Psychiatric Mental Health Nurse Practitioner, Kirby Williams

[00:00] Michelle: I really enjoyed talking with Kirby Williams, a psychiatric mental health nurse practitioner. While working as a nurse on a Med-Surg unit, Kirby saw the disconnect between caring for patient's physical health and the lack of care for their mental health, and she decided to do something about it. She continued her education, became a nurse practitioner, and delved even deeper into this niche nursing specialty. She gave us all the details on where a PMHNP can work, the training required, the subspecialties as well as the heaviness of the job, and how she cares for her own mental health. Her students are lucky to have her as a mentor and her patients as their provider. In the five-minute snippet. I absolutely love her advice for babies, explore ALL the possibilities. Here is Kirby Williams. You're listening to the Conversing Nurse podcast. I'm Michelle, your host. And this is where together, we explore the nursing profession, one conversation at a time. Well, hello, Kirby. Welcome to the show.
[01:13] Kirby: Thank you, hi, Michelle, how are you doing?
[01:16] Michelle: Well, thank you. We're drying out a little bit in California. We have sun today, so I'm happy about that.
[01:24] Kirby: That's good.
[01:26] Michelle: Yeah. Thank you so much for joining me. I kind of, quote-unquote "met" you on Instagram when I started my Instagram for my podcast. Instagram likes to give you suggestions like, "you might want to follow this person." You popped up and I said, "oh my goodness. What is a psychiatric mental health nurse practitioner?" Never heard of this nursing specialty before. And then I learned a little bit more about you and I saw you've been doing this for eleven years.
[02:03] Kirby: Yes. Going on twelve now that we've just hit the New year, but yes.
[02:09] Michelle: And I was like, oh my God, where have I been? I've had my head stuck in the NICU.
[02:14] Kirby: Right? Yes.
[02:16] Michelle: Why don't we just start by giving our listeners kind of just a broad description of what you do.
[02:24] Kirby: Yeah. So a psychiatric mental health nurse practitioner, some people might see the acronym PMHNP. And what we do is we are advanced practice nurses. So we are nurses who have a master's degree in nursing with a focus on psychiatric and mental health conditions. And so what I do, more generally speaking, or what we do as a collective in our careers, is that we treat mental health conditions and that is with medications or with nonpharmacologic treatments as well. And so that's what we do, kind of more generally speaking.
[03:08] Michelle: Okay, well, that is a very good overview. So I know that there are some kind of sub-specialties within this specialty, some of those being like addiction treatment, but yeah, tell me about some of these subspecialties.
[03:27] Kirby: Yeah, there are a lot of subspecialties. The one that I feel is growing, or has been growing recently has been the perinatal mental health specialty or subspecialty. And that is a really special one because there are a lot of providers who are nervous when they have to manage the medications of a person who's pregnant because they have to think about the health of the pregnant person and then also the health of the fetus and when the child comes out. And so that's one specialty. Another specialty is addiction. And so those psychiatric mental health nurse practitioners or other providers in mental health who focus on addictions are focused on recovery, are focused on helping people continue their recovery from different types of addiction. And sometimes in those cases, they're using medications to help kind of supplement their efforts to recovery, so to speak. And then there's also and then when you look at the inpatient side as far as a subspecialty, there it's called consult and liaison psychiatry. So those are specialists who have a really good background in medical as well as psych. And what they focus on is being able to go to medical units and do consults on medical units. And sometimes even in the ER, if there is a case that is maybe a little bit more complex and they're trying to differentiate from is this a psychiatric illness or is this a physical health illness or is it a mix of both? Because sometimes it can be something like that as well. So those are just three of the specialties. I probably could talk all day about the specialties, but those are just three of the probably more common specialties.
[05:27] Michelle: Well, those are so interesting. My ears kind of went up a little bit when you talked about the perinatal sub-specialty working in the NICU for so many years, of course, we would see the mothers, postpartum, come in and many of the NICU nurses were trained to do the Edinburgh Assessment for postpartum depression. And we had some pretty severe cases. And just exactly like you said, the OB'S were kind of at a loss of how to go about treating these women. And so I would imagine you would be an amazing resource for a lot of other medical professionals out there to help guide their treatment.
[06:16] Kirby: Yeah, there is a certification that actually any provider can get it's through Postpartum Support International. And I took the training on it just because I love information and even though I'm not specialized in it, I wanted to know more information about it because kind of no matter where you choose to practice as a psychiatric nurse practitioner, you may come upon someone who's pregnant. And you need to be good to have some familiarity with what's the research out there say, what kinds of things are safer, and then it talks about, like, breastfeeding safety when it comes to medications as well. But yeah, for anybody who wants that kind of training, they train therapists, they train nurses. You don't have to be an advanced practice provider to take the training because I think all information is good information and they believe that as well. But I think you just have to be I think a healthcare professional is kind of how they say it, could even be a doula and can take the training through Postpartum Support International. So it's really good training. It's like two to three days, and it's definitely a worthy investment, I would say.
[07:35] Michelle: Yeah, that's a great organization and great training, especially for any medical professionals that work with postpartum women, for pregnant women. So you talked a little bit about, when we were talking about pregnant women, one of the things that came up for me was as a lactation specialist, doctors well, providers would frequently call me and want to know if a certain drug that they were going to put the mom on was safe for her and for the baby. And I was not qualified at all. I'm not an IBCLC. I'm a CLC, and the scope of practice is much different. But I'm also a registered nurse, so I had a few resources that I went to for drugs. One of them was LactMed, which is great because it always linked the PubMed article and they liked that. The other one was Dr. Hale from Texas A&M. He has a great site, Infant risk. But you, as a prescriber, must be friends with your pharmacist. So talk about the relationship that you have with the pharmacist.
[09:03] Kirby: It's always good to have a friend, the pharmacist, when you are prescribing medications. Yes, and currently, where I work now, I'm in a community mental health setting, and so in this setting, it is a community health organization that is funded some by the state, some by the city. And we actually have a pharmacy on-site, which is very nice. And then, of course, that means there's a pharmacist on site, which is also very nice. Me and the pharmacist are best friends, and it comes in handy when you are prescribing medications if there is something that you're not sure about or sure about restarting. So yes, in the case of pregnant women or someone who's breastfeeding getting information from them, or just in the case of maybe managing a medication that you're just not that familiar with those. Yes, I've been practicing for a very long time. There are still some medications that I don't maybe have used as often or just that are not used as often. Right, exactly. New ones all the time. And I'm like, I haven't really read up on this one all the way yet if there's some pearls from the pharmacist, and that really helps. So I keep a very close relationship with the pharmacist. And when I worked inpatient, it was very similar. It was very close as well. Always when I know someone and they're on-site, it becomes very close. And I recommend that anyone who's a psychiatric nurse practitioner, make sure you have a close connection with a pharmacist. And if you can get a close connection with a retail pharmacist, even that's great, too.
[10:42] Michelle: Oh, man, yes, fantastic, the retail pharmacists. Being a NICU nurse, we had a pharmacist stationed on our unit at all times, and it was great. They were there for codes and just any questions that we had. So, yeah, fantastic.
[11:01] Kirby: Yeah.
[11:03] Michelle: Well, how did you get into this specialty? Talk a little bit about that. What excited you about it that caused you to say, I want to do that.
[11:13] Kirby: Right. So my journey, at least I think it's unconventional. Maybe it is, maybe it isn't. So I started nursing school, and I believe when I started nursing school, I was really interested in the ER. Why? I'm not really sure. Maybe because I was like, oh, that's where the action is. I think sometimes that's what we think. Or maybe we saw the show Adrenaline. Yeah, we see the show ER that used to be on a long time ago, all that good stuff. So I think that's what it was. And then got into clinicals and things like that. And I saw something recently on Instagram where someone was saying that students should make sure they're going into their clinicals with, like, an empty cup, meaning, like, an open mind. And even though no one ever told me that, I think I did go into my clinical experiences with an open mind because I was never like, oh, this is probably going to be boring, or this is going to be this or this is going to be that. I never thought that at all. And so I did my psych rotation, and a lot of people in undergrad and undergrad nursing weren't too interested in psych, and I was like, well, I don't really know much about it, and so let's just see what it's about. Let's be open to what it's about. And I got to meet they had, like, a recreational therapist on staff, and there were a lot of more therapists, and I didn't really know what therapists do, but he never really worked with one or around one, so I was like, okay, that's kind of interesting. I really enjoyed kind of the activities we got to do with patients. And then I got to attend, like, an outpatient group that I think it was a clinical nurse specialist was running the group, and so I was like, oh, this seems, like, really interesting. And then even some of the activities that we got to do, we got to create our own, I think, psycho-educational group. And I really went all out to the arts and craft store to create this group that we did, and I was like, oh, this is really cool. It felt like it was more focused on patient education and what kind of things are going to be going on once you leave and things like that. But the feedback I got from, I would say, some of the instructors. So not the psych instructor, but just instructors and maybe guidance. We call them guidance counselors in nursing school who were like, oh, no, you don't want to go on Psych. You're going to lose your skill. And I really do hate that saying. Hate the strong word. But I really do dislike that saying. Yeah, dislike that saying. But when you tell someone that I started college when I was 16, so I was in clinical at 18. And so you tell someone who is new to the world, they're going to lose their skill. And they're like, all I've been trying to do is become a nurse and go to school. And now you're telling me I'm going to lose my skill if I do something. So then I was like, oh, no, I can't do that. But I was still very interested because people kept telling me when I lose my skill. And so even at the end of my Bachelor's, I forgot what it's called. But there's something that you do at the end of your bachelor's degree training where you get to choose a specialty, and you work in that specialty for like, maybe 100 hours, 150, something like that. So I did put psych on there, and I did not get it. And I think because again, I think they were just like, oh, you're going to lose your skill, we're not giving her that. They gave me the OR. And I was like, what the OR? But I went and I did not like the OR at all, but I went. I did my hours, did my time. I said, okay. And so I started in Med-Surg because that's where they tell you to start. Every nurse has to start Med-Surg so they tell you to do that. So I said, okay, I'll start in Med-Surg. But when I started to see in Med-Surg, I worked at a very busy trauma hospital, actually, out West. I was in Phoenix, Arizona, at the time, and there were a lot of car accidents, and overdoses, some accidental, some intentional. And so, like, a good amount of those types of things were coming to the unit that I was on. And what I was noticing was that there's just this gap of things that we were addressing. So we were addressing all the physical needs, which is good. We want to address the physical needs, of course, but we weren't addressing the mental health needs. And even when the person was being discharged, there was no discharge information about mental health needs, or care, follow-up here. Sounds like this is weird. That's a real big gap for a person who's experienced this. And this is such a big gap. And so that's where my interest kind of even more kind of started. It was like, okay, I really am interested in this. I really want to get more information about this and see how I can really be a solution to this gap and how can I do that. And so I started looking up different kinds of options. I even think I thought about being a therapist, an RN and a therapist. I thought about that as well. And then I was like, oh, well, there's a specialty in nursing that you can do. So I'll do that because I do love being a nurse. I was like, well, I'll do that. And then at the time I know you haven't heard of this specialty, but at the time, it was like, really? No one was doing the specialty. Yeah, a lot of the programs were actually closing. Like, the first program that I wanted to attend, this was in 2009, was like, no, we didn't have enough people apply, so we're just going to put this program on hold for now. So I had to attend my second program, which is fine, but it was just like, no one was really interested. And I was like, is this a good idea? Were they right? Am I going to lose my skill because no one else wants to do it? Oh, no. But I was still very passionate about it, and I did it and I did it with seven other people in our cohort, so to speak, and we got really close because it was just seven of us, and it really was just a great experience. Once I started doing clinical, the education was great as well, like the didactic or the lecture education, learning more about mental health conditions and mental illnesses. But then in clinical, I was like, oh, this is where I'm supposed to be. I really felt like once I got clinicals in my Master's program, I said, oh, yeah, this is it. This is where I'm supposed to be all along.
[17:47] Michelle: Wow, that is quite a story. And, I mean, all the way through your story, I could hear your passion for the specialty, for nursing, for your patients. That's amazing. A few things stuck out there. First of all, really sad that in nursing school you're discouraged from doing anything. That's the time where, like you said, our minds should be wide open and we should be gravitating towards those things that really set us on fire and just really call us to be there. And then second, like, wow, you were so young.
[18:29] Kirby: Yeah, I was.
[18:32] Michelle: I share that, too. During my psych rotation in nursing school, I was 20, so I was a little bit older than you. But my experience with psych was very small. I think we only had two weeks there, and we had a very small rural hospital that had a mental hospital in the basement. I'm like, really, you guys?
[19:06] Kirby: Right?
[19:07] Michelle: Yeah, you're putting people that need nature and sun and all that. Really, you're putting them in the basement. And we were there during our clinicals, and I just remember this one gentleman came in, and he was my age, he was 19, and the law enforcement had picked him up on the freeway because he was trying to get into people's cars. And at that time, in 1985, the Geneva summit with Reagan and Gorbachev was going on, and he was saying that he had to warn them about something, and they picked him up and they diagnosed him as schizophrenic. And I just remember feeling like, oh, my gosh, that's so sad. This person is my age, and they're in this mental hospital, and now they have this big diagnosis. So I imagine that can kind of get to you. Talk a little bit about how optimism is so important when you're treating your patients.
[20:21] Kirby: Yeah. So I really definitely think that optimism is something that is really important for sharing with the patient. Because nowadays, especially now, with maybe social media or access to other things or even access to the wrong information or not validated information, they may assume if they've been given a diagnosis and then they Google it themselves or whatever, they might look at that. It's going to be something like whatever they've seen that's distressing. And so it's like that's not quite it still letting clients know that there is hope, one, that there is hope if they are given a diagnosis, that it's not a sentence, that they cannot live a fulfilling life. I've seen people who have a diagnosis like schizophrenia live a very fulfilling life. I've seen others who've been given me the bipolar diagnosis or been really in a deep depression, who've been able to live a fulfilling life. And I think knowing that and even sometimes I'll tell patients those stories without using patient information, but just going over. I had a patient who had a similar diagnosis, and they're doing this and this now to let them know that, because that even energizes the patient, I believe. And maybe the family, if the family is involved, the patient to really take ownership, I guess, of their treatment plan and then really release they involved in their treatment plan and really try to push forward themselves. Having that optimism and knowing that this isn't all their life is their life isn't just necessarily coming to a hospital or being in a hospital, or sometimes they feel like my life is just always having to take these medications or something like that. They may have to take medications for life, but they can still have some fulfillment in other ways. You can still have a life. You can still have connections with others, your own family, even a job that you enjoy, all those things.
[22:38] Michelle: Optimism is huge, and I think your patients could definitely feel that talking to you. I'd like how you gave examples of other patients that you treated. And this is not a death sentence. This is something that, like you said, you can have a fulfilling life with meaning and connection, and these are the steps that you need to take to do that. I think that's really important.
[23:05] Kirby: Yeah.
[23:07] Michelle: Do nurses in your field experience burnout or like a high turnover, I would imagine it's kind of heavy at times.
[23:17] Kirby: That's the word I use. I like that. Yes. Heavy. Yes, I use that term. Yeah. The work that we do and I think the work that all nurses do, but thinking about those in the mental health field and the mental health space, the work that we do, I tell people can be emotionally heavy. Sometimes it can be very distressing to see maybe a patient come back in for similar symptoms, come back in for similar reasons. It can also be distressing if a person makes any attempt on their life in any way. These can all be very distressing things or even what can be distressing, and I feel that might be the most distressing for mental health nurse practitioners is that we are exposed to very traumatic information from patients. So we are asking patients for more details about maybe past trauma that they've experienced or very distressing situations that they experience and sometimes, if it's therapeutically appropriate, having them talk about them. And so when you experience that, it's almost like experiencing secondary trauma. When you hear these types of stories when you hear these types of scenarios and encounters and so there can be burnout in the way of like maybe people might call it compassion fatigue or burnout in the way that it just feels so heavy that if you're working 40 hours a week, Monday through Friday, the two days in between are not enough time to recoup, to be your full, emotionally available self. I'll say on Monday. So I definitely think there could be a high rate of burnout or those feelings of secondary trauma that do come up.
[25:19] Michelle: Gosh, I would imagine talking about the secondary trauma and all that right now I'm reading a book, The Body Keeps the Score.
[25:31] Kirby: Good one. That's a good one.
[25:33] Michelle: It is really good. And I think I'm experiencing a little bit of what you're talking about. But yeah, that's real. How important you talked for a moment about the family, but how important is the family in the success of the treatment of the patient?
[25:54] Kirby: Yeah, so I think family or any support system, any support system or support persons is really important. And in some cases, there isn't family involvement and there are a lot of different reasons for that, but in some cases, there isn't. But what I've seen is that when there is family or support system involvement and it's very strong, I have seen a lot of those patients do very well. I've seen them stay involved in their treatment and stay active in their treatment for longer. I've seen them ensure that they're coming to appointments. I've seen them be stronger and more consistent in that and I've seen them even be more active in their treatment. So again, even asking more questions about their treatment, what does this mean? Do I have to be on this medication for what period of time are there options for lowering the doses or something like that? So when there is family or support system involvement, I have seen that be very helpful. But at the same time, one thing I've told other students that I have worked with are precepted is that sometimes family involvement occurs. Because sometimes if we think about a patient, for example, who might have schizophrenia and they might experience delusions, sometimes those kinds of symptoms have been so scary to a family have been so distressing to a family that family members have had to can say the word like keep their distance because they felt very either triggered by that or it was becoming so overwhelming for them that they had to keep their distance for that reason. So I do try to be understanding when I know there isn't family involvement because I could only imagine what that might be like for someone and to experience that from a close family member.
[27:59] Michelle: Yeah, it could be scary too. Definitely. Do you do any one-on-one counseling with the patient and or the family?
[28:10] Kirby: Usually for me, and kind of in the roles that I've been in, the counseling is more educational that I do now about the disease process, the medication, what the prognosis or trajectory might look like or could look like. So I do more of that educational piece. Now, there are some nurse practitioners who do mostly therapy so similar to like a therapist do mostly therapy, and really enjoy that piece of it. But for the most part, a lot of organizations are looking for providers to be able to add that prescribing aspect because as we know in a lot of different kinds of communities, whether it's a rural community or not, there may not be as many professionals who are skilled in that area.
[29:13] Michelle: That's really important to treat the family with the patient, make sure they're all on the same page, all of that. Well, is there a psychiatrist shortage and do you think that this specialty in nursing came out of that? If there is one.
[29:33] Kirby: I got you. Yeah, so I believe so. I'll start with one question first, right? I believe. I would say that I think that this specialty in nursing did come out of a psychiatrist shortage. I think that was one piece of it. And I learned that when I started working inpatient because it was at an academic medical center and some of the medical directors there were mentioning that what they were noticing is that medical students that wasn't a top choice for a lot of people in medical school. It was usually like surgery, I think like ER trauma surgery for doctors. So they were noticing that for residents coming in that wasn't usually like a top choice for a lot of medical students. So I think that was a piece of it. Is there still a psychiatrist shortage, I think, in the sense of how much need there is? It is more than it was when I started about twelve years ago. Not sure. But I know that the need I will say that the need is larger. And I think that in the last maybe it's been about the last three to four three to five years, there's been more talk about mental health and mental health wellness that I think more people are tapping into the need to address things in their life that may be of concern for them. But maybe they didn't want to talk about it because of stigma or they didn't know. Or they couldn't name it. Maybe they had something, experiencing something, but couldn't really name it. And so now seeing more information about that in different places, media, social media, things like that, they're like, oh, maybe it is that, so I should look into these types of things. Or maybe it is this, so I should, yes, try reading this book, or doing this thing like this, but maybe I should actually seek professional help in case it requires something more.
[31:34] Michelle: That's a good point. In addition to having more awareness brought to mental health, people are actually listening to that and reaching out in your area. You're there in Richmond, Virginia.
[31:51] Kirby: Yes, that's correct, yeah.
[31:53] Michelle: Are you having any shortage of mental health services just in general there?
[32:00] Kirby: I would say so. What I still hear about, and even we experienced it too, at the Community Mental Health Center is that sometimes there still is a wait. So there's people here, people available, but there still is a wait. And that's even for therapists as well. And sometimes there's a wait because maybe it's an insurance issue where, okay, they have certain insurance, and maybe only certain providers accept that insurance. Or sometimes it's not even that it's just a wait. It's just a wait because there's not enough. It's still not enough. Like I said, there's that great need. And then what I also think is happening, at least I believe that more mental health professionals, so I think therapists, psychiatrists, psych, mental health nurse practitioners are becoming more aware of that secondary trauma, burnout, things like that. And so where we used to say like, okay, we're available 40 hours a week, we know that's not sustainable, right, that's good, yes, we know that. So I would say that it may be the same amount of mental health providers out there, but we're putting good boundaries maybe around our time. And so now we used to say, okay, 40 hours a week, patients I can handle, and 40 hours a week, but now we're saying, okay, I'm probably only going to see patients for like 25 hours a week, for example, or something like that, something that's manageable and sustainable. But knocking out some of those patient hours then makes it feel like, oh, it's a squeeze, so to speak, because you don't have. As many don't have as many appointments available. And so there's more wait list for services, for care, for things like that.
[33:58] Michelle: Gosh, I'm so glad to hear you talking about mental health of the professionals. And you are a professional that treats mental health patients and so who should be on it? Yes, and it's so important. One of the things that the pandemic revealed definitely was mental health being a big priority. How do you think that the pandemic affected mental health? Is there a before and after in your mind?
[34:35] Kirby: Yeah, I would say that during, meaning at the start of things. At the start of things, I think there was this collective I would say trauma or collective grief that I believe we all persons in the world, to be honest experience because there was a nonstop kind of news cycle about dying, death, and this unknown. It was also this unknown thing. So the unknown is, like, very scary. Like, what is this? It's unknown. We're not exactly sure how it travels, how it doesn't travel, why some people get it, why some people don't everybody stay home. So that was just you were just on maybe, like, high alert for what I would say is a sustained period of time because you're like, okay, we're not going to leave our house, but we do have to leave, but we're on high alert because we don't know how this moves. And even if we are wearing a mask, we were hearing that people were still getting ill, getting sick. So I think that was one thing that we all experienced, this collective trauma and being in like, hyper-vigilant mode for probably a good maybe somewhere three to six months. I'm sure some people might have been less, people might have been more, but probably in that time, three to six months where it was like, really first happening and a lot of unknown was going on and unraveling. And I think since later during the pandemic now, I would say that there though I see some relief. What I also have noted in people that I treat is that they are still some there's still grief from that time, and there's that grief during the hyper-vigilant stage of it all. You weren't really processing it if you get what I'm saying. You weren't really processing what was happening. You were just like in survival mode, so to speak. How do we survive? How do we get through this? How do we stay safe to the best of our ability? And so now you're in the, okay, we're surviving, and we know what's going to be here a long time, possibly forever, but how do we deal with all that's just happened? So I think that people are still processing some of that and processing even maybe some of them if they had any losses during that time, processing those as well. Because, again, if you're in hypervigilant mode and you had a loss. You probably didn't process it because you're like, yes, this happened and this loss occurred, but we're still on high alert about what's about to happen, who's going to get it next, or what's happening, all of that. I do see patients who are having delayed grief processing that's been happening probably, I would say, until the end of 2021. Until now, some delayed, sorry stages of processing grief because they weren't able to, and realizing that because probably that first Thanksgiving, Christmas, those first holidays, so to speak, we were able to say, like, okay, we know we're not going to see persons, because it was like, oh, still on high alert. But then now the person really realizes, oh, that person of that loss happened, and I'm not going to see this person when I usually see them. So those kinds of delayed things still happening and processing. And so I think there's been more of the tapping into mental health resources. So mental health professionals, and psychiatric care from that standpoint as well.
[38:23] Michelle: Like I said earlier, the pandemic revealed so much about mental health. And definitely, as a nurse in a hospital, we really felt that a lot of people thought in the NICU, like our friends and family, couldn't figure out why we were so cautious as NICU nurses and NICU professionals, because they thought, well, you're not on a COVID ward. You don't work with COVID patients. It's like well, that's true. Our babies don't have COVID. We never had a baby test positive for COVID. We had a lot of moms and dads test positive for COVID. But we saw the separation of the parents delivering at 25 weeks and then only the mom being able to see the baby for the first, you know, month or six weeks. It's really traumatizing. And, you know, I remember the first mom that we had that delivered early and then went to the ICU and died a couple of weeks later. It's like, oh, wow, this really sucks. But yeah, I think it affected everybody in different ways, and I think it's led to a lot of what they call the great resignation. A lot of people kind of reassessing their life and where they are and where they want to be. And whether you're a patient or a nurse or a physician, that kind of affects us all the same. Right?
[40:11] Kirby: Right. Yes.
[40:14] Michelle: Well, I want to talk for a minute about what kind of training Psych NPs go through. Like, what do I need to do?
[40:28] Kirby: To be me a lot, but to be me in the sense of a psychiatric nurse practitioner? Yes. So if there are any persons out there or nurses out there who are thinking about the specialty or interested in the specialty, what kind of training that you go through? So first you will have to go to nursing school and obtain your bachelor's degree. And at that time, after you obtain your bachelor's degree, what is usually recommended, even though none of the I don't believe I don't think any of the schools require it anymore. But what I would personally recommend is that you do work as a nurse for a period of time, so let's say one or two years to get that really good nursing foundational experience and exposure and just even health care experience and exposure to health care. And it doesn't mean you have to be in a hospital. I know when I was going through school, that was like, the only way hospital. But that can be at a clinic, that can be at a community health organization, that could be at a home health organization. It could be on a psychiatric unit. But you want to get experience working with patients, having a little bit of an understanding of, just, like, the healthcare system. You won't know everything about the healthcare system, because I don't, and I've been a nurse for almost 20 years. But you want to get some exposure to it, some understanding of it, and then after maybe one or two years of working as a nurse, you would return to school for your master's degree, which is usually a two or three-year program. It's two years if you are full-time and usually like three years if you are part-time. And most of us, including myself, did part-time because we wanted to work and still had bills to pay, and things like that. And so you can work part-time. And as many of us nurses already know, you have many PRN opportunities. Some work as travel or agency nurses. That way you can work a few hours a week for like, a high level of pay, but then still have a lot of time to devote to your studies. And so usually that first one to one and a half year is what's called didactic or lecture. So that's where you're learning, doing a deep dive into mental health conditions, the neurobiology of the brain, and understanding pharmacology. So even though you took pharmacology in your bachelor's degree program, you'll take it may be called, like, advanced pharmacology and master's program. You'll take, like, a physical assessment or health assessment class. Again, even though you took one in your bachelor's program, this is just a higher-level health assessment class that you'll be taking because we're going into the stage where we're going to be diagnosing conditions. So it's a little bit of a different type of health assessment that you're learning and a little bit of a different type of maybe pharmacology that you're learning, because, again, you're going to be prescribing not just maybe providing the medication, you're going to be actually prescribing it. And then after those that year, year and a half of didactic, then usually most schools nowadays either do two, three, even four clinical rotations that they're doing. So you're going to do a total of like 500 to 600 hours working with either a psychiatric nurse practitioner or psychiatrist. And some schools even give you the ability to do maybe 25% of those hours with a therapist or psychologist. So every school is a little bit different in how they do that, but usually, most of your hours are going to be with a psychiatrist or psychiatric nurse practitioner. And because there is a shortage of preceptors sometimes that has gotten in the way of a lot of students. Because there is a lot of interest in becoming an advanced practice nurse and a lot of interest in mental health and the psych specialty sometimes that's a little bit that preceptors are kind of few and far between. I tell students that sometimes preceptors were people, too, so we might also be burned out. So maybe we're taking a break for a semester or a year. So give us some grace. Give us some grace. If you're coming up against the wall where you can't find a preceptor or having a hard time or wondering why your school is having a hard time finding a preceptor, it's because a lot of us precepted during the pandemic, myself included. And I don't know if some people might say, well, do you think you should have precepted or not? I'm not sure, but I did because I always precepted students, and something some people may or may not know about me, but I actually found out I was pregnant in March 2020. Yeah. So I was precepting while pregnant. I was probably doing too much. But that just means that for those of us who were precepting during the pandemic in different stages, whether it was all online or in person, some of us are probably a little bit burnt out in deciding to take a break. But after you complete those 500, some schools are 600 clinical hours. Then you take, of course, certification tests. And I don't know if this test is harder or easier than the NCLEX, but it's a test. It's a test of that similar kind of level, but a higher level, because we're talking about prescribing and diagnosing. So you have a communication test that you'll take and then you celebrate.
[46:19] Michelle: That's right.
[46:20] Kirby: Wow.
[46:21] Michelle: And you should be right.
[46:23] Kirby: Celebrate enjoy yourself. Yeah.
[46:26] Michelle: I saw the ANCC has a certification. So it's the PMHNP-BC.
[46:32] Kirby: Yes, correct. And it's just through the ANCC for the psychic certification, just the ANCC has it. So that's the only one test that should be taken forward. Yeah.
[46:45] Michelle: And I was surprised that I saw quite a few professional organizations the American Psychiatric Nurse Association, the Neuroscience Education Institute, the American Association for Nurse Practitioners, the ANA,  Foundations for Addictions Nursing, and the International Society of Psychiatric Mental Health Nurses.
[47:09] Kirby: That's a member. It is.
[47:14] Michelle: There are a lot of organizations that support this very niche specialty.
[47:19] Kirby: Yes. And definitely, if you have anyone who's listening who is interested, once you do all that work that I talked about, you'll want to make sure you stay connected to, like, one of those organizations. I'm a member of the APNA and you do attend and tap into all the resources they have because there's a lot I mean, at first I was a member just, I don't know, for fun. But if you actually really look into what the membership offers, there are resources, there's everything, and then they always have a conference, and you want to go and continue to learn and grow.
[47:56] Michelle: Exactly, yeah. I'm a big fan of professional organizations. Okay, so now I went to school, and I did all the things, and I got my preceptorship, and I got my hours in. I took the test, and now I'm celebrating. So where can a psych NP work? What kind of setting?
[48:14] Kirby: So after you're done celebrating, then you can I mean, the great thing is that there's a lot of different settings. So a lot of times and the only thing I knew of when I graduated was like, okay, hospital or private practice. That's it, right? Because that's maybe all we know. But there are so many settings. So as we know, a lot of people and a lot of organizations are doing telehealth. So there are some telehealth organizations and telepsychiatry organizations that hire psychiatric nurse practitioners as well as they hire therapists and psychiatrists too. You can work at a community mental health organization like myself in every state is different too. So some of the places are all names. You might be like, what is she talking about? So just know that states have different things that they have, but there are what we call partial hospitalization programs. So what those are is we try our best. Like, everyone, I hope, does do preventative care and keep patients out of the hospital. So if a patient who has a mental health condition, who has their symptoms start to exacerbate or start to worsen in some places in some states, they have these programs called partial hospitalization programs. So the person can get admitted into that kind of program. And what they do is they attend this program Monday through Friday. It's like, usually 830-3, 9-3. And usually, they attend this program, let's say 7-14 days. And what they get in this program is there are a lot of groups that they do. They do individual counseling. They get seen by a psychiatric nurse practitioner or a psychiatrist. Sometimes it's every day, sometimes it's every two to three days, something like that. But what it's for? It's to help, again, prevent a person from going to the hospital. So they want to get you into a space where you have a higher level of care, but you're still outpatient. So there's partial hospitalization programs. There's crisis programs for people who are in crisis. And what you do is you're seen by a psych nurse practitioner, and then we kind of make a plan, okay, is this a crisis where the person needs to go to the hospital? Or is this a crisis where, okay, they need to just be honest, just but they need to be connected to resources to help them because maybe they just do not have an outpatient team. And so we work with people on that. You can work in an eating disorders facility. I think in the beginning I didn't hear much about psychiatric providers being there. I know they had a lot of medical providers, which is good as well, but now most of them that I'm hearing about now have a psych provider there if not full-time, but sometimes it's not. Maybe they just have someone who is like PRN or part-time working there in case something comes up that needs to be addressed. And then therapy offices hire psychiatric nurse practitioners because a lot of therapists really do want that comprehensive care in one place. And so adding a psychiatric nurse practitioner to their practice could really provide them with that. I know I'm missing a whole bunch, but even some, like residential group homes have places. There are some places that have psychiatric emergency departments or some Ers that have psychiatric kind of wings, so to speak. And so people can work in that kind of area as well. But there's a lot of different places that you can work. And then if you're really like me or a person who wants that balance, I always say it's good to do some clinical work or like direct patient care work and do something nonclinical. So maybe you decide to your nonclinical work might be working with nursing students, like undergraduate, doing an undergraduate clinical or something like that, because it's going to help give yourself some balance.
[52:29] Michelle: I mean, there's so many choices for new Psych NPs and somebody that wants to make a move into another specialty. It's like the world is their oyster.
[52:41] Kirby: There's so much out there and I'm probably missing about 50, but I tried to hit the high notes of the ones that came to my mind quickly.
[52:51] Michelle: You're blowing me away. Yeah. That's amazing. Well, so you're there for your patience. You are there as a mentor for Psych NP students. Who's there for Kirby? Who do you go to for help?
[53:11] Kirby: Yeah. Oh, that's such a nice question. So I have mentors myself and some of my mentors are actually persons who I precepted years ago, because we just talked about Michelle, that there's so many different options for psych nurse practitioners that some of my students have gone to, like, let's say addictions. And I've never worked in Addiction specialty. So sometimes I lean on that student that I know who's been Addiction for five years or five or six years, like, oh, I need your help with figuring this out for this patient because that's not my specialty because not everything is my specialty. Or I have another student who's owned her own private practice as a nurse practitioner for probably six, seven, maybe even eight years going on now. And so when there's some things that come up or like I'm wondering about policies and procedures, I'll lean on her. And then my husband is also there for me. He's very supportive of my career and my business adventures and helping me get out of my own way and making me take a break when I need it.
[54:23] Michelle: They know us so well, right?
[54:25] Kirby: Yes.
[54:27] Michelle: I love it that I've said on this show many times that we're all students and we're all teachers, and just the fact that you are not afraid to reach out to former students that you mentored because now they have some experience that maybe you don't have. Like, I love that. I wish that we could do more of that in nursing. I think sometimes we tend to say, well, now I've gotten here and I don't need to look back. It's like we can all look back and remember what it was like to be a student or a new grad and take that with us. So I love that you said that, and I think it's so important for caregivers to have mentors and support because what you do is not easy. I can tell that it's very fulfilling for you and I can hear your passion, but it's not easy.
[55:29] Kirby: It's not easy.
[55:31] Michelle: Yeah, well, you've given us a ton of information. My mouth has been just dropped open the whole time. I can't believe I didn't know about this. It's very cool. At the end of the session, we do this thing called the five-minute Snippet, and it's just five minutes of, kind of, just fun, letting the audience see kind of the off-duty side.
[56:01] Kirby: Oh.
[56:04] Michelle: These are all just questions that, you know, it's just a lot of fun. So are you ready for the five minutes?
[56:10] Kirby: I'm ready.
[56:13] Michelle: Yay! Okay, I'm going to bring up my timer. If you were or if you are musically inclined, who would you want to have a jam session with?
[56:29] Kirby: That's a good one. I'm not musically inclined, but I think if I were to have a jam session with someone, it would be Beyonce. Oh my God.
[56:44] Michelle: Just go for the gold, man. Go for the top.
[56:47] Kirby: We're going for the top. Me and  Beyonce are about the same age, and I have watched her grow through her career and that would be really cool.
[56:58] Michelle: Oh my gosh, so cool. Yeah. Okay, what do you consider yourself an expert at?
[57:06] Kirby: Yes, I would consider myself an expert in mental health and mental health education. Those are two big things that I feel like I'm an expert in. I think one of the things I have so much enjoyment for is educating other people about mental health. Whether it's students, whether it's mentors, whether it's coaching clients, whether it's just individuals who individuals and their families. That's the part I enjoy the most. So I feel like I am really an expert in that, and I've tried to tweak it and become better and better at that, I think. Anything else? I'm an expert in that outside of my work. Yeah.
[57:55] Michelle: I second that. You are the expert. That's really cool.
[57:59] Kirby: Thank you.
[58:01] Michelle: Yeah. Let's see, the best female role model in your life.
[58:06] Kirby: Best female role model in my life. I know. Yes, sir. Man. There are many great female role models in my life, but I would say that my biggest role model is my mother. My mom is well, she was retired. She was a teacher for a very long time, longer than I've been alive. She was a teacher in public schools in Chicago, which is where I am from. And she did that until she was ready to retire, which is great. And she really had an enjoyment for teaching. She still talks about it. She really loves teaching. She really enjoyed it. She said it did not feel like work to her at all. That's what she right. Yeah. She really had fun with the kids and enjoyed that. And now, as a person who is retired, she still finds enjoyment in her life. She travels a lot now. The pandemic put a pin in that for a moment. But she's back to traveling as we are recording. She is on a cruise as we speak, but she just lives her life to the fullest, and that's just such a great testament, like living your life to the fullest as a teacher and enjoying what you do. And then, okay, I'm retired now. I'm going to still live my life to the fullest and enjoy traveling, which she enjoys doing.
[59:36] Michelle: It sounds like mother, like daughter.
[59:39] Kirby: Yeah.
[59:44] Michelle: Let's see. You're going on a trip. Talking about traveling, you're going on a trip. What three things could you not leave without?
[59:53] Kirby: Well, my cell phone. I would say my cell phone. I would even say my passport because the plan is probably that we're going to go somewhere out of the country. So my passport. And then I would say, oh, man, of course, my wallet. Even if I don't have anything else on there, I can buy more clothing, whatever this is.
[01:00:25] Michelle: Yes, that's right. All right, last question. Let's see.
[01:00:31] Kirby: Okay.
[01:00:31] Michelle: If you could install one piece of advice in a baby's mind, what would that be?
[01:00:39] Kirby: Oh, wow. Okay. Because I do have a toddler, I would say the idea would be something like, there's no traditional route to life, and you should explore all the possibilities.
[01:01:04] Michelle: Oh, my gosh.
[01:01:05] Kirby: Yes.
[01:01:07] Michelle: That is amazing. Wow. All right. Perfect. You did awesome in the five-minute snippet, as I knew you would because there are thought-provoking questions, but there's stuff that you all know, and you have given me and you have given our listeners so much great information about psychiatric mental health nurse practitioners. And thank you so much for being here and just calling attention to this really unique nursing specialty.
[01:01:40] Kirby: Yeah, no problem. Thank you so much for having me. I appreciate the opportunity.
[01:01:46] Michelle: Man it's been my pleasure. You have a great rest of your day, all right?
[01:01:51] Kirby: You too.
[01:01:52] Michelle: Thank you.