Written by Jake Johns PMHNP, MSN

Ten years ago, before I was a nurse, I was a case manager. I was in the middle of a home visit, sitting with a Seriously Mentally ill patient.

I looked around the house, taking in the accumulated trappings of a family's life, and my gaze rested on a picture of my patient from high school, wearing his letterman jacket. That moment hit me right across the face.  

The person in front of me was a regular high school kid! Just a couple of years ago, he looked happy and confident. And a few years later, the tragedy of Schizophrenia had enveloped him. 

While I had been eagerly awaiting entry into nursing school, this moment, staring at that picture, set the course for my nursing career.

My name is Jake, and I'm a psychiatric nurse practitioner - PMHNP. 

I currently work in a psychiatric emergency room, where most of our patients are brought in involuntarily. 

I have fourteen years working in behavioral health. I've been a behavioral health tech, case manager, crisis worker, registered nurse, and now Psychiatric Nurse Practitioner.  

I thought about sharing all the interesting stories I have heard, the names I've been called, or the exciting things that have happened while I have been in the mental health profession. This would probably get clicks - they are fascinating stories - but would likely contribute to a narrative and stigma that people with mental health issues deal with daily. 

I chose instead to share this story that I think about often, that keeps me motivated and helps to humanize those on the other side of the nurse's station.   

Seeing that letterman jacket photo has been a catalyzing event for why I do what I do. Every person that I come into contact with had a future interrupted and has the opportunity of recovery. They deserve respect and hope. Something I have always said, it only takes a couple of traumatic events in my life, and I might be on the other side of the nursing station. This is my guiding principle and helps me connect and be empathetic when listening to my patients' stories. 

Mental health nursing is unlike all other fields of nursing. Our assessments aren't deciphered with machines, our stethoscopes are neglected, and we talk a lot with our patients. 

• It's different

• it's creative

• it's about human connection

So maybe this has piqued your interest, made you excited to explore this path.

So what does it take to be a psychiatric nurse practitioner?

For any nurse wanting to become a nurse practitioner, the greatest pre-requisite is experience. Nurse practitioner schools cannot teach you everything you need to know in 500 – 1000 hours of clinical experience. You have to have the foundation of experience to understand the nuance and difference between diagnoses prevalent in psychiatry. You have to have the experience to understand the unique language used in assessment of patients. You need to understand that part of the psychiatric assessment is listening to the words people say; also, it's watching how they say them and often listening for what a patient doesn't say.  

Secondly, it takes a tremendous amount of self-reflection. 

A good psychiatric nurse practitioner is self-aware, examining their expressions or lack thereof, and understanding transference and countertransference issues that can come up in every situation.  

Patients deserve compassionate self-less care despite their treatment of you.  

Can you listen to someone who is expressing hatred towards you while making balanced clinical decisions about their treatment? 

Can you discuss issues of grief, death, suicide, and the like with a sense of calm?  

These are uncomfortable topics to discuss, and some people won't ever get comfortable with these. It's ok if you aren't comfortable with these, and it's ok if the PMHNP path isn't for you. 

The Pay is Excellent

Yes, the pay is excellent! Like, people expect you to pay for lunch excellent. But don't let that tempt you if the things above are not your comfort zone. The patients deserve better than people coming to the profession without any semblance of compassion. It is a hard job; burnout is prevalent in the profession.  

My Strongest Advice

Most importantly, find a good mentor, someone in the profession that can tell you the highs and lows of this profession. 

An individual's key characteristics that would be perfect for this profession are an experienced, compassionate, non-judgmental person who is unafraid to ask hard questions and has a good grasp of psychiatric illness and medication that can be helpful. If this sounds like you, go get a mentor, study hard, and prepare yourself for a wild ride full of ups and downs. Ultimately this is treatment for people that have often been treated as "lesser than."  

If I can walk into my work and see their trauma rather than their behavior, I can do well. Every person has an opportunity to recover, to better their life, to get opportunities to change their course.  If you have a similar vision, PMHNP could be a great choice for you.

Hey my name is Jake,👨🏼‍⚕️PMHNP-BC, I mostly survive on fortnite 🎮 and ☕️ these days. I’m married and a father of two boys, and I’ve been in Arizona for about 12 years by way of California.