The psychiatric-mental health nurse practitioner (PMHNP) cares for mental health needs across the lifespan. By providing pharmacologic and non-pharmacologic interventions, the PMHNP ensures that patients receive the quality and cost-efficient services they need.
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Key Terms and Statistics
According to the American Psychiatric Association, “mental illnesses are health conditions involving changes in thinking, emotion or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.”
Approximately 19 percent of U.S. adults suffer from some form of mental illness. Depression affects more than 26 percent of the U.S. adult population, making it the most prevalent type of mental illness. By 2020, depression is projected to be the second leading cause of disability on Earth, after ischemic heart disease.
Career Outlook and Opportunities
Approximately 60 percent of BSN graduates are offered a job upon graduation, compared to only 30 percent of graduates in other disciplines. PMHNPs have a projected job growth rate of 31 percent, and their average salary is $96,460 annually.
Psychiatric-mental health nurse practitioners can work at hospitals, home health care organizations, outpatient mental health organizations, jails or prisons. PMHNPs may have other therapeutic areas of focus, including marital and family therapy, substance abuse and forensics.
PMHNPs are also able to work in the mental health field as consultation-liaison advanced practice nurses. As advocates in an advanced practice role, PMHNPs may work in settings that combine primary care with behavioral health.
Roles and Responsibilities
Before becoming employed as PMHNPs, many health practitioners start working as registered nurses (RNs) to receive clinical experience in roles connected to psychiatric-mental health nursing. However, PMHNPs are able to prescribe medications and provide therapy to groups and individuals, which differentiates them from RNs.
Certification and Training Overview
PMHNPs conduct psychotherapy sessions, provide crisis intervention and prescribe medications. The American Nurses Credentialing Center (ANCC) provides “certification for PMHNPs at all levels.”
In 1974, the Psychiatric Mental Health-Clinical Nurse Specialist (PMH-CNS) certification was established.
As of 2017, Adult Psychiatric-Mental Health CNS & Child/Adolescent Psychiatric-Mental Health CNS certification exams are being discontinued. According to the ANCC (2017), the final test administration for renewal took place on October 31, 2017.
Psychiatric-mental health nurse practitioners determine patients’ mental health needs by conducting evaluations and using this information to develop individualized treatment plans. PMHNPs are also able to provide counseling for patients and their families; coordinate care with patients’ families and other health practitioners; and assist patients when they’re grooming, getting dressed, taking medications and completing other daily tasks.
PMHNPs can treat bipolar disorder, depression and other mood disorders as well as panic attacks, phobias and other anxiety disorders. They may also treat substance abuse from drugs and alcohol, and the various forms of dementia, such as Alzheimer’s disease.
The PMH-APRN may own a private practice or a corporation, in which case they may consult with communities, legislators or other corporations.
PMHNPs provide holistic care and practice from a nursing foundation instead of from a medical model. This is what differentiates PMHNs-APRNs from psychiatrists, psychologists and social workers, although, according to the American Psychiatric Nurses Association (APNA), “the role of a PMH-APRN with a master’s degree may overlap with that of a psychologist, social worker and psychiatrist.” APRNs and psychiatrists are also able to prescribe medications, unlike counselors, social workers and many psychologists.
Participation in Therapeutic Milieu
A PHMN diagnoses a patient, develops a plan of care, establishes a nursing process and checks it for effectiveness. According to Nurse Key, “milieu therapy refers to socio-environmental therapy in which the attitudes and behavior of the staff in a treatment service and the activities prescribed for the client are determined by the client’s emotional and interpersonal needs.”
PMHNs working in an integrative and collaborative health care environment can promote therapeutic milieu by working in multidisciplinary treatment teams. Therapeutic milieu can exist in homes, hospitals, private practices and other settings.
Developing a Therapeutic Relationship
PMHNs must handle new and unpredictable experiences regularly, placing them in a role that can greatly differ from that of other nurses.
PMHNs are able to develop therapeutic relationships with their patients using the six concepts of the therapeutic milieu. These concepts include exhibiting kindness and compassion, respecting human dignity, remaining calm, caring for the self and one another, engaging intellectually and cultivating a restorative physical surrounding, with the purpose of displaying tenderness for all things.
Encouraging Quality Therapeutic Relationships in Psychiatric-Mental Health Nursing
PMHNs must display empathy and a genuine understanding of their patients’ needs. Respecting patients and avoiding shock when learning about their experiences is also important.
PMHNs must demonstrate clear boundaries with patients and keep the relationship professional at all times. “Boundaries are essential to protect both the patient and the psychiatric/mental health nurse, and to maintain a functional therapeutic relationship.”
PMHNs must also remain self-aware and focus on serving patients’ needs. Being mindful of self-awareness allows PMHNs to develop interpersonal skills and determine how to vary their approach with patients.
The demand for nurses is growing, and the role of PMHNs is expected to increase within the U.S. health care industry. Prospective BSN students with an interest in providing care for the stigmatized and vulnerable should consider specializing in psychiatric-mental health nursing.