Psychiatric Clinical Nurse Specialist or Nurse Practitioner?

[MarshaRabbit]

Hi!

I just graduated from my undergrad with a degree in psychology and am working on getting into grad school. I have been working in nursing for about 5 years as a CNA and I am thrilled that there is a field that combines my interests: medicine and psychology.

Thus, I intend to enter a direct entry graduate program for psychiatric nursing (MEPN).

Until earlier tonight I was thinking I would enter a clinical nurse specialist program, but now I am unsure.

When I google it, the differences most commonly noted between NP and CSP are that NPs tend to work in outpatient settings providing assessment, diagnoses, and medications. I'm assuming in the psychiatric world this means a Psychiatric NP plays a role that is similar to a psychiatrist?

Where as CSPs (according to google) implement care management, administration, cost policies, and occasionally therapy.

It would probably be helpful if I mention what it is I want to do with my career:

I am very much interested in direct patient care within an inpatient facility, preferably a hospital (I understand that APPNs do a lot of administrative work, but I would like several years of experience with patients before I move fully into admin). I am also interested in acute mental health crises, such as psychosis. In general, I just want to help people and I am a patient, caring person who truly loves psych. Also I want to provide therapy- I would like to work with adults.

Any relevant input would be greatly appreciated. Thank you for taking the time to read, an hopefully help!

[elkpark]

It's a moot point -- the ANCC is "retiring" the psych CNS exam and credential in 2014; it's no longer going to be possible to get certified as a psych CNS. The only option, goin forward, is psych NP.

Don't know what sources Google was directing you to, but psych CNSs have always been educated and have functioned as psychotherapists. This emphasis on direct client care is v. different than the CNS role in other specialties, and i wonder if you may have been reading about CNSs in general. I've been a child psych CNS for almost 20 years, and my various jobs over the years have included some limited stff development/policy/program development responsibilities, but the primary focus and responsibility of the positions has been providing direct clinical services to individuals and families.

[MarshaRabbit]

Thanks for the reply, it was very helpful!

I eventually found a document from the ANCC (linked below) that suggests that the psych APPN certificons are being condensed into one single title "psychiatric mentalh health nurse practititoner." Is that about right?

http://www.nursecredentialing.org/Documents/Certification/APRN-Materials/APRN-CertificationNameChart.pdf

If this the case, I see grad school are still offering programs for the psychiatric clinical nurse specialists, and other titles scheduled for retirement. Although thankfully my top choice school also offers the PMHNP.

Any thoughts on that? Maybe they are planning to take down the admission information for those programs next year.

Your insight was much appreciated!

[Psychcns]

The PMHNP is also being retired. The only one left is the FMHNP. Family MH NP.

[MarshaRabbit]

Hm well this chart here suggests they are changing the FMHNP to a PMHNP:

http://www.nursecredentialing.org/Documents/Certification/APRN-Materials/APRN-CertificationNameChart.pdf

But I wonder how this will play out in the graduate programs? Or how to even being researching this?

The only thing I can think to do (beside probing for information here) is to contact grad schools with the PCNS programs and ask them what's happening to them in 2015, and what changes are being made to their (any) psychiatric NP programs.

Thanks for the input!

[Psychcns]

@Marsha. Thanks for update. I didn't realize the PMHNP now means family. (I am still shocked they retired the psych CNS credential)..

[MarshaRabbit]

Right? There are definitely a lot of major changes happening, and unfortunately I haven't been able to find any articles about it that are both accurate and comprehensive.

I've a lot of experience in child psychology, so although it would probably help me get into one of those programs I really don't wish to work with families (anymore) as a specialty. I'm more interested in adult psychology, so I'm really unsure how to proceed. I'll keep researching and probably post threads here when confused.

If anyone has any advice for me on this that would also be awesome.

[Psychcns]

There is an article. "The Plight of the Psychiatric Clinical Nurse Specialist" by Jeffrey Jones that gives a good overview of the advanced psych nurse situation. You can find it on google..

I have an adult psych CNS, trained as a therapist and to prescribe meds, but the program also prepared us for other advanced roles including administration and education. At the time 1993, it was the only advanced psych degree. I currently do locums in psych np and CNS jobs, mostly outpatient but my last job was inpatient forensics and very interesting. I have work experience in administration and education..

[MarshaRabbit]

That does sound exciting! You're experience is pretty much what I want to do with it all. Thank you for all your help. I found and read that article, it gave me a lot of helpful background information.

Now if I could only figure out what the implications are for graduate programs. Any idea if the new PMHNP (formerly FMHNP) is heavy on family psychology??

I'm not thrilled about the idea of going to grad school for family psychology; it was alright but I interned in a family setting and that was enough for me :)

[elkpark]

Under the new model, all psych NPs will be prepared and credentialed to treat clients across the lifespan, small children to geri. Of course, realistically, that means most of the content will be focused on adults, with little training with children or geri clients. And the psych NP focus already is on prescribing, with v. little content in therapy.

[MarshaRabbit]

Thank you, that really helps.

I (and I'm sure you too) wish they had kept the PCNS. Here's hoping I can find a grad school that offers adequate training in therapy as well as medicine.

[elkpark]

Here's hoping I can find a grad school that offers adequate training in therapy as well as medicine.

You won't -- take a look at the curricula of existing psych NP programs. They are focused on physical assessment and pharmacology (which makes sense, since that's the part of the role that can kill people if you do it wrong :)), with a class or two on therapy tacked on, just enough to justify calling it a psych NP program. The old CNS programs (like mine) focused entirely on two years of rigorous training as a psychotherapist. Those programs don't exist any more. Even before the blasted "LACE" model started lousing everything up, enough states were offering prescriptive authority to psych CNSs that the programs had started to "blend" with psych NP programs and include the "three P" courses and emphasize prescribing. IMO, people who are serious about being psychotherapists should take another route rather than nursing nowadays. If you want to push pills, though, you'll be all set.