Here is the part no one prepares you for as a new PMHNP—the emotional weight of making clinical decisions in isolation. It’s more than clinical responsibility. It’s the quiet anxiety after hours, wondering if you missed something. It’s the mental replay of questioning, “Did I do enough?” It’s the invisible load that builds when you feel like you have to be the expert—without a safety net. That stress isn’t a reflection of your competence. It’s the natural outcome of working without support.