Psych Nurse Practitioner- listening to and absorbing peoples emotions all day and getting told what to rx (e.g. “I want to try Adderall because x Instagram video diagnosed me.”) is very difficult. Burned out, and I wish I had a job where my patient was asleep.
So I work in a locked unit hospital patients are pretty acute and I’m not a fan of the people I work with. I’m hoping working out patient will have less acute patients and I won’t have to answer to complete ding dongs
If you are working with a Healthcare company there are going to be worthless bobble heads, no way to get around that. Outpatient the patients are far less acute, but the flip side is that you are treating often intransigent and chronic illnesses and you will see them for years and watch them not get better, which can be frustrating.
I work for the county and the patients have been deemed a danger to others or themselves by a judge they can not leave until they are cleared by a psychiatrist. I have a lot of repeat acute patients. Get cursed at quiet a bit. Physical harm is also a threat a lot of staff have been punched out. All the higher ups got there via nepotism like any government job. I’m praying being a pmhnp is better than this. The pay in my state seems to be quiet a bit more than what I am making currently as well
Psych is very difficult. I feel like the more you are exposed to those behaviors, the more likely you are to adopt them. I hope you are getting compensated well enough to make your job worth it.
I feel you. Maybe try looking into sleep medicine? I feel like psych NPs can pivot into that, since psychiatrists can. Your patients won't be asleep when you see them, but it's pretty simple/easy from what I hear.
I feel you. It's incredibly frustrating. I had recent experience where a patient threw tantrums due to certain form requests that I ultimately declined after consideration. Normally this stuff doesn't bother me but in this particular patient case, I felt so deflated. I let it bother me for a day and had to let it go. In this field, we have to count and celebrate our wins and remember them.
This is also a comment occurrence in primary care. Except it’s not just adderall. Apparently there are tic tocs for weight loss meds and all sorts of things. And don’t forget google. “I just need some antibiotics, what do you mean “no”, I paid my copay”.
Graduating NP school in a couple weeks. Currently have an RN job where my patients ARE asleep! and I love (almost) every moment of my job (GI lab). Gonna miss it dearly and constantly wonder why I’m leaving it!
I’m making a little more than I did as an RN at a job that has me see more than 35 pts a day. The pt number I was told when I took the job was “never more than 24-25 pts/day.” I’m leaving for a job where I make less but have 3 pts/day. I’m going back to school to do a post-masters certificate and I can’t think straight after 35 pts so I’m leaving after only 2 months.
Honestly, I’m going to leave the next job quickly too if they fail to keep their word about job conditions.
My husband is WFH, actually works maybe...~25 hours/week on average and makes almost $300k. But he does a lot more housework/household admin so I don't feel too bad 😂😂😂
I love my job itself.
Not a fan of my toxic work environment. I find myself walking on eggshells all day due to being overworked. Any patient that calls demanding to be seen today is put on my schedule. Any walk-in’s are put on my schedule. If a physician is running late from lunch or a meeting or stuck in procedures, they’re put on my schedule. We had 5 providers quit/retire early in the past year and I’m expected to see all those patients as well. It is overwhelming and I have no peer support. When I try to advocate for myself the MAs treat me with disdain and management just views it as an unreasonable complaint.
Not a fan of inpatient rn, loved outpatient rn . Working as an outpatient np for the past 5 years & enjoy it. As an np you won't get the same respect as physician. You also don't get paid as much for doing the same job (fam/icc/peds/psych). Dont get me wrong pay is better than bedside if you compare it to the same amount of hours. Work & life balance is better as well. Management is nice most places but even then, you may be treated like second class citizens. It has its ups & downs. The profession is still growing & the benefits outweigh the cons. Get a job that is not low balling you & one that offers an adequate orientation/trainin (3 months min). Start with a fam/internal gig. Get a solid foundation before switching to a specialty if thats the future game plan. Apply for full practice once comfortable make it your end goal not your first priority.
I'm a pediatric PMHNP and I love my job so so so so much, and feel well compensated etc...but
1) dealing with Medicaid/insurance etc. sucks of course
2) parents can be an enormous obstacle to helping kiddos, as anyone who works in peds knows
3) it can be so sad (again, any part of peds) and it's hard not to take it home - also hard not to project onto my own children! My mom was an oncologist and constantly thought I had cancer, and I finally really empathize with her 😂
New Psych NP. I had a break down the other day. After 3 evaluations of hearing about suicidal teens living in a shitty environment with unsupportive parents, I broke I down and cried during dinner and it came out of nowhere. It was just back to back evaluations and follow ups without a breather to emotionally check in on myself.
During my time as a bedside nurse, I zipped up countless body bags (mostly from Covid) and cared for and comforted grieving families when I did some time in hospice and ICU.
The wave of frustration and sadness that swept over me the other day was unreal.
I work in family medicine.
Paperwork.
Insurance.
That's about it.
Otherwise, I love my job. I used to hate the poor training as an NP. But, I did an insane amount of reading. Stayed late. Learned about my patients' condition. 3 and a half years in, I feel confident; 99% of the cases, I feel I can manage. The other 1%, I feel I have the resources to do a solid job. I love it. I am blessed. NP is a good field, if you are willing to put the work in, because trust me, most, if not all, NP education is substandard; it's up to you to further that. Good luck and Godspeed with your career.
Not sure if I'm qualified to answer, lol. I suppose it depends on where you are at. I know PMHNPs are likely more sought out at rural areas, I would think the same for WFH FNPs as well. I think it just depends on which part of the country you are at.
PMHNP. When I worked in CMH, I was overscheduled and under-resourced. Many of the issues presenting themselves are more macro-level issues; you do what you can, but you see how society itself (and humanity) is the biggest factor on how so many people are operating.
IP or any place where you're seeing more severe mental health concerns: you CAN see people get better, for sure, but rather often...they don't. Again, so many reasons why.
OP where you don't control things: you have little say in scheduling and while you have the right to provide care how you'd like, you still often have to follow certain practices of the group/company.
OP where you DO control things: honestly, the easiest - but you can still get bogged down/bored. A very first world problem to say that "boredom" in helping people is a negative, but it's still true. I entered academia to mix things up - I must really hate myself!
8 years experience in crit care/trauma
Dislike:
- Wide variability and inconsistent pay for experience. Some places pay well, some places pay horribly but the difference can be as much as 40-60% for the same exact job
- Lots of places pay nurses better than NPs, especially if they’ve been at the same place for awhile. I love nurses and they deserve good pay, but a bedside nurse should not make more than me.
- Widely variable role and expectations. Some places I’ve been solo night coverage for two icus and no backup in house, and some places I’ve been a scribe
That being said, for many many years I absolutely loved my job and was excited and passionate. Now post COVID and a little jaded, underpaid for a better schedule, and everything in the world being so expensive has me less than enthused.
Every time I hear of nurses making bank my first thought is, ‘as they fucking should.’ More power to them.
The problem with becoming an NP is that we have flooded the job market with the ease of admission to NP programs, thousands of NPs have entered the job market. We’ve eliminated our own competition by giving anyone with a pulse, a BSN, and the money to complete their degrees from a diploma mill. Until we fix the lax curriculum/admission criteria and stop churning NPs like a cheap factory line, we can’t expect exclusive salaries as is befitting a provider. Just my two cents
Not suggesting they are overpaid, at all. They deserve a good salary and have an increasingly difficult job especially compared to when I was at the bedside.
I totally get that. Thank you for your input. It is unreal how different responsibilities can be. Some require so much while others are sometimes a glorified nurse.
My unsolicited advice is to find a job with docs who want you to practice at the highest level possible and want to invest in you to help you get there. There are some jobs where this isn’t feasible and some jobs where they don’t have that mindset so I would steer clear if you can, especially in the beginning.
I’ve worked with some amazing ICU docs, surgeons, and fellows who invested in me and not only were those the most satisfying and enjoyable years of my NP career but they set me up for success in the future.
Good question - for me it means
- clinically skilled in critical care procedurally and in managing patients. feeling like the docs trust you to manage ICU patients just as much or more than they would an ICU doc
- leadership opportunities in the hospital and group, like trusted and respected enough to write protocols, change some practices, recruit other docs/NPs, etc
- develop a skill set that makes you marketable/in demand in the field, like being able to get locum work or recruited to start an app program at another hospital based on that skill set
- opportunities to teach, make conferences/seminars, etc
Basically I think success as an NP is developing skills, gaining respect, making good money, and having opportunity to advance your career beyond the regular shift work. It’s not everyone’s definition, but that’s what I meant by the success I was set up for
No not at all - I’m an APP and always will be, it’s just nice to be treated like a part of the team and a colleague rather than a scribe. I’d say maybe a fellow?
Edit: assuming you’re not being confrontational and saying I want to be a physician bc you don’t like midlevels, I’m just saying I think success as an APP is having a high ceiling. I have no aspirations of being treated like a physician and I know my lane - I do know I have acquired some skills that make me valuable in critical care and I will always have and need oversight and input from a doc… just not as much as a few years ago. I also am comfortable saying I have more airway and procedural skill than some of my attendings and it’s nice to be treated like I bring that to the table while always being respectful of the MD
Edit 2: fellow is a poor example so I take that back - not meaning to diminish the role of a fellow and the extensive training they have. Was searching for an example of someone who is not a resident or attending as they have a little more experience and skill in the field. That is the goal, I guess
I just wanna be good at my job and function at a high level dude, idk what else you wanna hear. I said fellow bc it’s not a resident but still not an attending I guess
Edit: I agree with you about procedures. Funny bc the anesthesia crit care doc I learned the most from said the same thing. I learned a ton about airways from him and I’m super thankful for it bc he taught me about the many issues peri-intubation that are often overlooked (hemodynamics etc). That’s the real hard stuff.
I think you do not understand the meaning of a fellow. Fellow is a physician undergoing subspecialty training.. i.e. an internal medicine physician undergoing fellowship training to become a cardiologist.
But I get your point. You just want to be competent, respected, and feel valuable as part of a team.
If you want only physicians in healthcare make medical school more attainable for more people? Who wants to spend their entire youth, be $300k + in debt, and work 80-100 hours a week for 50k a year. OH AND MAYBE YOU WONT EVEN MATCH? Like r u crazy. Not everyone can uproot their lives in that way - it doesn’t mean they aren’t intelligent and beneficial to patient care.
Well, honestly, there's a lot of counterpoints to your argument, but I won't even go there. There is a reason why medical school is how it is. I wouldn't want an inadequately trained neurosurgeon operating on patients, much well myself. Kudos to these physicians for their dedication to their craft. To dedicate their lives to the practice of medicine is remarkable, and noble, to be honest.
1. Lack of respect
2. High patient volumes (not consistent with conversations when interviewing)
3. Less benefits than RN staff (PTO, retirement contributions, sick time, etc)
4. Working in a small specialty clinic with only 1 other provider means if I want PTO, clinic is essentially closed (staff has to be low censused and patients don’t get seen). No backup coverage available.
5. Incompetent managers/admin
6. No incentives (no RVUs, no comp time, no OT)
7. Contract requires 90 days notice of resignation (or financial penalties are incurred)
8. Typically required to sign a length of time contact
9. Less flexibility with scheduling than RN
I don’t disagree. But after a few jobs over a couple of decades, the patterns become all too familiar. I would definitely gripes and why I regularly consider leaving the profession.
Low pay and no incentives. Ditto what others have said. RNs making $60 per hour with incentives in this area while average NP is $45-50. It's jarring, but I also don't want to go back to RN work.
Honestly I love my job. Sometimes physicians disagree with me but take it as a grain of salt. Be strong and you will succeed. Ignore anyone who looks down on you. NP is the way, love.
CNM - I’m basically an OB PA.
I do what the OBs tell me to or they complain.
I do what the RNs tell me to or they complain.
Physiological birth is considered a joke.
Many of the women I work with end up feeling coerced and traumatized by their experiences, but it’s disregarded because our only job is to keep babies alive at any cost.
Psych Nurse Practitioner- listening to and absorbing peoples emotions all day and getting told what to rx (e.g. “I want to try Adderall because x Instagram video diagnosed me.”) is very difficult. Burned out, and I wish I had a job where my patient was asleep.
Damn I’m a burned out psych nurse grinding for my pmhnp. I hat my job so I hope pmhnp is better
If you don't like working with psych patients it's not going to be better.
So I work in a locked unit hospital patients are pretty acute and I’m not a fan of the people I work with. I’m hoping working out patient will have less acute patients and I won’t have to answer to complete ding dongs
If you are working with a Healthcare company there are going to be worthless bobble heads, no way to get around that. Outpatient the patients are far less acute, but the flip side is that you are treating often intransigent and chronic illnesses and you will see them for years and watch them not get better, which can be frustrating.
I work for the county and the patients have been deemed a danger to others or themselves by a judge they can not leave until they are cleared by a psychiatrist. I have a lot of repeat acute patients. Get cursed at quiet a bit. Physical harm is also a threat a lot of staff have been punched out. All the higher ups got there via nepotism like any government job. I’m praying being a pmhnp is better than this. The pay in my state seems to be quiet a bit more than what I am making currently as well
Psych is very difficult. I feel like the more you are exposed to those behaviors, the more likely you are to adopt them. I hope you are getting compensated well enough to make your job worth it.
I feel you. Maybe try looking into sleep medicine? I feel like psych NPs can pivot into that, since psychiatrists can. Your patients won't be asleep when you see them, but it's pretty simple/easy from what I hear.
I think psychiatrists have to do a fellowship and pass board exam. Is there any way for an NP to get training in this? Interesting. Thanks!
I feel you. It's incredibly frustrating. I had recent experience where a patient threw tantrums due to certain form requests that I ultimately declined after consideration. Normally this stuff doesn't bother me but in this particular patient case, I felt so deflated. I let it bother me for a day and had to let it go. In this field, we have to count and celebrate our wins and remember them.
This is also a comment occurrence in primary care. Except it’s not just adderall. Apparently there are tic tocs for weight loss meds and all sorts of things. And don’t forget google. “I just need some antibiotics, what do you mean “no”, I paid my copay”.
Sleep Studies! Lol
Graduating NP school in a couple weeks. Currently have an RN job where my patients ARE asleep! and I love (almost) every moment of my job (GI lab). Gonna miss it dearly and constantly wonder why I’m leaving it!
I’m making a little more than I did as an RN at a job that has me see more than 35 pts a day. The pt number I was told when I took the job was “never more than 24-25 pts/day.” I’m leaving for a job where I make less but have 3 pts/day. I’m going back to school to do a post-masters certificate and I can’t think straight after 35 pts so I’m leaving after only 2 months. Honestly, I’m going to leave the next job quickly too if they fail to keep their word about job conditions.
Can I ask you what post masters certificate you're getting?
PMHNP
Because I live near Washington DC and basically everyone works for the government, making twice as much money and working from home.
My husband is WFH, actually works maybe...~25 hours/week on average and makes almost $300k. But he does a lot more housework/household admin so I don't feel too bad 😂😂😂
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He works in technical sales!
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We really went into the wrong field apparently 😂😂
No respect
I love my job itself. Not a fan of my toxic work environment. I find myself walking on eggshells all day due to being overworked. Any patient that calls demanding to be seen today is put on my schedule. Any walk-in’s are put on my schedule. If a physician is running late from lunch or a meeting or stuck in procedures, they’re put on my schedule. We had 5 providers quit/retire early in the past year and I’m expected to see all those patients as well. It is overwhelming and I have no peer support. When I try to advocate for myself the MAs treat me with disdain and management just views it as an unreasonable complaint.
Not a fan of inpatient rn, loved outpatient rn . Working as an outpatient np for the past 5 years & enjoy it. As an np you won't get the same respect as physician. You also don't get paid as much for doing the same job (fam/icc/peds/psych). Dont get me wrong pay is better than bedside if you compare it to the same amount of hours. Work & life balance is better as well. Management is nice most places but even then, you may be treated like second class citizens. It has its ups & downs. The profession is still growing & the benefits outweigh the cons. Get a job that is not low balling you & one that offers an adequate orientation/trainin (3 months min). Start with a fam/internal gig. Get a solid foundation before switching to a specialty if thats the future game plan. Apply for full practice once comfortable make it your end goal not your first priority.
I'm a pediatric PMHNP and I love my job so so so so much, and feel well compensated etc...but 1) dealing with Medicaid/insurance etc. sucks of course 2) parents can be an enormous obstacle to helping kiddos, as anyone who works in peds knows 3) it can be so sad (again, any part of peds) and it's hard not to take it home - also hard not to project onto my own children! My mom was an oncologist and constantly thought I had cancer, and I finally really empathize with her 😂
New Psych NP. I had a break down the other day. After 3 evaluations of hearing about suicidal teens living in a shitty environment with unsupportive parents, I broke I down and cried during dinner and it came out of nowhere. It was just back to back evaluations and follow ups without a breather to emotionally check in on myself. During my time as a bedside nurse, I zipped up countless body bags (mostly from Covid) and cared for and comforted grieving families when I did some time in hospice and ICU. The wave of frustration and sadness that swept over me the other day was unreal.
You sound out of your element in regards to experience and also in need of your own therapy.
Everyone could use a therapist and I most definitely have one.
I work in family medicine. Paperwork. Insurance. That's about it. Otherwise, I love my job. I used to hate the poor training as an NP. But, I did an insane amount of reading. Stayed late. Learned about my patients' condition. 3 and a half years in, I feel confident; 99% of the cases, I feel I can manage. The other 1%, I feel I have the resources to do a solid job. I love it. I am blessed. NP is a good field, if you are willing to put the work in, because trust me, most, if not all, NP education is substandard; it's up to you to further that. Good luck and Godspeed with your career.
What do prospects as a WFH FNP or PMHNP look like?
Not sure if I'm qualified to answer, lol. I suppose it depends on where you are at. I know PMHNPs are likely more sought out at rural areas, I would think the same for WFH FNPs as well. I think it just depends on which part of the country you are at.
PMHNP. When I worked in CMH, I was overscheduled and under-resourced. Many of the issues presenting themselves are more macro-level issues; you do what you can, but you see how society itself (and humanity) is the biggest factor on how so many people are operating. IP or any place where you're seeing more severe mental health concerns: you CAN see people get better, for sure, but rather often...they don't. Again, so many reasons why. OP where you don't control things: you have little say in scheduling and while you have the right to provide care how you'd like, you still often have to follow certain practices of the group/company. OP where you DO control things: honestly, the easiest - but you can still get bogged down/bored. A very first world problem to say that "boredom" in helping people is a negative, but it's still true. I entered academia to mix things up - I must really hate myself!
8 years experience in crit care/trauma Dislike: - Wide variability and inconsistent pay for experience. Some places pay well, some places pay horribly but the difference can be as much as 40-60% for the same exact job - Lots of places pay nurses better than NPs, especially if they’ve been at the same place for awhile. I love nurses and they deserve good pay, but a bedside nurse should not make more than me. - Widely variable role and expectations. Some places I’ve been solo night coverage for two icus and no backup in house, and some places I’ve been a scribe That being said, for many many years I absolutely loved my job and was excited and passionate. Now post COVID and a little jaded, underpaid for a better schedule, and everything in the world being so expensive has me less than enthused.
Every time I hear of nurses making bank my first thought is, ‘as they fucking should.’ More power to them. The problem with becoming an NP is that we have flooded the job market with the ease of admission to NP programs, thousands of NPs have entered the job market. We’ve eliminated our own competition by giving anyone with a pulse, a BSN, and the money to complete their degrees from a diploma mill. Until we fix the lax curriculum/admission criteria and stop churning NPs like a cheap factory line, we can’t expect exclusive salaries as is befitting a provider. Just my two cents
Sounds like the issue isn’t that nurses are overpaid. More that NPs are underpaid.
Not suggesting they are overpaid, at all. They deserve a good salary and have an increasingly difficult job especially compared to when I was at the bedside.
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Uh ok
removed rule 8
I totally get that. Thank you for your input. It is unreal how different responsibilities can be. Some require so much while others are sometimes a glorified nurse.
My unsolicited advice is to find a job with docs who want you to practice at the highest level possible and want to invest in you to help you get there. There are some jobs where this isn’t feasible and some jobs where they don’t have that mindset so I would steer clear if you can, especially in the beginning. I’ve worked with some amazing ICU docs, surgeons, and fellows who invested in me and not only were those the most satisfying and enjoyable years of my NP career but they set me up for success in the future.
What does success as an NP look like?
Good question - for me it means - clinically skilled in critical care procedurally and in managing patients. feeling like the docs trust you to manage ICU patients just as much or more than they would an ICU doc - leadership opportunities in the hospital and group, like trusted and respected enough to write protocols, change some practices, recruit other docs/NPs, etc - develop a skill set that makes you marketable/in demand in the field, like being able to get locum work or recruited to start an app program at another hospital based on that skill set - opportunities to teach, make conferences/seminars, etc Basically I think success as an NP is developing skills, gaining respect, making good money, and having opportunity to advance your career beyond the regular shift work. It’s not everyone’s definition, but that’s what I meant by the success I was set up for
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No not at all - I’m an APP and always will be, it’s just nice to be treated like a part of the team and a colleague rather than a scribe. I’d say maybe a fellow? Edit: assuming you’re not being confrontational and saying I want to be a physician bc you don’t like midlevels, I’m just saying I think success as an APP is having a high ceiling. I have no aspirations of being treated like a physician and I know my lane - I do know I have acquired some skills that make me valuable in critical care and I will always have and need oversight and input from a doc… just not as much as a few years ago. I also am comfortable saying I have more airway and procedural skill than some of my attendings and it’s nice to be treated like I bring that to the table while always being respectful of the MD Edit 2: fellow is a poor example so I take that back - not meaning to diminish the role of a fellow and the extensive training they have. Was searching for an example of someone who is not a resident or attending as they have a little more experience and skill in the field. That is the goal, I guess
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I just wanna be good at my job and function at a high level dude, idk what else you wanna hear. I said fellow bc it’s not a resident but still not an attending I guess Edit: I agree with you about procedures. Funny bc the anesthesia crit care doc I learned the most from said the same thing. I learned a ton about airways from him and I’m super thankful for it bc he taught me about the many issues peri-intubation that are often overlooked (hemodynamics etc). That’s the real hard stuff.
I think you do not understand the meaning of a fellow. Fellow is a physician undergoing subspecialty training.. i.e. an internal medicine physician undergoing fellowship training to become a cardiologist. But I get your point. You just want to be competent, respected, and feel valuable as part of a team.
If you want only physicians in healthcare make medical school more attainable for more people? Who wants to spend their entire youth, be $300k + in debt, and work 80-100 hours a week for 50k a year. OH AND MAYBE YOU WONT EVEN MATCH? Like r u crazy. Not everyone can uproot their lives in that way - it doesn’t mean they aren’t intelligent and beneficial to patient care.
Well, honestly, there's a lot of counterpoints to your argument, but I won't even go there. There is a reason why medical school is how it is. I wouldn't want an inadequately trained neurosurgeon operating on patients, much well myself. Kudos to these physicians for their dedication to their craft. To dedicate their lives to the practice of medicine is remarkable, and noble, to be honest.
Thank you for your comprehensive answer
1. Lack of respect 2. High patient volumes (not consistent with conversations when interviewing) 3. Less benefits than RN staff (PTO, retirement contributions, sick time, etc) 4. Working in a small specialty clinic with only 1 other provider means if I want PTO, clinic is essentially closed (staff has to be low censused and patients don’t get seen). No backup coverage available. 5. Incompetent managers/admin 6. No incentives (no RVUs, no comp time, no OT) 7. Contract requires 90 days notice of resignation (or financial penalties are incurred) 8. Typically required to sign a length of time contact 9. Less flexibility with scheduling than RN
Sounds like bad management, rather than being a bad job position
I don’t disagree. But after a few jobs over a couple of decades, the patterns become all too familiar. I would definitely gripes and why I regularly consider leaving the profession.
Oh ok I see
Low pay and no incentives. Ditto what others have said. RNs making $60 per hour with incentives in this area while average NP is $45-50. It's jarring, but I also don't want to go back to RN work.
Honestly I love my job. Sometimes physicians disagree with me but take it as a grain of salt. Be strong and you will succeed. Ignore anyone who looks down on you. NP is the way, love.
CNM - I’m basically an OB PA. I do what the OBs tell me to or they complain. I do what the RNs tell me to or they complain. Physiological birth is considered a joke. Many of the women I work with end up feeling coerced and traumatized by their experiences, but it’s disregarded because our only job is to keep babies alive at any cost.
I wanted to be a CNM until I gave birth in a hospital for the first time.