What is a Psychiatric Mental Health Nurse Practitioner (PMHNP)? (Comprehensive Education + Career Guide)


Written By: Darby Faubion BSN, RN

Have you considered an advanced nursing career that specializes in treating mental illness and that promotes mental wellness? If so, you may have asked yourself, “What is a psychiatric mental health nurse practitioner (PMHNP)?” In this article, we will take discuss what a PMHNP is and will answer questions about this career path, including where you could work and what income expectations you may have as a psychiatric mental health nurse practitioner.

Formal Definition: What is a Psychiatric Mental Health Nurse Practitioner (PMHNP)?


A psychiatric mental health nurse practitioner (PMHNP) is an advanced practice registered nurse specializing in caring for the mental health and well-being of their clients. They provide assessment and management of mental health illness and diseases and implement measures to achieve overall physical and psychological well-being and balance for their patients.

What Does a Psychiatric Mental Health Nurse Practitioner Do?


Mental well-being is essential to overall health, and psychiatric mental health nurse practitioners play a significant role in patient care and mental health management. Psychiatric mental health nurse practitioner duties include assessing, diagnosing, and treating clients' mental health needs. In some settings, the PMHNP may perform physical and psychosocial assessments and/or emergency psychiatric care.

What is the Scope of Practice for Psychiatric Mental Health Nurse Practitioners?


Psychiatric mental health nurse practitioners are trained to provide specialized care to patients across the lifespan. PMHNPs provide an approach to patient care, which is holistic in nature. A holistic approach to patient care is essential because, although psychiatric disorders are their specialty, psychiatric mental health nurse practitioners recognize the impact that physical health can have on mental well-being. Therefore, both physical and mental health are addressed.

PMHNPs perform functions associated with a general advanced-practice registered nurse. However, they also provide a specific focus on diagnosing and treating common acute and chronic psychiatric issues and crises. Other duties of a psychiatric mental health nurse practitioner may include:

• Provide psychotherapy for individuals, families, and groups
• Coordinate care with the multidisciplinary team
• Monitor clients for non-psychiatric health care problems and refer them, as needed for specialized care or treatment
• Prescribe medications to manage symptoms associated with psychiatric disorder within their State’s recommended guidelines of practice for PMHNPs

What is the Difference Between a Psychiatric Mental Health Nurse Practitioner and a Psychiatrist?


Both psychiatric mental health nurse practitioners and psychiatrists provide mental health care services to individuals and their families. Psychiatric mental health nurse practitioners are registered nurses who have completed either a Master of Science in Nursing (MSN) or Doctoral of Nursing degree Program (DNP) and have taken and passed an examination to become an APRN (Advanced-Practice Registered Nurse). On the other hand, psychiatrists have achieved a degree to practice as a medical doctor as well as specific training to diagnose disorders involving emotional, behavioral, and mental health disturbances.

At one time, PMHNPs did not have the authority to prescribe medications. However, many states now allow psychiatric mental health nurse practitioners to prescribe and evaluate the effectiveness of medications. The degree of prescribing authority and whether supervision by a board-certified psychiatrist is needed varies from State to State. Therefore, if you are considering becoming a PMHNP, it is important to check with your state licensing agency to verify the scope of practice regarding prescribing medications.

What are the Different Types of Psychiatric Mental Health Nurse Practitioner Sub-Specialties?


Advanced-practice registered nurses who are interested in the field of psychiatry have the option of choosing from specific subspecialties of psychiatry. A few of the sub-specialty roles of a psychiatric mental health nurse practitioner include:

• Child and Adolescent Psychiatric Mental Health Nurse Practitioner: PMHNPs who specialize in child and adolescent psychiatric care are trained to assess and treat behavioral disorders in children. Disorders such as attention-deficit hyperactivity disorder (ADHD), autism spectrum disorders, and mood disorders are among the issues addressed by this specialty. Depression, anxiety disorders, and eating disorders such as bulimia and anorexia may also be treated by these specialists.

• Geriatric Psychiatric Mental Health Nurse Practitioner: Geriatrics refers to the care of older adults. The specialty involves working with older adults, their families, and care providers to promote and support healthy aging and independence as much as possible. The role of a geriatric PMHNP includes the assessment, diagnosis, and treatment of mental health conditions that occur in older adults. In addition to changes in the way the brain functions, which could lead to disorders like Alzheimer’s and other forms of dementia, the older adult population often experiences feelings of isolation, grief, and the fear of dying, which can lead to anxiety and depression. Alzheimer’s disease, which is a form of dementia, and depression are common disorders treated by this sub-specialty.

• Addiction Disorders: Often, when people hear the word addiction, they think of the use of drugs, alcohol, or other harmful substances. While these do fall in the category of addictive behaviors, addiction to food, gambling, sex, or the internet also occurs. Psychiatric mental health nurse practitioners who specialize in addiction disorders focus on assessing, diagnosing, and treating people who suffer from different addictions. Hospital settings that offer acute care for those with addictive disorders are one of several places that an addiction PMHNP may work. Additionally, outpatient addiction centers, detoxification centers, halfway houses, and addiction recovery centers are common places that this subspecialty of PMHNP may be found.

What Education is Required to Become a Psychiatric Mental Health Nurse Practitioner?


Becoming a psychiatric mental health nurse practitioner takes some time but comes with great rewards once the goal is accomplished. Nurses who plan to become a psychiatric mental health nurse practitioner should first complete a bachelor’s degree in nursing (BSN) and pass the NCLEX-RN to obtain licensure. After achieving a BSN degree, nurses have the choice of enrolling in a Master of Science in Nursing (MSN) or doctoral in nursing practice (DNP) degree program. Courses in advanced health assessment, pharmacology, and pathophysiology is required. Further, those wishing to obtain certification from the American Nurses Credentialing Center must have studied health promotion and maintenance, differential diagnosis, and management, which includes clinical training and prescribing medication in a minimum of two areas of psychotherapy. Upon successful completion of an MSN or DNP degree program, you can seek national certification as an advanced practice registered nurse (APRN).

How Long do You Have to go to School to be a Psychiatric Mental Health Nurse Practitioner?


The amount of time it takes to become a psychiatric mental health nurse practitioner varies from person to person. The most significant factor in determining how long it takes to become a psychiatric mental health nurse practitioner is whether students can attend school full-time or part-time.

The first step in becoming a PMHNP is to obtain a degree and become licensed as a registered nurse. Those for whom direct entry into a master’s program may not seem feasible may choose to get a two-year Associate Degree in Nursing and then enroll in an RN to MSN. In contrast, others opt to take the Bachelor of Science in Nursing (BSN) program and then begin the MSN pathway. A doctoral in nursing degree program (DNP) is another option for nurses who wish to become an advanced practice registered nurse.

The table below reflects the anticipated length of time that may be required to become a psychiatric mental health nurse practitioner based upon the choice of a pathway and full-time or part-time enrollment. However, it is important to keep in mind these estimates can be influenced by the successful completion of each course or whether a class needs to be repeated. Additionally, because nursing instructors are limited regarding the number of students they may supervise at a given clinical site, clinical rotation spots may not be available at a student’s convenience. This could increase the amount of time it takes to complete a selected program.

Program Type Pathway Full-Time Part-Time
MSN RN to MSN 30 to 36 months 36 to 48 months
BSN to MSN 15 to 24 months 24 to 48 months
Direct Entry MSN 20 to 24 months 24 to 48 months
DNP BSN to DNP 3 to 4 years 4 to 7 years
MSN to DNP 1-2 years 2 to 4 years
Certificate Post-Master's Certificate 12 to 16 months 16 to 24 months


How Much Does Schooling Cost to Become a Psychiatric Mental Health Nurse Practitioner?


Becoming a psychiatric mental health nurse practitioner takes time, dedication, and money. The average cost to earn an Associate Degree in Nursing ranges from $6,000 to more than $40,000 at a public college or university and could be as much as $100,000 at a private school. A BSN degree can cost from $8,000 to more than $50,000 at a public school and up to $150,000 at a private institution. After completing an associate or bachelor’s degree program, enrollment in a graduate program is required. The program type, pathway choice, whether the educational institution is publicly or privately funded, all contribute to the total cost of becoming a psychiatric mental health nurse practitioner.

To help meet the financial requirements of becoming a PMHNP, some students choose to pursue RN licensure then go to school part-time to earn a graduate degree. There is also the option of seeking student financial assistance in the form of loans or grants and applying for scholarships to offset some of the expenses. If loans are required, many student loan lenders offer forbearance of payment obligations if the student is enrolled in and taking classes.

Program Type Pathway Tuition Ranges
MSN RN to MSN $22,070 - $231,600
BSN to MSN $18,810 - $185,280
Direct Entry MSN $22,570 - $222,340
DNP BSN to DNP $26,490 - $254,260
MSN to DNP $17,660 - $169,510
Certificate Post-Master's Certificate $9,710 - $83,690


How to Obtain Certification and Licensure?


After obtaining a graduate degree and meeting other eligibility requirements, candidates can apply to take the certification examination to become a psychiatric mental health nurse practitioner-board certified (PMHNP-BC). Requirements for taking the certification exam include having a current unencumbered RN license and a designated amount of clinical experience. Clinical experience should include a minimum of 500 hours of supervised clinical within the psychiatric mental health nurse practitioner program.

The American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP) are two of the certifying boards most commonly used. Eligibilty requirements for certification may differ from state to state. Therefore, candidates should always check with their state board of nursing prior to applying for or scheduling a certification examination.

Upon successful completion of a certification exam, a nurse practitioner may then apply to his/her state to become licensed. The licensing requirements to become an advanced practice registered nurse vary from state to state. Unlike licensure exams for licensed practical nurses and registered nurses, currently, there is not a designated nurse practitioner licensure exam. Many states use a nurse practitioner certification examination to determine if a nurse is competent to be licensed as a nurse practitioner.

Psychiatric Mental Health Nurse Practitioner Residency and Fellowship Programs


A residency is a part of a graduate student’s clinical education during which he/she provides patient care under the supervision of another nurse practitioner or a licensed physician. Currently, residency programs for nurse practitioners are not mandatory. However, some graduates do choose to pursue acceptance to residency programs to help increase their knowledge and abilities and to focus on a sub-specialty of practice.

The Durham Veteran’s Administration offers a psychiatric mental health nurse practitioner post-graduate training program that is provided through its partnership with Duke University’s School of Nursing. The program is a 12-month training program that is divided into three-month clinical rotation assignments. Eligible applicants must be a graduate of an accredited PMHNP program, possessing a minimum master’s degree and be board certified as a psychiatric mental health nurse practitioner.

Atrium Health offers the Advanced Practice Provider Behavioral Health Fellowship to nurse practitioners who want to pursue a psychiatric mental health nurse practitioner's career path. APRNs who participate in this fellowship are allowed to experience clinical settings including outpatient, inpatient, emergency departments, and psychiatric facilities in and near Charlotte, North Carolina, who are partnered with Atrium Health.

Where do They Work?


Psychiatric mental health nurse practitioners can work in any specialty area of health care. Options for subspecialties include child and adolescent care, geriatrics, forensic, addiction medicine, psychosomatic medicine, and care of both active duty and retired military servicemen and women.

A few examples of possible settings where a PMHNP may work include:

• Residential substance abuse facilities: Addiction disorders are a type of mental health diagnosis. Many people who have a substance abuse disorder also have another type of mental illness. PMHNPs are key care team members in substance abuse facilities where they focus on helping affected individuals address their issues and learn to develop healthy coping mechanisms.

• Correctional Centers/Facilities: An estimated 25 percent of people who are incarcerated have a mental health condition, an addiction disorder, or both. PMHNPs in this setting evaluate and treat patients, provide crisis intervention and make referrals for those who may require inpatient psychiatric care.

• College or University Instructor: PMHNPs who have at least five years of experience (in most states) may choose to become nursing instructors. A minimum bachelor’s degree in nursing is required to become a nursing instructor/professor. However, most schools prefer nurses with an MSN or DNP.

• Mental Health Clinics: PMHNPs often work alongside psychiatrists and licensed professional counselors in mental health clinics where they assess, diagnose and treat clients receiving mental health care services.

• Homeless and domestic abuse shelters: Many people who are homeless or have been victims of domestic abuse experience mental illnesses. Anxiety, depression, and mood disorders are commonly treated by PMHNPs in these settings. Additionally, a large number of homeless people suffer from mental illnesses that alter their mood or behavior. In some cases, especially without treatment, this may lead to the loss of employment and/or homelessness, such as bipolar disorder and schizophrenia.

Working Conditions


Working as a psychiatric mental health nurse practitioner can be very rewarding. Many PMHNPs express feelings of accomplishment when they can educate clients about mental illnesses or disorders and see an improvement in a patient’s mental health or a client’s ability to recognize and manage symptoms.

On the other hand, as with other careers, being a PMHNP can also be stressful. Depending on staff size and the number of patients, having the responsibility of heavy patient loads is a possibility. In fact, according to the American Association of Nurse Practitioners, there are more than 290,000 nurse practitioners in the United States. This is an increase from the 125,000 that practiced in the US in 2011. However, among the almost 300,000 nurse practitioners in the United States, only approximately 1.8 percent are certified as psychiatric mental health nurse practitioners.

Starting Salary of a Psychiatric Mental Health Nurse Practitioner


The anticipated beginning salary of a psychiatric mental health nurse practitioner is approximately $84,720. Prior experience in mental health nursing may be something that potential employers consider a plus when interviewing candidates. Therefore, there is a possibility of a higher starting salary for some.

Hourly Monthly Annual
$40.73 $7,060 $84,720


Average Annual Psychiatric Mental Health Nurse Practitioner Salary


Like other options for employment, the psychiatric mental health nurse practitioner's salary varies. Factors that play a role in determining salary include whether you choose to work full-time or part-time, what type of facility you are employed in, and the amount of experience you already have. Most sources indicate the average annual salary of PMHNPs is approximately $116,390. This is the equivalent to an hourly pay rate of $55.96 and a rate of roughly $9,700/monthly. Sign-on bonuses, paid time off, and vacation or sick pay may or may not be included in this average salary. It is recommended to clarify with potential employers how these options are factored into any offered salary.

Hourly Monthly Annual
$55.96 $9,700 $116,390


Annual Salary by Level of Experience


As previously mentioned, the amount of experience a PMHNP has is generally a factor in determining the annual salary that he/she is offered. For example, the beginning salary of a psychiatric mental health nurse practitioner in the United States is approximately $84,720. Typically, as the chart below indicates, with each additional five years of experience, PMHNPs can anticipate between $10,000 to $25,000 higher salary ranges. Again, these are average annual salary estimations, and other factors may be considered to help determine the salary that a PMHNP is offered.

Type Hourly Monthly Annual
Starting (Entry-Level) $40.73 $7,060 $84,720
1-4 Years of Experience $46.43 $8,050 $96,570
5-9 Years of Experience $54.95 $9,520 $114,290
10-19 Years of Experience $63.56 $11,020 $132,200
20 Years or More Experience $76.13 $13,200 $158,350


Which State Pays Psychiatric Mental Health Nurse Practitioners the Most?


Currently, California is the highest paying State for psychiatric mental health nurse practitioners. PMHNPs in California can expect an average annual salary of around $144,303. Although salary may determine where you may want to live and work, it is worth noting that the cost of living in certain areas is often a factor that determines the salary employers offer.

California
Hourly Monthly Annual
$69.38 $12,030 $144,303


Salary by State


Differences in salary for psychiatric mental health nurse practitioners vary considerably among different states. Idaho is currently the state with the lowest salary range for PMHNPs, ranging from 47,610 to $165,110. California is the highest paying state with salary ranges between $109,160 for entry-level PMHNP up to $197,680 for those with more experience.

State Hourly Monthly Annual Salary Range
Alabama $49.82 $8,640 $103,622 $74,580 - $134,530
Alaska $57.98 $10,050 $120,607 $64,030 - $172,420
Arizona $55.78 $9,670 $116,017 $68,230 - $161,660
Arkansas $52.96 $9,180 $110,148 $86,210 - $137,450
California $69.38 $12,030 $144,303 $109,160 - $197,680
Colorado $53.42 $9,260 $111,105 $75,860 - $146,730
Connecticut $57.61 $9,990 $119,826 $80,970 - $165,110
Delaware $56.25 $9,750 $117,006 $87,150 - $154,370
District of Columbia $56.01 $9,710 $116,506 $90,820 - $148,480
Florida $50.79 $8,800 $105,641 $64,780 - $137,040
Georgia $52.87 $9,160 $109,971 $79,520 - $146,340
Hawaii $62.04 $10,750 $129,047 $78,360 - $171,630
Idaho $55.47 $9,610 $115,372 $47,610 - $165,110
Illinois $53.97 $9,350 $112,250 $82,150 - $145,200
Indiana $53.23 $9,230 $110,710 $86,570 - $137,360
Iowa $54.99 $9,530 $114,383 $87,980 - $146,030
Kansas $50.31 $8,720 $104,642 $66,260 - $134,180
Kentucky $49.81 $8,630 $103,612 $71,300 - $139,050
Louisiana $53.16 $9,210 $110,564 $69,570 - $157,840
Maine $53.52 $9,280 $111,313 $85,420 - $137,090
Maryland $55.94 $9,700 $116,350 $84,520 - $158,700
Massachusetts $61.16 $10,600 $127,215 $93,330 - $170,080
Michigan $54.37 $9,420 $113,082 $88,000 - $138,870
Minnesota $61.47 $10,650 $127,850 $95,610 - $161,320
Mississippi $55.41 $9,600 $115,247 $81,220 - $160,530
Missouri $52.56 $9,110 $109,326 $84,950 - $137,970
Montana $54.60 $9,460 $113,561 $87,490 - $140,780
Nebraska $52.76 $9,150 $109,742 $86,340 - $137,400
Nevada $58.02 $10,060 $120,690 $90,000 - $159,080
New Hampshire $55.38 $9,600 $115,185 $85,660 - $148,570
New Jersey $61.95 $10,740 $128,849 $96,560 - $164,640
New Mexico $56.00 $9,710 $116,486 $87,700 - $153,410
New York $61.32 $10,630 $127,538 $89,000 - $169,070
North Carolina $52.98 $9,180 $110,200 $86,440 - $141,470
North Dakota $55.51 $9,620 $115,466 $87,620 - $147,980
Ohio $51.92 $9,000 $108,004 $84,070 - $139,120
Oklahoma $56.64 $9,820 $117,807 $88,460 - $158,980
Oregon $56.75 $9,840 $118,047 $87,860 - $159,190
Pennsylvania $51.01 $8,840 $106,099 $75,910 - $134,510
Rhode Island $57.69 $10,000 $120,003 $92,590 - $153,810
South Carolina $50.37 $8,730 $104,778 $84,110 - $132,720
South Dakota $51.15 $8,870 $106,391 $84,210 - $133,820
Tennessee $48.29 $8,370 $100,438 $64,420 - $133,690
Texas $57.76 $10,010 $120,138 $88,280 - $163,680
Utah $52.66 $9,130 $109,523 $72,820 - $149,180
Vermont $52.96 $9,180 $110,148 $84,630 - $148,670
Virginia $54.59 $9,460 $113,551 $86,170 - $146,400
Washington $63.50 $11,010 $132,086 $90,150 - $168,170
West Virginia $51.62 $8,950 $107,369 $80,720 - $138,480
Wisconsin $56.10 $9,720 $116,694 $92,060 - $139,510
Wyoming $59.09 $10,240 $122,917 $88,430 - $166,540


Job Outlook


With 46.6 million people in the United States affected by some form of mental illness, mental health care professionals are in high demand. As the population increases, the need for psychiatric mental health nurse practitioners can naturally be expected to increase, as well. The Bureau of Labor Statistics has predicted that at least 16,000 new jobs for PMHNP will become available each year until at least 2028.

PMHNP Related Organizations and Associations


There are several organizations and associations related to the practice of psychiatric mental health nurse practitioners. Some of the most popular include the following:

American Psychiatric Nurses Association

American Psychiatric Nurses Association (APNA) - The APNA is reported to be the largest professional membership organization dedicated to psychiatric mental health. Additionally, it is currently the only nursing organization that caters to all psychiatric mental health nursing professionals who have achieved various educational degree levels. The American Psychiatric Nurses Association is accredited by the American Nurses Credentialing Center’s Commission on Accreditation to provide continuing nursing education.

Association of Advanced Practice Psychiatric Nurses

Association of Advanced Practice Psychiatric Nurses (AAPPN) - The AAPPN is located in Washington state. However, it does offer membership to out-of-state psychiatric nurses. Membership in the AAPPN is open to psychiatric nurses from various employment populations, including educators, community mental health settings, hospitals, inpatient and outpatient providers, and those in private practice.

International Society of Psychiatric-Mental Health Nurses

International Society of Psychiatric-Mental Health Nurses (ISPN) - Membership in the ISPN is open to registered nurses and advanced practice registered nurses who are interested in psychiatric mental health nursing regardless of the setting in which they practice. The organization offers three memberships. Full membership, which is available to all advanced practice registered nurses, gives the member the right to serve on committees, hold an office within the organization, and vote on organization matters. Student membership is available to students who are enrolled part-time or full-time in an undergraduate or graduate program. While students can serve on committees, they are not eligible to vote or to hold an elected organization office. Retired memberships are available to those who have retired from full-time paid employment or have met the criteria for full membership. Those holding retired memberships can exercise the same benefits as those with full memberships.

The Society of Psychiatric Advanced Practice Nurses

The Society of Psychiatric Advanced Practice Nurses boasts the accomplishment of being the first professional nursing body in the United States to certify clinical nurse specialists in psychiatric nursing. Since its inception in 1972, the Society has evolved to include clinical nurse specialists in advanced practice nursing and psychiatric nurse practitioners.

Conclusion


So, what is a psychiatric mental health nurse practitioner? A psychiatric mental health nurse practitioner is a person who has a strong desire to care for patients who are affected by mental illness and related disorders. A PMHNP is a professional who has accomplished a Master of Science in Nursing degree or a Doctor of Nursing Practice program and has become certified as a psychiatric advanced practice registered nurse. A career as a PMHNP offers many opportunities to provide patient care to a diverse populations in a variety of healthcare settings. If a career as a psychiatric mental health nurse practitioner is appealing to you, don’t wait! The opportunities are endless!

Darby Faubion BSN, RN
is a nurse and Allied Health educator with over twenty years' experience. She has assisted in developing curriculum for nursing programs and has instructed students at both community college and university levels. Because of her love of nursing education, Darby became a test-taking strategist and NCLEX prep coach and assists nursing graduates across the United States who are preparing to take the National Council Licensure Examination (NCLEX).