FAQs about Advanced Practice Psychiatric Nurses

General Information
1. What is an Advanced Practice Psychiatric Nurse?
2. How did the Advanced Practice Psychiatric Nurse role begin?

APPN Education
3. How is an Advanced Practice Psychiatric Nurse educated?
4. What are the prerequisites for applying to an Advanced Practice Psychiatric Nursing program?

Scope of Practice
5. What areas can Advanced Practice Psychiatric Nurses work in?
6. Can Advanced Practice Psychiatric Nurses prescribe medications?

Physicians and APPNs
7. What do physicians think of Advanced Practice Psychiatric Nurses?

Organizations: APNA and APNF
8. What is the American Psychiatric Nurses Association (APNA)?
9. What is the American Psychiatric Nursing Foundation (APNF)?



1. What is an Advanced Practice Psychiatric Nurse?

Advanced Practice Psychiatric Nurses are health care professionals licensed, or in the case of those employed by the federal government they are credentialed, to practice as specialists in psychiatric mental health nursing. The advanced practice psychiatric nurse may be certified by the American Nurses Credentialing Center (ANCC) in several Psychiatric Mental Health (PMH) advanced practice nursing roles. 

This board certification recognizes specialization in populations:
       • Child & Adolescent Psychiatric & Mental Health Clinical Nurse Specialist (PMHCNS-BC)
       • Adult Psychiatric & Mental Health Clinical Nurse Specialist (PMHCNS-BC)
       • Family Psychiatric & Mental Health Nurse Practitioner (PMHNP-BC)
       • Adult Psychiatric & Mental Health Nurse Practitioner (PMHNP-BC)

States and place of service often title APRN-PHMs differently. For example, in New Jersey APRNs with CNS or NP credentials in psychiatric mental health nurse are titled by the state as nurse practitioners. Standardizing the titling among states and places is a goal of APNA. From a national perspective, little difference exists between APRN-PMH roles except that nurse practitioners may provide primary health care for patients and in all states they have prescriptive authority. In contrast, clinical nurse specialists may focus more on system issues such as staff development or may focus their practice on individual, group or family psychotherapy. In 36 states psychiatric & mental health clinical nurse specialists also have prescriptive authority. Both Psychiatric NPs and Psychiatric CNSs are responsible for assessment, diagnosis, treatment, and evaluation of mental illness such as depression, schizophrenia, bipolar disorder, anxiety, etc. APRN-PMHs may conduct physical exams, order and interpret tests, counsel on preventive health care, and write prescriptions. Within the physician-APRN relationship, APRN-PMH exercise autonomy in decision making and provide a broad range of diagnostic and therapeutic services. APRN-PMHs also engage in education, research, and administrative services.   

APRN-PMHs are educated at the master’s or clinical doctorate (DNP) level in a holistic biopsychosocial model of psychiatric & mental health nursing.  APRN-PMHs also understand the medical model because they work closely with physicians. Upon graduation, Advanced Practice Psychiatric Nurses may take a national certification examination developed by the American Nurses Credentialing Center (ANCC). To maintain their national certification, APRN-PMHs must provide 1000 clinical hours of patient care and log 75 hours of continuing education every five years. They must recertify every five years.


2. How did the Advanced Practice Psychiatric Nurse role begin?

In 1955 at Rutgers University, Dr. Hildegard Peplau initiated the first clinical nurse specialist (CNS) program with a grant from National Institute of Mental Health. With a vision for nurses who had expert theoretical and practice knowledge to improve patient outcomes and change systems to promote quality care, advanced practice psychiatric nurses were prepared to link nursing science and nursing practice. Advanced Practice Psychiatric Nurses (APRN-PMHs) provided care to persons with psychiatric disorders, for example depression, anxiety, bipolar disorder, schizophrenia and substance abuse, or mental health problems such as loss, grief, adjustment problems, difficulty with coping with aspects of their lives including physical health problems. APRN-PMHs focused on therapeutic milieu (assuring the activities and interaction in the environment supported positive outcomes for patients) and psychotherapy (individual, group and family). By 1965, more than 30 programs prepared APRN-PMHs. In the early 1990’s as nurse practitioners in other fields were claiming their place in the advanced practice nursing world, leaders in psychiatric nursing began to explore the nurse practitioner role for APRN-PMHs.


3. How is an Advanced Practice Psychiatric Nurse educated?

Advanced Practice Psychiatric Nurses are educated in intensive accredited graduate nursing programs. The average APRN-PMH program curriculum runs approximately 16-24 months. All APRN-PMH programs must meet the same standards.

APRN-PMHs are educated in a holistic model of psychiatric & mental health care. APRN-PMH students learn to diagnose and treat simple and complex psychiatric and mental health problems from adjustment disorder to serious mental illness such as schizophrenia, bipolar illness, major depression or anxiety disorders. APPNs work with specialty populations such as children, adolescents, adults, and older adults. They are employed in hospitals, community mental health centers, home health care, partial hospital care or residential settings.
 

Number of U.S. Graduate Programs Educating Advanced Practice Psychiatric Nurses 2003-2007
 
Psychiatric & Mental Health Nurse
Psychiatric & Mental Health Nurse
 
Clinical Nurse Specialist
Nurse Practitioner
           YEAR
Child & Adolescent
Adult
Family
Adult
2003
7
61
6
41
2004
8
58
6
50
2005
11
57
15
44
2006
13
57
17
56
2007
16
50
23
59
         AACN (2008). 2007-2008 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing.

 
















The education of an APRN-PMH builds on a bachelor degree in nursing. Often nurses with bachelor degrees obtain a graduate degree in psychiatric and mental health nursing after working as a registered nurse in various areas of health care and mental health care. The APRN-PMH graduate education consists of basic science, i.e., pathophysiology, advanced health assessment, brain and behavioral correlates, advanced psychopharmacology and psychotherapeutic techniques; followed by clinical rotations in outpatient mental health settings, hospitals or residential care settings. Graduate students may specialize in a particular population such as children, adolescents, geriatrics, the seriously mentally ill, forensics, or lesbian, gay, and transgendered populations, to name a few.

An Advanced Practice Psychiatric Nurse's education doesn't stop after graduation. APRN-PMHs are required to take ongoing continuing education and be retested on their clinical skills on a regular basis. A number of postgraduate APPN programs have also been established to provide practicing APPNs with post graduate certification in psychiatric and mental health nursing.


4. What are the prerequisites for applying to an Advanced Practice Psychiatric Nursing program?

APRN-PMH programs look for students who have a desire to study, work hard, and to be of service to their community. Most Advanced Practice Psychiatric Nurse programs require applicants to have previous health care experience and an undergraduate college degree. The typical applicant has a bachelor's degree.


5.  What areas can Advanced Practice Psychiatric Nurses work in?

Advanced Practice Psychiatric Nurses are found in all areas of health care. They practice in primary care - that is family medicine, internal medicine, pediatrics, and obstetrics and gynecology, prisons, home health care, hospitals - as well in outpatient and other subspecialties.

APRN-PMHs receive a holistic education in health care and specialize in psychiatric and mental health care. Their education is ongoing after graduation through continuing education requirements and continual interaction with other health care providers.
 

Can Advanced Practice Psychiatric Nurses prescribe medications?

All fifty states and the District of Columbia authorize Advanced Practice Psychiatric Nurses prescribing if they are certified as a Nurse Practitioner. If a Clinical Nurse Specialist, APRN-PMHs are authorized to prescribe in 36 states.


7. What do physicians think of Advanced Practice Psychiatric Nurses?

Most physicians who have worked with Advanced Practice Psychiatric Nurses like having APRN-PMHs on staff. Studies done by the Federal Government have shown that APRN-PMHs, working with physicians, provide care that is comparable to physician care. The Eighth Report to the President and Congress on the Status of Health Personnel in the United States (released in 1992) states, "Advanced Practice Psychiatric Nurses have demonstrated their clinical effectiveness both in terms of quality of care and patient acceptance."


8.  What is the American Psychiatric Nurses Association (APNA)?

The American Psychiatric Nurses Association is the largest national professional society to representing psychiatric nurses. Founded in 1987, APNA has chapters in most of the 50 states, the District of Columbia and the federal services. APNA is the voice of psychiatric nursing. A professional organization of more than 9,000 members, we are committed to the specialty practice of psychiatric-mental health nursing, health and wellness promotion through identification of mental health issues, prevention of mental health problems and the care and treatment of persons with psychiatric disorders. APNA pursues these goals through alliances with stakeholders, research and data collection efforts, and continuing education programs. Learn more about what APNA has to offer by exploring what is available on the homepage: www.apna.org.


9. What is the American Psychiatric Nursing Foundation (APNF)?

As the philanthropic arm of APNA, the American Psychiatric Nursing Foundation's mission is to foster education and research that enhance the delivery of quality mental health care. Related to this mission are the Foundation's goals to increase the understanding of the Advanced Practice Psychiatric Nurse profession and to develop and promote philanthropic activities. Learn more about the APNF here.


*Work completed by the APNA Business Manual Taskforce; Chairs Nancy Hanrahan and Topsy Staten, 2009.