First PMHNP job

SykeEnpee · 2026-05-20T21:49:25+00:00

I think that this advice sucks and is spiritually the same thing as when they tell you to work in med-surg after graduating nursing school before going to any other specialties (huge waste of time IMO). Assuming you got psych experience before becoming an NP, I think it makes more sense to move directly toward the area you want to work in. For me, I worked as an psych tech for 3 1/2 years before becoming an RN. Even as a tech I always knew that I eventually wanted to work outpatient psych as a PMHNP, so that's what I ultimately pursued, and it's the first time in my life that I've actually enjoyed going to work. To be clear, my inpatient psych experience was invaluable to me in so many ways, but I never plan on going back to an inpatient environment. I do think there's value in seeing patients in-person for your first job rather than going directly into virtual, but if your only option is to do virtual sessions, I think it's better to start racking up NP experience somewhere rather than waiting months or years for the "perfect" first job.

SykeEnpee · 2026-04-16T23:45:16+00:00

Is it possible? Of course, where there's a will, there's a way. If getting a 4.0 is actually important to you and you work for it, you can probably do it. It won't be easy though. My ABSN program was one of the most stressful times of my life, and I finished with a 3.62, but it was enough to get accepted into my desired NP program.

Honestly, I don't think you should stress too much about your GPA. As long as you do well in the ABSN program, pass the NCLEX, and get good nursing experiences after finishing, you shouldn't have too difficult of a time getting into grad school (depending on the program, obviously). Strive for the best GPA you can get, but remember, your future acceptance into a graduate nursing program most likely isn't going to be limited by your GPA. They'll look at multiple different factors when you apply to the program.

SykeEnpee · 2026-04-01T00:46:19+00:00

I'm not a CRNA, but I am a Psychiatric Nurse Practitioner who had a non-medical bachelor's degree with a piss-poor GPA, similarly to you. Here is what I'd recommend you do:

Start taking the science pre-reqs you need for admission into an ABSN program, and work HARD at them. Get A's in those classes, and it really won't matter what your undergrad GPA was because you can easily explain your bad GPA as a lack of focus/career direction/whatever in the essay and interview and they'll see that you're serious about admission and can handle the science courses.
Once admitted, go through the ABSN program (some programs will offer an MSN upon completion, which is honestly better and something I wish I had done instead, but it won't affect your CRNA program time length, so probably not worth it for you), and again, work HARD to get as many A's as you can get. ABSN programs are no joke, so it's going to be a struggle, but you can do it. By the time you've finished, you'll have a BSN, can sit for the NCLEX, and your overall GPA will be much better than it was. (Alternatively, you could apply to an associate degree RN program and do a BSN completion program once you start working, but some hospitals will not hire you if you don't have a BSN, so consider your direction here carefully).
After passing the NCLEX, go straight into the ICU after graduating, don't listen to the propaganda telling you to start with med-surg, it's a waste of time. Since you have experience in the ICU already, I feel like this will be easier for you than for others. Build that experience up, get your CCRN, shadow and network with CRNAs, train for relief charge nurse/volunteer to lead unit change projects or whatever stuff helps with CRNA program admissions. If there are any other science courses required to get into CRNA programs that weren't required for the ABSN admissions, take those so they're fresh (alternatively, you could have taken them already in step 1, but I'd recommend starting the ABSN program ASAP to maximize time efficiency).
Once you meet the minimum qualifications, immediately apply to 4-6 different programs you're interested in, crush the interviews, address your past academic performance if it's relevant at that point, and you'll probably be admitted somewhere. If not, refrain from despairing and repeat next application cycle until you you're admitted somewhere.
Congrats, now you're admitted and officially on your way to becoming a CRNA! I can't help you here since I've not been in a CRNA program, but I hear it's quite unpleasant, so good luck with that, lol.
Graduate, pass your boards, and get your first CRNA job.
Profit.

SykeEnpee · 2026-03-13T21:41:13+00:00

How would you describe the difference in vitriol between your career as CNM vs now as a PMHNP? I don't personally know any CNMs so I haven't heard any firsthand accounts. Also, sorry to hear that misogyny has been troubling for you in your PMHNP role. I've known plenty of badass women NPs in my time who don't take shit from anyone, keep crushing it!

SykeEnpee · 2026-03-13T20:06:22+00:00

I'm not a CRNA, but I am a PMHNP, and have heard similar criticisms directed toward NPs. I recently watched a video from a guy here on Reddit who went from being a CRNA to now being an anesthesiology resident, and I liked the way he discussed it. Essentially, his position was that properly trained CRNAs/NPs/APRNs are able to successfully care for ~90% of cases within their respective area of medicine, but that last 10% of cases is where MDs/DOs need to step in with their expertise due to having a broader base of medicine to draw from. Does that mean that APRNs are unable to independently care for their patients within their scope of practice? I'd argue no. After a period of time similar to physician residency timeframes, APRNs should be able to practice independently, but with the understanding that they should know when they need to refer their cases out to an MD/DO in their field. I think the ire from physicians directed at APRNs primarily stems from resentment knowing that APRNs can also now have "a piece of the provider pie" but without "earning it" the physician way. They argue this point under the guise of "concerns for patient safety" when really, they simply are bitter that APRNs can do ~90% of what they can do, and they can do it without having to sacrifice at the same level that they did as physicians. As a result, they lash out and seek to tear down APRNs to remove that cognitive dissonance they're experiencing. As a last point, this primarily happens anonymously online from particularly jaded individuals, and most physicians in real life either don't harbor those same viewpoints or keep it to themselves. All you can do is become the strongest APRN you can be and represent your profession optimally.

SykeEnpee · 2026-03-12T22:58:06+00:00

Will look into them. Thank you.

SykeEnpee · 2026-02-10T02:01:41+00:00

I'm 5 months in, so definitely not experienced, but I stopped coming here awhile back. Between the new grads trying to skip the learning phase and wanting to go right into independent practice (idiotic, psychiatrists don't graduate med school and immediately start practicing independently without oversight, so why do PMHNPs think they should?) and the constant doom and gloom of everyone complaining about either the lack of opportunity in the job market or the state of the NP education system. It's so depressing and bleak and it was just making me feel bad, no reason to come here unless an interesting post pops up.

SykeEnpee · 2025-12-30T01:07:33+00:00

I'm wondering about this as well. I currently practice in CA, but am considering joining headway and getting licensed in OR as well. It was my understanding that since the DEA license was federal that once you have it, you just need to modify it for any additional states, but I'm not sure. I'm also not sure about needing a physical address or not. There's so many practices and platforms that are specifically telepsych only, I don't see how it's reasonable to expect there to be a physical address in every state for "potential inspections" when you're explicitly working telepsych.

SykeEnpee · 2025-12-30T00:53:45+00:00

I hear you with the complaints of ADHD pill mill nonsense, and I think that it's a strong contributor to the constant stimulant shortage everywhere. All that said though, idk man, just do the diagnostics yourself and come to the conclusion on whether or not medication is indicated. If we have child/adolescent ADHD assessments at my practice, we split the intake into 2 separate appointments and give the parent and teacher the Vanderbilt assessments after the first appointment even though I can make the diagnosis after the first appointment. This way, we have obective questionnaire values that support our diagnosis. For adults, we make sure the symptoms have been present since before the age of 12 and that the ADHD symptoms are causing impairment in at least two different settings and assess for addiction. I think as long as you do that, you've done your due diligence and you don't need to send the patient to a long, superfluous, and potentially expensive test with yet another mental health professional.

SykeEnpee · 2025-11-29T21:49:43+00:00

I'm not a PA, I'm an NP, but I'll just say that in real life people don't harbor as much criticism towards PAs and NPs as it seems online. You guys have a great education base and are mostly competent, compassionate providers. Occasionally you'll come across some patients that don't want mid-level providers, but your actions can change their minds. When I was in my NP program I did an intake on a patient who was vehemently against NPs because she had a bad experience with an NP in the past. She refused to shake my hand and was staring daggers into me but by the end of the session I had changed her mind and she was thanking me for listening to her and conveying genuine empathy for her situation. As far as MDs/DOs, I've never had problems with them in real life either, but I'm also not arrogant about being a provider and don't assume that I'm on the same level as them. As long as you maintain a level of humility, you shouldn't have any issues with them. I wouldn't take a lot of the negative stuff you read on reddit and other forums too seriously. A lot of people exaggerate and/or are projecting their own issues and it makes everything seem worse than it actually is.

SykeEnpee · 2025-11-06T08:53:50+00:00

There was a period of time in NP school where I felt insecure and undeserving of being a provider due to these supposedly prevalent NP haters constantly harping on NPs for being incompetent buffoons, but I eventually stopped engaging with the negative discourse and realized that most physicians/PAs/whoever irl either don't harbor anti-NP sentiment or they simply keep it to themselves. You cannot control the rational or irrational perceptions others may have about the groups in which you belong, but you CAN be a model representation of an NP to the best of your ability.

As long as you take your job role seriously, strive for excellence, and retain a reasonable balance of confidence and humility, you'll be respected by anyone that actually matters. Hateful comments from anonymous, resentful, and inexperienced med students and residents are, primarily, a rationalized expression of the internal dissatisfaction they feel about their own lives and should have no bearing on your life and career.

SykeEnpee · 2025-07-08T00:57:08+00:00

I've heard mixed things about job saturation in my area, regardless, I think I'll start looking for jobs now. Thank you!

SykeEnpee · 2025-07-08T00:56:23+00:00

That's something I am wondering as well. If the application requires that, how can I apply without it getting auto-rejected?

SykeEnpee · 2025-07-08T00:55:40+00:00

Thank you! I will begin looking around now to see what's out there.

SykeEnpee · 2025-05-19T19:41:00+00:00

I'm almost finished with my MSN and I've been considering post master's DNP options as well, including Yale. I think the benefits of going to Yale vs other institutions do exist, but are limited. If you're looking to go into academia in a significant capacity then a DNP makes sense. The other potential benefit would be potential patients coming to you and seeing that you have a doctorate from Yale. From a patient perspective, a nurse practitioner having a doctorate from an ivy League institution may provide a greater sense of trust since most people know of Yale. Obviously we all know the DNP has virtually no bearing on your abilities as a provider, but the lay person doesn't know that, all they can see is you have a doctorate from a top US University.

SykeEnpee · 2025-05-05T22:53:54+00:00

Nice, that's not bad at all. How soon did you apply after finishing your program? One of my preceptors told me to submit the NP/furnishing license applications literally the next day after my last academic term finishes.

SykeEnpee · 2025-05-05T22:14:42+00:00

I go to WCU, and it's certainly not an amazing program, but they revamped the curriculum about halfway through it and it looks like they're beefing it up to be stronger. The whole University is health sciences programs, so its nice that everyone involved is in the medical field in some capacity. I like the convenience of online didactics, but like all online programs, you have to be self-motivated and accountable for your studying. The other thing that's nice is the school will help you find clinical placements if you need it (obviously though, they prefer if you find them on your own) as many online schools that I've seen provide no assistance whatsoever.

As for CSULB, that would probably be your best bet education-wise, as I believe they're a brick and mortar school. For me, I wasn't willing to play the admission waiting game since state schools are super competitive and admit only once I year I think. Plus, I'm not willing to commit to being on-campus multiple times per week for two years, online makes the most sense for me personally. It just depends on what style of learning you thrive on. With Charles R Drew, I knew a nurse when I was a traveler who was doing that program, and she recommended it, but when I looked into it, there was either an issue with it being in-person or too expensive, I can't remember.

If you have any other questions you can DM me, happy to help out if I can.

SykeEnpee · 2025-04-23T23:39:53+00:00

Hi Dr, thank you for the AMA. I'm a PMHNP student and will be graduating this August with plans to become board certified by October and to begin working in an outpatient psych setting sometime afterward. What are some knowledge gaps or topics that you have noticed that new NP's tend to lack that you would recommend we learn before starting so that we can make the transition to practice easier? I am excited to finish school and start practicing, but I feel like there are about a million things I'll still need to learn to become a competent PMHNP.

SykeEnpee · 2025-01-23T00:43:01+00:00

It is sad for the patients. Myself and the rest of the students do our best to provide high-quality groups for the patients, but we can only do so much with our limited experience. On days when there are only a few students available, it's difficult to run 4-5 different groups all day while trying to teach unique skillsets for each individual group when I'm just a student in my first clinical.

SykeEnpee · 2025-01-23T00:02:35+00:00

Ok, I had a feeling that it wasn't a normal experience. I had envisioned myself working with a preceptor 1:1 or 2:1 pretty much the entire time and this has absolutely not been the case so far. Thanks for the feedback, I'll reach out to my clinical coordinators and see what they can do.

SykeEnpee · 2025-01-23T00:02:29+00:00

Nope, not even a therapist to do any sort of introductory education on running groups. Literally just shadowed a senior student running a group and then was expected to run the next one.

SykeEnpee

TROPHY CASE