Common Questions about Advanced Practice Psychiatric Nurses
1. What is an Advanced Practice Psychiatric Nurse?
2. How did the Advanced Practice Psychiatric Nurse role begin?
Advanced Practice Psychiatric Nurses (PMH-APRNs) are health care professionals licensed – or in the case of those employed by the federal government, credentialed – to practice as specialists in psychiatric-mental health nursing. The PMH-APRN may be certified by the American Nurses Credentialing Center (ANCC) in Psychiatric- Mental Health (PMH) as a Psychiatric-Mental Health Clinical Nurse Specialist (PMHCNS-BC) or Psychiatric-Mental Health Nurse Practitioner (PMHNP-BC).
States and places of service often title PMH-APRNs differently. For example, in New Jersey APRNs with CNS or NP credentials in psychiatric mental health nursing are titled by the state as a nurse practitioner. From a national perspective, little difference exists between PMH-APRN roles. As a PMH-NP, all states grant prescriptive authority. In many states, PMH-CNSs also have prescriptive authority. However, PMH-CNSs may focus more on system issues such as staff development or may focus their practice on individual, group or family psychotherapy. Both PMH-CNSs and NPs have the education and certification to provide therapeutic interventions. Both PMH-NPs and CNSs are responsible for assessment, diagnosis, treatment, and evaluation of mental illness such as depression, schizophrenia, bipolar disorder, anxiety, substance use disorders etc. PMH-APRNs may conduct physical exams, order and interpret tests, and counsel on preventive health care. PMH-APRNs exercise autonomy in decision making and provide a broad range of diagnostic and therapeutic services. PMH-APRNs also engage in education, research, and administrative services.
PMH-APRNs are educated at the master’s and/or doctoral (DNP or PhD) levels in a holistic biopsychosocial model of psychiatric-mental health nursing. PMH-APRNs also understand the medical model because, not only is it included in their education and training, they work collaboratively with physicians and other health care professionals. Upon graduation, PMH-APRNs must take a national certification examination developed by the American Nurses Credentialing Center (ANCC). There is one certification for all PMH-NPs, which is across the lifespan. The PMH-CNS certification and Adult PMH-NP examinations have been retired. Those certified as a PMH-CNS or Adult PMH-NP can maintain certification if the individual meets re-certification requirements. All but five states require certification for practice. To maintain national certification, PMH-APRNs must re-certify every five years and meet the requirements which may include a combination of specified clinical practice hours and continuing education contact hours.
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 practical knowledge to improve patient outcomes and change systems to promote quality care, psychiatric-mental health advanced practice psychiatric nurses (PMH-APRNs) were prepared to link nursing science and nursing practice. PMH-APRNs provided care to persons with psychiatric disorders, for example depression, anxiety, bipolar disorder, schizophrenia and substance use, or mental health problems such as loss, grief, adjustment problems, or difficulty with coping with aspects of their lives including physical health problems. PMH-APRNs 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 PMH-APRNs. In the early 1990s as nurse practitioners in other specialties were claiming their place in the advanced practice nursing world, leaders in psychiatric nursing defined and implemented the nurse practitioner role for PMH-APRNs.
Advanced Practice Psychiatric Nurses are educated in intensive accredited graduate nursing programs. The average PMH-APRN program curriculum runs approximately 16-24 months. All PMH-APRN programs must meet the same standards.
PMH-APRNs are educated in a holistic model of psychiatric-mental health care. Students learn to diagnose and treat simple and complex psychiatric and mental health problems from adjustment disorders to serious mental illnesses such as schizophrenia, bipolar illness, major depression or anxiety disorders. PMH-APRNs work with populations across the lifespan, from early childhood to older adulthood. PMH-APRNs are employed in hospitals, community mental health centers, home health care, partial hospital care, residential settings or private practices.
The education of a PMH-APRN builds on a bachelor degree in nursing. Often nurses with bachelor degrees obtain a graduate degree in psychiatric-mental health nursing after working as a registered nurse in various areas of health care and mental health care. The PMH-APRN 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. Post-graduation, PMH-APRNs may specialize in treatment of a particular population such as children, adolescents, geriatrics, the seriously mentally ill, substance use disorders, trauma, forensics, or lesbian, gay, bisexual, and transgendered populations, to name a few.
A PMH-APRN’s education does not stop after graduation. PMH-APRNs are required to take ongoing continuing education contact hours in areas such as diagnosis, psychotherapeutic treatment, or psychopharmacology. A number of postgraduate PMH-APRN programs have also been established to provide practicing APRNs a post graduate certification as a PMH-NP.
PMH-APRN programs look for students who have a desire to study, work hard, and to be of service to their community. Most PMH-APRN programs require applicants to have previous health care experience and an undergraduate college degree. The typical applicant may need to have a bachelor’s degree in nursing and a license as a registered nurse (RN).
Advanced Practice Psychiatric Nurses work 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 treating symptoms of or mental health disorders.
All fifty states and the District of Columbia authorize PMH Advanced Practice Nurses to prescribe if they are certified as a Nurse Practitioner. Each state has different requirements to prescribe medication from full practice authority to needing a supervising psychiatrist. PMH-CNSs may prescribe in some states as determined by the individual state nurse practice acts.
The American Psychiatric Nurses Association is the largest national professional society 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 unifying voice of psychiatric-mental health nursing. A professional organization of more than 11,000 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 publications, and continuing education programs. Learn more about what APNA has to offer by exploring what is available on the homepage: www.apna.org.
*Work completed by the APNA Business Manual Taskforce; Chairs Nancy Hanrahan and Topsy Staten, 2009. Updated by APRN Council Chairs, 2017.