Learn how real students navigate their way through the graduate school admissions process and grad school itself with our What is Graduate School Really Like? series.
Meet Javier, a DNP student on a mission to increase mental health awareness in his community.
Javier, thank you for sharing your story with us!
What inspired you to pursue a career as a nurse practitioner?
Javier: I always knew I wanted to work in mental health as some sort of therapist. As such, I applied to social work school with the idea of becoming a licensed clinical social worker. However, while I absolutely think the social work curriculum is outstanding, I felt as if it did not place an emphasis on neurophysiology as much as I would have liked it to.
I withdrew my application and thought to myself, What now?
At this time, I was working for an after-school program which utilized nursing students as volunteers. One of the nursing students suggested that I become a psychiatric nurse practitioner. At the time, I was not familiar with the role of a nurse practitioner. After looking more into what the role of the psychiatric nurse practitioner entailed, I found it aligned perfectly with what I saw myself developing a career out of.
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The fact that PMHNPs (psychiatric mental health nurse practitioners) are trained to provide both medication management and psychotherapy would allow me to enjoy the best of both worlds. This specialized role would allow me to treat patients holistically, both through medical management and therapy.
With this in mind, I knew that I had to become a nurse first before becoming a nurse practitioner. I did consider staying a nurse and working in a psychiatric unit. However the role of an RN in psychiatry is different from the purpose and interest that I have: which was to be able to provide psychotherapy to clients and gain a deeper understanding of neuroanatomy and psychopharmacology. More importantly, I wanted to be able to have more autonomy over the treatment plan of the patient, which as a nurse practitioner, I would be able to have.
Did you work at all as an RN or go straight on to begin your PMHNP training?
Javier: I did not work as an RN prior to starting NP school. The PMHNP program at Columbia School of Nursing is a unique program. They are considered a Masters Entry into Nursing Program (MENP) program, which is designed for professionals who already possess a bachelor’s degree in an area of study other than nursing. For example, I had a bachelor of science in psychology with a focus on marriage and family therapy. As such, the program at Columbia School of nursing does not require RN experience. Our first year is considered the Master Direct Entry year. Throughout this time we take traditional BSN courses. However, given that it is a Masters program, we take additional courses that BSN nurses do not take. These courses include advanced pharmacology, advanced pathophysiology, advanced physical assessment, and care coordination. Completing this program allows us to sit for our RN licensing exam (NCLEX), before seamlessly transitioning into our NP specialty program.
Is it common for students to work as nurses before NP school? How about during NP school?
Javier: As a very academically demanding full-time program, it is very difficult to work throughout our DNP, but there are a few folks that do work as an RN while in the DNP portion, especially those in the Acute Care specialty, as that specialty requires students to work during their program in order to gain experience.
All in all, though it is common for students to work as RNs first and then move toward the advanced practice registered nurse (APRN) role, it is no longer a requirement.
To this point, there have been times where I have received negative attention for taking this route. I have heard things like, “You’re going to become an NP without working as an RN first?” or “You can’t be a good NP without bedside experience.” I disagree. I think in the case of the PMHNP specialty, bedside nursing experience does not necessarily equate to developing the skills necessary for excellent patient-centered holistic care.
In my case, while I do not have any bedside RN experience in psych, my previous academic background in psychology has given me a foundation in psychiatry. More importantly, working as a case manager also provided me with invaluable experience, given that most of my clients had some sort of DSM-5 diagnosis.
Additionally, throughout my RN curriculum, I was able to secure a preceptorship inside a high acuity inpatient psychiatric unit here in the City of New York. This added experience was in addition to the psychiatric rotation that all nurses have to complete.
How does your program divide students’ time between classroom learning and clinical encounters? Are you happy with the breakdown?
Javier: Our program currently has us taking didactic courses such as individual psychotherapy theory, group psychotherapy theory, and family psychotherapy theory. In addition, we complete hundreds of hours of clinical time focusing on these three modalities. We have classes three days out of the week and clinicals on the other days. At times it can feel overwhelming, however it does make it easier to apply what we are learning in the classroom to our clients.
Did you ever consider becoming a physician assistant? How are the fields different?
Javier: I did not consider becoming a physician assistant (PA) for a few reasons. One of these reasons is the fact that PAs get trained broadly in medicine, similar to the education of a medical doctor (MD, DO) and do not really specialize until they have graduated and found an area they would like to work in. In contrast, the training that NPs receive is very specialized with the exception of a few specialties that focus on primary care health.
I really wanted to focus in psychiatry and decided that having a focused education would be a better fit for me. In addition, as of now in all 50 states, PAs are required to have physician oversight or some sort of collaborating agreement with a physician at all times. However, for nurse practitioners, depending on the legislation of the state, there are different scopes of practice. In other words, some states require NPs to have physician oversight, while others do not require physician oversight at all. This depends on the state and the type of organization you work for.
Lastly, the biggest differences are the educational models that we are trained under. PAs are trained closely using the medical model of care while nurse practitioners are trained under the nursing model of care, which stresses patient-centered care and places a huge emphasis on holistic care as well as culturally competent care.
What is the gender breakdown of your NP class? Have you encountered gender bias as a male NP student?
Javier: Throughout my experience in nursing school, males are definitely the minority when it comes to gender representation. However there are currently six men and twenty women in my NP cohort. That said, there is definitely gender bias in nursing. For example, there have been times where I have walked into a patient’s room and been called a physician- while my female peers have been confused with nurses. This is interesting given that we all have the same role and give similar introductions when we walk into a patient’s room.
At what point does an NP student select their specialty track? Is it common to choose more than one track? Is it possible to switch tracks, either as a student or later as a practicing professional?
Javier: In order to apply to NP school, you must select a specialty track from the very beginning. For example, I applied to the Psychiatric Mental Health Nurse Practitioner specialty. In general, it is uncommon for students to pick more than one track unless they are in a program that simultaneously satisfies the requirements for more than one track. For example, some programs have a combined nurse midwifery (CNMW) and women’s health nurse practitioner (WHNP) track or a family nurse practitioner (FNP) and psychiatric mental health nurse practitioner (PMHNP) track.
Once you sit for your boards and become certified as an NP, if you wanted to switch specialties you would be required to apply to the additional specialty. Luckily, you do not have to start from scratch again. Most of your credits from your previous NP training will transfer, such as advanced pharmacology, advanced pathophysiology, and advanced physical assessment. However, you would be responsible for the specialty courses and clinical hours within that specialty, and of course you would be required to sit for your boards in the specialty.
What sparked your interest in psychiatry as a specialty?
Javier: I absolutely love psychiatry, I think most of my interest came from having personal experience with close family members having psychiatric conditions. Additionally, I do remember taking a high school psychology course and absolutely falling in love with it. In fact, I ended up majoring in psychology in college.
it was really my abnormal psychology class which covered DSM-5 disorders that really sold me on it. I remember just being in complete awe when I learned about personality disorders and the role of trauma in our lives. After taking that course and other courses throughout college I was able to understand people from a different perspective.
The following year I took neuropharmacology and neurophysiology. Understanding the physiology of the brain was so complex and intriguing, it kept me engaged even outside of the classroom. Even more so, learning how different medications interact in different areas of the brain with different receptors was beyond fascinating.
Outside of the classroom I began to notice that there was truly a huge need for psychiatric services. It was during this time that my classmates began emerging with complaints of anxiety and depression and I was able to provide support using the skills I had learned. I was able to support friends who needed help, and provided them with resources for them to utilize should they find themselves in crisis.
I also noticed in them a common theme and complaint. That is, many of them were blamed for their current symptoms or told to be stronger by another individual. As a result, I realized that mental health was a topic that was not prioritized in families, let alone the community around us. For this reason, I knew my purpose was to increase awareness in our community regarding mental health.
Do you see yourself focusing more on psychopharmacology or psychotherapy as a practicing NP?
Javier: As a practicing NP, I will most likely be focusing on medication management, as psychotherapy is often left to other mental health professionals who focus solely on therapy. However, we do receive training in psychotherapy while in school. It is often standard practice to incorporate psychotherapy interventions in your sessions regardless. This may involve asking the client to track negative thoughts throughout the day (CBT), or to focus on their senses when feeling overwhelmed (mindfulness). Another approach would be to perhaps ask the client to hold ice cubes in their hand when they feel like engaging in self harming behaviors. However, if I am able to find a job that allows me to do both, I would definitely prioritize that over a job that only allows me to do medication management.
Ultimately I would like to own a private practice where I can do both medication management and psychotherapy. I am particularly interested in cluster-B personality disorders such as borderline personality disorder (BPD). Clients with this diagnosis require intensive therapy and at times benefit from medication therapy.
Do you have questions for Javier? Questions for us? Do you want to be featured in our next What is Graduate School Really Like? post? Know someone else who you’d love to see featured? Are there questions you’d like us to ask our students in this series? LET US KNOW!
You can learn more about Javier by following him on Instagram.
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