Ever read about the large number of people suffering from depression in the U.S.? Or realize that one in four adults has an experience with mental illness every year? Patients often turn to psychiatrists to help alleviate some of their emotional and mental suffering and work on a path of treatment and healing, but nurses with advanced practice skills can also help. Known as psychiatric-mental health nurse practitioners (PMHNP), these health care professionals can also diagnose symptoms, develop a treatment plan for patients and even prescribe medication, according to the American Psychiatric Nurses Association (APNA). But, as PMHNPs, they may also do many other things, too, such as practice evaluation and quality improvement.
How do their roles differ from psychologists or even psychiatrists and social workers? As a matter of fact, all of the professionals in these positions can be involved in psychotherapy, but only advanced practice registered nurses (APRNs), such as the PMHNP, and psychiatrists can prescribe medication. Social workers and psychologists cannot, according to the APNA. What may be more important is that all of these providers can practice independently, providing care where it may otherwise be inaccessible, although they are always under the authority of state law when it comes to scope of practice.
Only 3.2% of nurse practitioners (NPs) choose employment in the psychiatric and mental health field. Many more, 48.9%, choose to work in family care and another 18.9% pursue adult care. The American Association of Nurse Practitioners reports that the average age of the nurse in psychiatric/mental health care is 53 and that she or he has been an NP in the field for an average of 9.1 years. What about compensation? This occupation is one of the higher-paying nurse practitioner fields, according to the 2011 American Association of Nurse Practitioners (AANP) National NP Compensation Survey. Of eight specialty fields, only NPs working in neonatal care had a higher average total yearly income, at $124,450, compared to PMHNPs, who had an average total yearly income of $111,220. The next closest total income was that for acute care NPs at $105,200, according to the AANP.
It may not always be obvious how to become a psychiatric nurse practitioner, and in fact there are several pathways, but no matter the path, the terminal degree is either a Master of Science in Nursing (MSN) degree or a Doctor of Nursing Practice (DNP) degree. An associate’s degree in nursing (ADN), and experience working as a registered nurse (RN) are common admissions requirements for such programs. Sometimes, a bachelor’s of science in nursing (BSN) is required rather than an ADN. Current nurses may pursue pathway programs, such as ADN-to-MSN and BSN-to-MSN PMHNP programs, or even DNP programs such as ADN-to-DNP (relatively rare), BSN-to-DNP, or MSN-to-DNP. Nurses may also be able to complete a post-master’s certificate if they hold another master’s degree. For non-nurses, there are direct entry nursing programs that provide a direct path to advanced nursing from a non-nursing bachelor degree. These accelerated MSN programs are intense, as the student must complete an RN and BSN on the way to the specialized MSN degree, and the student must also earn clinical experience working as an RN. The time and commitment to complete coursework in a graduate-level program whilst employed as a full-time or part-time nurse is non-trivial, to say the least.
Typically, students seeking admission to an MSN-PMHNP program need to meet a number of additional requirements, which vary from school to school and program to program but can include:
Some admission counselors may even want to do an interview with students. While the type of graduate-level program completed by students can vary, most nurses eventually seek certification in their specialty area. For the psychiatric-mental health field, credentialing is offered through the American Nurses Credentialing Center (ANCC). There are actually two certifications available for these nurses that include:
The exam for board certification is computer based and includes 200 questions. The window of test time is four hours, with 175 questions scored for results and 25 simply being pretest non-scored questions. To be eligible to take the exam, applications must hold a current nursing license and be a graduate of an accredited degree program that included a minimum of 500 supervised clinical hours. Graduate level courses in advanced health assessment, advanced physiology/pathophysiology and advanced pharmacology must also have been completed.
Certification is good for five years and then can be renewed through professional development and completion of 1,000 already obtained practice hours in the field, professional development and re-testing, or a number of other combinations and options.
Options for entering the PMHNP field will vary, but nurses without a graduate-level education may start by applying to an MSN program or even look to complete a Doctor of Nursing Practice (DNP). However, whatever degree option they do choose, nurses at the advanced level should find programs that include core components of advanced health assessment, physiology/pathophysiology and pharmacology, as this is part of the new knowledge model being promoted in advanced nursing education. Nurses may choose the most appropriate path to becoming a PMHNP from the list below.
1. The ADN or BSN to MSN – Many programs will require a student to already have a bachelor’s of science degree in nursing to apply for admissions to an MSN program. This may not always be the case, but is true for admission to the program in psychiatric mental health nursing practitioner care available through Ohio State University, in Columbus. Students take both core and specialty courses in this degree and complete 16 clinical hours per week during the two semesters of their last year of study. At the University of Southern Mississippi, in Hattiesburg, where specialization in mental health is also available, students must complete core coursework first before being admitted into the specialty area. These 11 credits are done in the first semester of this overall 47-credit program.
2. Post-master’s certificate – Students who are already advanced practice registered nurses (APRNs) and specifically want to train for the mental health field can work on a graduate-level certificate. Applicants still need to submit many of the similar types of paperwork that they do for admission to an MSN program, and generally have to have completed advanced health assessment, pathophysiology and pharmacology courses. Ohio State University also offers a post-master’s certificate specialty in mental health care as does the University of Southern Mississippi.
3. BSN-to-DNP or MSN-to-DNP – Students wanting to complete their terminal education in the nursing field can work on their Doctor of Nursing Practice, focusing in psychiatric and mental health nursing. Rush University, in Chicago, offers both options to applicants interested in advanced education, with online learning also being available. Applicants must have their RN license and either a BSN or MSN degree. Nursing experience in the field of psychiatric/mental health is also suggested. A DNP program is also available through the University of Kansas Medical Center, in Kansas City. This 79-credit program prepares students through both core and specialty area coursework as well as requires them to complete a DNP capstone project. When done, students should be prepared to sit for national board certification.
Any student interested in advanced nursing education will want to ensure that their program is accredited. This accreditation is important for board certification and also for applying to more advanced education programs, such as the DNP, in the future. The American Association of Colleges of Nursing (AACN), the National League for Nursing (NLN) and the American Commission for Education in Nursing (ACEN) accredit programs, but the APNA also makes a list of graduate-level nursing programs specifically available in mental health nursing in the U.S. searchable by state.