Things I Don’t Feel Guilty About Anymore as a PMHNP

When I first started practicing as a Psychiatric Mental Health Nurse Practitioner, I felt pressure to make quick decisions, solve every problem during the visit, and appear confident at all times. Looking back, I realize that many of those expectations weren't signs of competence—they were signs of inexperience.

Over time, I've let go of a few things that used to make me feel guilty. Ironically, I feel that doing so has made me a more thoughtful and effective clinician.

1. Looking Something Up

Medicine changes constantly. New research is published, treatment guidelines evolve, and every patient presents a unique situation.

Looking something up isn't a weakness—it's part of practicing safe, evidence-based medicine. And the more efficient you become with using your resources, the more your PMHNP confidence will grow.

Patients generally appreciate knowing you're willing to verify information rather than guess. Take the extra minute to confirm a medication interaction, dosing recommendation, or guideline is far better rather than pretending to know something you're uncertain about.

2. Saying, "I Want to Think About This Before Making a Decision."

Not every clinical decision needs to happen on the spot.

Sometimes a case deserves more reflection. Maybe you want to review previous records, consider different diagnoses, or think through the risks and benefits of several treatment options.

I've learned that it's perfectly acceptable to tell a patient:

"I need to look into this further before making a recommendation." As a new Psych NP, it may feel akward to say this the first few times but I have yet to have a patient respond poorly to this approach.

3. Consulting with Colleagues and Mentors for Their Perspective

Some of the biggest learning moments in my career have come from conversations with more seasoned providers.

Even experienced PMHNPs consult colleagues.

Fresh perspectives can help uncover possibilities you hadn't considered, challenge assumptions, or simply confirm that you're on the right track.

Seeking consultation isn't a sign that you're struggling—it's a sign that you care about providing the best care possible.

4. Setting Boundaries So Work Doesn't Come Home with Me Every Day

Psychiatry is emotionally demanding.

Many of us carry difficult patient stories long after the appointment ends. While compassion is essential, constantly carrying the emotional weight of every encounter isn't sustainable. This was probably one of the toughest hurdles for me to get over as a new psych NP.

Healthy boundaries allow you to continue caring deeply without becoming emotionally exhausted.

Please remember that protecting your own mental health isn't selfish—it is essential for longevity in this profession.

5. Accepting That I Can't Fix Everything in One Appointment

This may be the hardest lesson of all and the one piece of new PMHNP advice that I wish I had gotten earlier on.

Patients often come to us after months or years of struggling. We naturally want to help as much as we can.

But meaningful progress usually happens over time.

One visit may involve gathering information, building trust, creating a safety plan, or making the first medication adjustment. Those are meaningful accomplishments, even if every problem isn't solved that day.

Good psychiatric care is a process, not a single appointment.

Competence Doesn't Mean Perfection

One of the biggest PMHNP mindset shifts I've experienced is realizing that confidence doesn't come from pretending to know everything.

It comes from practicing thoughtfully.

Thoughtful providers:

• Look things up when they're uncertain.

• Pause before making complex decisions.

• Ask colleagues for input.

• Protect their own well-being.

• Recognize that healing takes time.

If you're a new PMHNP, remember this: these habits don't make you less competent.

They help you become the kind of clinician your patients deserve.

Explore our resources for more tips for the new PMHNP starting out in practice.

New PMHNPs Charting Tips: One Habit I Wish I Learned Sooner

When I was a new PMHNP, I spent way too much time trying to find details that were discussed weeks or months ago. Over time, I realized there was a simple habit that made my documentation more efficient:

I started intentionally carrying forward the most important clinical history from note to note.

Not every detail needs to be repeated every time. But important information that impacts future treatment decisions should be easy to find. If your EHR does not have a way for you to access the patient’s psychiatric history and medication history (i.e. the psychiatric medications they have tried in the past that are unsuccessful), this is a must.

The information I stopped rewriting from scratch

For many patients, some parts of their psychiatric history remain relevant across multiple visits.

Examples include:

• Previous medication trials and outcomes

• Medications that were ineffective or poorly tolerated

• Reasons medications were discontinued

• Significant psychiatric history such as suicide attempts, self harm, or violence towards others

• Prior psychiatric hospitalizations

• Important medical history affecting psychiatric treatment

• Previous treatment goals or patient preferences

Having this information easily accessible saves time and helps prevent important details from being overlooked.

Why this matters for new PMHNPs

Early in your career, it is easy to feel like every note needs to be a complete retelling of the patient’s story.

But good documentation is not about writing the longest note.

Good documentation helps communicate:

• What is important about this patient’s history?

• What treatments have already been tried?

• Why are we making this treatment decision?

• What information will the next provider need to understand the plan?

A well-organized chart tells the patient’s story without requiring someone to dig through years of notes to find it.

Clicking through years of notes every visit takes time.

Here’s what I do:

At the end of my note, I keep a quick summary of the above information and update it as needed. Adapt this approach to your organization’s documentation policies/EHR workflow.

Yes, it’s an extra couple of clicks at the beginning to create this, but it will save you from having to search through multiple past notes every time you see the patient going forward. This means more time focusing on the patient in front of you. Additionally, if another Psych NP takes over the patient later on, this approach will make it much easier for them for them to get a snapshot of the patient’s history.

Final thoughts for new PMHNPs

Learning efficient documentation is one of the biggest adjustments when you are starting out as a psychiatric mental heath nurse pracitioner.

Your focus should be on creating documentation that is accurate, clinically useful, and easy to follow. The small habits you develop early in practice can make a huge difference in your confidence, efficiency, and ability to provide thoughtful care.

Explore our resources for more tips for the new PMHNP starting out in practice.

New PMHNPs: Don't Wait to Send Orders

When I first started practicing, part of my psychiatric nurse practitioner workflow was waiting until the end of each patient visit — or if I was really busy that day, until lunch or the end of the day — to place every medication, lab, referral, and order.

It seemed more efficient to finish the conversation first and then complete everything at once.

Then, I started seeing that this was actually slowing me down and creating more work for me towards the end of the day.

By the end of a busy day, I was trying to remember exactly what I had discussed with each patient. Did I already send that medication? Did I remember to order those labs? Did I forget the referral we talked about?

The busier you get and the more patients you see in a day, the easier it becomes to overlook or forget something.

The PMHNP workflow change that made a difference

Now, as soon as I know an order needs to be placed, I try to enter it before moving on.

For example:

• If we've decided to start or adjust a medication, I place the prescription while we're discussing the plan. It’s okay to tell the patient “Bare with me for one moment, I want to make sure I get this prescription ordered right away.”

• If I know I want baseline labs, I submit those orders before we move on to the next topic.

• If the patient needs a therapy or specialty referral, I submit it while it's fresh in my mind.

I don't wait anymore until the very end of the appointment if I already know what needs to be done.

Why this helps

Making this small PHMNP workflow change has helped me:

• Reduce the chance of forgetting an order.

• Spend less time having to go back because a patient messaged or called saying “You forgot to order the medication we talked about…”

• Feel less mentally overwhelmed by the end of the day because I know all orders have been entered and all I need to do is finish writing any notes that are pending.

• Finish visits with greater confidence that everything has been addressed.

It's a simple workflow habit, but over weeks and months it saves so much time and mental energy.

A few exceptions

There are times when it still makes sense to wait.

If I'm still gathering information, considering different treatment options, or discussing a decision with the patient, I hold off until we've finalized the plan.

The goal isn't to rush—it's simply to complete tasks as soon as you're confident they're appropriate.

Small habits add up

One thing I've learned while I was starting out as a psychiatric mental health nurse practitioner is that the biggest improvements often come from small workflow changes rather than dramatic ones.

You don't need a completely different system to increase your productivity and efficiency as a PMHNP.

You just need small habits that reduce cognitive load and make your clinic day a little smoother. They often have the biggest impact over time as you get your bearings as a new Psych NP.

Explore our resources for more tips for the new PMHNP starting out in practice.