Mental Health MSN or MSW?

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    I am a critical care nurse with a BSN and a BS in psych. I like my job but believe that I have a stronger calling in counseling. I am considering two of the many routes: an MSN in psych nursing or an MSW? I am more inclined to do the MSN route because I already have a BSN, Shorter duration, many options for school either online or class, and it just seems more convenient overall. However, I am under the impression that mental health NPs usually work in drug dependency, methadone clinics. The kind of work that I want to do is one on one counseling. The typical therapist with the couch and how-does-it-make-you-feel kind of work. What route do you think is best?

    Thank you!
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    I have my BSN and plan to go back for my LMHC--I also am more interested in the counseling side of things since doing psych.....I would say not the MSW as I know many and they make horrible pay. I would say a psych NP if you have the time and money and a program near you. If not a masters in counseling. The program I plan on doing is a Masters in Mental Health Counseling and will allow me to certify as a Licensed Mental Health Counselor. There are many routes but I would say to avoid the SW path only because it is a lot of work and the pay is horrible.
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    I'm a MSN with a CNS in adult psychiatry. That degree let me prescribe until I decided I didn't want to do that anymore. Now I do counseling. The degree I earned prepared me much more for counseling than it did for the physicals/prescribing medications role, but it didn't prepare me well for either role. I think MSWs get much better preparation. In psych, MSN nurses (NPs and CNSs), make alot more money than MSWs, at least in my state. That means MSWs get hired more easily IF there are openings, unless there's something the MSN can do that the employer needs. That means they'd hire you if you can do physicals and prescribe IF there's an opening.

    Going it alone, with your own business as either an advanced practice psych nurse or a MSW is pretty complicated. There are lots of hoops to jump through to be able to get reimbursement by insurance companies.
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    MSN is more practical. You already have the nursing foundation, the pay is certainly better-perhaps even twice as much as the MSW alternative, and the job prospects are better.

    But I don't think the MSN really targets your goal of being a bona fide therapist. It is within the scope, but everything I have heard and read indicates that the training is inadequate. Getting your MSW, and concentrating on the clinical track to be a LCSW or LICSW will better prepare you for therapy.

    practicality vs passion..I am in a near identical situation, and chose the latter, MSW. Good luck
    nguyenhnic likes this.
  7. 0
    Quote from Whispera
    I'm a MSN with a CNS in adult psychiatry. That degree let me prescribe until I decided I didn't want to do that anymore. Now I do counseling. The degree I earned prepared me much more for counseling than it did for the physicals/prescribing medications role, but it didn't prepare me well for either role. I think MSWs get much better preparation.
    Until comparatively recently, when some states started offering Rx authority to CNSs (inc. psych CNSs), a psych CNS graduate program focused completely on preparation as a psychotherapist -- that was the psych CNS role. I completed my psych CNS program back in the "good ol' days" and got excellent preparation as a psychotherapist.

    I'm v. disappointed that the psych CNS role is being "polluted" now by the prescribing piece, which means that the educational programs are focusing on that, and the role of expert psychotherapist is being lost.

    I agree with you, though, about the difficulty of finding good clinical positions that don't involve Rxing these days. Also v. disappointing.
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    Curious as to where those who have posted about CNS's prescribing. I am in NY state and only NPs can prescribe. Interesting how totally different it is in each state.
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    I'm in Indiana. I began prescribing in 2005, after getting my CNS is 2001. My schooling had NO information about prescribing at all. I had to learn it on my own through extra courses outside my MSN/CNS courses. I took an independent study course with a sympathetic DNS and designed the course for myself. I learned alot on the job with lots of reference books nearby and psychiatrists to ask for input.

    I wonder if being a PSYCH CNS has anything to do with our acceptance to prescribe? We are pretty similar to psych NPs... When I took my certification exam, I could have taken the NP exam if I had chosen it instead of the CNS exam.

    The course of study for doing therapy wasn't much better.

    But, enough complaining.


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