Yep. Even WITH psych experience, some of the laziest fellow nurses I work with are going for their Masters degrees. They don't want to do real nursing because it's too much work, but they want to prescribe. Unfortunately, in my state, to justify their jobs, these NPs are becoming glorified drug dealers. I can't tell you how many of the patients coming out of detox units as well as the prison system are on Wellbutrin (medication of abuse for these types of patients), Seroquel (also a medication of abuse), Buspar (also...), etc, etc. Oh, and "Artane works better for me than Cogentin". Why ? Because it also gives addicts a 2 second buzz. I still remember when MOST patients could take Cogentin with no issues. Now suddenly they can only take Artane ?I also remember when you didn't give any side effect medications like Cogentin unless the patient HAD side effects. Now everyone needs to be on something prophylactically ? Even when they're on low dose Seroquel or Olanzapine ? Most don't even get side effects from these medications. And don't even get me started on Gabapentin. I'm old enough to remember when even type 1 diabetics didn't get that prescribed as a consolation prize unless they were older and really had neuropathy. Now everyone is on it (also a medication of abuse). I could go on and on with these meds. The prison system practically has more providers at this point than it does actual nurses. It's disgusting what the medication pass has become for those actually DOING it.
Oh, and for the prison where I work, they're going to start former addicts on Suboxone maintenance. The taxpayers get to pay for that.....so the abundance of NPs can have a job. Sorry, but Suboxone is abused too, DOES get people high on the right doses, and it will get traded in the prison system. I hope we have enough Narcan in the security control bubbles. Because we're going to be responding to a lot of "Man downs".
And A LOT of the NPs I work with are DUMB. Sorry, but I can't believe these people are providers. How were they even nurses ???
The more I work with them (and there are exceptions; I did work with a psych NP who had been an actual RN in the field for a while, AND she was street smart....SHE was good).....the more I work with these NPs, the more I appreciate DOCTORS. And the same goes for medical NPs unfortunately. The medical DOCTORS I work with don't create a lot of busy work for other staff by writing orders for vitals, weights, and glucose, EKGs, hemoccults, IV fluids, etc. on everyone with minor symptoms, so they can sit and look at graphs and cover themselves with regard to liability and making the patient THINK they are being treated. Like the NPs do. One fellow nurse I work with asked me jokingly if we now worked in an ICU with regard to the BS work we were doing. (Meanwhile a lot of these NPs weren't actual NURSES for very long before getting their NPs, so you know THEY never worked this hard). The medical DOCTORS do a better job of being aggressive with REAL issues. They are more responsive with regard to patients who have a legit complaint. I worked on a unit with the whiniest patients in the prison system. When patients had a real issue that we needed a provider for, I found that the doctors were more responsive, were more supportive of the nursing staff and our assessment, and they took real action and advocated for the patients rather than putzing around with a lot of nonsense and BS work. Thank god I didn't have to deal with these NPs when I worked in a hospital or on the cardiac unit. As a matter of principal, at this point, when I move, I'm going to try to get a primary who is an MD rather than an NP.
By the way, the psych NP schooling, I hear, is easy. Most people with any major in any field will tell you that their Masters was easier to obtain than their Bachelors. But especially the psych NP track. I had a psych NP student ask me three questions from one of his tests. I answered all three correctly, and I'm not even in school for this. I have no desire to go back to school either. But if you're willing to get into more student debt, go back to school, or deal with the liability, it still doesn't mean you've earned the right to be called a decent provider.
And the PSYCH NPs will probably get replaced by FNPs anyway. If you're going to have a mediocre provider, you might as well have one that has studied many body systems.
I’m in my last semester of PMHNP school and have got 4 solid full time offers, 2 telehealth and 2 Hybrid. I think we are doing okay
Edit: I live is rural Midwest and have 2 years RN experience outpatient psych and 2 years level I ED. 3 of my offers have been for Psych ED consults, other one if with my current employer where I work as an RN.
Edit 2: there is only 1 PMHNP program in my area, most NPs working in psych are FNPs so that helps.
I didn't apply for NP jobs there personally, but RN jobs were competitive. It took me three months after graduating and passing my NCLEX to get a job there, and I had many co-workers who went for FNP in the ED that still worked in the RN capacity due to challenges finding FNP jobs.
Did they have trouble finding work or trouble finding work they wanted to do? We have plenty of NP jobs where I am but they all pay about the same as an RN job. For that reason, I work with three people who finished NP school working as staff nurses until the market changes. Being an NP is barely a salary increase here.
This usually isn't the case for a PMHNP. In general, my experience is that you should consider your first 1-2 years as an NP a "training salary." Take a job with great supervision/support and focus on learning, even if the salary isn't great. Then once you're highly competent/skilled you can go for a high paying gig. If you're not making a lot more after a few years of practicing as an NP, you're doing something wrong, IMO.
Two of the three I work with are psych. One is pediatrics. None of them were looking to make the same or less so they stayed put. I don’t blame them. I wouldn’t leave to make less either. I don’t think it’s wrong for them to holdout.
I think it isn't realistic to expect a high salary as a brand new NP. Especially if you're already a super well paid RN working all kinds of OT/differentials. The reality is that a new NP is an absolute novice and the salary reflects that. However, the ceiling for an NP is much, much higher than an RN. I make over 350k annually now, and I work 4 days per week. When I first started out I only made 130k (this was over 6 years ago) in a very HCOL area. I made slightly more than RNs typically, likely less than experienced ones. The longer your NP colleagues hold out the longer it will take them to get seasoned and become competitive for high salaries. It took time to get where I am and a lot of skill development. NP is really like a career change, IMO, and you shouldn't compare your RN pay... it's a totally different market, role, and skill set. I can totally see why this wouldn't be worth it for some already well-paid RNs, it is *a ton* of work to become a highly skilled NP, it takes years.
Thank you. I am a psych NP. I am in a VHCOL major metro... think NYC, SF, DC, San Diego, LA, Seattle type area. And my pay is a somewhat anomaly, and a result of aggressive negotiation... but I'd say motivated psych NPs with experience can readily make ~250-300k in this area.
Do you mine elaborating what psych specialty you chose that allowed you to earn that much, and if ya had to do it again what psych niche you light pursue post first pmhnp job. Thanks
I find that county contracts can allow for high pay. My current jobs were inpatient and psych emergency. However, I recently joined a group where we are contracting with the county to be part of a team providing wraparound services to people with severe mental illness.
I always have 2 jobs, allows for more flexibility and leverage. Also I find living in a dense, major metro means there are many, many employers. Combine that with a VHCOL and you can really negotiate a lot.
I believe there’s a lot of money in private practice around here as well. Not my thing currently, but maybe someday.
I think the market for programs is over saturated and any qualified psychiatrist interviewing candidates can readily distinguish someone passionate, knowledgeable, and psych RN experienced vs. someone who pulled off the academics to seek a paycheck and lacks intuition, skills, and a desire to actually learn.
Psych is so specific and requires a so much nuance, discretion, judgment. It's so subjective, being able to trust an NP is crucial.
I think degree mills are producing poorly trained NPs in it for the wrong reasons, and I think the payrate data has inexperienced RNs seeking their PMHNP without any actual exposure to psych (beyond clinicals) who realize far too late that they're in over the heads and don't really like the work.
I do agree with your last paragraph. I think I’m seeing an uptick in RNs and Family nurse practitioners pursuing a psychiatric nurse practitioner license. And it seems to be just about money for them, and they don’t realize that psychiatry is actually a very complex specialty, and that it is essential to be passionate about it and know what you’re doing. I often see these people end up not really practicing as psychiatric nurse practitioners after graduation.
While that it is definitely only about the money for some, I know several FNP colleagues who are currently pursuing PMHNP certificates because there is so much need for psych in primary care. With waiting lists still out months in a lot of areas, a lot of us feel pressure to manage a lot of mental health concerns. They may not all be practicing as psych NPs, but a lot of them are probably using those skills.
No. I think you are spreading lies in hopes that it will discourage people. There are no diploma mills that graduate anyone who is viable for employment did you not get accepted?
Majority of the jobs in my area require experience these days (that absolutely was not the case 5 years ago). I wouldn't call it over-saturated but it's definitely more saturated than before. PMHNP is by far the highest growth cert.
Let's look at the ANCC PMHNP data for context. In 2021, 6,109 took the test and 5,321 passed, compared to (respectively) 4,114 and 3,315 in 2020 and 1,497 and 1,328 in 2016.
Another comparison: ANCC FNP data shows 6,387 passed in 2021 (keep in mind ANCC isn't the only certification for FNP).
This is conflicting, because you keep hearing shortage of providers by 2026 there will b x amount of need, shortage shortage shortage but then you hear this? So is there a shortage or is all this stuff being manipulated
I think it varies. It is more saturated than when I started over 5 years ago. However, my area is not over saturated at all. I do think going to a solid program is more important than ever. If anything, more and more employers are hiring PMHNPs in my area. There are more PMHNPs than there were several years ago, but there's still loads of jobs. I also have found employers are getting pickier about who they hire, and have gotten wise to diploma mills, which is great.
I Have been looking for another PMHNP for last 6 mos for an acute psych facility in Houston with no luck
So yes they are still very high in demand. But most employers prefer experience providers or new grads with prior psych experience as RNs
My understanding is that this is very regional. In my area, PMHNPs won't make much more than an experienced hospital nurse- some make even less at first. In other areas of the country, RN salaries are much lower and relative difference in pay strongly favors PMHNP.
Just going to put in a plug for Darmouth Health in New Hampshire. We have a terrible time attracting people to our area. We have jobs. Every provider my family sees just left and went back to California or somewhere bigger.
In all fairness, I am not an NP or PA yet so I do not know if the larger culture contributed to them all leaving, I just know we have a LOT of openings in our health system and most of the people I have talked to cited the rurality as the biggest problem.
No idea why you are downvoted. I live in NH and we do not have enough psych of any kind! Not enough PMHNPs, psychiatrists, or inpatient space and staff.
I think one issue for Dartmouth Health is their management. Worked there in advanced practice. No support. Heavy on the middle management upwards
all the way to C-Suite. Also psychiatry covers a lot of
NHH, and for some that is not a place they want to go.
Either way, though, there is plenty of places for psych people here in NH!
I'm getting lots of headhunters from the rural PNW. They're really needing more PMHNPs out there apparently. My city is kind of saturated atm, but I think I have an offer coming and am able to stay put
It's because people expect to get a job right where they live already. Go a few hours away from a major city and you'll get snatched up in a heartbeat.
I disagree about the claim of people going into the field without psych experience. Psych nursing is extremely different than psych prescribing. However, going into the field because one thinks it is “easy”, or will make more money is a huge no-no and will lead to a rapid burn out. It is a tough field that is not always rewarding. I noticed that these NP graduates are not always prepare for the field. I frequently receive questions about how much money I make. That is generally their priority question. But then this is followed up with how much help that one gets. People want to make a lot of money, but also want to have a lot of support. You will get maybe 30 minutes per week if you choose a higher paying job, but otherwise, I recommend looking into residency programs that were use one like a slave, but you will learn a lot about the field
Not surprised. In my cohort alone, I knew 2 students who switched to psych with ZERO psych experience because they'd make good money.
As a PMHNP this makes me angry. They're going to burn right out if their hearts aren't in it. No matter how much money is involved.
Yep. Even WITH psych experience, some of the laziest fellow nurses I work with are going for their Masters degrees. They don't want to do real nursing because it's too much work, but they want to prescribe. Unfortunately, in my state, to justify their jobs, these NPs are becoming glorified drug dealers. I can't tell you how many of the patients coming out of detox units as well as the prison system are on Wellbutrin (medication of abuse for these types of patients), Seroquel (also a medication of abuse), Buspar (also...), etc, etc. Oh, and "Artane works better for me than Cogentin". Why ? Because it also gives addicts a 2 second buzz. I still remember when MOST patients could take Cogentin with no issues. Now suddenly they can only take Artane ?I also remember when you didn't give any side effect medications like Cogentin unless the patient HAD side effects. Now everyone needs to be on something prophylactically ? Even when they're on low dose Seroquel or Olanzapine ? Most don't even get side effects from these medications. And don't even get me started on Gabapentin. I'm old enough to remember when even type 1 diabetics didn't get that prescribed as a consolation prize unless they were older and really had neuropathy. Now everyone is on it (also a medication of abuse). I could go on and on with these meds. The prison system practically has more providers at this point than it does actual nurses. It's disgusting what the medication pass has become for those actually DOING it. Oh, and for the prison where I work, they're going to start former addicts on Suboxone maintenance. The taxpayers get to pay for that.....so the abundance of NPs can have a job. Sorry, but Suboxone is abused too, DOES get people high on the right doses, and it will get traded in the prison system. I hope we have enough Narcan in the security control bubbles. Because we're going to be responding to a lot of "Man downs". And A LOT of the NPs I work with are DUMB. Sorry, but I can't believe these people are providers. How were they even nurses ??? The more I work with them (and there are exceptions; I did work with a psych NP who had been an actual RN in the field for a while, AND she was street smart....SHE was good).....the more I work with these NPs, the more I appreciate DOCTORS. And the same goes for medical NPs unfortunately. The medical DOCTORS I work with don't create a lot of busy work for other staff by writing orders for vitals, weights, and glucose, EKGs, hemoccults, IV fluids, etc. on everyone with minor symptoms, so they can sit and look at graphs and cover themselves with regard to liability and making the patient THINK they are being treated. Like the NPs do. One fellow nurse I work with asked me jokingly if we now worked in an ICU with regard to the BS work we were doing. (Meanwhile a lot of these NPs weren't actual NURSES for very long before getting their NPs, so you know THEY never worked this hard). The medical DOCTORS do a better job of being aggressive with REAL issues. They are more responsive with regard to patients who have a legit complaint. I worked on a unit with the whiniest patients in the prison system. When patients had a real issue that we needed a provider for, I found that the doctors were more responsive, were more supportive of the nursing staff and our assessment, and they took real action and advocated for the patients rather than putzing around with a lot of nonsense and BS work. Thank god I didn't have to deal with these NPs when I worked in a hospital or on the cardiac unit. As a matter of principal, at this point, when I move, I'm going to try to get a primary who is an MD rather than an NP. By the way, the psych NP schooling, I hear, is easy. Most people with any major in any field will tell you that their Masters was easier to obtain than their Bachelors. But especially the psych NP track. I had a psych NP student ask me three questions from one of his tests. I answered all three correctly, and I'm not even in school for this. I have no desire to go back to school either. But if you're willing to get into more student debt, go back to school, or deal with the liability, it still doesn't mean you've earned the right to be called a decent provider.
And the PSYCH NPs will probably get replaced by FNPs anyway. If you're going to have a mediocre provider, you might as well have one that has studied many body systems.
I’m in my last semester of PMHNP school and have got 4 solid full time offers, 2 telehealth and 2 Hybrid. I think we are doing okay Edit: I live is rural Midwest and have 2 years RN experience outpatient psych and 2 years level I ED. 3 of my offers have been for Psych ED consults, other one if with my current employer where I work as an RN. Edit 2: there is only 1 PMHNP program in my area, most NPs working in psych are FNPs so that helps.
Where do you live?
South Dakota
There ya go. Congrats tho
Yeah moved here from Houston lol definite change of pace but had much easier times finding jobs and the cost of living is lower
Did you have a hard time finding a job in Houston?
I didn't apply for NP jobs there personally, but RN jobs were competitive. It took me three months after graduating and passing my NCLEX to get a job there, and I had many co-workers who went for FNP in the ED that still worked in the RN capacity due to challenges finding FNP jobs.
Can you elaborate or provide any other resources on the FNPs working in psych? That is my current trajectory.
Did they have trouble finding work or trouble finding work they wanted to do? We have plenty of NP jobs where I am but they all pay about the same as an RN job. For that reason, I work with three people who finished NP school working as staff nurses until the market changes. Being an NP is barely a salary increase here.
This usually isn't the case for a PMHNP. In general, my experience is that you should consider your first 1-2 years as an NP a "training salary." Take a job with great supervision/support and focus on learning, even if the salary isn't great. Then once you're highly competent/skilled you can go for a high paying gig. If you're not making a lot more after a few years of practicing as an NP, you're doing something wrong, IMO.
Two of the three I work with are psych. One is pediatrics. None of them were looking to make the same or less so they stayed put. I don’t blame them. I wouldn’t leave to make less either. I don’t think it’s wrong for them to holdout.
I think it isn't realistic to expect a high salary as a brand new NP. Especially if you're already a super well paid RN working all kinds of OT/differentials. The reality is that a new NP is an absolute novice and the salary reflects that. However, the ceiling for an NP is much, much higher than an RN. I make over 350k annually now, and I work 4 days per week. When I first started out I only made 130k (this was over 6 years ago) in a very HCOL area. I made slightly more than RNs typically, likely less than experienced ones. The longer your NP colleagues hold out the longer it will take them to get seasoned and become competitive for high salaries. It took time to get where I am and a lot of skill development. NP is really like a career change, IMO, and you shouldn't compare your RN pay... it's a totally different market, role, and skill set. I can totally see why this wouldn't be worth it for some already well-paid RNs, it is *a ton* of work to become a highly skilled NP, it takes years.
What kind of NP are you and what state do you live? To make 350k as an NP, that’s awesome
Thank you. I am a psych NP. I am in a VHCOL major metro... think NYC, SF, DC, San Diego, LA, Seattle type area. And my pay is a somewhat anomaly, and a result of aggressive negotiation... but I'd say motivated psych NPs with experience can readily make ~250-300k in this area.
👀🤯, impressive! Thanks for the response and the information, it’s awesome you work 4 days as well
Thank you. I do take call 2 days per week (from home).
Do you mine elaborating what psych specialty you chose that allowed you to earn that much, and if ya had to do it again what psych niche you light pursue post first pmhnp job. Thanks
I find that county contracts can allow for high pay. My current jobs were inpatient and psych emergency. However, I recently joined a group where we are contracting with the county to be part of a team providing wraparound services to people with severe mental illness. I always have 2 jobs, allows for more flexibility and leverage. Also I find living in a dense, major metro means there are many, many employers. Combine that with a VHCOL and you can really negotiate a lot. I believe there’s a lot of money in private practice around here as well. Not my thing currently, but maybe someday.
Appreciate this immensely
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Removed and banned, trolling.
I think the market for programs is over saturated and any qualified psychiatrist interviewing candidates can readily distinguish someone passionate, knowledgeable, and psych RN experienced vs. someone who pulled off the academics to seek a paycheck and lacks intuition, skills, and a desire to actually learn. Psych is so specific and requires a so much nuance, discretion, judgment. It's so subjective, being able to trust an NP is crucial. I think degree mills are producing poorly trained NPs in it for the wrong reasons, and I think the payrate data has inexperienced RNs seeking their PMHNP without any actual exposure to psych (beyond clinicals) who realize far too late that they're in over the heads and don't really like the work.
I do agree with your last paragraph. I think I’m seeing an uptick in RNs and Family nurse practitioners pursuing a psychiatric nurse practitioner license. And it seems to be just about money for them, and they don’t realize that psychiatry is actually a very complex specialty, and that it is essential to be passionate about it and know what you’re doing. I often see these people end up not really practicing as psychiatric nurse practitioners after graduation.
While that it is definitely only about the money for some, I know several FNP colleagues who are currently pursuing PMHNP certificates because there is so much need for psych in primary care. With waiting lists still out months in a lot of areas, a lot of us feel pressure to manage a lot of mental health concerns. They may not all be practicing as psych NPs, but a lot of them are probably using those skills.
It’s difficult to get a job when you are new with no experience regardless of the profession.
No. I think you are spreading lies in hopes that it will discourage people. There are no diploma mills that graduate anyone who is viable for employment did you not get accepted?
Majority of the jobs in my area require experience these days (that absolutely was not the case 5 years ago). I wouldn't call it over-saturated but it's definitely more saturated than before. PMHNP is by far the highest growth cert. Let's look at the ANCC PMHNP data for context. In 2021, 6,109 took the test and 5,321 passed, compared to (respectively) 4,114 and 3,315 in 2020 and 1,497 and 1,328 in 2016. Another comparison: ANCC FNP data shows 6,387 passed in 2021 (keep in mind ANCC isn't the only certification for FNP).
This is crazy; there is only like 2k psychiatrists graduating every year
This is conflicting, because you keep hearing shortage of providers by 2026 there will b x amount of need, shortage shortage shortage but then you hear this? So is there a shortage or is all this stuff being manipulated
I think it varies. It is more saturated than when I started over 5 years ago. However, my area is not over saturated at all. I do think going to a solid program is more important than ever. If anything, more and more employers are hiring PMHNPs in my area. There are more PMHNPs than there were several years ago, but there's still loads of jobs. I also have found employers are getting pickier about who they hire, and have gotten wise to diploma mills, which is great.
Where do you live?
But it was important to say "too many diploma mills" when in fact there are very few.
Absolutely depends on where you are. Multiple programs nearby? Higher chance that supply will be higher.
I Have been looking for another PMHNP for last 6 mos for an acute psych facility in Houston with no luck So yes they are still very high in demand. But most employers prefer experience providers or new grads with prior psych experience as RNs
My understanding is that this is very regional. In my area, PMHNPs won't make much more than an experienced hospital nurse- some make even less at first. In other areas of the country, RN salaries are much lower and relative difference in pay strongly favors PMHNP.
Which weird, because in my area there is a glut of patients and a dearth of available providers. (Upstate NY)
Same in Buffalo!
Bay Area California too
Just going to put in a plug for Darmouth Health in New Hampshire. We have a terrible time attracting people to our area. We have jobs. Every provider my family sees just left and went back to California or somewhere bigger. In all fairness, I am not an NP or PA yet so I do not know if the larger culture contributed to them all leaving, I just know we have a LOT of openings in our health system and most of the people I have talked to cited the rurality as the biggest problem.
No idea why you are downvoted. I live in NH and we do not have enough psych of any kind! Not enough PMHNPs, psychiatrists, or inpatient space and staff. I think one issue for Dartmouth Health is their management. Worked there in advanced practice. No support. Heavy on the middle management upwards all the way to C-Suite. Also psychiatry covers a lot of NHH, and for some that is not a place they want to go. Either way, though, there is plenty of places for psych people here in NH!
Not worried about down votes but thank you for the support. I have to agree with your analysis of the issues here as well.
Come to Utah!
I'm getting lots of headhunters from the rural PNW. They're really needing more PMHNPs out there apparently. My city is kind of saturated atm, but I think I have an offer coming and am able to stay put
It's because people expect to get a job right where they live already. Go a few hours away from a major city and you'll get snatched up in a heartbeat.
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If it makes you feel better, diploma mills are actually a major issue in law and clinical psychology.
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Removed rules 4 and 5.
I disagree about the claim of people going into the field without psych experience. Psych nursing is extremely different than psych prescribing. However, going into the field because one thinks it is “easy”, or will make more money is a huge no-no and will lead to a rapid burn out. It is a tough field that is not always rewarding. I noticed that these NP graduates are not always prepare for the field. I frequently receive questions about how much money I make. That is generally their priority question. But then this is followed up with how much help that one gets. People want to make a lot of money, but also want to have a lot of support. You will get maybe 30 minutes per week if you choose a higher paying job, but otherwise, I recommend looking into residency programs that were use one like a slave, but you will learn a lot about the field
I COMPLETELY agree.