From Navy Wards To CBT: A Psychiatric NP’s Rule Book For Care with Dr Pam Wall

What if the most powerful clinical upgrade is the simplest one: clean your station, fix sleep, and show up prepared to do therapy that fits the brain in front of you? We sit down with Dr. Pam Wall—Navy veteran, psychiatric nurse practitioner, professor, and legal nurse consultant—to map a practical path through complex mental health care. From Marine divisions to university classrooms, Pam’s rule book blends scope-and-standards rigor with hands-on psychotherapy that actually sticks.

We dig into why sleep is the keystone for anxiety, depression, and recovery after traumatic brain injury, including the underrecognized link between mild TBI and sleep apnea. Pam walks through when to shift from cognitive work to behavioral focus, how to control the therapy environment for overstimulated brains, and why functional medicine basics—movement, nutrition, and inflammation control—amplify every intervention. Her take on trauma care is candid: medications can help, but therapy drives healing; pills without processing are a stall, not a solution.

Students and clinicians get a masterclass in professional durability: know the national standards, respect scope, anchor to guidelines, document clearly, and prepare before every clinic session. Pam’s story of a Marine who “wasn’t supposed” to click with CBT—and did—challenges bias and celebrates the quiet power of structured care. Along the way, she reflects on serving as one of the first female nurses embedded with a Marine division, the realities of military training and opportunity, and what’s working—and not—in psych NP education, from simulations to faculty engagement.

If you’re building a sustainable practice or sharpening your therapy toolkit, you’ll leave with an approach that is calm, repeatable, and battle-tested. Subscribe, share with a colleague who needs a recharge, and leave a review with your top clinic ritual—we’ll feature our favorites next week.

Let’s Connect

Dr Dan Wesemann

Email: daniel-wesemann@uiowa.edu

Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner

LinkedIn: www.linkedin.com/in/daniel-wesemann

 Dr Kate Melino

Email: Katerina.Melino@ucsf.edu

 Dr Sean Convoy

Email: sc585@duke.edu

 Dr Melissa Chapman

Email: mchapman@pdastats.com

Transcript

Meet Pam: Career And Credibility

SPEAKER_00 0:02

Yeah. I got that number two.

SPEAKER_03 0:34

This is not a familiar voice to me, because typically the person you initiates this podcast is Doctor Dan Lichton, but then is Oxidani and I can only know an opportunity to leave this. You and I met September 1st of 2001 while we were both in uniform. It was a rather fateful day. And I asked if could you just take us a few moments just to kind of give us your elevator speech in terms of your experiences professionally and academically that makes you particularly valuable to the listenership of this podcast.

SPEAKER_02 1:32

So as Sean said, shipmate, that's S-H-I-P Shipmate. Um so I just wanted to clarify that. So hey, yeah, it's nice to be here. Thanks, Sean. So I am a psychiatric nurse practitioner. I was also a clinical nurse specialist. So I'm one of those old ones. And when Sean said we met on September in 2001, that means we're very old. We're older than the dirt. So my experience is that I have been a nurse since 1996. I joined the Navy about the same time. And I've done most of my career as a psychiatric nurse, a psychiatric CNS, and an NP, both in the military and in the civilian sector. So spent 20 years in the Navy as a nurse core officer. And then when I retired, I have been working in a variety of civilian settings. I've been a professor in four different universities. The first one was a place called Uniformed Services University of Health Sciences, that is the military university. I started the Psych Nurse Practitioner Program there. Oh boy, 2008. It's been a while. And then I was at Duke University. I started the Psych Nurse Practitioner Program there. And that was in 2016 or 2017. I was also at the University of New Hampshire, and now I'm at Rosalind Franklin. I'm an associate professor there. Some of the other fun stuff that I've done was I worked at the United States Peace Corps as an international health coordinator. So I was the only prescriber for all of the Peace Corps in 61 countries that the volunteers served in until that pesky little virus changed our international

Best And Worst Parts Of The Work

SPEAKER_02 3:20

landscape. So that's just a little bit about me, and I think I'm going to be done there.

SPEAKER_03 3:25

Cool. Thinking about the gigs, right? What was the best gig and what was the worst gig?

SPEAKER_02 3:33

I think they're all good and bad. I think it depends upon the people that you work with and the things that you like and you don't like. So I think I've always liked them in that I like the patients that I'm working with and a lot of the people that I work with. And really what I hate is the admin, the charting, all that icky stuff that's in the background. That's the stuff that I really don't like. In academia, I really love the students. I really love watching the aha moments that occur. You know, you have to be three steps and five days ahead of every single one of the students. So you yourself learn a lot about clinical practice. So it's all good and it all has its drawbacks. I can't say that there's one thing I loved and one thing I didn't love.

SPEAKER_01 4:27

Yeah. Pim, I'm so happy to have you here today and have the opportunity to pick your

Psychotherapy Toolkit: CBT And Beyond

SPEAKER_01 4:32

brain. Uh, you've had such an amazing career. You know, one thing I'm wondering if you could tell us about is your experience providing psychotherapy in your role with the Navy, with you know, veterans or active duty service members, and how you honed your skills, the types of psychotherapy you provided. You know, give us a picture.

SPEAKER_02 4:54

So that's a that's a big question. So I'm gonna start off with uh my favorite is I love CBT. So I actually started doing CBT with Sean way back in the early 2000s. We had a cognitive behavioral group, and we learned a lot, we learned the basics there. And you know, I think I hate to say this, but the best practitioner is the one that does it on themselves every day. And so through a series of learning it there, and then I actually learned from the experts themselves at Penn, my education at Penn, the we had a course there on CBT from the Beck Institute. So I learned a lot of strategies from them. And so I really have, I don't think there's a single session that happens in my patients where I'm not implementing some kind of cognitive or behavioral strategy. And so that's a big chunk of what I do. There's a little bit of gestalt here, a little bit of the miracle question here. And I also do a lot of functional medicine stuff. I know it's not therapy, but I'm I really focus a lot on exercise and proper nutrition because I really think decreasing neuroinflammation in our patient population is a good strategy to decrease some of our negative outcomes in our patient population. Pam, for all of the questions.

SPEAKER_03 6:21

You got your PhD at Penn, and you if I remember correctly, you your your focus was a lot on TBI and sleep. Am I correct? Yes. How does

TBI, Sleep, And Clinical Strategy

SPEAKER_03 6:30

that practically translate to your patient care on a daily basis?

SPEAKER_02 6:34

So I always look at there are so there are things that I start off with. So I look at the medical, the substance, and those are the things that I'm gonna try to focus on first. And we get rid of that and we peel that away. And I the next thing I always look at and focus on is the sleep disorder. And if we have impaired sleep, that's gonna affect anxiety, it's gonna affect depression. And so it's really important to strategize on decreasing uh the impact of a sleep deprivation in our patient population. It could be a number of different things that are going on. It could be patients having problems falling asleep, staying asleep, it could be as related to pain, it could be related to a medical condition. So that's really one thing that I try to focus when I'm managing those patients. It could be from sleep apnea. And sleep apnea, and I just did a podcast with NEI, and one of the things that I look at in my patient population, especially those with TBI, people don't really think about this, is that patients with a lot of repetitive myonic brain injuries can have sleep apnea, even though they don't fit the normal profile. And so if I can't figure out what's going on, I will send them for polycemography, especially with patients who have mild traumatic brain injuries, and they do actually do have sleep apnea, which again, repairing that sleep problem is definitely going to help those mental health outbumps.

SPEAKER_01 8:10

Yeah, you know, this makes me wonder. In my clinical practice, I also work a lot with folks who have brain injuries of various types. And I'd be curious to know, Pam, how do you, you know, modify or maybe adapt your psychotherapeutic approach or strategies for folks who

Adapting Therapy For Brain Injury

SPEAKER_01 8:30

have TBIs?

SPEAKER_02 8:32

So I think number one is environmental when people have brain injuries, especially when they're more in the post-acute phases. I want to definitely attune my environment to them. So you want to soften the lights, you want to make sure that you're not yelling or screaming at them. Of course, you wouldn't want to do that anyway, but decreasing the environmental sensory load on them. The psychotherapy, you can do just about anything with them, but you have to make sure that they are cognitively capable of managing. So, you know, if they're having a lot of headaches or a lot of pain, CBT's probably not the best approach for them. You might want to wait until a lot of the pain issues have been resolved and focus more on a behavioral management strategy more than on the cognitive strategies.

SPEAKER_03 9:24

Awesome. Pam, I'm thinking I'm I'm gonna take you back to your time in uniform. There is a subset of the of the community of individuals listening to this podcast who are gonna be women and they're considering military service. And I'm wondering if you might be able just to share some thoughts with the community about what it was like being a female naval officer, psychiatric mental health nurse practitioner working

Women Leading In A Marine Division

SPEAKER_03 9:50

in what was presumably a male-dominated field.

SPEAKER_02 9:56

Interesting and loading question. So most of my career, if you if you think about the Navy, most of your career as a nurse is probably gonna be located in what's called an MTF or military treatment facility. And it is going to be heavily saturated with other women, especially in the nurse corps. But there are some certain billets that one can now go to. It wasn't always that way when I was in the military. But you can now get into billets where, such as in the Marine Corps, infantry billets, where it is heavily saturated with men. And I was, I took Sean's billet with uh one of the Marine Divisions. And when I went there, I was the first female nurse with one of the Marine divisions, and I think there was maybe 70 or 80 women, and I don't know how many people are in a division, tens of thousands of male Marines. And when people ask me about that particular two and a half years, I I define it as formative. They expect a certain they expect certain things from you, and I I think that I had to work a little bit harder as one of the first women who was living in that lane. I definitely took care to make sure that my physical readiness was always up to standards, if not above standards. So every day we would go out and and PT with our group. I had a service dog and not my own personal service dog, but she worked with the unit that I work with, and she was out there PTing with us as well. And it can be very uncomfortable sometimes when they don't assume that you're a woman. And here's what I mean by that the Marines they look at the your collars, they look for shiny things on your collars because that means whether or not they have to salute you. And they see something shiny on your collar and they salute you, and they're not expecting at that time to see a woman. And so almost 99 times out of a hundred, I would get saluted, and they would say, Good morning, sir. And then they would look up at my face, and then there is this shocked moment and this moment of embarrassment when they realized it's a girl. So it was kind of funny, kind of awkward, but they approached it with, I'm not expecting this. Now, here's a funny moment, and this is probably gonna embarrass people that I don't know, I don't care. My husband is a former Marine, he was a Marine reconnaissance marine, so he was special forces, and he is now my husband. And when you're an officer, you would generally the general's wife would send out emails to the officers' wives. My husband would get emails from the general's wife that were entitled Dear Ladies. So

Why Join The Military And How Training Works

SPEAKER_02 13:40

they just hadn't moved to this spectrum of now there's women in an infantry billet. So it was just very, very, I would say awkward, I think is the word I would use. I was never sexually harassed by anybody because they weren't stupid enough to do that. Because I was a feel-grade officer, nobody was dumb enough to do that. But I can't say that that's the same experience for every woman who served in and around men in the military.

SPEAKER_01 14:16

Thank you, Pam. You know, I'm just thinking about how, you know, a lot of our audience is American, but we actually have a global audience. And so this is really, I think, insightful in terms of, you know, how does this world operate? And I'm wondering if you can maybe say a little bit about, you know, what inspired you to join the military. And then how does it work in terms of becoming a provider as part as an officer?

SPEAKER_02 14:43

So when I was considering joining the military, I was working as medical assistant in a west side Chicago emergency room. And I loved the idea of continuing. I went through nursing school, and I was considering whether or not I wanted to continue working in the emergency department, which is very exciting, but it's very emotionally draining. And so we had a recruiter come through school, and one of the things that she said was, we will pay for your graduate education, which was very exciting for me. And I think that was probably one of the things that drew me to the military. And the second thing was is they said you can go anywhere you want to. And they flew us to San Diego and they took us on a nice recruiting trip. And of course, I was sold. And so I think one of the best experiences that I had in the military was the opportunity to get not just one graduate degree, but two. And so the military paid for two Ivy League degrees, which I would have never been able to attain on my own. And I think that was probably the best experience that I ever had. I think part of nursing is not only growing as a nurse, but diversifying yourself. And it doesn't matter how or where you diversify yourself, but finding a population that you love and and and going there. I fell into mental health nursing literally because I thought it was going to be Johnny trauma. And I ended up as a mental health nurse practitioner. So the military did a great job of allowing me to go with go with where I loved going, and they paid for it.

SPEAKER_03 16:32

Pam, you and I have have cared for probably more

The Clinician’s Rule Book

SPEAKER_03 16:35

Marines than we can count on all the hands that are probably in our immediate vicinity. I I want to ask you a question. We know, both of us, that Marines, when they deploy, they develop a rule book. And that rule book is a set of rules they use to survive a rather challenging situation and circumstance. I'd like to think that a seasoned advanced practice psychiatric mental health nurse in or out of the military also has developed a rule book. Can you share a few thoughts about what's in your rule book? Being mindful that a pretty good chunk of our listenership or students that are running through a psych nurse practitioner program as we're speaking.

SPEAKER_02 17:16

That's a great question. So I think I one of the things that I hadn't told you about myself is that I am a legal nurse consultant, and um I was also trained by a forensic psychiatrist. So a lot of how I think and what I do is from a forensic, a legal and forensic perspective. And so my rule book is largely driven by that lens. And so what I recommend is having a process that you do all day, every day, and stay with it. And so what I tell myself and my students is always know what this the scope and standards are that you operate under. And so the APNA has it, know it, get to know it, because you can and will be held against it or for it and with it, right? So that's the national standard. And so I know that book by heart, and it drives your state practice apps and and how you will be licensed and credentialed, what you can do, what you can't do. I don't deviate from it, right? So I think that there's some people who kind of go out on the fringes and do some things that maybe not are within our scope of practice. I don't ever do that. And so anything that I think is not within my scope of practice, I I move it to another provider that's within their scope of practice. I stick with the clinical practice guidelines and the FDA recommendations. And if it's not FDA recommendation recommended for something, I always document everything. I document all my decisions, I document everything that happens in the care. And so I'm I'm pretty good about documenting everything. And then what I do every day before I get ready for clinic is I I prepare ahead of time. And so I will pull up my records every day, spend about an hour, and I go through all my notes and I refresh my memory with what happened last time. What did we do? What's the outcomes? What's what do I what am I thinking about? And what do I want to do in this session? And so I prepare ahead of time because I always go back to me being that floor nurse. I could not start my day without cleaning my nursing station. And so that's how I practice. I clean my nurses station, I get ready, and so I prepare myself every day for my practice by getting to know my patients all over again. So that's my rule book.

SPEAKER_01 19:57

I love that. Clean your station.

SPEAKER_03 20:01

I think we've found the title for our podcast.

Trends In Psych NP Education

SPEAKER_01 20:07

So Pam, you know, as an educator yourself, I'm curious to know, you know, what are some trends that you're seeing in psych and pea education that maybe you feel excited about? And what are some trends that you feel maybe not so excited or cautious about?

SPEAKER_02 20:24

I don't think there's well. Let's start with I'm not so excited about, and I'm probably gonna get thrown under the bus for this, but I think there's a lot of programs out there that are popping up that I would say not a lot, a few that I'm concerned about because there's not a lot of hands-on between professors and students. The students are left to their own devices to learn on their own. There's not a lot of interaction with between the students and the professors, and I am very concerned about that type of interaction and those types of programs, and I'm just gonna leave it at that. I am very excited about all of the new technology that's out there. I know that a lot of people don't like the technology, but it's kind of cool. The stuff that we can do in simulation, the stuff that we can do, and I'm sorry if you can hear that. I have a new puppy and she's howling right now. Okay. All of the new technology that we have available to us, the simulations, and again, I've said this before, functional medicine. I am a really big proponent of it. I think we just need to go back to basics in our care. We need to go back to being nurses, all this bougie stuff that's out there. Let's just go back to sleep, diet, exercise, being healthy, and and really focus on therapy, right? Therapy, nothing is gonna work that we do without a good healthy dose of therapy. It they just it doesn't work. So I think you know, if you're treating depression, you have to have therapy. If you're treating anxiety, you have to have therapy. You can't just throw

A CBT Breakthrough And Final Reflections

SPEAKER_02 22:20

pill, and you definitely can't treat trauma without therapy. In fact, I think medications, and I'm gonna throw, I get thrown under the bus for this. So putting medications for trauma is like putting a band-aid on a bullet hole. They need they need therapy. That's the only thing that's gonna help people with trauma, really bad trauma. So we just need to go back to the basics. That's what I'm excited for. And I think I think that we're going in the right direction.

SPEAKER_03 22:46

Bam, I'm gonna finish up with our last question for the day. And uh, this question, let me set it up. Each and every one of us have an experience with a patient that once it happened, we went, oh my God, it actually worked, right? And it actually kind of emboldens us to realize that wow, there is something special about psychotherapy that I didn't really consider. Can you de-identify and and and share the story with us to let us know that point in time where you realized I'm an advanced practice nurse, but you know what? I'm also a really good psychotherapist.

SPEAKER_02 23:24

Oh my gosh. Oh my gosh. I gotta think about that one for a minute. You know, this was probably when I was in at 2nd Marine Division, and I had this Marine that I was working with, and I was thinking about doing CBT with him, and this is my fault. I had some really negative assumptions about this person, and I thought it's never gonna click. This person's never gonna get CBT. And I had your office, and you had the CBT stuff on the wall, and I was drawing all this stuff on the wall, and I was doing CBT, and he got it. He got it, and he started making all these positive changes in his life. And I sat back and I went okay. First of all, I'm an idiot for making these assumptions about him, and that's on me. And then I'm just like, I can't, I gotta stop making assumptions about people because that makes me a poo-poo head. And second of all, he got it. I I know how to do this and he got it, and so I thought that was a great story.

SPEAKER_03 24:31

That's awesome. That is absolutely awesome. Pam, I'm actually I'm gonna press pause. Kate, final thoughts for you, my friend.

SPEAKER_01 24:44

I guess, you know, Pam, you know, going back to cleaning your station and so on, if there is one piece of advice that you could give to, you know, psych and p students who will be graduating soon in this in this context in which we're all living in 2026, what would it be?

SPEAKER_03 25:04

Excellent. Excellent, excellent, excellent. Friends, for those of you listening, uh I will I'll share with you if you jump into higher education, if you jump into academia, if you jump into advanced practice nursing, it will be difficult for you not to come across the name Dr. Pam Wall. She's incredibly well published. Uh, you'll see her national conferences. When you do, I encourage you to approach her and make her feel uncomfortable and tell her about all the cool things that you read because she really does love that. And Pam, I want to thank you very much. This is a perfect point for our 25th anniversary as friends and colleagues. So thank you so much for you for your time.

SPEAKER_00 25:39

Thanks for having me, Tom. Thanks for having me thank you like this. They feel it before it's true, recording to those thoughts are finally leaving, so you can be you, huh? They feel it before it's true, recording to those thoughts are finally leaving, so you can be you, that discovery. Identify challenge, you're believed, called below frame in your mind. Negative thoughts believe that girl, cock the crease, the creep. Identify challenges, you're believed, for the frame in your mind. Negative thoughts break.