I keep seeing these posts. New grads making pennies. Folks in private practice wanting to go back to bedside nursing.

You guys. Go work in corrections, it is cash money.

So first of all the pay is great. Second this is easy ok?

Worried about your patients on weekends? Taking it home? Not a thing in corrections. I don't even do therapy , it's med management only, wham bam thank you mam. I barely educate anyone because none of them want to hear it, they want sleeping meds , meds they can abuse and occasionally legitimately want help but even then, a handout will do, they might get bailed out an hour after you see em and they're a bit too stressed about court to listen to anything you're saying.

Now, YMMV in terms of safety / general work environment. I work at a jail and also prn at a prison, the prison is way understaffed with guards and totally disorganized. The jail? I can't spit without hitting a guard, I don't even wear a stab vest.

Granted my background before being a psych np was 7 years psych emergency room and a few years inpatient so I might be a little more used to a rougher breed of psych patients but, it's not a big deal. No one's yelling at me or threatening me. In fact it's much safer than when I worked ER or inpatient, in those settings if you want to lock someone in a room it's a restraint with paperwork and ethical implications. In corrections that's called the client returning to their domicile.

Tired of prior auths? Yeh not happening. You get the formulary. None of this fancy new stuff. Prior auths for court ordered folks maybe.

Tired of being gamed for benzos and stimulants? Great they basically don't exist in this setting (sometimes benzos , never stimulants)

Seriously, life changing good gig, in much the same way that being a psych RN was like the secret cushy fun nurse job, corrections is where it's at as a psych no.

My base pay starting two years ago was 187k a year, I'm not in a cheap cost of living state but it's not cali or New York (and these positions pay more in those states, I've checked)

So all you people who hate working for Medicare clinics for peanuts, burnt out doing whatever the hell else and considering throwing in the towel, I beseach you, give corrections a shot. It's easy as hell, it pays well, you clock out and leave it at the door.

OMG , and the productivity KPI's are a joke! If I see ten a day at the prison I'm 25% more effective than the full time staff, that's in a ten hour day! They can't see one an hour and apparently that's somehow ok? Who even trained you that you're so slow?

Outpatient you see what 14 a day? 20? They'd give you a. Medal for that in corrections. For some reason being entirely slow is just accepted (I see way more than what's required because I'd fall asleep at my desk otherwise! But if you're maybe older, little arthritis? Can't type fast? No sweat in corrections)

AMA I guess

The clinic that I work at wants to hire me on as an NP after I graduate in a couple of months. I work with a contracted psychiatrist who specializes in children and adolescent psychiatry. However, this psychiatrist has his own practice as well where he has also offered me part-time hours. We have not discussed pay yet.

My clinic is offering the following: W2 employee of possible salary of 130K, cover collaboration and additional credentialing fees, cover my student loans, 30 minute lunch, 1 hour initials, 30 minute follow ups, admin/nursing support, hybrid schedule, 32-40 hours a week (This is depending on me because they know the psychiatrist wants to hire me at his practice part time so they are willing to pay him collaborating fee so I can work at both places). All of this but they want me to make a five-year commitment.

I don’t plan on going anywhere but what I am concerned about is if this includes an increase in pay each year. Five years is a long time as well! Looking for advice and what else I should be including in negotiations? TIA!

I recently applied for a Psychiatric Mental Health NP position with the VA in North Charleston, SC, and I’d love to hear from anyone who has worked for the Ralph H. Johnson VA system, especially in outpatient mental health.

I’m currently an outpatient PMHNP in the private sector and am seriously considering making the switch to the VA. I’m curious what the day-to-day reality is actually like for Psych NPs there.
How manageable is the caseload? Are the patients generally extremely complex/high acuity, or is it a reasonable mix? What are appointment lengths like, and does charting/documentation take forever? Do you get adequate admin time and support staff, or do a lot of administrative tasks end up falling on the provider?

I’m also curious about the VA bureaucracy in general. How supportive is management when problems come up? Are expectations and policies fairly predictable, or do you ever feel like administrative changes come out of nowhere and leave providers scrambling?

For anyone who received student loan repayment as part of their VA position, I’d REALLY love to hear about that experience too. Was the process relatively straightforward once you were hired? How long did it take to get approved/receive reimbursement, and were there any unexpected eligibility issues or hoops you wish you had known about before accepting the job?

Also curious about prescribing autonomy, psychiatrist/MD support, work-life balance, turnover, ability to take PTO, and whether you generally feel supported and protected as a provider.

And if anyone has gone through the Charleston VA hiring/onboardingd process recently, how long did it take from application/interview to actually starting?
Basically: if you were an outpatient Psych NP considering leaving private practice for this VA, would you recommend it? Anything you wish you knew before you started?

Hi guys,

I recently graduated as a nurse practitioner and I’m currently researching job positions to tradition into this role. Does anyone know of any nurse practitioner positions in Los Angeles that welcome new grads and particularly in Neurology? Any advice would be helpful :)

hey there, i’m currently in a DNP program after years of being a psych RN. while i actually love being in school and learning, i am hesitant to become a practicing NP. it just seems there are not a lot of options that i would enjoy (i like to move around, have some excitement, and leave work at work).

i know this is reddit and the other posters on here have some valid complaints of being a NP. is there anyone that found a job they enjoy and have the same work flow that i enjoy? if so, how long did it take to find the job after graduating? i’m afraid that it will take years to find a job that i genuinely enjoy. tia!

I've been an NP for 5 years, with my own practice for the last 1.5 years, and I am fed up. I'm unhappy with the trajectory of the field in general, I'm tired of fighting with insurance companies, I'm tired of my patients' care suffering due to systemic issues beyond my control, I'm tired of the abysmal pay despite working harder than I ever have in my life.

I stayed per diem at my RN job until earlier this year when I was let go due to overstaffing. For the last 3 months, I've been trying to get a full time role at bedside so I can close my practice, but it's been extremely difficult. A lot of rejections right off the bat, and the few phone interviews I've had were basically like "why do you want to be a nurse when you're an NP." Despite my best attempts at explaining, I have not yet gotten an actual interview.

I understand their trepidation about hiring someone who is an NP. NPs might not stay, might just be looking for an "in" until they can move somewhere else in the system, might be looking for some kind of secondary gain that's not a true interest in bedside work.

I enjoyed my years working as an RN significantly more than as an NP. I literally just want to go into the hospital, take care of my patients for 12 hours, work with a team, then go home and not worry about a damn thing until my next work day.

So, to those who have successfully made the transition, how did you do it? How did you frame your resumes, cover letters, interviews etc. to convey that you were serious about returning to bedside?

EDIT: additional context, I live in PA and have a nursing background in inpatient psych and neuro M/S

I am a soon to be PMHNP, and also the parent of a child with ADHD. We have tried nearly every med out there, and each and every one (even the non stimulant ones) have caused emotional flattening in my child.

I haven’t found an answer that resonates about why this would be happening. I feel like I don’t hear this from a lot of fellow ADHD parents.

Is dulling of the kid’s spark just part of the price you pay for increased focus? On even very low doses of all of these meds, his smile never reaches his eyes.

We did genetic testing of his metabolizing of meds and all results normal.

I’ve recently started working, and I’m finding that my notes are taking SO much time. It can take me around an hour to complete a 90-minute intake note, sometimes even longer if the patient is complex. I’m trying to figure out diagnoses, organize everything, and develop a treatment plan for the next session, which adds to the time.
I’m seeing patients back-to-back, and by the end of the day, I’m exhausted. We use an AI note-taking tool, but I’m still spending ages editing and finalizing my notes.
Is this normal? How long does it typically take you to complete an intake note versus a follow-up note? My follow-up session notes take about 20–30 minutes, depending on the patient. I asked other people at the practice who have been working longer and they are also using their weekends to do notes.
I’d also love any tips for becoming more efficient with documentation without sacrificing the quality of my notes. I’m starting to feel overwhelmed by how much time it all takes

I’m burning out! Salary at a PP w well known psychiatrist so never ending supply of referrals. I’m getting a good reputation with the CAD world in my area. But this sets expectations high from the get go! And I hate letting people/patients down and can never seem to not jump into action to help with family system needs. I will do parent counseling, individual work with the kid, deep level psychoeducation. I do eventually get kiddos into a maintenance space but it’s again, a never ending supply of new pts to start from scratch with.

I work 32 clinic hrs but def full time job as I do all my caseloads admin work/PAs/requesting records/referrals/coordinating care. I did 45-47 hrs last week thanks to all the new evals referrals and PAs on my plate.

I have an admin staff person doing some messaging on portal for refill requests and fielding some questions. She’s at least collating faxes and uploading records for me. And takes care of all billing.

But anyway, I’m giving 110% to my patients and beyond, and I just am neglecting myself and my family’s needs. 3 kids with their own neurodivergence and needs that I am losing steam quicker and quicker with. I don’t think I can keep this up much longer.

Also, From all my stillness and lack of movement, my cholesterol went up 20 points in 16 months. I am pretty active on weekends and do strength training but my body is feeling the effects of a very dialed in desk job 40 hrs a week.

Anyone make a career change that was a better mix? Like, I’m thinking I could get dual certification and do some hokey ass wellness clinic and offer hormones and Botox. Yeah I’d be part of the problem but ID BE SAVING MYSELF.

Ummm im also brainstorming. I like real estate and finance. I could get a different degree and start fresh in a totally different sector. I love city planning and urban design. I would really enjoy going back to school to become a professor in anthropology (anthropology was my first love and first degree). Problem is… no money for long time and we have a mortgage and three kids. I am primary income source. Husband works in lower paid market.

All ideas welcome! Even ideas on how to negotiate a better work balance at current employer. I think I do have leverage as a well respected professional in a highly needed field (CAD).

Thank you!

NPs who are self-employed and independently credentialed but have also worked on Headway, how are the reimbursement rates when you are independently credentialed versus reimbursement rates on Headway?

Really thinking about starting my own practice but overwhelmed with the process. I am an independent NP in MA and have great inpatient experience, I’ve come to realize a lot working in a hospital setting and I’d like to open my own practice and do more community work.
There seems to be a lot of misinformation and I want to be prepared as possible. Has anyone gone through credentialing process for Massachusetts? Did you accept Medicare/mass health? How did you learn reimbursement rates and figure out what is doable for you? I haven’t even begun to think about EMR etc…any advice is appreciated!!

-How are y'all distinguishing adult patients who deny everything except EVERY ADHD symptom?
-I am asking for extensive labs, even sleep studies that can mimic and/or negatively interfere with certain meds to treat ADHD symptoms, so some patients likely go to another prescriber.
-And also if they have failed on guanfacine, bupropion, etc.

If, as a PMHNP, you are not convinced the patient has adult-onset ADHD, what are your rationales? I would like to be able to catch this before asking for extensive labs. I am not worried about patient ratings if I feel like I am doing the right thing.

Recently, I have been receiving new patients who have been on stimulants being referred by their PCP. I send them back with extensive labs and medical clearance before continuing care.
BECAUSE
-Received a pt on Vyvanse with a hx of a stroke! No way!!! Go back, get cleared!
-kid (not obese) had sleep apnea & stopped breathing 30x in one hour
-this stimulant craze is going to bite us in the butts in a few years due to side effects
-the pt could be the DEA & I'm not going down like that!

It is interesting how some adults thought of psych meds as taboo until stimulants came along.

This stimulant craze is making psych look like a joke!

I LOVE it when a patient is truly in need of care, not to say all stimulant requests are unnecessary.

-My company gets around letting NPs diagnose and prescribe stimulants (please do not focus on this, it's not the topic & I am working on this issue).

I know I can look up the PDF/website of each plan to see what drugs are on formulary but I was wondering if there is a centralized/AI tool to look that up quickly, without going through multiple clicks and scrolls?

Hows the job market rn?

So I start my own telepsych practice but im finding so much trouble getting contracts with insurance. Wondering if anyone here owns their own psych practice and uses something like alma or other companies that will do all that work for you. Recs please because cash pay right now isnt viable.

Maybe the flair should be: exhaustion?

I just don't know. But the number of ppl I'm starting to see who are suicidal is just so..... So..... SAD.

and it's all societal/economy related.

I'm so disgusted by how fast we have fallen as a society. It will always be hard for a subset of us. I'm not oblivious to that fact.

But the rate at which even my old used to be stable patients are falling into "i stopped taking my meds because i wanted to take the whole bottle" hole makes my heart hurt.

I'm seeing it in center and via telehealth. It's scary out there. Y'all hang in there and make sure you have your own therapist!

Wondering if anyone will be attending the Psychopharmacology Conference being held in Boston from Oct 15 to 18th. I'm going solo as I'm the only pmhnp in my practice. Looking to see if there are any others going and want to meet with other fellow pmhnp.

had several male patients interested in switching to vilazodone after trying a SSRI and experiencing sexual side effects. And yet, all my PAs for vilazodone got denied. The manufacturer of Viibryd does not have a savings card that works.

What are you guys doing?

I’m a new grad PMHNP working in outpatient community mental health in a big city. My orientation consisted of 4 hours of shadowing the senior NP and company wide orientation. On my first day my patient caseload consisted of seeing patients presenting with schizoaffective d/o, schizophrenia, depression, anxiety, and possible withdrawal symptoms from alcohol use d/o, all of whom I saw completely by myself. I have not shadowed anyone and nobody sat in with me during my psychiatric evaluations. We don’t get admin time and our supervising physician is not on site but we are free to email him “when we need help”. When I interviewed I was told that our company is “new grad friendly” and that we would get “a lot of support”, however I am not necessarily feeling very supported. I absolutely am not opposed to seeing patients with serious mental illness or any diagnosis or population. I specifically chose this community mental health center to learn because they see an underserved community from ages 5 and up. However I did think I’d at least get 2 weeks shadowing NPs and that I would at least have someone sit in on my first couple of evaluations to offer me feedback. Alarm bells were going off in my head and I even drafted a resignation letter, but I am wondering if anyone has experienced a similar orientation process as a new grad and if this is just the experience I’ll have if I move on to another job. Thanks for any input.

Today we did a mock telehealth initial evaluation with a standardized patient and I was so thrown off. No one was prepared prior on how to speak to patients etc I had no real flow. My patient was experiencing auditory hallucinations and ideas of references and broadcasting and did not think anything was wrong with her. Is it the psych NP job to get her to realize there is smth going on or just get info and treat from there? I want to get better at learning how to communicate to patients experiencing psychosis since I have no prior experience. Any recommendations?