No Prior Auth Podcast — EP 02: The Psych NP Struggle Is Real (Here’s Why)

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This story is the kind of arc every new PMHNP graduate eventually faces. I got into school nursing because I wanted to work part-time. I wanted to go back to school. I needed to work in a job that was a little bit flexible. What would you say to the psych student who’s like struggling to find preceptorship? Sometimes people underestimate the effort for different things in life. And I think yeah, that’s I like that you kind of quantified that for people. When I started researching, I started realizing that there are federal guidelines and then there are state guidelines and I needed help. Hey everyone, welcome back to No Prior, the podcast where we celebrate psychiatric NPs who didn’t wait for permission to build something extraordinary. I’m Lindsay Hill and today I’m talking with Heidi Reid, a boardcertified psychiatric mental health nurse practitioner whose path into psych is one a lot of you are going to relate to. Heidi didn’t start in psychiatry. She came from school nursing, spending years on the front lines with kids, teens, and families, watching the mental health crisis unfold in real time. At some point, she made the decision to pivot, to go back to school, earn her psych, and step into psychiatric practice. If you’ve ever thought, maybe I’m in the wrong specialty, or I keep seeing this problem, and I want to do more about it, Heidi’s story is for you. Let’s get into it. Hey, Heidi.

Lindsay, thanks for having me. Of course. Okay, so can you just tell us a little bit about you? Just where you’re from? What kind of got you into even wanting to be a nurse in the first place? Oh, wow. That’s kind of loaded. Okay. Well, I’m from Ohio. I live in Georgia now. I’ve been here since 2014. And why did I become a nurse? You know what? I started trying to become a nurse in 2007 when my kids were really little and it took me a super long time to finally get there. I graduated in 2020 during co because I was still having children and raising my children. It took a long time, but I never lost sight of wanting to help people. In the meantime, in between starting school and graduating, I started a charity in Florida for a little while. So, I’ve always had that desire to help people. That’s really cool. So, nursing felt natural. That’s awesome. And tell us more about how you got into like school nursing and how long you did that for. Tell us more about that journey.

Why the New PMHNP Graduate Confidence Gap Exists

I got into school nursing because I wanted to work part-time. I wanted to go back to school. I needed to work in a job that was a little bit flexible. And so I decided to be a substitute school nurse so I could work as needed. And it my gosh, it turned into a job that I love. Like I I love this job. And if I hadn’t already been in school when I got this job, I would have never gone back to school because I love it. So now, you know, we’re what, four years later, and I don’t want to give it up, but I also love psychiatry. So, I’m hoping eventually to be able to kind of victim, you know. Yeah. What do you think that would look like? It’s okay. I don’t know. Yeah. Obviously, working with adolescence, you know, um Yeah. There’s such a huge need for that with your husband and then you have three almost adult children. I Well, two of them are adults. I have a 21-year-old, a 20-year-old, and a 17y old. Okay. And tell us a little bit about your Psych NP program experience.

How was that for you? I actually feel like I got a great education. Um, I loved the college. So, I got my master’s degree in nursing education first and I was afraid to become a nurse practitioner because I didn’t want that responsibility of prescribing medications. It just scared me a lot. through my experience in the master’s program, I changed my mind and decided to go for it. And so I did a postgrad certificate at the same college um because I had such a great experience in that program. So I really feel like even though it was an online school that I got an excellent education where I feel like it sort of fell apart a little bit was when I started needing preceptors. That was rough. That’s a pain point for a lot of psych students that I think they can relate to us. Will you tell us a little bit more what that looked like it falling apart? Yeah. So, I had to get my own preceptors and there aren’t very many preceptors in psych. I’m fortunate that I live in a huge or near a huge city, Atlanta, but still I had difficulty trying to get specific either a psychiatrist or a psychiatric nurse practitioner. And eventually for my last two practicums, I had to pay and it’s really expensive to do that. And there’s no guarantee that I was going to get the experience that I felt I paid for and I didn’t. Yeah, that’s frustrating. That’s very frustrating. So, the first couple rotations, how did you get connected with those? Was it through like networking connections or Yeah. So, I’m not afraid to talk to people or ask questions or just go after it. I I know that when you’re a student, especially in a graduate program, you have to be assertive. So, because I’m a school nurse in a very large school district, I set out like I talked to my boss. She was fine with it. that I sent on a mass email and I was like, I need people to help me. So, my very first preceptor I got just from asking other nurses in my school district and that was excellent. And then the second one is a funny story actually. Yeah. I was having surgery and my this is funny and my nurse anesthetist was just very friendly and I was like, “Hey, before you put me under, do you know anybody who can help me with my second practicum and that was the one where I needed a a counselor, like a licensed counselor.” And she was like, “I actually do know somebody.” And I said, “Well, I’m not going to remember this conversation, so please write it down.” And she did. And when I woke up, it was on my lap. What? Are you furious? So, I called her and she said yes. What? I’m dead serious. So, my second preceptor I got because I wasn’t afraid to speak up right before I was put under. These are some really great examples of like out of the box things that I don’t think most people would think to do right off the bat. You know what I mean? But like you’re right, you do have to be kind of like assertive and make the ask, make the request even if it feels awkward, you know what I mean? So that was that was smart. So with the paid preceptor thing, cuz I know that’s another like hot topic. Um, did you go through a company and how much were those rotations? I did go through a company and the rotations um and I use the same company for both preceptors. I don’t think the company has full control over what they charge. They obviously take a cut of it. So, my first preceptor cost $2,400 and my second preceptor cost No, that’s not right. My second preceptor was 24,400. My first was $3,200. Gotcha. It was expensive. It was very expensive. Yeah. Yeah. And you felt like maybe it wasn’t quite the experience that you had hoped for. No, it definitely wasn’t. But but I couldn’t choose them really. I couldn’t interview them. I was so desperate for a preceptor and I wanted to graduate on time. And so honestly, I don’t think schools really want their students doing this, but we have no choice. And so I did. And you know, it’s not that they were bad at being nurses. They were great at that. I just don’t know that they were good teachers is all. Yeah, that makes sense. That makes a lot of sense. What would you say to the psych student who’s like struggling to find preceptorship? Well, I will tell you I kept track of how many people I contacted and it was over 200 people. So, I would suggest not being shy.

(For the new PMHNP graduate listening: this is the part about why your discomfort is normal.)

You have to just you have to email everybody. You have to contact everybody. You have to remember that nurses know nurses. So, reach out to them. Don’t be afraid if you’re at the doctor’s office asking questions like, “Hey, do you know anybody in this field and would you mind, you know, giving me their contact or at least, you know, like hooking us up or whatever?” I got outside the box entirely and it I would ask everybody and it’s a shame that I ended up having to pay for the last two even though I did all that work. You know, there are organizations out there that help. It’s just it’s not for you, right? That makes sense. That’s a really great point though you make about like you contacted 200 people. like that’s that’s a lot of contacts to make, you know, and I think that sometimes people underestimate the effort for different things in life. And I think yeah, that’s I like that you kind of quantified that for people to kind of see, hey, that got you rotations and yet still that was your reality. So, thanks for sharing um vulnerably about that. So, you didn’t work in psych nursing. You worked part-time as a school nurse as you went through the psych program. Is that right or no? Yes. Okay. That’s right. And you still work as a school nurse. I do.

Skills Most Programs Underteach

I love it. It’s my favorite job. I’m not going to quit until I have to. Yeah. Yeah. So, tell us when you graduated um and took boards. I graduated uh I think it was November 9th and um then I had to have surgery on my eyes. So four days later I did that and then we had Thanksgiving and Christmas and the day after Christmas I took boards. So all through the holidays I was studying. I didn’t think I passed it. When I walked out of that room, I felt so scared and so unsure and I got my stuff out of my locker and I went to my car and I sat down and opened the email because thank god technology now you know if you pass within a few minutes. Yeah. And I opened my email and it I had that green check mark that said I passed and I baldled my eyes out. Oh, because you know how hard it is to become a nurse practitioner and all the hours that you study and all the things that you give up and all of the stuff you overcome and then it come all comes down to this test. Yeah, it’s so stressful. I did it all pretty quickly because I didn’t Yeah, I just didn’t want to wait a long long time and keep feeling that anxiety every day. So, I studied a lot after I graduated. Yeah. Okay, that makes sense. Uh tell us a little bit about your plans postgraduation. Oh well that’s the exciting part. So um my husband and I are forming a partnership and I am opening a private practice in two different states and the reason my husband is involved is because he’s he’s a tech guy. Um so he’s helping with all of that. So, I’m opening a private practice as a psych in two states I don’t live in because they have autonomy and my state does not. Yeah. When did you decide you wanted to do private practice? Right around the time I was getting ready to graduate and the reason for that is not a selfish reason. It’s really that during practicums I saw the way mainstream psychiatry is done and I just don’t think that that’s the way I want to operate. I know that’s not the way I want to operate. And so I talked to my husband for a long time one night and we decided that we’re going to we’re just going to go for it. And so I’m almost there. Like I’m almost done and ready to start seeing patients. We’ve come a long way in just 3 months. Wow. That’s incredible. Do you mind walking us through a little bit more about like how much money it’s cost, how you’ve kind of navigated this process because I think it’s an area where there’s a lot of different ways to do it. And I think a lot of psych NPs stay stuck in the indecision piece. And so I’m just I think it could inspire other people to hear more specifics if you don’t mind sharing. Yeah, I don’t mind at all. Um because there there are so many ways to skin a cat, right? Isn’t that what they say? So I started to I thought I could do all of this by myself because I was listening to people who had started LLC’s for like I don’t know like a boutique or like I don’t know landscaping company or you know whatever. But medicine is different and it takes longer. And so when I started researching, I started realizing that there are federal guidelines and then there are state guidelines and I needed help. Like I just I needed help. Time out. I don’t know what I’m doing. So after a lot of consideration and looking into different ways of getting help, I decided to hire a law firm. And I chose a law firm that is specializes in healthc care business setups and and whatnot. So, first there’s there’s fees associated with licensing. Um, each state is different. It’s real easy to Google that. I cannot remember how much I paid in the states that I’m going in. I think one was 200 and one was 300. That was just for my license. And then, let’s see. I Oh, so the attorney wants a retainer. At least mind it. And so, it was $7,500 for the retainer. Okay. But they do everything for me. like I I have done they do all the research they make sure that everything is federally compliant state compliant they talk to if they don’t get the an or if they don’t have the answer they have other attorneys they can reach out to in those states and then they get their answer so although that was expensive it was worth every penny because ever since I hired them I have been able to sleep at night and I know that when my business is open they’re going to be compliant and I’m not going to have any issues starting up. So, it was worth every penny for me. Also, I got your program and that was probably the best that was probably the best decision I made. That that happened even before I hired an attorney. Like, I knew going into private practice I wasn’t going to have anybody to ask. And I’m a brand new nurse practitioner. So, having a mentor that I can trust. I have followed you for two years I think on Instagram and I’ve been watching and listening and paying attention and reading the comments and so I was like wow private practice Lindsy Hill. So here I am. So that actually was the first step. Then I did everything else because I have the confidence now to do it and I still get afraid sometimes but I’m trying to make the best decisions I can. Yeah, when I have questions, I I have a place where I can go now to ask them. So, I don’t know how much have I spent so far, like maybe around 10 or $11,000 to get started. And I don’t think it’s, you know, other than getting an EHR, which is going to be a monthly fee and malpractice insurance. Like really, that’s it.

For the new PMHNP graduate listening, this section is about EHR decisions. Yeah. Have you decided what EHR you’re going to go with? No. It’s like one day I think I want one, the next day it’s another. It it’s hard because I don’t know a lot of people, you know, that live close to me that are doing this. So, I have to go to like online forums and read and I’m like, “Oh, I want that one.” And then the next day someone else post about something else and I’m like, “Oh, maybe I want that one.” I know. So, I know. I don’t know. Yeah. That’s okay. That’s okay. You want stellar customer service is really important with picking an EHR. Yes. because if it goes down or if I need help or I have a question, I need I need customer service to be really really good. So that’s that’s important to me. Yeah, absolutely. Can you tell us like the name of your practice and when you’re hoping to see your first patient? Yes. So my practice is Intersect Mental Wellness and my website’s not up yet, but it will be hopefully in another month or two. And I would like to start seeing patients today, but I can’t. So it looks like it might be May. Now the problem with this is that each step depends on another step and everybody’s very slow about processing paperwork.

So my next big step with a waiting period is DEA registration which can take up to eight weeks for approval. So I hope May, but I don’t know. Yeah, it could be June. Yeah. Now, tell us about are you going to have an in-person space and why or when? Oh, no. I can’t because I’m not going to be Yeah. No, not an in person. All tella health and Yeah, that’s why. Okay. Okay. And you were told in both states, tell us about what you were told like with the DEA and whatnot because I think that that’s also relevant. Yeah. So, um, the DEA is very, very strict and, uh, the state of Arizona, you only have to get their approval. In the state of Nevada, you have to have the board of pharmacy and the DEA’s approval and both states are very strict. So, because I don’t have an actual office, I have to have registered agents in each state. I called the DEA because if you look online, it you get mixed messages. Some DEAs it’s some states are more lenient than others. I’m finding out for me when I called and talked to a DEA agent in Arizona and the same as the one that was affiliated with Nevada, they said I could have a registered agent. That registered agent has to have an actual physical building. It has to have a staff that’s there during regular business hours Monday through Friday. And the lady was sure to tell me a couple of times, we will check. So, so that’s what I’ve done. I have a registered agent in Arizona and now I have to get one in Nevada. How did you find your registered agent in Arizona? Through my attorney. They found it and then they sent me the information. And registered agents are not that expensive. I’m paying $35 a year for the one in Arizona and I think the one in Nevada I’m looking at is 50 a year. So, it’s really cheap. That’s good to know. That’s really good to know. Okay, finally something cheap. Yeah. Right. So, in five years from now, what do you hope your practice looks like? Like, do you see this staying more boutiquey, small, or do you see this being more of a group multi-state practice? What do you are you going to niche down, keep it broad? So I again the fear creeps in with that but the plan is to grow in multiple states. Obviously it’s going to be the ones that have autonomy first. It’s hard because you know those states seem to be out west and everything on the east coast is just a little bit harder to deal with. So we’ll see how Nevada and Arizona go in the beginning because it’s just me right now and I’ve never done this before. I’ve never hired anyone before and I know that creating this is going to make this kind of my baby. So, I’ll be protective of it. I’ll be protective of my p Yeah. of my patients, too. So, hiring people might be a little bit of a challenge just for me emotionally. But, we do want to grow. So, five years from now, I don’t know, maybe 10 states would be great. Yeah. That’s awesome. That’s awesome. And tell us about like do you think you’re going to work with insurance? Do you think you know how did you make that decision too? Well, because I see how insurance treats people and not just I mean I’m a patient too. I go to the doctor too. I can’t stand prior authorizations. I can’t understand for the life of me how people who are in medicine can make medical decisions. Like it just blows my mind. So no, I’m not taking insurance at all. Um, I also have seen the provider side where they either don’t get paid enough or they don’t get paid at all. And then I found out recently that sometimes insurance companies will pay the provider and then two or three months later they make them give it back. Like what? So yeah. No. No. And I think that’s sad because there are there are people who need what I’m going to offer who may not be able to afford my fees because I’m not taking insurance, but I am I’m just not. I I don’t want to go through that. So, what is your plan as far as getting patients for your practice? I got to leave that to my husband. He’s in technology and and he’s well, he’s creating my website, so that’s one thing. psychology today. I’ll have I’ll have an ad on there for sure. He’s going to work now. Now we’re getting into the land of what I don’t understand. So, forgive me if I get this wrong, but he’s going to work on Google Analytics if if I think that’s what it’s called. So, he knows how to do those things and he’s going to help me with the marketing part. I did actually talk to somebody in Georgia the other day who knows somebody already in Nevada who may or may not want to work with me. So even word of mouth and just like talking about things on Facebook, I have a page on Instagram where I’m just like myself. But you know, talking about school nursing, I’m talking about setting up my business. So, you know, those things help, too.

What Actually Helps a Struggling New PMHNP Graduate

(New PMHNP graduate context: the gap Lindsay describes is what mentorship actually closes.)

Yeah, that’s awesome. That’s really cool. Well, this has been awesome having you on. I know we’re coming up on our time, but any other pieces of advice for the psych who might be kind of behind you in their journey? Ask a lot of questions and start early and swallow your fear. Do not let fear get in the way of your dream. Don’t do it because I don’t regret a single thing I’ve done and I’ve been afraid a lot. Yeah. You said something to me yesterday that I liked about like I’m scared to do a lot of things and I still do them and like I’m okay. You know what I mean? Like you don’t let that stop you from doing the thing, which I think is really important. And then this last question we ask everybody, what does no prior mean to you? Not just the insurance term, but as a philosophy for your career and your life. I love that name. Oh my gosh. Um, you know what? It makes me think of getting involved in politics and I never thought I would say that, but it’s just the whole idea of prior authorizations is so frustrating. So, it it makes me want to advocate for nurses.

Yeah, it really is frustrating. So, I hear you there. Well, I would love to have you back on the podcast maybe in like six months and we can see an update of how things are progressing. I just really want more psych NPs and nurses to see kind of what’s possible and see more of the behind the scenes because I think that also helps when you can feel seen right in somebody else’s journey. Yeah. All right. Well, thanks Heidi. I would love that. Thanks. This has been great. Thank you.