According to Merritt Hawkins, a leading physician placement firm, psychiatrists rank second—after family physicians—on its list of 20 most-requested recruiting assignments. That makes four years running that psychiatrists have claimed the penultimate spot, indicating "a severe shortage of mental health professionals nationwide."
The opioid crisis—declared a nationwide public health emergency on October 27, 2017—isn't helping. In 2017, more than 72,000 Americans died from drug overdoses, including illicit drugs and prescription opioids, according to the American Psychiatric Association (APA). Given the circumstances, the need for more mental health practitioners to administer medication-assisted treatment (MAT) and counseling and behavioral therapies couldn't be clearer, nor more urgent.
Psychiatric mental health nurse practitioners (PMHNPs) represent one solution to the shortfall. These advanced practice nurses have the training to perform many of the same tasks as MDs—and, in the 23 states and territories where they enjoy full practice authority (more on that later), they have the right to diagnose patients and prescribe medications without an MD's supervision. There are currently about 12,000 psychiatric mental health nurse practitioners in the United States. According to PMHNP Kathleen McCoy, more can't be trained quickly enough. "There are few psychiatrists and fewer pediatric, geriatric, and addiction psychiatrists," she explained to the American Association of Nurse Practitioners (AANP). "These trends indicate the US needs PMHNPs."
Think you'd like to be one of them? Read on to find out how to become a psychiatric mental health nurse practitioner. In this article, we'll cover:
As nurse practitioners, psychiatric mental health nurse practitioners are one of four types of advanced practice registered nurses (APRNs). The others are:
APRNs are highly trained registered nurses who can look beyond symptoms of disease to provide comprehensive preventative health care for individuals of all ages across the lifespan.
According to Vanderbilt University, PMHNPs can perform all of the following functions:
PMHNPs work with youth, teenagers, adults, and seniors in a variety of settings, including:
They typically treat issues like anxiety, substance abuse, or bipolar disorder, or help people through difficult life stages, including grief and loss.
"Patients feel well cared for by NP's," says PMHNP Andrew Penn of the Permanente Medical Group, California. "Probably because of the emphasis on patient education in nursing training, we do a good job of explaining our interventions and getting patients to participate in their own care."
Laws governing PMHNPs vary by state, according to the AANP. In Washington, for example, PMHNPs operate under a full practice structure recommended for NPs by the National Academy of Medicine. Under full practice authority, PMHNPs can do any of the following autonomously (i.e., without the approval of an MD):
In other states, PMHNPS practice on a more limited basis. In Florida, all NPs work under restricted practice, a designation that means they cannot perform some types of services and must have the supervision of other health providers to provide patient care.
Many APRNs, including PMHNPs, advocate for full practice rights, particularly in the wake of the opioid crisis. Public health needs, they say, have outpaced access to medication-assisted treatment (MAT) and counseling and behavioral therapies specific to managing opioid use disorder. Under the Comprehensive Addiction and Recovery Act, trained NPs can prescribe buprenorphine to help with the disorder, but several states limit NPs in this practice.
Upon arrival at his job in a mental hospital, Jonathan V. Llamas, a PMHNP in California, checks where he is assigned for the day, according to his blog in Minority Nurse. He likes to arrive early to chat with staff who are leaving for the day. "I do this because it gives me an opportunity to 'feel out' the unit and get a sense of what might be required depending on the type of patients we have and the acuity level of the hospital," he writes.
Next, he and his team review reports on the status of each patient, in addition to who might be admitted or discharged. From 12:15 AM to 4 AM, he focuses on what needs his immediate attention: admitting new patients, updating care plans, or dealing with emergencies. Finally, he makes rounds during the time clients may be eating breakfast or grooming. He checks on each patient to discern how they are responding to treatment. Before leaving for the day, he creates a report for the incoming staff.
"The PMHNP role considers all that a patient is as well as the potential of each one," PMHNP Kathleen McCoy told a reporter for the American Association of Nurse Practitioners (AANP). "PMHNPs use biological interventions, psychotherapies, traditional approaches, and more." Reflecting on the bigger picture, she says: "Professionally, I want nothing more than to have this ongoing connectivity with humanity, this gift, as a driving force in my life. I am a world changer with humanity as a mission field and health as my vision."
The Bureau of Labor Statistics does not collect income data specifically for psychiatric mental health nurse practitioners. Its data show an annual average income for all nurse practitioners of $113,930 per year. As a result of an emphasis on preventive care combined with a shortage of physicians and the healthcare demands of an aging population, the number of NP positions is projected to grow by a robust 26 percent between 2018 and 2028.
The AANP conducts an annual salary survey. Its most recent report, in 2018, indicates that full-time NPs certified in psychiatric mental health earn a total annual income—including base salary, productivity bonuses, and incentive payments—of $130,967. Job listings for PMHNPs on Indeed have recently included full-time salaries of $65 to $75 an hour for a job in New York and $165,000 to $175,000 a year for a placement in Las Vegas.
PMHNPs are nurse practitioners, which means they must earn a Master of Science in Nursing (MSN) and earn an APRN license.
First, they need to earn a bachelor's degree. While that bachelor's needn't necessarily be a Bachelor of Science in Nursing (BSN), having a BSN does expedite matters. That's because you'll need to become a registered nurse before you can apply to an MSN program. Becoming a registered nurse requires completing a nursing program and passing the NCLX-RN exam. While the BSN is not the only pathway to this goal (you can get an Associate Degree in Nursing (ADN), although you'll then need to pursue a RN to BSN or RN-to-MSN program), it is certainly an efficient one.
All told, a PMHNP spends four years in school earning a BSN (as a full-time student; part-time study takes longer), then another two years earning an MSN. They will likely work for several years between the two degrees (most MSN programs prefer candidates with professional experience). Other pathways to this career take longer. It could be worse: to become a psychiatrist, you need to graduate from medical school, a four-year commitment followed by two to four years of residency.
Certification for PMHNPs is provided by the ANCC. The certification is called the Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification. The credential is valid for five years, after which it must be renewed.
This certification was previously offered as the Adult Psychiatric-Mental Health Nurse Practitioner Certification (PMHNP-BC). Those holding the PMHNP-BC can renew it, but the certification is no longer being issued to new practitioners.
A number of top universities offer an MSN leading to certification as a PMHNP. They include:
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