What is a Psychiatric-Mental Health Nurse Practitioner (PMHNP)?

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According to the American Association of Nurse Practitioners (AANP Oct. 2016), 5.4 percent of the more than 220,000 licensed NPs across the country work in the psychiatric mental health subfield. They take on a wealth of cross-disciplinary responsibilities including making medical and psychiatric diagnoses; conducting various physical and mental health assessments; designing holistic treatment plans; prescribing psychopharmaceuticals and other medications; offering counseling or psychotherapy; consulting with other healthcare professionals; and educating patients, legislators, and communities on optimal practices to promote psychological health and well-being. psychiatric-mental health nurse practitioners (PMHNPs) may be involved in shaping public policy and often specialize in working with specific populations such as children or the elderly. Others may focus on particular areas of need such as substance abuse treatment, forensics, family counseling, or specific psychiatric disorders. Above all, PMHNPs offer integrative care paying thought to the mind-body connection.
This piece offers a detailed overview of what PMHNPs do, including a discussion of their typical skills, education, and credentialing for the profession.

 

What does a Psychiatric Nurse Practitioner Do?

The American Psychiatric Nurses Association (APNA)—one of the most vibrant professional associations in this field—states that psychiatric-mental health nurse practitioners (PMHNPs) assess the mental health needs of communities, individuals, families, and groups. They formulate healthcare plans, implement treatment, and evaluate the effectiveness of short- and long-term progress. In further detail, advanced practice mental health nurses may also:

  • Offer outpatient or home-based care to address sudden changes in a patient’s mental status or chronic conditions
  • Serve as consultants for community groups, corporations, healthcare agencies, legislative advocacy groups, and other organizations
  • Perform various patient assessments (e.g., physicals, family risk analyses, diagnostic exams, mental health tests)
  • Develop holistic, cross-disciplinary treatment plans
  • Prescribe medications in compliance with state scope of practice laws
  • Collaborate with doctors and make appropriate patient referrals
  • Maintain detailed patient records
  • Conduct original research and present findings through conferences or scholarly journal articles
  • Analyze effectiveness of treatments
  • Educate patients, families, and others on challenges in mental health

There are various professional associations which assist PMHNPs in their professional role. The aforementioned American Psychiatric Nurses Association (APNA) has an abundance of resources for advanced practice nurses in the psychiatric field (APRN-PMH) such as evidence-based position papers for advocacy, wage statistics, opportunities for continuing education, conference notifications, networking opportunities, scholarships, information about specific conditions (e.g., tobacco addiction, suicide prevention), and other useful tools for the profession. The International Society of Psychiatric-Mental Health Nurses (ISPN) has similar resources for members in addition to global leadership development in the PMHNP community, broad-based legislative efforts, and recognition of outstanding professionals in this field worldwide. Additionally, there are various regional organizations, including the Association of Advanced Practice Psychiatric Nurses (AAPPN) of Washington state.

It’s important to distinguish between PMHNPs and other psychiatric healthcare specialists such as psychologists, psychiatrists, social workers, and counselors. All of these professionals generally offer some form of psychotherapy for patients, but there are some key differences. The most obvious distinction is that PMHNPs hold advanced nursing degrees. Also, while PMHNPs and psychiatrists can prescribe medications*, social workers and psychologists cannot. Lastly, PMHNPs are qualified to perform advanced physical assessments and diagnostic exams, while the other mental health professionals tend to focus squarely on the mind.

*Please note that this may vary according to a PMHNPs state of practice.

Skills & Personality Traits of Successful Psychiatric Nurse Practitioners

According to the APNA (2017), psychiatric-mental health NPs require excellent communication skills and relationship-building abilities in order to practice effectively. These competencies are especially important since providing the right kind of treatment can depend on the NP’s ability to assess and understand a patient’s underlying issues, as well as to liaise with other healthcare providers and advocate for improvements to policies and regulations. Other desired traits and proficiencies among PMHNPs include:

  • High-level understanding of the impact of mental health issues on society
  • Ability to exercise compassion, empathy, and sensitivity to the gamut of human problems and conditions
  • Competence with medical equipment (e.g., EKGs, defibrillators, etc.)
  • Experience with medical software and coding systems for diagnoses

In sum, psychiatric nurses work across the medical and psychological disciplines to therapeutically engage with patients. They bring various skills to the table, tapping the disparate realms of behavioral intervention strategies, neurobiological knowledge, psychotherapeutic understanding, and an ability to assess the physical condition of the body.

Education & Experience Requirements for a Psychiatric Nurse Practitioner

Like other nurse practitioners, PMHNPs must have at least a master of science in nursing (MSN) or a post-master’s certificate prior to practice. There are various PMHNP programs available, including many which can be completed online. It’s important to note that while an MSN is currently the minimum academic credential in this field, there’s a growing trend toward the doctor of nursing practice (DNP), the terminal degree for NPs. The American Association of Colleges of Nursing (AACN 2017) notes that this practice-centered doctorate helps NPs meet “the changing demands of this nation’s complex healthcare environment” and represents “the highest level of scientific knowledge and practice expertise to assure quality patient outcomes.”

Before enrolling in any graduate program in nursing, prospective PMHNPs are strongly encouraged to verify their school and program accreditation status. There are two main entities which offer accreditation to graduate NP programs: Accreditation Commission for Education in Nursing, Inc. (ACEN) and the Commission on Collegiate Nursing Education. To learn about how programs are approved, please visit the individual websites or the ‘accreditation’ section of the online NP programs page.

Regardless the graduate credential achieved, PMHNP programs typically involve instruction in:

  • Psychiatric mental health disorders
  • Older adult mental health assessment & evaluation
  • Psychopharmacology & biological interventions
  • Child & adolescent mental healthcare
  • Advanced statistics & research methods
  • Health promotion & disease prevention
  • Social determinants of health & health equity
  • Advanced family clinical practice
  • Advanced pharmacology
  • Advanced pathophysiology

As part of the academic experience, aspiring PMHNPs also garner hands-on experience through clinical practicums or preceptorships. These experiences put PMHNPs into direct contact with patients under supervised conditions, and may expose students to particular client populations which may inform the selection of a subspecialization such as adolescents or adults.

Once they have completed a psychiatric mental health NP program, students typically seek national certification through the American Nurses Credentialing Center (ANCC). To be eligible for the psychiatric mental health NP certification, applicants must have an active registered nurse (RN) license; a graduate degree from an accredited nursing program with proof of specific coursework (e.g., health assessment, pathophysiology, pharmacology); proof of at least 500 supervised clinical hours; clinical training in a minimum of two psychotherapeutic modalities; and a passing score on a comprehensive examination.

The exam is computer-based and includes 200 questions, 175 of which are scored and the other 25 of which are non-scored ‘pretest’ items. Examinees have four hours to complete the test, which is scored on a pass or fail basis. The certification is valid for five years and can be renewed following the submission of proof of 1,000 hours of direct patient care and 75 hours of qualifying continuing education (CE). The American Psychiatric Nurses Association (APNA) lists various CE opportunities on its website.

In addition to national certification, all PMHNPs must ensure that they have all necessary state credentialing prior to seeking employment. To learn about regional licensure for PMHNPs, please reach out to a specific state’s Board of Nursing, a list of which is available through the American Association of Nurse Practitioners (AANP 2017).

Finally, describing the responsibilities of a PMHNP isn’t always adequate to give people a feel for the embodied experience in this profession. To discover the lived realities of joining this rewarding field, please check out these two pieces:

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