330,000 NPs practice in the United States, according to the American Association of Nurse Practitioners (AANP). Of that number, around five percent specialize in psychiatry and mental health care. These more specialized professionals typically earn excellent wages. According to the AANP, NPs earned a 2020 median base salary of $110,000; Indeed lists the average base salary for PMHNPs at nearly $140,000.
Psychiatric nursing has its roots in the reform movements of the late 19th century; medicine knew little about mental illness back then but practitioners understood they needed better ways to treat it. By the early 20th century, psychiatric nurse education programs started to pop up at universities, establishing the discipline’s academic bona fides.
The National Mental Health Act of 1946 recognized psychiatric nurses among the four core mental health disciplines, empowering the government to fund mental health nursing education programs. Not long after—in 1954, to be exact—Hildegard Peplau launched the first psychiatric nursing graduate program at Rutgers University. And in 2000, the American Nurses Credentialing Center (ANCC) released the first psychiatric mental health nurse practitioner (PMHNP) exam. Today, psychiatric nursing stands as a bedrock of mental healthcare.
Medicine employs mental health nurses at all levels. Psychiatric mental health nurse practitioners—a type of advanced practice registered nurse (APRN)—rank near the top. Professionals in this field must earn a graduate degree (a master’s or doctorate) and pass a rigorous examination. Their work overlaps considerably with that of medical doctors; in most states, PMHNPs autonomously engage in patient care, diagnose conditions, and prescribe medications.
If you’re ready to level up, this article on the path from registered nurse (RN) to psychiatric mental health nurse practitioner (PMHNP) can show you how. It covers:
Before examining the move from RN to PMHNP, you’ll need to become an RN. Earning a Bachelor of Science in Nursing (BSN) offers one route to this designation. Bachelor’s degree programs typically require four years of full-time study to complete. Those who already hold a bachelor’s degree in another subject can earn the BSN on an accelerated calendar.
Many schools offer BSN to MSN programs to ease the undergraduate-to-graduate transition and reduce the number of prerequisite classes students must take. Many schools offer direct-entry Doctor of Nursing Practice (DNP) programs, enabling undergraduates to enter with a bachelor’s (you will need a master’s if you want a PhD, however).
Not all RNs have a BSN. A two-year associate degree or corresponding hospital program can qualify you for your RN license. Most MSN programs require RNs who follow this path to complete additional study before commencing graduate study. For example, University of Maryland, Baltimore students earn their BSN as part of the school’s RN-to-MSN program. Some programs even allow ADN-holders to pursue a doctoral degree.
Make sure any program you choose meets Commission on Collegiate Nursing Education (CCNE) accreditation standards. Many states allow graduates of accredited programs only to sit for the National Council Licensure Examination (NCLEX) certification exam.
Many nurses enjoy successful, satisfying careers without advancing beyond the RN level. Some pursue a credential from the American Nurses Credentialing Center (ANCC) to work with psychiatric patients. They need at least 2,000 clinical hours of work in a psychiatric mental health setting and 30 or more hours of continuing education. If you want to practice more broadly and with more autonomy, however, you should consider earning your Master of Science in Nursing (MSN).
As a PMHNP, you’ll share many responsibilities with physicians. You’ll make diagnoses, which may involve ordering testsand conducting assessments. You’ll be able to offer a combination of psychotherapy and medication as part of a treatment plan you develop. Degree programs cover all these skills and more.
Certified professionals work with many populations, including those in rural and underserved areas, the elderly, adolescents, and substance abuse users. They can work in many settings, most often hospitals and institutions—both inpatient and outpatient. According to an American Psychiatric Nurses Association (APNA) 2022 workforce survey, 70 percent of APRN psychiatric mental health nurses work in outpatient settings. They can also work in non-healthcare institutions such as correctional facilities and schools. PMHNPs may also open private practices in some states.
After completing a graduate degree, you’ll need to pass the Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC) examination, which consists of 175 questions presented over a 3.5 hour testing period. It covers competencies like diagnosis, treatment plans, and evaluation. PMHNP credentials must be renewed every five years.
A Master of Science in Nursing (MSN) qualifies candidates for advanced practice nursing roles, including nurse practitioner. MSN programs offer many specializations, including not only psychiatric mental health but also public health, adult gerontology, primary care, and a dual degree in nursing administration and urban policy and leadership.
Alternatively, you could pursue a Doctor of Nursing Practice (DNP) degree to develop your psychiatric mental health nursing credentials. DNP programs typically take three or four years to complete, if you already have a BSN. Part-time PMHNP programs may also be available but take longer to obtain. Some within the industry have pushed to make the DNP the standard education for advanced practice nurses, but progress on this front is slow at best. Most advanced practice nurses still hold an MSN as their highest-level degree.
For BSN holders, MSN programs typically take two years or less (occasionally 18 months). RN-to-MSN programs can take longer, especially if the student must complete makeup coursework.
Admissions criteria and prerequisites differ by program. For instance, the Vanderbilt University School of Nursing does not require two years of work experience as other programs do; recent and soon-to-be BSN graduates can apply. Applicants may not even need an RN license if they complete additional coursework.
BSN holders must show they’ve taken an approved statistics course, while those with non-nursing degrees must complete credit hours in subjects like microbiology, anatomy, physiology, statistics, nutrition, and developmental psychology.
Most programs follow traditional graduate admissions standards. This means you can expect to submit a personal essay, letters of recommendation, and your resume and transcripts from previous academic institutions. Many programs have undergraduate GPA requirements, often 3.0 or higher.
First, students typically complete core MSN coursework regardless of their nurse practitioner specialty. At Yale University all advanced practice nursing students take courses in health assessment, advanced pharmacology, advanced pathophysiology, health promotion, and evidence-based practice.
The bulk of the degree program revolves around the specialization, including courses that build on core classes. Psychiatric mental health students pursue education in preventing and treating mental illness and mental health disorders. Course titles include:
Throughout the degree program, students complete clinical rotations in which they gain experience learning how to diagnose psychiatric disorders in actual care settings. This experience is essential to build skills for the licensure exam, which requires at least 500 hours of approved clinical practice.
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