Concern/question about PMHNP and Clinical Psychologists

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Hi, I have two areas of NP interest right now: cardiology and psych. I'm a little more skeptical about Psych for one reason.

If clinical psychologists gain more prescriptive rights in the future, what could this mean for PMHNPs (and psychiatrists for that matter)? Will there still continue to be a higher demand for the psych NP over the prescribing psychologist? Like I said, I'm undecided between both right now and I've always had a love for psych. I didn't have an interest in cardiology until nursing school. However, I don't want to spend tons of money on schooling if I won't be able to find a job. Do you think prescribing psychologists could possibly phase out PMHNPs (and psychiatrists) since there are so many psychologists? Or do you think PMHNPs will be more preferred over psychologists due to their medical/nursing background?

I know psychologists do mostly therapy and research while PMHNPs will do more med management like a psychiatrist, but they can do therapy. However, if psychologists are given prescription rights, would there really be any difference between the PMHNP and psychologist?

I know there is a HUGE shortage of psychiatrists and there will continue to be, so this may open up more opportunities for the Psych NP. However, it leaves me wondering if psychologists will use this as an excuse to gain more prescription rights.

So can anybody give me any insight into this so called "turf war" in the mental health field? Also, would you recommend me pursuing this field, given the turf going on?

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Specializes in Psychiatric Nursing.

Re: prescribing psychologists--you might want to do a google search or look over on the student doctor network. I expect it will become more common the next ten years. But I think psychologists will continue to do therapy and testing because it is so important. Insurance companies like psychopharmacology because it is cheaper than therapy. patients like meds. the pharm companies advertise and market meds. So lots of factors to Influence modalities. I was trained in therapy, added meds, now do med management and add in therapy when I can.

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I wouldn't be worried about psychologists universally getting prescriptive rights any time soon. Currently, psychologists only have prescriptive rights in Louisiana and New Mexico and for some psychologists in the military. There are indeed some "turf wars" going on in the mental health field, but this particular battle is looking like a longer road. Unless there is some dramatic new development or shift in the next few years, psychologists face a long uphill battle on this issue. Tons of opposition from psychiatrists just to mention one resistant factor.

In terms of there being a difference between a PMHNP and a clinical psychologist if psychologists were to get rights on a broad scale:

There would be a big difference in that on top of their prescriptive rights, a clinical psychologist would have at least 4-6 years of supervised psychotherapy experience in a variety of settings (including an internship) as well as the ability to conduct and interpret psychological testing, not mention extensive research training.

Most Psych NP programs are 2-3 years and don't have the same depth of psychotherapy training.

However, right now, in my humble opinion, PMHNP is the best bang for your buck in terms of training time, scope of practice, and income potential if you are looking to get into mental health. As a PMHNP, you might not be a "doctor" but you can do therapy, manage meds, and have a private practice (varying scope by state) in a much shorter period of time with better earning potential right out of the gate.

Full disclosure, I write this as one who was originally planning to go into a clinical psychology PhD program and has now switched and is pursing PMHNP. ;)

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Thank you for your responses!

Smoothjams, I was hearing that psychologists could have right within the next 10-15 years, but then again that's just what I've heard. Do you agree with this? Do you think this will happen? I'm trying to keep an open mind about this.

Also, I love pharmacology and I know that a lot of PMHNPs do medication management for psychitric patients. However, are they able to do med management for other kind of patients with medical issues as well? Like for example, can a PMHNP do pain management medicine and manage meds for patients with chronic pain or with other medical condition? Do they need a special certification for that?

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Specializes in Mental Health.

Smoothjams,

I just joined this site, so I cannot PM you. I was hoping you could offer some advice. I have been on the road to Clinical Psychology (honors thesis, research experience in two labs, clinical experience in mental health clinic) but now am having doubts. The field looks pretty abysmal. Lots of hoops to jump through for little reward in the end. And I agree that it'll be a very, very long time before Psychs can prescribe. Even if they do get the ability, it will be after further post-doc coursework that makes the whole trip not worth it IMO. I believe I agree with what you said about NP being the best bang for your buck for those who want to get into mental health, and that's what I am thinking of doing now.

I am not sure though which path to take. Should I go for a direct entry MSN program? I have a Bachelors but no nursing experience. I heard that DNP will become necessary for Psych NP license -- does that mean that an MSN won't be enough anymore? Any advice would be appreciated.

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Specializes in Psychiatric Nursing.

I have a BA in Psych and considered for years what to do next? I eventually went back and got a BSN. At the time it was the most practical path and I loved my BSN program. I eventually went back and got a MSN.

If you know you want to work as a Psych NP, the direct entry seems like a good option for you. There are several threads about DE programs on this site. It sounds very rigorous and I understand the good programs are expensive and competitive.

As far as the DNP required for advanced practice,, this has not been adopted by any state yet but educational program are leaning in that direction. Again there are threads on All Nurses about this too.

Hope this helps--psych is a great field. I do locums as a psych np--diagnostic evals and meds and therapy when I can.

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...I was hearing that psychologists could have right within the next 10-15 years, but then again that's just what I've heard. Do you agree with this? Do you think this will happen?

Right now, I am quite confident that the concept of clinical psychologists gaining prescription rights on any kind of wide scale is in no way something that someone entering the mental health field should view as a significant factor at all. No one can predict the future, but 10-15 years is a long time and even if it does happen on some grand scale, it's not like psychologists are going to overtake Psych NPs and Psychiatrists and push them out of the market or anything. It's just not a realistic or worthwhile concern right now. I think it may happen on a broader scale someday, but a lot of things would have to change. Bottom line, I really wouldn’t factor it in to any kind of decision making.

...However, are they able to do med management for other kind of patients with medical issues as well? Like for example, can a PMHNP do pain management medicine and manage meds for patients with chronic pain or with other medical condition? Do they need a special certification for that?

Bear in mind that psych patients often have other medical issues. A psych NP is a nurse first and depending on the setting you ultimately work in, you will have to be prepared to help manage the non-psych related medical conditions and meds of any of your patients. Now, if you are talking about getting your NP in psych and then working in a non-psych focused environment like a med/surg unit or something, you probably wouldn’t be hired as a psych NP and would have to obtain additional/different kind of certification/training. This is one reason why there are post-masters certificates in various nursing specialties. Someone may get their masters as a Psych NP and then decided they want to work in the ER so they might go back and do a post-masters certificate to gain that certification. But, in general, as a Psych NP you will most likely be managing patients with other general medical conditions on type of their mental health issues.

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I am not sure though which path to take. Should I go for a direct entry MSN program? I have a Bachelors but no nursing experience.

Direct entry programs are a great option. Just be aware that the 1st year where you get your accelerated RN license is usually pretty expensive in these programs. Also, be aware that you will have to take some basic science classes and other prerequisites in order to be considered for these programs if they were not part of your original bachelors.

I heard that DNP will become necessary for Psych NP license -- does that mean that an MSN won't be enough anymore? Any advice would be appreciated.

This is an important point to be clear about. The DNP as an entry point for nurse practitioners is NOT mandated as a requirement. It was simply a “recommendation” that a lot of folks have misunderstood and now this rumor is going around and won’t die. Granted, because of the recommendation some schools have started to transition MSN programs to DNP..but…this is really just a cash grab as it allows them to charge higher tuition for what used to be a masters program. The DNP is not really a clinical degree. There are still plenty of MSN programs left and there probably will be for the immediate future. It’s definitely something to pay attention to, but don’t believe the rumors that it has been mandated. It’s just not true. Check out these threads from this site for more on this:

https://allnurses.com/doctor-nursing-practice/2015-dnp-529004.html

https://allnurses.com/nurse-practitio...-a-505362.html

https://allnurses.com/post-graduate-n...al-511344.html

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Specializes in Mental Health.

Thank you so much. Really appreciate the advice!

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All very good advice in this thread. I also left clinical psychology to become a psych np. I'm in the accelerated rn portion of my program right now. I start my advanced practice work in the fall. Clinical psychology appears to be somewhat of a sinking ship. They have tried for more prescriptive authority lately and failed. My suggestion is to go for the direct entry NP. Apply broadly as these programs can be highly competitive. Just make sure you do well in your prereqs and you should be good.

What's great about psych np is not only can you do assessment, meds, and therapy, but you also learn all about managing physical health as well, which in my opinion is vital for being a psychiatric provider. Ive always wondered - do prescribing psychologists get that training? Do they take anatomy/phys and patho?do they learn the basics of diabetes, asthma, etc? Can they order and interpret labs?I'm really glad to be going a route where I will understand my patients' physical ailments as well as their psych issues.

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Specializes in Mental Health.

Hey Myelin,

That's great that you're in an NP program and are enjoying it! I am looking at direct entry programs right now. Is it true how expensive they are? Is yours expensive? The majority seem to be in big metro areas and cost a fortune. I'm going to have to take out at least $100k in loans to cover the 3 years. At least some let you work part time after you get the RN, but it seems like it's very difficult to get an RN job with no experience. Have you started looking?

I realize that these programs are competitive, but honestly after preparing for Clinical Psych PhD programs, I find it much more relieving to apply to these programs. As you probably know, Clinical PhD programs usually take around 6 out of ~250-300 applicants. Comparatively, the direct entry MSN programs are a breeze to get into. All I need is some pre-reqs, and hopefully I'll be applying next year.

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Sorry for a late reply, school has been busy.

Great information and advice here. Thanks so much everybody. For those of you who are PMHNPs or are in the process of becoming one, what does a typical day for a PMHNP look like? Also, what is the big difference between the psych NP and a prescribing psychologist? I would assume that in general, they can both treat the patient in the same way: med and/or psychotherapy.

Also, how important is experience went entering the mental health field as a nurse? What other kinds of research can they engaged in? Can they specialize in say, neuropsychiatry and work along neurologists and with patients with epiliepsy and other neurologyical disorders? I'm mostly interested in the mental health of medically ill patients either in oncology, neuro, nephrology, etc. I'm also very interested in the biological aspects (and research) of things, which is why I'm choosing the NP route. However, how much "biology" is even in psychiatry?

Also, can PMHNPs also help manage coexisting physical conditions with physical assessment, differential diagnosis, and drug assessment? Or are they stritly tied down to psychiatric patients?

Tried to stay away from this question but I'm curious: What's the salary like for psych NPs? I know reimbursment for psychiatrists isn't the greatest and they are one of the lowest paid physicians.

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