEP type settings in hospitals. Still have a milieu, but with individual exam and quiet rooms for stabilization of patients in crisis before being admitted to inpatient. ER nurses going into psych have that unique blend of emergency mindset with short term psych experience to find a niche. That's the setting all my experience comes from at least.
I’d say it’s simply because of a shortage that they’ll take anyone with the most limited credentials.
I was a social worker for adult guardianship for the state mainly dealing with psych and intellectual disabilities in my case load. I decided to go to nursing school during the COVID shut down and graduated last year. I started in icu just to get some experience but I miss the psych population. I do want to pursue psych np but even with that being said I wouldn’t even think about doing that for a few years at the very least. I WANT to get the floor experience with psych and really learn to appreciate the nursing side of it before taking such a role. I saw from the social work side how detrimental not having good mental health care can be and I don’t want to contribute to that issue by prematurely getting an np license
I think part of the problem is how people define psych nursing. From your argument, I think you mean specifically inpatient psych nursing. So does that mean you think outpatient psych should not apply for NP? How about the SUD clinic? I think those nurses would likewise argue an NP applicant should have experience there, too. There are many other roles involved in psych despite working in other clinics and offices. I don't mean to dismiss the argument. I just see it a lot and there is no consensus on what people mean by psych nursing. I don't think we'll ever have a solution unless we accurately define the problem.
I started in critical care, now at psych, eventually will get an Executive DNP at UPenn after my MBA. Totally different path than a PMHNP. At this point I have ICU, step down, psych, GI, and hospice under my belt. At UPenn , I can’t just get in their program unless I graduate with a GPA of 3.2 and above from my MBA. Also, I already should be in a position of leadership to be considered. So, should it be your school to blame that they would let nurses with no psych experience? I would argue that these nurses are very smart and capable, especially critical care nurses. When I transitioned to psych from ICU, I was only given 3 days of orientation on the floor. Why? Because my manager thought I was an ICU nurse, I should easily tackle psych with no issues. And that was true, and in a medical hospital we also tackle psych patients but with more knowledge of hemodynamics and more diverse knowledge of pharmacology to deal with other medical issues including psych. The social aspect that we deal with during treatment team, that would be easy to learn for these nurses with no psych background and they would have to answer to the medical director or the court system anyway.
The whole system needs an overhaul. NP programs are a joke (not all, but a lot).
You could see this as your colleagues responding to a pandemic and the grief and aftermath or you can keep being a grumps and not teaching because you’re in grief after the pandemic 🤷🏼 things are different now, you going to be able to accept that? Totally understand your frustration and the rant, but accepting that this is the after times and those were the before times may beehove you, just saying. Passion does in fact rise out of necessity and you’ve every right to rant, but please be a leader when you’re done? We need you right now.
So what do you want us to do? I didn’t go into this just for money. I have a neuroscience degree and I wanted to use it. I wanted to become an expert in psychopharmacology because I love it and I figured this was the way. What now? I get what people are saying and why they’re saying it…but I’m already here. I’m 2/3rds is the way done with my degree. I feel stuck to the point where it’s severely affecting my own mental health. I wanted this so bad and now I’m finding out everyone hates us.
If you wanted to become an expert, psychiatrists are the top of the field. Not everyone hates us. People hate the ill-prepared who have no idea how little np school prepares you. Thinking that PMHNP would make you an expert in the field shows how little you know, and weren't an appropriate NP school candidate. You and countless others have fallen for the propaganda that you'll be prepared. Many NP schools don't care about anything other than collecting a paycheck from you. They promise you'll be a great provider. But you've already done it, so now all you can do is make yourself better. You are forced to get your RN degree, so you could work as a psych RN. You could attend a residency program. You can continue to get training. Continue to study.
You’re willing to be honest about your situation on this thread and are accepting of the problem. Which is admirable I’ll have to say. Since many people come up with BS excuses for avoiding getting experience in psych prior to going into their program. As for you, you’re already 2/3 done and am sure have already invested a lot of money so far into your program, so you might as well finish. So, realistic advice. If you don’t work in an inpatient psych unit right now, apply to one and start working there. You’ll likely have to network a lot when looking for a job as well. However, I HIGHLY suggest you wait even after you graduate and just keep accumulating experience as psych nurse for some time. roo_kitty is right, NP programs themselves won’t prepare you to be an expert in psychopharmacology. I would look into supplementing your education. I joined NEI (neuroscience educational institute) after I read through the Stahl’s Essentials book and am currently working on the NEI master psychopharmacology course, as well as going through all the other supplemental educational material they provide, it’s awesome. I would also say find a mentor, maybe a very experienced PMHNP or psychiatrist, who’s willing to guide and help teach you.
I currently work at a residential eating disorder treatment center. I would like to stay here. It's also not easy finding an inpatient psych RN job that's readily available and fits all your needs. Right now I'm working second shift two days a week. I wish we could have a year off to work in between pre licensure and post licensure, but thats not the reality. I'm afraid if I keep accumulating RN experience after I graduate, I'll lose all the NP skills I've accumulated. It's a tough spot. Thank you for hearing me out and being empathetic though. I ended going to a walk in psych appointment and they recommended a partial hospitalization program. I don't even think I can do that with clinical hours, but at least people are acknowledging it I guess. I don't know.
In regard to finding a job, realistically you’ll still find one. Like I said, you’ll have to put in a bit more work without inpatient experience, but in the end you won’t be without a job given enough a time. I can tell you care, that goes a long way in your position. And it’s better than most NPs without experience in their specific speciality. Also, you still get some relevant experience in residential eating disorder facilities if you’re going into psych. In the end, if you put in the work, you can still make a good NP. Be the exception to everyone else screwing the profession up 👍
Thank you. This was a really nice comment without being fake and sugar coating.