How to Become a Psychiatric Nurse Practitioner

Nurses have always been able to find satisfying work in a variety of clinical areas and settings. Because of rising populations and fewer psychiatrists,  nurse practitioners may take on some of the workload under a physician’s supervision, especially in rural areas. Nurses require additional education and clinical practice to achieve advanced nursing careers, but these nursing programs create a mostly autonomous niche for registered nurses. One of these specialties is the psychiatric nurse practitioner (PNP), sometimes referred to as a psychiatric mental health nurse practitioner (PMHNP).

The extra commitment and investment associated with a psychiatric nurse practitioner designation may seem daunting, but with careful planning and methodical steps, any nurse can accomplish it.  

Reasons to become a psychiatric nurse practitioner

If you’re a registered nurse wanting more professional autonomy and self-direction, consider becoming a nurse practitioner. As a nurse practitioner, you will perform many of the same tasks as a physician, such as prescribing medications and ordering tests and treatments.  As a psychiatric nurse practitioner, you will have expanded opportunities such as what types of clients you serve, what setting you choose and which modalities suit you best. You can even open a private practice to see people with mental health and substance problems in your own office, billing directly for your services.

The variety of practice settings and types may ensure a higher level of engagement for the psychiatric nurse practitioner. Daily experiences are fluid and often challenging, leading to a greater sense of satisfaction and professionalism.  

Psychiatric RNs working in mental health settings often want to advance their careers within the psychiatric arena by becoming PNPs. They have an advantage over nurses in other settings in that they are accustomed to managing mental health disorders and patients before entering the PMHNP program. Mental health language, strategies, medications and other factors are familiar to them, making it easier to incorporate new facts and therapies.

Education and experience needed to become a psychiatric nurse practitioner

A psychiatric nurse practitioner must first be a registered nurse. To do this, nursing education is required at the associate or baccalaureate degree level. An associate degree nurse must complete a bachelor’s degree; some schools offer accelerated RN to MSN programs where an associate degree nurse can obtain a baccalaureate and master’s degree at the same time. Not all of these organizations offer a master’s degree in psychiatric practitioner education, however. In this case, further education would be required to achieve the PNP designation. 

Most nurse practitioner programs also require at least two years of clinical practice to qualify for entry. While this can be in any field, acceptance into a PNP program after psychiatric nurse experience is preferred. A psychiatric nurse is typically an RN who works with mental disorders in a hospital clinic, inpatient or another setting. 

Unless the MSN program bestows a specific Master’s in Psychiatric Mental Health Nurse Practitioner, further education and clinical experience will be required before becoming entering into practice as an NPN. This may take another year or more, depending on the program and the time you commit to it.

By the end of the decade (2030), psychiatric nurse practitioners will likely be required to complete a doctorate to practice. This degree typically takes a year to two years, sometimes longer, to complete for the candidate with a masters’ of science in nursing degree. 

Certification

Candidates must complete a minimum of 500 supervised clinical hours to become certified through the American Nurses Credentialing Center (ANCC.)  Additional requirements include courses in:

• Advanced physiology/pathophysiology
• Advanced health assessment
• Advanced pharmacology

Also needed is educational content that includes the following :

• Promoting and maintaining physical and mental health
• Differential diagnosis approaches and testing
• The use of psychotropic medications such as antidepressants, anti-anxiety and other drugs
• Non-pharmaceutical interventions like therapy, holistic physical maneuvers like tapping or visualization
• Health care needs across all life stages
• Administration of psychiatric nurse practitioner businesses, if applicable

Further clinical training in at least two psychotherapeutic treatment modalities is further required for ANCC certification. This may include depression, bipolar disorder, eating disorders and personality disorders, to name a few

The certification exam itself tests a wide range of knowledge around mental health and psychiatric issues and interventions, including but not limited to:

• Scientific foundation, like advanced pathophysiology and pharmacology, advanced physical assessment, and neurodevelopment, among other topics
• Advanced practice skills, such as clinical interviewing, emergency psychiatric management, and substance abuse screening and treatment
• Diagnosis and Treatment: complementary and alternative treatments, differential diagnosis, and psychotherapeutic management
• Psychotherapy and related theories
• Ethical and legal principles

Online PNP education

Some universities offer partially online education for the PNP designation. These allow working clinicians to proceed toward a psychiatric nurse practitioner career while working, at least part-time, or caring for their families. It’s important to check that the program is accredited by the American Nurses Credentialing Center and qualifies you to sit for the certification exam. 

One such program is through Walden University, which offers several online nursing programs, including a Psychiatric-Mental Health Nurse Practitioner master’s degree. EDUMED.org lists comprehensive profiles of many schools offering online PMHNP education, including data on tuition, school type, and core goals.   

Demand for psychiatric nurse practitioners

Psychiatric nurse practitioners are currently in high demand, and this need is expected to rise as the population increases and the need for mental health care rises. While high demand exists in major cities such as New York, Boston and Los Angeles, rural areas and inner cities remain underserved by mental health clinicians, driving demand higher. 

According to a report by the American Psychiatric Nurses Association, approximately 56 million adults in the U.S. struggle with a mental illness or substance abuse problem and only 44% receive needed care. In children and adolescents, the deficit is 20%. There is already a shortage of psychiatric nurses and psychiatric-mental health nurse practitioners that impact patient access and outcomes.

At present, psychiatric mental health RNs and advanced practice RNs rank #2 in the number of behavioral health specialists in the U.S. The need is expected to increase over time. The Bureau of Labor Statistics, which keeps track of job outlooks for various occupations, including nurse practitioners, predicts a positive change in employment numbers of about 120,000 advanced nursing practitioners. 

Nurse practitioners’ ability to coordinate access to care and the treatment and maintenance of mental health patients is a characteristic of psychiatric nurse practitioners. General nurses who have completed a baccalaureate or MSN are uniquely positioned to consider all aspects of a patient’s life: social, cultural, physical and mental well-being. This particular skill makes a case for psychiatric nurse practitioners to take an active role in the lives of mental health and substance abuse patients.

One of the benefits of an advanced nursing degree such as a masters’ or doctorate in honing critical thinking skills that can see core issues through what may be many layers of information. Psychiatric nurse practitioners are no exception. The potential difficulty of analyzing and breaking through each client’s defense mechanisms and social or cultural issues requires an ability to think globally with an eye toward the individual. 

Benefits of becoming a psychiatric nurse practitioner

There are many professional and personal benefits for the psychiatric nurse practitioner. RNs who become PNPs can look forward to increased autonomy in their clinical work, as well as heightened satisfaction of having a direct influence on patients struggling with mental health and substance abuse issues. Whether practicing mental health care in an institution like a hospital, inside a corrections facility, or a school, PMHNPs can consider all aspects of a mental health patient’s life and wellness level.

One of the sought-after benefits of becoming a psychiatric nurse practitioner is the ability to see patients in a private practice setting. While a PNP needs to have a supervising psychiatrist overseeing some therapies and outcomes, most of the practice is autonomous. Increased flexibility is another benefit: the ability to set hours as desired and not have to adhere to a regular eight- or 12-hour shift in another setting. 

The challenges inherent in advanced treatment of mental health clients benefit ongoing skill-building efforts for PNPs. Unique mental and social issues require critical thinking along with ongoing clinical experience.

To some, an important advantage of becoming a PNP is the salary. Boston, Los Angeles and New York are the highest-paying cities for PNPs, with Los Angeles’s $131,000 topping the list. The practitioner’s years and types of experience also influence salary amounts and the fees for private sessions.  After several years of practice in a given community, PNPs earn trust among patients with mental disease and caretakers. 

Professional partnerships among psychiatric nurse practitioners that encompass different modalities and personalities provide a broad spectrum of opportunity for communities to center their mental health care. As part of primary care offices, the NPN can offer temporary or long-term therapeutic interventions that closely meet physical health priorities.

Career paths for psychiatric nurse practitioners

Psychiatric-mental health nurse practitioners have a wide array of practice settings and occupations to choose from. Some of the places to practice include:

• Academia
• Community mental health centers
• Correctional facilities
• Shelters for domestic violence victims and families
• Government agencies
• Home health agencies
• Hospitals
• In-patient mental health facilities
• Primary care practices
• Private psychiatric practices
• Public health agencies
• Substance abuse facilities
• Schools
• Student health clinics
• Nurse-managed clinics
• VA facilities

Potential roles include therapist, advocate, medication manager, and mental health consultant, for example. Psychiatric testing, placement and therapy in K-12 schools is another career path open to the PMHNP, as is working with inmates to help them acclimate themselves to their lives in incarceration.

Mental health nurse practitioners are sometimes a catalyst to developing programs in prisons, schools and other facilities for the enrichment and personal optimization of the population.  They may also facilitate referrals to community practitioners that can target specific needs.

Psychiatric nurse practitioner responsibilities

PNPs have many different responsibilities in their work, depending on the location and type of jobs they hold. They may include:

• Diagnosing and treating acute and chronic psychiatric problems
• Managing pharmacological treatment of psychiatric disorders
• Practicing psychotherapy for individuals, couples or families
• Coordinating services for mental health clients
• Supplying mental health education to clients and families
• Identifying and treating health problems that are concurrent with mental health issues; referring to other specialists
• Performing screening procedures
• Addressing self-care issues and opportunities
• Advocating for mental health clients and families

The range of potential roles and responsibilities provides an environment in which psychiatric nurse practitioners can incorporate one or more into a single practice or move among them with ease. 

How are a psychiatric nurse practitioner and a psychiatrist different?

Several professionals may work with mentally ill clients, including NPNs, physicians, psychologists and social workers, and some of their functions overlap. Focusing primarily on differences between psychiatric nurse practitioners and psychiatrists, the main one is that typically a PNP has a master’s degree, and physicians have earned a doctorate. Some PNPs may pursue a doctorate as well, which may expand the types of roles they can have, such as teaching and research in academia. 

PNPs can prescribe medications for treating mental conditions, but they must collaborate with a psychiatrist. In other ways, except when they manage complex cases or have a less than successful outcome, they are largely autonomous. 

A physician’s education includes a bachelor’s degree, generally in a scientific field like biochemistry, followed by medical or osteopathic medical school. After obtaining an MD or DO designation, clinical residency narrows the scope to specialized psychiatric care. To become a specialist in a particular area of psychiatry, a fellowship is a next step on a psychiatrist’s path. Additional certifications and degrees may further sharpen skills in a specific field of psychiatry. 

A psychiatric nurse practitioner, as noted elsewhere, must be an RN who acquires a master’s degree in psychiatric mental health nursing with added clinical education and practice. Concentrations of study may provide education in specialized nurse practitioner areas such as psychiatry for cancer patients, gerontology or support of parents of mentally challenged children. There are no formal residencies, but PNPs spend a considerable amount of time in clinical study and practice before being allowed to sit for a PNP certification exam. 

Degrees and certifications needed to become a psychiatric nurse practitioner

Beginning with a bachelor’s degree, a nurse must complete a master’s in a psychiatric nurse practitioner program. The sequence can be either BSN to MSN or APN to BSN to MSN. Some universities offer accelerated programs to progress from RN to MSN as well.

This may be accomplished on-site at a university or online where virtual education is offered or a combination of the two. The ANCC may require further courses to sit for the certification exam. Certification is not required for a PNP to practice but it is an added credential that validates the education and experience it has taken to become one. A psychiatric mental health nurse practitioner may then return for a doctorate if that will help accomplish career goals or is required in academic or other practice settings.

A nurse who already has an MSN in mental health nursing may seek a doctorate in psychiatric nurse practitioner. Nurses with doctorates in psychiatric mental health may work in educational or practice management and administration, become faculty, and conduct research, among other career opportunities.

The cost of becoming a PNP

A nurse who wishes to pursue a psychiatric nurse practitioner career may spend from $500 to $2,000 per credit or more for the degrees needed, depending on the school and its location. The total will be determined by the number of credits each program requires, which can vary. Some psychiatric mental health nurse practitioner programs require 50-plus credits.

It’s important to keep in mind that tuition doesn’t include materials, texts, and other related expenses. There are many grants and scholarships available to help with these costs, including several from the American Psychiatric Nurses Association. Larger colleges and universities may have the ability to offer scholarships and grants through endowments or donations.

The ANCC PNP certification exam costs $395 and is good for five years. Certification isn’t required to practice, but the added credential identifies you as a professional with an accomplished and committed level of expertise and practice. Certification may also be a requirement for specific employment opportunities. 

Renewal of certification has as one of its requirements 2,000 hours of continuing professional development per five-year certification period. Continuing education has costs associated with it, including admission fees, potential travel and housing costs, and expenses for conference or seminar materials and activities. You should add expenses to the total for obtaining and maintaining psychiatric mental health nurse practitioner status.

Clinical requirements

During the coursework for the PNP, all programs require clinical practicum hours spanning one or more semesters, with preceptors and mentors to guide the learning. This clinical practicum takes place in a hospital, clinic or another accredited setting. During the practicum, the student will be exposed to simple and complex cases of mental health and substance abuse issues, along with therapy and counseling strategies.  

Requirements differ from program to program in terms of the number of hours and types of clinical practice but often are within the 500 hours range. Essentially, they encourage students to understand actual mental health issues and psychiatric that affect specific ages, cultures, and other factors.

Nursing homes and other senior housing facilities may offer clinical practice sites for specific mental health issues affecting older adults. This is true of some schools as well for children and their teachers. They often encompass general health practices and holistic practices that enhance the psychological aspects of the clinical experience. 

There may be a need for Employment Assistance programs that benefit individuals and teams or groups in any field of work. This provides an opportunity for the psychiatric nurse practitioner to engage in another practice category and may require additional human resource or management clinical experiences.

Best psychiatric nurse practitioner programs available

Several factors will need to be considered when choosing the best PNP program for you, including:

• Curriculum
• Cost
• Proximity to home
• Reputation
• Whether an online program is available 

U.S. News and World Report ranks many types of schools and professional programs. It has produced a  list of the best psychiatric nurse practitioner collegiate nursing education schools and programs. Here are the top five:

• Duke University – Durham, NC
  Ranked #1 for Psychiatric Nurse Practitioner programs in the U.S., Duke’s tuition costs $1,838 per credit. It has reserved more than 100,000 square feet of space for its nursing education, research and innovation programs. Duke also offers a doctorate in nursing.
• Vanderbilt University – Nashville, TN
  Vanderbilt is tied with Duke for #1 in the Master’s Nurse Practitioner program. Tuition is $1,717 per credit. It has 143 full-time, full-time faculty and 969 students. Most of Vanderbilt’s programs are online or an online hybrid program with limited on-campus and clinical experiences. Vanderbilt offers other nursing programs that complement or support the psychiatric nurse practitioner in practice.
• University of Pennsylvania – Philadelphia, PA
  Penn is ranked #3 in the Master’s Nurse Practitioner programs. Tuition is $45,249 per year, or $1,931 per credit. With fewer than 1,000 students and 98 faculty members, the nursing programs provide optimal teacher/student ratios.
• University of North Carolina – Chapel Hill, NC
  This is a public school, with tuition for in-state students of $19,062 per year and $40,394 for out-of-state students. It ranks #4 in Psychiatric Nurse Practitioner programs, according to U.S. News.  Its NPN program has 176 enrollees and 90 full-time faculty members. 
• Ohio State University – Columbus, OH
  This is another state school, with an in-state tuition of $973 per credit and $2,447 per credit for out-of-staters. Ohio State has a large student enrollment with an average of 500 graduate enrollees to 108 full-time faculty.

Other schools on U.S. News and World Report’s list include the University of California – SF, Yale, Case Western University, Emory University, and New York University (NYU).

Most of the higher-ranked Psychiatric Mental Health Nurse Practitioner programs offer similar courses in assessment, pharmacology, treatment and maintenance of mental well-being, and a robust clinical and research curriculum. Courses and psychiatric concentration are meant to prepare the student to sit for an accredited certification exam.

Tuitions vary depending on the educational entity, whether it is a public, state or private school, and its value on ranking lists. Some state schools offer low average tuitions while others total over $40,000 per year. While tuition is expensive, the earning potential of graduates of psychiatric nurse practitioner programs is high, sometimes as high as $130,000 per year. Faculty for virtually all PMHNP programs is at the doctorate level, and enrollee-faculty ratios are typically favorable.

Science, nursing, and clinical faculty interact with the students, and a clinical practicum is part of each curriculum. The practicum is proctored by practicing mental health professionals and exposes the student to mental health clients across the age, cultural and gender spectrum with various conditions and needs. The clinical practicum may occur in many different settings, such as hospitals, elder care facilities, hospices, etc. 

Many schools have mechanisms by which an RN MSN can achieve psychiatric mental health nurse practitioner status with other specialties. For example, family practice nurse practitioners may take additional specialty courses and clinical experiences to acquire a PMHNP. Other programs include an accelerated curriculum with RN to MSN offerings. 

Finding the best PMHNP program for your needs

With so many choices in PMHNP programs throughout the U.S., the decision can be complex and confusing. It’s important to think about and rank your wants and needs to narrow the field. For some, the best program is proximity to home or at a school that offers online courses. For another, the number of hours, type and location of clinical placement during the practicum is important. 

Today, most mental health nursing programs show flexibility and an understanding of the needs and limitations of working nurses, especially those with families. They offer class times that can fit with work schedules or alternative ways to learn from and interact with faculty and classmates. PNP candidates have significant experience in another field in many cases, and psychiatric nurse practitioner programs incorporate prior learning and experience into the curriculum. 

Factors to consider when choosing a psychiatric mental health nurse practitioner program include:

• Location
• Admission requirements
• Application fees
• Tuition and other costs
• Clinical sites nearby
• Faculty-student ratio
• Faculty degree level 
• Lab facilities
• Research capabilities
• Program flexibility
• Part-time vs. full-time
• Time to complete the program
• On-site, online, or hybrid educational offerings
• Student support capability (daycare, for example.)
• Other school benefits, such as a fitness center, food services, et al.
• Program reputation
• Graduate employment potential 
• Other specific criteria important to you