Nurse practitioners occupy a middle ground between traditional nursing and doctoring. In 25 states, primarily in the Northeast and Northwest, they enjoy full practice authority; that means they can diagnose, treat, and prescribe without an MD’s oversight. Only 11 states (primarily in the South) require an MD’s oversight for all three.
These health professionals even specialize like physicians—common specializations include pediatrics, women’s health, neonatal medicine, adult gerontology, emergency care, and psychiatric mental health.
Nurse practitioners don’t have all the same authorizations as MDs, but the differences are barely noticeable to most patients. NPs earn less than medical doctors but also spend less time in school, meaning they start earning sooner. And what they earn is impressive; according to Indeed, the average psychiatric mental health nurse practitioner (PMHNP) earns an average base salary over $140,000.
Traditional NPs serve many of the same functions as primary care physicians. PMHNPs provide many of the same services as psychiatrists; they can diagnose mental illnesses, prescribe relevant medications, and offer psychotherapy services. Due to a growing national psychiatrist shortage, PMHNPs figure to play a key role in the campaign to increase access to mental health care for a population in need.
This article offers several answers to the question why become a psychiatric mental health nurse practitioner? It covers:
PMHNPs undergo intensive training and education and deal with immense work challenges. In return, they enjoy a career that can be high-paying and fulfilling.
PMHNPs often work in challenging, high stress environments (more on that later), where they can change lives and reach patients in need. The American Psychiatric Nurses Association (APNA) surveyed over 4,000 psychiatric advanced practice registered nurses (APRN) and determined 44 percent
serve federally insured patients who, without that program, would lack access to mental health care.
One study indicates that PMHNPs could be even more effective by expanding behavioral health care services to primary care settings. The idea is somewhat new, but the study notes that mental health issues prompt as many as 70 percent of visits to primary care facilities. Evidence strongly supports incorporating psychiatric evaluations into these visits.
Nursing school teaches essential skills like how to prescribe medication and read charts. But many PMHNP skills don’t come naturally to everyone. For example, time management is key; they balance helping multiple patients at a time with administrative duties. Organization is one of many skills that can help you excel in this profession.
PMHNPs also rely on emotional intelligence. They listen to patients and often deal with issues like physical violence. That’s one reason nurses have high burnout and substance abuse rates. Addressing others’ mental health needs is a rich and rewarding career but it’s not for everyone.
According to the APNA survey, most PMHNPs work in outpatient facilities, including mental health clinics, community health centers, and federally qualified health centers. The definition also includes private practices, which PMHNPs can operate, depending on state regulations. These professionals can also work in inpatient facilities like correctional facilities and long-term psychiatric units; about 30 percent do.
As a PMHNP, you can specialize in working with a specific population, including adolescents, the elderly, prisoners, families, and addicts. The subspecialty you choose can influence your place of employment.
PMHNPs earn excellent salaries—often above $140,000. Of course, factors like geographic location impact earnings; PMHNPs who work in rural areas typically earn less than those in cities. States with the lowest salaries include New Mexico, Alabama, Kansas, Mississippi, Florida, Georgia, and Louisiana. Professionals in these places still earn six-figure salaries, according to the US Bureau of Labor Statistics (BLS). Top-paying states, where PMHNPs typically earn more than $140,000, include Washington, Maryland, Virginia, Colorado, Nebraska, and Delaware.
PMHNPs typically don’t impact the mental health care system, though they can help many individuals. These providers can bring mental health services to previously isolated rural populations. Though the APNA says only one percent of psychiatric APRNS currently serve rural communities, telehealth advancements can increase this number. In fact, 86 percent of PMHNPs currently offer psychiatry services via teleconferencing platforms (usually in multiple states).
If you want to impact the practice of psychiatric nursing and change the healthcare system, consider a research career. Policymakers and industry leaders use APRN researchers’ work to improve the profession. Researchers may need a PhD, which requires more time in school. The APRN says the rate of psychiatric APRNs with a PhD has decreased since 2010.
PMHNPs typically start as RNs—most schools include it as an admissions requirement. NPs typically spend an average of 13.75 years RNs before attending graduate school, according to one study. Many RNs have a Bachelor of Science in Nursing (BSN), but other pathways exist, including an Associate Degree in Nursing (ADN). After graduating, you must pass the NCLEX exam.
PMHNPs complete rigorous graduate education—either a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP). Those who already have a graduate degree in nursing can pursue a post-graduate certificate.
One non-negotiable factor when choosing a degree program is accreditation. Commission on Collegiate Nursing Education (CCNE)-accredited programs prepare you to sit for the credential exam. An unaccredited degree may disqualify you.
Though the APNA reports that more nurse practitioners are choosing DNPs, MSNs are still the more common choice for nurse practitioners in all specialization areas. According to the APNA survey, more than two-thirds of APRNs hold an MSN as their highest form of nursing education.
PMHNP students study topics like psychiatric pharmacology, crisis intervention, psychotherapy techniques, group therapy practices, health promotion and prevention (including for mental health and substance abuse).
The American Nurses Credentialing Center (ANCC) requires every candidate for the Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC) to have 500 or more faculty-supervised clinical hours. During their clinical hours, students work alongside experienced clinicians in outpatient and inpatient clinics. Clinical training can help students focus their education and develop a niche practice area.
The short and long answer is yes. Not only is it possible to become a PMHNP online, but it’s becoming increasingly common. Many top nursing schools either already have an online PMHNP program or are starting one—Yale University has its program launch scheduled for 2023. According to the APNA, APRNs under 50 completed an average of over 40 percent of their didactic coursework online. The numbers are even higher for younger nurses. One-quarter of APRNs in their 30s finished 85 percent of coursework online, while a quarter of those in their 20s selected entirely online programs.
Those who pursue an online program still complete in-person clinical rotations. Schools may help with placements, but it’s often up to the student. Still, many programs offer resources to guide the search.
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