APNA Position: Psychiatric-Mental Health Advanced Practice Nurses

The burgeoning mental health needs of the population demand access to highly qualified providers. Psychiatric-Mental Health Advanced Practice Nurses (PMH-APRN) include both the Clinical Nurse Specialist (CNS) and Nurse Practitioner (NP). Both are prepared at the graduate level in research, systems, and direct patient care to provide psychiatric evaluations and treatment, including individual, family, and group therapy and psychopharmacological interventions, as well as primary, secondary, and tertiary levels of prevention across the lifespan. They are a vital part of the workforce required to meet the increasing population’s mental health needs.

The PMH-CNS certification began in 1974. The introduction of the Psychiatric-Mental Health Nurse Practitioner certification examinations in the early 2000s created confusion regarding the scope of practice of the Psychiatric-Mental Health CNS and NP. This further became confounded with variances in state licensure and titles.

The position of the American Psychiatric Nurses Association is, “whether practicing under the title of PMH-CNS or PMH-NP, Psychiatric-Mental Health Advanced Practice Registered Nurses share the same core competencies of clinical and professional practice” (ANA, APNA, ISPN, 2022, p.19). Both PMH-CNSs and PMH-NPs are educationally prepared to “fulfill three key roles in a variety of clinical settings: provision of psychotherapy, provision of psychopharmacological interventions, and provision of clinical supervision” (p.19). They are “accountable for their own practice and are prepared to provide services independent of other disciplines in the full range of delivery settings” (p.21).

The following data lend further support to this position:

• The American Nurses Credentialing Center and the American Psychiatric Nurses Association conducted a Logical Job Analysis of the PMH-CNS and PMH-NP in 2005. Analysis of the existing role delineation studies of the PMH-APRN revealed 99% of the identified competencies were shared between the two titles (Rice, Moller et. al., 2007, p.157).
• The ability of Psychiatric-Mental Health Clinical Nurse Specialists to have title rights, prescriptive authority, and direct care billing of CPT codes began in 1978 in the Pacific Northwest. As of 2020, CNSs can practice independently in 28 states and prescribe independently in 19 (NACNS, July 2020). CNSs can bill for services in states where they are licensed to practice as APRNs (CMS, March 2022).
• Medicare continues to reimburse ANCC-certified Psychiatric-Mental Health Clinical Nurse Specialists for CPT codes related to psychotherapeutic evaluation and treatment. Certified Psychiatric-Mental Health Nurse Practitioners were added in 2007.

Adopted by APNA Board of Directors October 2010; Reviewed February 2020; Revised June 2022; Update in Progress

References

American Nurses Association, American Psychiatric Nurses Association, & International Society of Psychiatric-Mental Health Nurses. (2022). Psychiatric-Mental Health Nursing: Scope and Standards of Practice (3rd Ed.). Silver Spring, MD. ANA (pgs. 59–92).

Centers for Medicaid and Medicare Services (March 2022). MLN Booklet: Advanced Practice Registered Nurses, Anesthesiologist Assistants, & Physicians Assistants. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Medicare-Information-for-APRNs-AAs-PAs-Booklet-ICN-901623.pdf

National Association of Clinical Nurse Specialists (July 31, 2020). CNS Scope of Practice and Prescriptive Authority as of 7.31.2020. Retrieved from https://nacns.org/wp-content/uploads/2020/08/PractPrescAuthority7.31.2020.pdf

Rice, M. J., Moller, M. D., DePascale, C., & Skinner, L. (2007). APNA and ANCC collaboration: achieving consensus on future credentialing for advanced practice psychiatric and mental health nursing. Journal of the American Psychiatric Nurses Association, 13(3), 153-159.