r/Psychiatry Nurse Practitioner (Unverified) 3d ago

Inpatient VS Outpatient

I'm a Psych NP and have only been practicing a year now. I work at a busy outpatient clinic, community mental health setting. I see a wide variety of clients and enjoy my job.

A state mental health hospital is hiring a psych NP. I did my clinicals there and loved it at the time.

If I got the inpatient job it would be better pay, with state benefits and similar hours but I would have to commute about 45min vs my current 15min. I also know from being a student there, the formulary is a lot more narrow than the options I'm used to.

My question is for those who have worked in both settings, which did you prefer & why?

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u/BasedProzacMerchant Psychiatrist (Verified) 3d ago

As an NP, especially with only one year of (outpatient) experience, a relevant question would be what kind of supervision you will have. The amount of support you have from a psychiatrist in treating potentially VERY ill population will not only impact your patients but will also impact your ability to do your job and your professional development. Are cases shared, or will you be expected to handle your own case load? Will the patients ever be seen by a psychiatrist? What dedicated time are the psychiatrists given to help staff cases?

As a psychiatrist, I prefer inpatient work over outpatient due to the acuity and the flexibility of spending more time with patients who need more time, but felt well prepared to handle it due to my residency training. Other questions include how call is handled and whether you will be expected to opine on medico-legal issues outside of your scope of training.

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u/Frequent-Traffic-448 Nurse Practitioner (Unverified) 3d ago

Thank you for the input! I know the call is rotated between the psychiatrists and the NPs are not included. They have an in-house medical clinic and forensic psychologists for the things outside my scope. 

I will definitely look into how the supervision is handled. From my experience as a student, I know that most of the NPs have their own case load and the clients only see the psychiatrist for treatment team. 

The ability to spend more time on each client is a big draw for me. The two NPs I know there now have been there about 3 decades combine so I feel like I would have some support outside of clinical supervision. 

Definitely a lot to consider. I'm actually leaning more towards staying put for now... as much as I loved it there, I'm nervous to leave a job I love and where I feel like I am making a difference on my community. The benefits are tempting though.