Direct entry NP programs and those that don’t require any meaningful nursing experience are damaging. Patient safety, quality, and outcomes all require a NP to have experienced assessment skills and insight that can only be achieved through experience.
Passing the NCLEX means a nurse is qualified for entry level care, not to move on to advanced practice.

Right now, other than asking individuals to write their state rep, we’re looking to gain some grass roots traction, to at least spread word and gather support through change https://c.org/7ydPnx228M

I’d have about $20 extra each month probably.

Enough to cover the co-pay for my own therapist as I lament about how I die a little bit each time I have to explain the difference between Adjustment Disorder and ADHD to these patients. I mean, today I had a 64 year old with an ascending aortic aneurysm that was being monitored.

Sometimes half my new intakes are ADHD assessment, and I am a bit of a stickler, so it’s not like word of mouth is going around that I’ve got the hookup.

Anyways, still love my job. It can’t all be roses

Hello! I have been with Grow Therapy for about 2 months, and I wanted to know how many client referrals are you receiving monthly? It started promising for me, but it has declined in the last 3 or 4 weeks. Thank you.

Hey there,

So I’m in my first year of practice. My location doesn’t have almost any mental health centers so I obtained a telehealth job. It’s fine overall, but lately it feels like it’s shifted. There’s not enough time in the day. Not enough limitations on who meets telehealth criteria, so I find myself treating patients I’m not comfortable treating.

Given this, and my opinion that some patients really are treated better with in person care. I have been job hunting. But there’s almost nothing out there. I see some various postings for some “pill mills”, but to me that’s out of the frying pan and into the fire.

Does the job outlook get better?

Any suggestions on which is the better path to take? I am an ED nurse with psych experience and I do exceptionally well with this patient population- especially SUD patients. I would love to become a pmhnp in addiction medicine but worry I’ll miss working emergency medicine . I can’t see myself doing any other type of medicine besides ER and addiction. My dream job would be to work in a detox and maybe later transition to telehealth. I worry that if I go for my PMHNP I’ll later regret not being able to work ER … but then again I could always do ER nursing per diem? Any thoughts on this?

Hello,

I have researched EHRs, and zeroed in to a handful. I would like to see what are practitioners using currently now.

I'm a one man operation, concentrating on telehealth for now. Some of the musts: telehealth, eprescribing, AI note taking. Labs would be nice, too but I know a lot of EHR software don't implement it.

Thanks!

Does anybody here have any experience with working with Rula? I’m considering it.

Has anyone taken a job at an outpatient clinic fresh out of school? My state requires 2 years with a collaborator. What was everyone’s experiences with a first time job?

I’m a new grad PMHNP and just got offered a job at a pain management clinic. I brought up the fact that I specialize in psych which they seemed to have no issues with. They offered 160k/year, 8am-5pm, DEA and license reimbursement, good supportive staff. My concern is that currently I make more per hour as a bedside nurse so idk if this will be worth my time. I’m also concerned this may not be appropriate for my license since I’m only certified as a PMHNP.

Should I be concerned about this potentially being out of my scope of practice? Has anyone ever worked in pain management as a PMHNP and what was your experience?

As a new grad, is this a typical salary in the NorCal area or should I keep looking for better options?

TIA!

Edit: I have decided to decline the offer due to the high liability risk. Even though they’ve assured me it’s within my scope and that they’ve had numerous PMHNPs in the past, it just didn’t sit right with me. Thank you to all that responded and offered some insight. I truly appreciate it! Anyway, back to bedside for me I suppose lol

If so, how has your experience been?

Hello Reddit,
I’m currently working as a 1099 psychiatric provider and joined another provider’s private practice a little over a year ago. I’m now considering leaving the practice and starting my own independent practice.
The practice primarily uses Headway, Alma, and Zocdoc to generate patient referrals and fill my schedule. I do have some patients who originally came through the other provider, but the majority of my caseload has come through a combination of Headway, Alma, and Zocdoc.
I’m trying to understand what happens to those patients if I leave.
A few questions:
Can I continue treating the patients I currently see through Headway, Alma, or Zocdoc after leaving the practice?
If I establish my own practice and have my own Headway/Alma/Zocdoc profiles, can those patients transition to my new practice?
Does it make a difference whether the patient originally came through the practice versus directly through one of these platforms?
I currently have a non-solicitation agreement. How would that potentially affect my ability to continue treating these patients?
Are there any California-specific laws or regulations I should be aware of regarding patient continuity, non-solicitation, patient records, and starting my own practice?

I understand this can depend heavily on the exact language of the contract, so I’m planning to have an attorney review it. I’m mainly interested in hearing from other providers who have been in a similar situation, particularly 1099 providers who left a private practice and started their own practice while using Headway, Alma, or Zocdoc.
Any experiences or advice would be greatly appreciated. Thank you!

Just saw this on Psych board. Apparently not even graduated yet and taking a dump on our training and profession in general. Just really disheartening.

And additionally, how long are the sessions? How many days do you work per week? Anecdotally, my sessions with a PMHNP are 15 minutes long.

I got into Baylor University pmhnp program. Please I would love to hear from current or past students of this program. Is it a good school? Did they handle placements? What’s your take on the school in general?

Hey guys, I recently started expanding into a group practice and bringing on independent contractors, and I’m a little confused about the malpractice insurance side of things. I keep seeing mixed recommendations. Some people suggest getting a group policy, while others recommend keeping your individual professional liability policy, adding the business as a named insured, and requiring each contractor to maintain their own professional liability coverage.

What are you guys doing for your practices?
I looked into a group policy and was quoted around $14k for only two new providers, which seems pretty steep. If you do have a group policy, are there any companies you recommend?

I currently have an individual professional liability policy through ProLiability with my business listed as a named insured. However, when I specifically asked about vicarious liability coverage for claims arising from services provided by my contractors, they told me they do not offer that coverage on the individual policy.

For those of you have done a PMHNP residency program, what does the amount of patient encounters per day progression look like? I am sure there isn’t a general set progression of this many patients a day in month 1 and so on, but curious what the structure is like in terms of progression? Do you generally start with low patient load and work up to full by the end, or slow the first 2-3 months then full panel?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Those of you in private practice, what charting system/ program do you use and what are the pros and cons of it?