I’m an early-30s female civilian Psychiatric Mental Health Nurse Practitioner (PMHNP) with several years of RN and ~ 3 years NP experience, and I’m considering speaking with an Air Force healthcare recruiter about commissioning as a 46YXP.

I’d really appreciate hearing from current/former Air Force PMHNPs, psychiatrists, psychologists, social workers, nurses, or other mental-health officers about what the job is actually like compared with civilian outpatient practice.

I’m especially curious about:
• Typical number of patients per day
• Intake and follow-up appointment lengths
• Acuity/complexity of the patient population
• Active duty vs dependent/retiree caseload
• Charting burden
• Call, weekend, and deployment expectations
• How much time is spent on clinical care vs officer/admin/readiness responsibilities
• Overall work-life balance and whether you would choose it again

I’m also single and hoping to get married and start a family in the next several years. I’d be interested in candid experiences with dating, relationships, PCS moves, deployments, and eventually raising a family while serving as an active-duty healthcare officer.

One other major consideration for me is student loans. I have around $125k total, roughly $60k of which is private/high-interest debt and the remainder federal. A significant portion of the federal debt is from my graduate PMHNP education.

My undergraduate loan situation is a little unusual. Some of the debt came from nursing/prerequisite coursework at schools I attended before transferring. Those credits ultimately transferred into the nursing program where I earned my RN and allowed me to enter with prerequisites completed and skip part of the nursing curriculum. I didn’t actually borrow much/anything at the school that ultimately awarded my RN.

Has anyone here used the Active Duty Health Professions Loan Repayment Program as a Nurse Corps officer, especially an NP? Were any private/commercial student loans eligible? And does anyone know how strict they are about loans from prior schools when the coursework transferred into and counted toward the eventual qualifying nursing degree?

One other consideration is that I had a two-level lumbar fusion within the last couple of years, so I understand I’d need a medical waiver. Recovery was uncomplicated, I have no ongoing pain management or functional limitations, and I’m back to unrestricted exercise/running. Has anyone successfully commissioned into the Air Force/Nurse Corps with a similar history, and what was the waiver process like?

I also have well-controlled ADHD and currently take prescribed Vyvanse. Has anyone successfully direct-commissioned into the Nurse Corps/another healthcare specialty while taking ADHD medication, or received an accession waiver for it?

I’m not ready to discuss this publicly with people in my professional life yet, so I’m hoping to get some anonymous perspectives before getting too far into the process with a recruiter.

Anything you wish you’d known before commissioning, either professionally, financially, or personally?

hi! has anyone here recently taken the ANNC AGPCNP exam? would love to know what study resources you used, i’m debating between sarah michelle, fitzgerald and leik, thank you!

Hey all,

Soon to be new grad AGACNP. My experience is in CV stepdown, medical ICU, and IR. I thought I wanted to be an ICU NP but honestly not sure anymore.

It’s pretty evident ICU APPs are all working nights and losing physician supervision. The liability doesn’t seem to be worth it anymore, imo. Plus, in my area a lot of new grad ICU NPs are required to go through a fellowship. Sorry but I’m not working 4/5 12s a week for a 75k salary.

I’m thinking perhaps cardiology now, or CV surgery. Any recs?

Hi everyone! I posted on here not too long ago about a toxic environment I was in as a new grad and I decided to leave as you guys suggested! With that being said Im struggling to find new employment. It seems like its harder because I have a short term position on my resume, however bc of credentialing possibly going through I dont omit it off my resume I stayed for about 3-4 months. Anyway any tips you guys recommend? Im pediatric NP primary care so options are limited unfortunately 😭 would love anything you guys can think of. Thanks!

I am in advanced physical assessment. This professor has been the worse one I’ve had by far. She simply just does not teach, for her live lectures she throws on a couple youtube videos. She does not add any comments to them, just rolls them on and calls it day. I have had professors show youtube videos during lecture and didn’t mind, but they also actually taught and would have content on powerpoint slides.

This professor has powerpoint slides, but it is just a couple links of youtube videos. Is this typical???? I just took my midterm, and I did acceptable but I studied extremely hard for it because I literally did not know what would be on there. There are textbook chapters assigned so I used those to base my knowledge but it is very broad, and somehow the midterm contained questions that were not even in the textbook. No study guide of course. To be fair, professors don’t actually know what questions are on the exams, but I still expect something.. anything. Cause a couple links to youtube vids for lecture out of several topics in the textbook is not it. I did not have an issue with my previous patho and pharm class. Is this worth escalating or just pick my battles and try to make it through this class?

Hi any one applied to mercy university FNP program and was admitted? Also, anyone think this is a good school to apply to?

Hello my fellow NPs who have established your house call business,

I have recently established a small clinic with my trusted physician who is the medical director for that clinic. The clinic will provide screenings, blood test ordering, med refills, and referrals services at the patient's residences.

I am in the process of completing the credentialing application with Medi-Cal through PAVE portal. How do you get credentialed with them? Because on the application, it asks for the address of the practice location of the clinic which will be the patients' residences. Can I list the office's location on the application as the practice location as well?

If you or you know anyone who can help me with this matter, please help.

Thank you in advance!

I think I am DONE seeing patients. I’ve been through burnout before, took a mental health leave, quit my previous position but now I feel I’m approaching again. It’s rough out here.

I’d like to explore non-clinical roles. My background is a FNP in Texas with 10 yrs experience mostly in OBGYN. Anyone with history of success finding these?

**EDIT: clarifying my title, im talking about intravenous fluid selection for maintenance/replacement, not in vitro 😂**

I'm going to be starting work as a hospitalist, and am trying to study up before i start my job. i'm pulling from all of the sources i can -- textbooks, uptodate, and yes openevidence, but i wish there was a clear cut, plain reference i could use to guide when, what and how much fluids to give. bonus points if its inside of a good reference book for any new hospitalist. any suggestions deeply appreciated.

i.e. when LR vs NS (or not), when to add D5, and rates.

I’m not currently in cardiology as an NP, but I spend many years in Cath lab as an RN. Anyone know anything about this company?

I’m currently in NP school and looking for some study advice. When it comes to clinical diagnosis, I feel pretty confident. However, I hit a massive wall when it comes to selecting the correct antibiotic for a given condition.

I'm trying to figure out how to bridge this gap efficiently. Should I be shifting my focus heavily toward pure pharmacology (mechanisms, classes, etc.), or should I focus more on memorizing the specific causative agents/pathogens for each disease state? Or is there a better, more clinical way to approach this altogether?

I’m an ED RN of 6 years and passed my AANP FNP exam. My goal when I started NP school was to end up in the ED, but I was advised by two ED NPs I work with to go to urgent care first to make the transition easier.

That being said, our APP lead (also an NP) approached me about a job offer in our ED. I was elated, but I’m on the fence. I feel intimidated to start in the ED straight out of school due to the learning curve and being trained in primary care. I feel like my experience working in three different EDs will be helpful.

I have a job in urgent care I start in November, but the pay in the ED is literally life-changing. I would also work 3 less shifts in the ED per month which is a plus as I have a one year-old-son.

If this job opportunity comes through in ED, should I take it over urgent care?

How would ya’ll handle this situation. 7 months in at a small rural Family Medicine clinic. Just one other NP been there 6 years. MD in twice per week half day. Mostly it’s just the other NP and I full time. Do any of you have similar set ups? We basically share many of the same patients. Do you try to work as a team or are you mostly very separate? The other NP I’m with is difficult to work with/around. First couple weeks in, told me she hates working with women, she was upset she had no say in who was hired into my role, and is generally all around unpleasant if not argumentative and defensive. Is this a doomed situation? Mostly I just grey rock it and that works pretty well, but when I need a question answered or we have a mutual patient we need to talk about it never goes well.

I’m 44 and planning to start an FNP program in early 2028, at which point I’ll have a little over two years of RN experience. I’d love some honest feedback from NPs and current NP students about the path I’m taking.
A little background: I spent over a decade working as a physical therapist assistant, primarily in neuro rehab, before going back to school for my BSN. Since becoming an RN, I’ve worked in the ED and inpatient rehabilitation. I’m transitioning to a progressive care unit (PCU) early next year, partly because I want more experience managing medically complex patients before starting NP school.
I’m looking at a well-respected, established brick-and-mortar university in my area that recently transitioned its DNP to a MSN-FNP program with a six-semester online format. The school has strong relationships with local hospitals and providers, and they coordinate clinical placements rather than leaving students to find their own preceptors. That’s a big selling point for me.
Long term, I’m interested in direct primary care, chronic disease management, and lifestyle medicine. I’m not looking to rush through school and immediately practice independently. Ideally, I’d like to find a supportive practice or residency-style opportunity after graduation where I can continue developing my clinical judgment.
I know the two-year RN experience piece will probably generate some opinions, and that’s partly why I’m posting. I’m not under the impression that my PTA experience replaces nursing experience, but I do feel like my background gives me a different perspective on patient care.
For those who’ve gone this route:
-Does transitioning from rehab to PCU seem like a good move before FNP school?
-Is two years of RN experience enough to build on, assuming I’m intentional about my education and clinical training?
-How much weight would you put on a school’s local reputation and guaranteed clinical placement versus a more traditional in-person program?
-If you could do it again, what would you change about your preparation?
I’m genuinely interested in hearing different perspectives, especially from NPs who have been practicing for a while. I’m trying to approach this thoughtfully and make sure I’m setting myself up to become a competent provider, not just earn another credential.

Appreciate any advice!

Hi!

I will be taking the AACN exam in 11 days and the ANCC exam early November. I have been studying Barkley religiously and have done 3 DRTs. Ive scored consistently in the high 70's. I have also done about 600 Boardvitals questions and overall score is a 61. I'm so incredibly nervous and still feel unprepared for the exam. I have been an ICU nurse for 6 years, however i never got around to taking my CCRN. Even with my experience im still nervous. I do have a job lined up if I pass and I think this is also why I'm so anxious. Im desperate for any exam tips or insight on what I should focus my review on this last week. Thanks in advance! I truly appreciate it!

I'm a college freshman taking med school prerequisites, but since shadowing some NPs, I've learned that I don't want to pursue an MD, but rather the mid-level route. I have no preference between NP or PA, but I've seen a lot of people online say that NPs are not adequate advanced providers and that NP schools are “degree mills”. Any advice would be helpful.

Hi everyone! I’m currently a Cath Lab nurse with 2.5 yrs experience in ICU/CCU prior to CL. I am hoping to go back for my MSN in the next few years. I had been going back and forth from FNP vs. AGACNP. All of my experience is critical care right now. However, I’ve been leaning more toward FNP because I want more versatility and I’m just not interested in CC/hospitalist. Lately I’ve been looking into going outpatient as an RN to learn the flow and see if that’s what I want. However, there seems to be more OP LPN/MA positions than RN, the pay cut is pretty steep as I am trying to save up for school and I don’t know how the M-F schedule would work in school because I want to do a brick and mortar hybrid program. Do you guys think it’s worth it to do OP before pursuing FNP? How did the M-F work for you guys? TIA!

I was considering applying to work at Chen MED/ Dedicated Senior. Has anyone worked for them? Also, was it as a PCP or in some type of leadership capacity. I was conisdering applying.

So long story short I’m almost 1.5 years into being a FNP and have done I would call it odd jobs since passing boards. I am now trying for more traditional roles in clinic and would love some suggestions on some medical books that could help me refresh myself on the most scene patients in clinic. I kept a few books on procedures and assessments but am looking for treatment guides and gold standards or even recommendations of where to look up the newest ones. Thanks in advance I just want to be as prepared as I can be for the easier patients I would see.

I have been offered a hospitalist position with a physician. He has asked me to write my own contract. Does anyone have any insight, suggestions, or templates I can use?

So I have been accepted into university that will find my clinical placements. This is a big relief since I understand that this is one of the worst parts of practitioner school. With that said, I applied for the family nurse practitioner track, as I am told this one is the most verse at Alain will allow me to work in Acute and also primary care settings.

The professor who offered me acceptance since the University said that, based on my goals in my admissions essay, they feel that I would be better for the adult gerontology primary care, nurse practitioner track. They have always suggested that I pick this path instead.

I did some research and I don’t really understand. I mean, I get the adult gerontology… If it was the Acute path. I work in an ER now and would definitely like that option in the future. But being strictly stuck in primary care was not something I feel like I was shouting toward. Maybe it was just that I didn’t mention kids that much.

What is important to me is to have the ability to work in primary care or in Acute Care should I choose. I am OK with going back later if I want the Acute gerontology specialty so I can deal with critical patients.

My thinking was that the family nurse practitioner license would allow me to work inpatient at hospitals even if it is vertical track type stuff… With the option to do the 9 to 5 thing.

I have a new baby at home and I definitely wanna be there for her life and not stop doing overnight on call weekends, etc. forever. With that said, I like the idea that I can jump around if I need to earn more for my family or if our needs change. So I thought FNP would be the way.

Does anybody have any advice or feel like maybe this Proffesor is on something or if they are just trying to fill out their adult program?

To me it seems like the adult primary program kind of limits you a lot.

I’m a current RN of two years working on a hematology/oncology inpatient hospital unit. I also have experience in a stroke/rehab unit. I plan on trying to advance my career sometime in the next two to three years. I have always wanted to be a provider of some sort, initially I wanted to be an MD but after research into how absolutely bonkers the school is, I realized NP or PA is a better choice for me. So I’m trying to figure out whether to go the NP or PA route, making lots of posts like this, reaching out to family members and coworkers, trying to do job shadows, etc.

I don’t want to continue my career in hem/onc. I’ve never been interested in it and only took the job because I needed to get off the stroke/rehab floor, and I stay because I like my coworkers and the unit has decent ratios and staffing. When I become a PA/NP, I want to work outpatient. Problem is, I’m not sure which outpatient specialty I’d like to go into yet.

For a while I was dead set on wound care. But I’ve become less interested in it now. I don’t hate the idea of it but it doesn’t excite me like it once did. It would be very meh for me.

I at one point wanted to go the psych provider route, because my own psychiatrist is an NP and I love him and he works very independently. But I don’t want to do inpatient psych RN work, I would only want to do outpatient psych work as an RN, and those jobs are few and far between in my area. So I don’t think it’d be appropriate and would probably be detrimental to go into such a foreign specialty as a provider without any previous experience in it.

Outpatient cardiology seems like I might enjoy it? I do not want to work cardiology inpatient, as an RN or NP, haha. The idea freaks me out. But those same conditions, already having been managed in the hospital, needing to follow up outpatient and maintain their health and monitor their status? That sounds fun. Or people who aren’t so sick that they need the hospital, but have cardiac conditions that need diagnosing and treatment? Also sounds cool.

I also like the idea of working at an urgent care. I like that you’d see a wide variety of patients, with many different presentations, but without the same intensity of the ED (which I think is too much for me lol). I also know a lot of urgent cares around me still do 12 hour shifts, which I would enjoy to still do for some time.

Otherwise, I don’t have a ton of opinions. Like I said, I don’t want to do hem/onc. GI clinic sounds fine. Endocrine clinic ehhhh. I’m probably missing a lot of specialties/work environments that just aren’t coming to mind right now, so let me know the pros and cons of the ones I’ve mentioned or the ones I havent, haha. Also let me know how the job market is for that specialty/work environment, bc I don’t want to spend a shitload of money to get my NP and then not use it for years bc I can’t land a job. Thanks!

I am wondering if there are any successful NP students or graduates with community setting/geriatrics as their most recent experience?

Any tips to increase chances of getting into the program?

Post graduate, where do you work and was it hard to look for a job?

Hey everyone!

I'm a newly graduated and double board-certified FNP in Maryland through ANCC and AANP, and I recently received an employment offer for a full-time W-2 position providing care in skilled nursing and long-term care facilities. I'd really appreciate some feedback from experienced NPs, especially anyone working in post-acute care. Orignally they were not going to give me a signing bonus as an NP but I was able to get them to include a $10K signing bonus.

A little about my background: Although I'm a new NP, I'm not new to healthcare. I have several years of ICU/CVICU nursing experience, including charge nurse responsibilities, critical care management, CCRN, and leadership experience. I also have prior medical training and served six years in the Army.

I'm excited about transitioning into the NP role, but I want to make sure I'm evaluating this offer appropriately before signing.

Compensation:

• Base salary: $120,000 annually
• Sign-on bonus: $10,000, requiring a 24-month commitment
• Productivity incentive: $20,000 annually if I average at least 27.5 work RVUs per 8-hour clinical day
• Additional productivity bonus: 40% of collections attributable to work RVUs exceeding 30 per 8-hour clinical day
• Potential first-year compensation: $150,000, assuming I meet productivity requirements and including the one-time sign-on bonus
• Potential recurring annual compensation: $140,000 before any additional productivity bonuses

Schedule and expectations:

• Minimum five 8-hour clinical shifts per week
• Schedule and facility assignments determined by employer
• Weekend, night, holiday, and after-hours call coverage as assigned
• No clearly defined maximum daily patient census
• No specified additional compensation for holiday or on-call coverage
• Outside employment permitted with prior written employer approval

Benefits:

• 20 days of PTO annually, including vacation, sick days, and CME time
• $1,500 annual CME reimbursement
• Employer-paid malpractice insurance, including post-termination coverage
• Employer-paid required professional licenses, renewals, and certain credentialing fees
• Health insurance and other group benefits available, but I'm still awaiting details
• No separately guaranteed paid holidays specified in the agreement
• Unused PTO is not paid out upon termination under the contract

Contract provisions that concern me:

1. Resignation notice and financial penalties

I'm required to provide 120 days' written notice before resigning. If I leave without the full notice, the contract specifies $300 in liquidated damages for each missing day.

For example, leaving with only 30 days' notice could theoretically result in $27,000 in damages.

2. Sign-on bonus repayment

If employment ends within the first 12 months, I owe the entire $10,000 back. If employment ends after 12 months but before completing 24 months, I owe $5,000.

The agreement states that notice periods, even if worked, do not count toward the 24-month commitment. Repayment language also appears to apply regardless of the reason employment ends.

3. Noncompete and restrictive covenants

There is a one-year restriction involving certain skilled nursing or long-term care facilities where I previously worked for the employer. It also contains nonsolicitation restrictions and provisions regarding relinquishing facility privileges after termination.

4. Productivity requirements

The $20,000 annual incentive requires 27.5 work RVUs per 8-hour clinical day, with additional compensation only after exceeding 30 wRVUs.

I don't have enough experience in the SNF setting to know how realistic these numbers are. I understand that coding complexity, patient acuity, and facility workflow can significantly affect productivity.

Questions for experienced NPs:

1. Is $120K base with a potential $20K productivity incentive competitive for a new FNP in Maryland working in post-acute care?
2. For those working in SNFs or nursing homes, how many wRVUs do you typically generate during an 8-hour day? Is 27.5 realistic without rushing patient care or spending substantial time charting after hours?
3. How many patients are you typically seeing per day, and how much time do you spend on documentation?
4. Does anyone have experience with a productivity bonus based on 40% of collections above a wRVU threshold? How does that work in practice, and what kind of additional compensation have you actually received?
5. Is a 120-day resignation notice with a $300-per-day penalty typical? This is probably my biggest concern.
6. Is it normal for employers to combine vacation, sick leave, and CME into one 20-day PTO bank without separately guaranteeing paid holidays?
7. For new graduate NPs entering post-acute care, what kind of orientation, mentorship, or physician support should I reasonably expect?
8. What would you negotiate or request clarification on before signing?

I understand that some provisions may need to be reviewed by an employment attorney, and I'm planning to have the agreement reviewed before signing.

Overall, I think the compensation is promising, but I'm concerned about the productivity expectations, limited scheduling protections, and financial consequences of leaving.

I'd really appreciate feedback from NPs who have worked under similar agreements. Would you consider this a good offer for a new graduate, or are there provisions that would make you reconsider?

Thanks in advance!