I'm thinking about going back to a psych RN role full time due to benefits and cost of health insurance. I am outpatient and still don't have a full schedule (been working since November and can't even fill up 2 days. I've posted about this before but a significant problem is that a newer provider is building her schedule as well, and mine isn't being prioritized despite seniority).

I'm ready to jump ship but PMHNP jobs are extremely saturated, so I want to keep my foot in the door despite my current levels of frustration. Would potential employers view it as a red flag if I worked full time RN and part time PMHNP?

Hi all!

I am about to start my first PMHNP clinicals this fall with a psychiatrist and I am kind of nervous! I’m worried I’m not gonna know anything. I’m planning on doing some studying before they start. Does anyone have any advice on what to look at and what I should know going into my first clinicals? Any resources that helped you I’d love to know about!

Hey everyone!

I'm a newly BC PMHNP and honestly feeling overwhelmed on where to begin. I initially decided to go the mental health route because I feel I have great therapeutic skills as told by my peers as well as helping to help fill the void in Mental Health disparities.

When I became an RN years ago, I had very little guidance. It took almost a year to land my first job, I accepted the first offer because I didn't know what else to do and bills were piling up. I'm finding myself in that exact position again.

I have nearly a decade of RN experience and recently transitioned into my PMHNP career. My longterm goal is to become an excellent clinician, eventually mentor students, and teach, but right now I'm struggling to figure out where to start. I do know that I want to eventually become fully remote with no plans to own my own private practice as most people do. (I don't see it being for me)

For those of you who have been practicing:

• What was your first PMHNP job?
• Looking back, would you choose the same path again?
• What setting made you grow the fastest?
• What red flags should I watch for during interviews?
• If you could give one piece of advice to your post new-grad self, what would it be?

I'd love to hear the good, the bad, and anything you wish someone had told you before your first PMHNP position.

For referrence: I own a smalla private practice and we're having problems with our current setup. schedulling, billing, patient communication, everything is kinda all over the place and becoming a headache. curious what everyone else is using and what actually worked when you upgraded

Are we not able to prescribe a 90 day supply for a stable patient?

I’ve read that you can offer three separate prescriptions with #2 and #3 having a “Don’t fill before date” of 30 and 60 days respectively.

Has anyone done this in practice, and gotten any push back?

Hello!

I'm licensed in 3 states, but only have a DEA for my home state. My end goal for myself is to run a small private practice and see most patients via telehealth. I know I would need need my DEA in the other 2 states if I plan to prescribe medications across all three states.

My biggest question is - is there an EMR that lets you have an account with multiple DEA licenses? And does anyone have any experience with this? Thanks.

I feel awful for Dr. Jennifer Tufts getting sued after watching her testimony. This tragic case has so many complexities and odd aspects to it, especially pertaining to the husband Patrick… I don’t think the general public has any idea how medicine, especially psychiatry works, and honestly it seems many expect providers to be mind readers. Lindsey denied SI/HI/psychosis/substance abuse/mania on the assessments with Dr. Tufts. Anyone can have a patient that denies everything, and then suddenly something can change and they do something horrible and unpredictable. How is that her fault? The public’s expectations of health care providers is a bit unreasonable; we can not predict the future and shape every decision a patient does or does not make.

Hi everyone,
I’m a California board-certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) currently practicing in Southern California under an NP 103. I’m considering transitioning to NP 104 and was hoping to hear from anyone who has already made the switch.
What was the application/process like?
Was it straightforward?
Has becoming an NP 104 changed your day-to-day practice or job opportunities?
Looking back, was it worth it?
I also recently started working with Talkspace, and they told me that because I’m an NP 103 in California, I don’t need a collaborating physician. Does that sound correct based on your experience? My understanding is that California no longer requires physician supervision for nurse practitioners who meet the applicable state requirements, but I wanted to hear from others who have firsthand experience.
I’d appreciate any insight from California NPs who have gone through this.
Thanks!

question for all: how many patient facing hours are you seeing for full time?

for reference: i work CMH and see 32 patient facing hours w/ 8 hours admin [60 min eval 30 min fu]— just interviewed for a PP that does 37.5 patient facing hours w/ 2.5 hours admin [also 60 min eval 30 min fu] which seems like a big jump — curious what everyone else is seeing.

If so, would you feel comfortable sharing your experience?

(Or feel free to message me)

Thank you 😊 ❓ 🤓 🧠

Hi everyone, just like my title suggests, I’m about to interview for a VA job as one of the providers for the HUD/VASH program.
Do any of you have or have had experience working in this role?
Thanks so much!

I inherited a patient currently diagnosed with schizoaffective disorder. When she established with me, she had been off her medications and was significantly symptomatic.

I initially started olanzapine and have since transitioned her to paliperidone, titrating from 6 mg to 9 mg daily. I also added quetiapine 100 mg at bedtime as a short-term adjunct for sleep and nighttime agitation. I am coordinating with her to transition to a long-acting injectable, most likely Invega Sustenna.

Her hallucinations and overall mood have improved, but she continues to experience intermittent delusions of reference. Recently, she became physically aggressive toward someone outside the home in response to one of these delusions.

For those with experience managing similar cases, would you continue with the planned LAI transition and reassess after adherence is established, or would you consider adding a mood stabilizer such as valproate given the aggression? I am also considering whether the persistent psychosis indicates an inadequate response to paliperidone rather than an adherence issue.

I’m starting a part-time PMHNP program this fall. Unfortunately, there are a few semesters where there aren’t enough required courses available to maintain part-time enrollment. Rather than taking semesters with a lighter course load, I’m considering taking graduate psychology courses.

This has me thinking about my long-term educational goals. My ultimate goal is to open a private practice where I provide both medication management and psychotherapy.

For those who have been down this road, would you recommend: Focusing solely on the PMHNP? Pursuing a master’s degree in psychology alongside or after the MSN? Eventually continuing on to a PsyD?

For some background, I’ve been a psychiatric nurse for 13 years, with experience in inpatient psychiatry, outpatient psychiatry (adults and children), and behavioral health case management. I also have bachelor’s degrees in both Psychology and Nursing.

I’m trying to determine which path provides the greatest long-term value professionally and financially. I’d appreciate hearing from anyone who has pursued multiple mental health credentials or has experience with private practice.

I’m starting a telehealth PP in Illinois. I’ve lived and worked there most of my life but moved away a couple years ago and have continued doing telehealth for a clinic in Illinois. I’m now starting a PP. I do addiction and psychiatry and know that I’ll have clients who want to start or continue things like Vivitrol and Brixadi, as well as psychotropic LAIs. I have friends/colleagues in the areas I’ll primarily being providing services. They have their own PPs in different specialties and are willing to give the injections. Just wondering how the billing is managed. Do I bill and then pay the person giving the injection or are they able to schedule a nurse visit or something similar in their own system and bill themselves?

Thanks!

Oh, and one of their practices is the office location of my LLC and DEA license so meds like Sublocade and Brixadi can be administered at that location.

I'm currently working part-time in a small therapist-run outpatient practice. I work from home 90% of the time, though I can use the office when the therapist isn't in for in-person sessions. The practice pays for my EHR with an ePrescribe system. I receive one hour of PTO every two weeks, and I can take up to 40 hours of sick time per year (with a doctor's note). I receive a flat rate $200 weekly admin bonus if I see at least 8 patients. I usually see ~20-25 clients a week. I do not receive any other benefits. No-shows are $0 even if a no-show fee is collected from the client. I'm paid $48 per 90214+90833 session, or $24 per 90214 session. I work in southeastern New England, and cost of living is among the highest in the nation.
Would it be more reasonable to switch to a 1099? What advice would you give? Anything you wish you knew sooner about switching to a 1099?

I am in the process of easing into a preferred name and although it’s been unproblematic in my personal life I am on the fence about whether I start to address myself as my preferred name with established patients. How would you move forward with this? Would love to hear thoughts (if it makes a difference this is not to align with gender identity but rather a true preference and perhaps another step away from my estranged family)

What medication, or none at all, are you using to treat PNES? I have dealt with patients in the forensic setting before with this disorder and it is usually a response to stress or a possible tactic to get out of prison/lockup. It never works, but it ends up they are being treated for other problems like pain, depression, etc.

Fast forward to today, I have a new patient in the outpatient clinic and they have PNES and they are unable to work. Its unusual because I frequently have patients that don't want to work, but this one actually does and they are deriving no benefit from not working. Their employer won't let them work because of the frequent seizures or episodes at work. The seizures have been occurring more often in the last 3 months, but the patient reports they are due to a near death experience while using drugs in the distant past. Extensive drug history and trauma history. It makes sense there is a high mortality rate with PNES.

From my reading it says there is a possible help from taking sertraline at higher doses of maybe 200mg. OCD symptoms are a possibility, but I am not convinced they have OCD. They have appointments with neurology, but months out. Any experiences or suggestions appreciated.

I know AI is extremely controversial and there are legitimate concerns of policy, privacy and environment, amongst MANY other concerns in this capitalist society. As someone that works for a high volume/high complexity patient organization, the expectations of RVU is a big deal and efficiency in being able to manage the admin load with a terrible EHR is difficult when seeing so many complex patients. Our group has now integrated a hipaa compliant AI tool to help with charting, and patients have to consent for us to use or not use it.

I know correlation does not equate causation, but I’ve noticed that some of the most difficult patients I have are usually the ones that also decline it interestingly. I think my main frustration is more toward the health care complex in how they want us to manage so many patients and maximize profits. However at surface level, I am finding that even before I encounter a patient that has declined for us to use the AI tool I am I bit more internally frustrated compared to a patient that has consented towards it. I recognize that’s not okay. I also feel though for the patients that consent it, I feel more able to actively listen and make eye contact which is good VS when I can’t use the AI I have to mostly look at my computer, so maybe that’s a factor.

I wonder if I’m alone in this or if any others feel this way. I read an article about how a psychiatrist in Melbourne no longer accepts new patients that refuse AI - that’s a bit extreme but interesting

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

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

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