r/PMHNP

I'm heavily considering taking a VA job as an experienced PMHNP. I understand that overall experiences can vary by VA center, but I am hoping to get some feedback from actual PMHNP's employed in GS positions.

I am wondering about how it is day to day, how many patients you see, productivity expectations, acuity, burnout, admin requirements, Bureaucratic burdens.

Overall, the Southeastern VA I am looking at seems to have a pretty good reputation and is noted as a smaller VA compared to larger cities.

I would LOVE to learn ERP. I've already watched the NOCD videos, but feel like I need something more. Has anyone taken a class that really helped them move from enjoying the idea or ERP to doing it well with patients?

Occasionally I have patients who are very stable, busy with life, and difficult to engage in conversation despite using open-ended questions. Some simply do not have much to discuss, and I struggle to keep the visit going face-to-face for 20–30 minutes. However, my job requires the full appointment time to be spent face-to-face, and appointments are timed and recorded.

I really struggle with this because I want to do the right thing ethically and still meet my job requirements. I can’t imagine I’m the only one who occasionally encounters patients like this. How are others handling these situations while still meeting documentation and workplace expectations?

I want to add that all of our patients are cash pay so insurance requirements are not the issue.

Hello,

I have heard many people say that new grads should work an inpatient psych hospital before going into remote or other positions. Is that true?
I found other positions (fully in-person) but it is not in a psych hospital (more like a clinic, therapy etc.)
What do you think?

I got offered a position as a 1099 and was told to make a PLLC. They give me an office, therapists, a scheduler, and a biller. I'm being asked to create my own intake forms, no-show policies, etc. I know what I want on there in concept, but I don't know what legal jargon and stuff I might need. Do you just copy and reword others that have been written? Is there a central document hub I can utilize?

Looking for any advice or ideas for PMHNP side gigs to look into!

Hi all! I just graduated with my B.S. in psych and have always been interested in nursing, especially in the mental health and behavioral health field. I have worked mainly with major disorders such as schizophrenia, bipolar 1 and 1, BPD, etc.

I’m very interested in medication management and helping people (as generic as it sounds).

What degree would I go back for in order to get on track to become a PMHNP?

How do you find collaborating Drs as an NP. Is it free? How do you get them to work with you?

I currently was asked back to a private practice that was having issues with another NP. She was let go and I came back woth a promised 70/30 fee split.

I've been. There since April 1st. Seeing 30 patients a day, 4-5 days a week and sending meds for the attending while he's gone on vacation.

And I have yet to be paid. I don't know what to do. I need income I'm looking at headway and other places with limited luck. I've worked for a couple FQHCs and it was interesting to say the least. But now I'm running out of food from the food bank and can't make my mortgage. Anyone have any options for part time remote/hybrid PA? I'm just at the bottom of the depression pit at this point.

Wrote a short piece on what low-dose quetiapine is actually doing at the receptor level and why the risk-benefit doesn’t hold up for most insomnia patients. Unfortunately this is pretty common practice in my experience.

So I have a little over 6 months experience inpatient acute psychiatry. I was wanting to start my own practice via Headway. However, I need a collaborating physician which I do have an MD that would be willing to do it but she is not covered privately. She would need to be covered on my malpractice insurance I think. So then I was looking at NP collaborator which the first 2 months is free with Headway but it will then charge me $500-$1000/mo. The goal is to market my business enough to where I’ll be making what I’m making now which is around $10k months. I just don’t know how fast I’ll be able to grow it and if the NP collaborator company is worth it or should I just try to get the MD I’m already comfortable with covered??

I want to get out of inpatient ASAP!! My notice has to be 90 days so I already put it in but I’m starting to panic. I still have time though. So any tricks and tips to starting your own business this way, I would greatly appreciate it!

As the title states, I am a MH therapist--for many years. I also live with chronic pain. Like many of you, I have been gaslit, and told to see a therapist. Sorry--but therapists really are not equipped to deal with the reality of chronic pain. So, last week, I took a training on "the psychology of chronic pain." And OMFG--it angered me. Here are some of the gems that therapists are learning: "pain is not solely a result of physical injury, but rather a complex experience, influenced by cognitive and emotional factors."

Yeah, that's right--it's all in our heads.

Pain is not an accurate indicator of tissue damage, but rather your brain’s best guess based on the information available--again--all in your f*ck*ng head.

Pain is never purely physical-again--you are imagining this.

"Pain is located in your head, in your brain!  When you have pain, your brain is actively processing it. " No sh*t, Sherlock.

"CBT is recommended" for how we process pain, as is acceptance commitment therapy, as is mindfulness, and visualizing moving.

So your thoughts about pain are distorted, you need to breath more, and visualize getting off your a$$. I promise you--as a therapist I will never gaslight a patient like this. CBT is the biggest thing used to gaslight patients. It is a perfect modality for acute anxiety, phobias. But chronic stuff? Umm. nope.

I do lots of education and rule out their health issues all that . But pts push back .
I explain what ADHD look like , but they say that’s what they have .
Experienced PMHNPs here , what do you say to your pts regarding what is adhd ?

I swear to god these young kids have their script .

A custodial mother is bringing their child to our clinic in Nj. The noncustodial father states he has a court order to be involved in treatment and a signed Roi neither of these documents are on file. The patient has been prescribed Vyvanse 40 mg po daily for ADHD and the parents disagree on whether the patient needs medication (custodial believes he needs it). The provider does not mind including the father but without a court order is it required to include the father? The mother may disagree with including him

New PMHNP here looking for opinions on a PRN SNF psych offer in Oklahoma.

This would be a side gig (l1 day a week (not my primary job). Current offer is:

- $35 per patient encounter and up to 8 patient encounters and hour, so up to $250 an hour
- $15 telephone management note
- $.78/mile reimbursement
- malpractice covered
- precharting done by staff the night before
- mostly follow-up geriatric psych / memory care patients
- they estimated around 25–30 patients/day
- usually 1 facility/day
- W2 PRN position

A few things giving me pause:
- contract has a 120-day notice requirement from provider side
- 2-year noncompete/non-solicit language (although they verbally clarified my outpatient psych private practice + university psych job are fine and they mainly care about competing nursing facility work)

They do seem reasonable overall and have already clarified some contract questions for me.

For those experienced in SNF psych:
- Is $35/encounter reasonable for this type of setup?
- Is the workflow usually manageable if precharting is done?
- Is the 120-day notice clause a red flag or pretty standard in SNF psych?
- Anything else I should specifically ask before signing?

Trying to figure out if this is a decent entry into geriatric psych or if I’m undervaluing myself.

Does it make sense to anyone why stimulant medications are schedule 2 (higher up on the scale, under the same category as opiates, despite being a first line treatment for ADHD), and benzodiazepines and Z-Drugs are schedule 4?

I think it should be the other way around. I’ve seen more withdrawals/dependence/long term problems with long term benzodiazepines vs long term stimulants used carefully in the right patient (with a full assessment of the diagnosis, no cardiac/substance problems) with the FDA limit in mind…

What do you think is an appropriate amount of time to give an employer to leave a position? Was thinking of asking them something like: “How much time you need to find a new APRN?” But not sure that’s the right approach, and if I should instead give a 1-3 month notice, or maybe combination of both.

This is a community mental heath clinic and I am the only APRN. I’ve been there only 5 months and trying to hit 6 months before I seriously consider leaving. It’s just not for me long term and there are many red flags, so planning to jump ship in the near future. I do feel bad about leaving, and want to try to do it in a respectful way.

Appreciate any feedback!

Need input on work environment.

I have 4 years experience as a pmhnp. Have worked all 4 years at a small, pmhnp owned private practice. The owner is a good person but a shitty leader/boss. And I need input helping me decide if it’s time to stay or go…

The pros - flexible work schedule, good pay and freedom to say “yay or nay” to the patients that want to be seen. No micromanaging from the boss… but…

The Cons - office manager is insufferable. Tries to tell us (two other providers) what to do, how to respond to messages, when to discharge etc. the boss knows this - does nothing about it but tells us providers “you do what you want. You don’t have to listen” BUT says NOTHING about correcting her behavior. This person takes every disagreement personally. If I disagree - it’s days of petty behavior. The boss says “ignore it”.

The two other providers are part time as well - we all hate it there for this very reason - like we all love the freedom and autonomy but loathe having poor leadership and a old, salty office manager try to tell us how to do our jobs.

Today was just hard. I’ve gotten to the point I just smile and do whatever I want. It’s easier.

So - am I being to sensitive or expecting too much? I’m happy to answer questions.

Thank you! 😊

140,000 a year as a PMHNP fully remote. I think bonuses are available depending on how many patients you see but I am not sure. what do you guys think? (still interviewing). you are on call once a month. I am a new graduate

• 12 vacation days per year
  • Accrued at about 1 day per month
  • Allowed rollover up to 40 hours
• 12 wellness days per year
  • Front-loaded
  • Reset on your anniversary date
• 3 floating holidays per year
• 9 paid company holidays
• 3 bereavement days

They match your 401k by 3% and you are fully vested after 2 years. They pay for my licensure and professional coverage. Also offers CME reimbursement of up to 3,000$. Offer FMLA and unpaid leave if need be.

Edit: not sure why this post had a lot of downvotes. Lool but the patient load is anywhere between 10-15 patients a day.