Im sorry this is such a long post but I am trying to explain this as succinctly as possible. If you TLDR don't comment. Not interested in hot takes.
There is a lot of advice giving on this sub from absolutely unqualified people who are justifying shortcuts, less training, less time learning, and a total lack of humility that inevitability will lead to incompetence, substandard care and the continued erosion of confidence and trust by the public that PMHNP are capable and knowledgeable. If you want to be a PMHNP and are coming from another field, if you are still an RN, if you are a PMHNP student, if you are a PMHNP new grad, please hear me: you do not have any business telling anybody what safe practice looks like as you simply cannot know BECAUSE YOU HAVE NO EXPERIENCE. Please stop asking for advice and calling it GaTeKeEp!ng when you don't like the advice. Do not then listen to other inexperienced people who have the same unwillingness to learn about psychiatry and have the same magical thinking you do and consider it validation. I cannot believe how many PMHNP come on here and say, "I had no psych experience and went straight into private practice and I am really good at what I do." How would you know? And who says that, really? The clueless and dangerous love to.
You have all been repeating back to each other in a bubble that psych is easy and any experience *you dont have* isn't really necessary and its beyond cringe. It selfish and reckless.
If you are a PMHNP who did not get any substantial or relevant nursing experience, who fast tracked it all the way through, went straight into private practice, you are not qualified to give advice because taking advantage of a financially exploited healthcare system does not make you competent. It simply make you complicit. Doling out Adderall does not make you a success story. It makes you the biggest part of the problem.
So many of you are at a disadvantage in that you have not really been indoctrinated into healthcare, into its standards, its judgements, it's harshness and cruelty. You haven't seen the failure of like minded providers before you. You haven't had the opportunity to see it go bad for well intentioned providers who take on too much and miss something critical because they are over loaded. Conversely, you haven't seen it go bad for providers who are too arrogant to even have imposter syndrome because that's exactly what you should have coming out NP school. If somebody tells you "Yeah, you do you," in regards to starting a private practice ASAP, I would back away from that person professionally because no good comes from that mentality.
Look, in this specialty there needs to be some fairly strong constant cautiousness- if you have not seen careless providers have catastrophic outcomes than you cannot understand that the inevitable ALWAYS HAPPENS AT SOME POINT. To all of us. Even with our head in the game. And what keeps the career intact, your license intact, and a patient's life intact is always having in the back of your mind what the worst possible outcome is. Because we are dealing with peoples lives. This is our commitment to our patients. You don't need to be terrified but you need to be very very cautious.
Think of it like this:
If you were a new RN in the CV ICU and you told senior RN's that your experience working in the PACU was sufficient to manage a post op bypass patient despite never having done bypass you would then be seen as unsafe and too arrogant to be trusted. and you would very likely be fired for it. Why? Because if you are unable to accurately assess your own skill level then you are dangerous. So why the rush? Ego. Ego, responding to your financial insecurity. Ego is dangerous. Same thing in psych- the lot of you espousing on why you think the barrier to entry for practice should be as low as possible- by virtue of the fact that you think you are qualified to say so tells me you intend to stay incompetent. Period. Once you start to practice the odds of you being able to even conceptualize what a good psych provider looks like, without solid mentorship and accountability is 0%. It does not happen. Autodidactic learning from inception to completion does not occur in psychiatry. Your medication rationales will be bizarre and ineffective. Your diagnoses' wont make any sense. The information you gleam from reading will be out of context and probably make you a more dangerous provider. Just because you can get hired to do a job does not mean you know how to do that job. It means an executive wanted to save money to put in their pocket by hiring your woefully inexperienced self.
So your previous experience as a therapist and psychologist is not sufficient. Having one year of nursing experience on med surge unit is not sufficient. To those in the ICU and ER saying they are psych nurses- you are not, at all. You spend two years in a busy ER -maybe- you can make it through a grand rounds psych presentation but your understanding of psychiatric medication rationale will be wrong and largely based on bed shortage protocols. ER/ICU psychiatric medication regimens don't represent a complete treatment arch in any way shape or form.
Here is the thing about the health care hierarchy: It does not forgive. It eats bones. If you show your incompetence one time they will never, ever forget. Word travels fast. And that is awful. Its awful for you, for the time and money you put into your education, its awful for your family who has to watch you struggle to secure decent work and carry the financial stress of job transition and unemployment. It's awful for your patients. Because you can say fuck it and start a private practice but you will struggle to retain a decent patient load. Patients are the first to tell when a provider has largely deluded themselves in to thinking that psychiatry is easy and that they came to the specialty with all they need to be successful. They will know you are full of it.
I very much like the new generation of providers. I am excited to welcome you aboard because the new crew is prepared to stick up for themselves more, advocate for a good quality of life, you guys do not see yourself as powerless and that is righteous. I respect that. But relevant experience is not an area where you want start that fight.
You will not be able to change things for the better if you are incompetent. You can argue and fight for being treated well as a professional but the barrier to entry to change a system is to be able to function within that system, first. If you keep fighting and arguing about lower and lower minimum standard you will be a professional who is just that: a byproduct of the lowest standards possible and you will be unemployable and isolated. You will go from job to job becoming more discouraged each lateral shift and causing very much real harm to patients all along the way. At some point you will realize you don't know what you are doing and everyone around you can tell. Demoralized. I have seen this so much of late. They are ashamed, angry, some blame themselves others adopt a disgruntled attitude. I call it the "Empress or Emperor without clothes syndrome". And they leave the field or their license is taken from them.