MSW to NP?

Editorial Team / Admin · Aug 1, 2005

i am currently pursuing a master of social work, concentrating in clinical practice in mental health. i love the field, but have recently been thinking about a three year np program with a concentration in mental health, following my graduation from the msw program. i find psychiatry intellectually stimulating and clinical work challenging (in a good way!) and enjoyable. i feel as though getting nursing training would be an excellent compliment to my social work skills, and allow me to take a more comprehensive approach to patient care. i could be completely off-base here, so i am very interested in hearing what real professionals in the field have to say about this notion. thanks!!!

hello!! i think this would round out your career nicely. nursing, especially np, would allow you to treat the whole person, disease entity, etc. as well as mental wellness/illness. you may want to shadow an np who has specialized in mental health and see if it is something you would like to do.

good luck and come here often for more opinions about this.

siri, crnp, clnc, rlnc

suzanne4, RN · Aug 1, 2005

I think that is sounds like an excellent idea. You have my vote. :)

elkpark · Aug 1, 2005

I've been a psych CS (Master's prepared, but different from a psych NP; I'm not sure how familiar you are with the different roles) for ~10 years (and a psych staff nurse for ~10 years before that). Is your main interest in being a psychotherapist? Because most of the psych NPs I have encountered work as assistants to the psychiatrists (I'm speaking of inpatient settings); they manage the clients' physical illnesses/complaints and do some initial/admission psych evals and lots of daily rounds -- which means, basically, that they talk to the client for as short a time as necessary to figure out which meds to order for them (time is money for psych NPs as well as MDs). I have not seen any psych NPs functioning in a therapist role -- their time is considered too valuable for that, same as psychiatrists.

I am trained as a child/adolescent psychotherapist, and applied a few years back for a nursing faculty position at a university in a state which offers prescriptive authority to psych CSs. The position would have been a joint appointment, teaching part-time and practicing part-time in a local outpatient MHC. I was told in my interview process that the school and clinic would expect me to take the steps necessary to get prescriptive authority in the state ASAP, and my job at the clinic would be to see clients for 15-minute medication appointments (talking with each client v. briefly to find out what kind of response s/he is having to the medication, whether they're having any side effects from the drugs, and write new prescriptions ... All that, and the charting, within 15 minutes, and then on to the next person! :uhoh21: ) When I questioned this and explained that my real interest and training were in psychotherapy, the psych nursing department head who was showing me around for the day told me flat out that no one in that state would hire me to be a therapist, because I was much more "valuable" as someone who could write Rxs, and the only jobs I would get offered would be doing med management. Bottom line, the main value of psych NPs to most (all?) employers is that they can write scrips (and cost less than an MD). Is that what you're looking for when you write about taking "a more comprehensive approach to patient care?"

I'm sure you're aware that advanced practice psych nurses (whether Css or NPs) make a whole lot more money than MSWs, but have you really investigated the difference in the roles and what would be expected of you in school and practice? I've talked to quite a number of MSWs (and psychologists) over the years who have been interested in becoming a psych NP or CS because they have the idea that it would mean doing the same thing they've been doing, but getting paid more money for doing it (I don't meant to sound offensive, and I'm not drawing any conclusions about you or your motivations -- I'm just describing honestly my own personal experience.) Becoming a psych NP through a 3-year, direct-entry program like you mention would mean going through at least a year of general, basic nursing education ("regular" nursing, not psych nursing) -- getting very intimate with people's physical problems and providing for all their physical needs. You would take the same licensing exam that every RN working as a staff nurse on a hospital medical-surgical unit takes, and be held legally accountable for all the same knowledge and skills as every other RN ...

I am not trying to talk you out of anything, but would encourage you to investigate thoroughly what you would be getting into and whether that is something that seriously interests you. And this is just one person's opinion/experience; there may be others here on the board with entirely different views, and I'm sure you'll hear from some of them. Best wishes on whatever you decide! :)

Psychrich · Aug 1, 2005

I have read the previous entries and they all have good advice. One of things I would add to the last person would be that you also need to look at the scope of practice defined by the state nursing board for NP's. Each state is different and can go as far as the state doesn't allow prescriptive rights to full rights as an completely independant practitioner.

I have been an NP for about a year and in many circumstances the employer wanted me to be strictly there for med management, but there are circumstances where they were wanting me to do individual and group therapy. An NP will allow you flexability, but it really depends upon the state you want to work and the type of setting....ie inpatient, outpatient, partial hospitalization.

I think as a MSW and a NP your knowledge would be very valuable and well rounded.

Good luck.

krisssy · Aug 1, 2005

I am currently pursuing a Master of Social Work, concentrating in clinical practice in mental health. I love the field, but have recently been thinking about a three year NP program with a concentration in mental health, following my graduation from the MSW program. I find psychiatry intellectually stimulating and clinical work challenging (in a good way!) and enjoyable. I feel as though getting nursing training would be an excellent compliment to my social work skills, and allow me to take a more comprehensive approach to patient care. I could be completely off-base here, so I am very interested in hearing what real professionals in the field have to say about this notion. Thanks!!!

This is very interesting to me. I think you should definitely do it. I was wondering if you could post or PM me and let me know what school you are thinking of going to. I am an RN who was a school nurse and an elementary school teacher. I want to be a psychiatric nurse practitioner, and I am trying to decide how to go about it. I graduated from nursing school many many years ago with a BS in Nursing. I then got an MA in education. I took a refresher course and did very well. When I tried to get a psych. job, nobody would hire me because of lack of med surg experience. I do not want to work med surg. So I am trying to decide if I should redo my nursing skills education by taking a direct entry master's program where nobody has nursing skills. I found out that I could do this and would not have to take the boards as I am currently licensed. Your school sounds interesting to me, as you said you could take a concentration in mental health. My other choice is to go directly into a psychiatric nurse practitioner's program without redoing my nursing skills. I would appreiciate everyone's opinion. My three choices are

1- direct entry master's program with specialty in psych nursing

2- take a second refresher course in med surg (as the last one I took was two years ago) and then take a regular psychiatric nurse practitioner's program

3-just go directly to a psychiatric nurse practitioner's program.

I have been worrying that it may not be wise to become a psychiatric nurse practitioner with never being a psychiatric nurse. But if you guys think it is a good idea for an MSW to do it, would it be ok for me too? Thanks for any advice Krisssy

krisssy · Aug 1, 2005

I've been a psych CS (Master's prepared, but different from a psych NP; I'm not sure how familiar you are with the different roles) for ~10 years (and a psych staff nurse for ~10 years before that). Is your main interest in being a psychotherapist? Because most of the psych NPs I have encountered work as assistants to the psychiatrists (I'm speaking of inpatient settings); they manage the clients' physical illnesses/complaints and do some initial/admission psych evals and lots of daily rounds -- which means, basically, that they talk to the client for as short a time as necessary to figure out which meds to order for them (time is money for psych NPs as well as MDs). I have not seen any psych NPs functioning in a therapist role -- their time is considered too valuable for that, same as psychiatrists.
I am trained as a child/adolescent psychotherapist, and applied a few years back for a nursing faculty position at a university in a state which offers prescriptive authority to psych CSs. The position would have been a joint appointment, teaching part-time and practicing part-time in a local outpatient MHC. I was told in my interview process that the school and clinic would expect me to take the steps necessary to get prescriptive authority in the state ASAP, and my job at the clinic would be to see clients for 15-minute medication appointments (talking with each client v. briefly to find out what kind of response s/he is having to the medication, whether they're having any side effects from the drugs, and write new prescriptions ... All that, and the charting, within 15 minutes, and then on to the next person! :uhoh21: ) When I questioned this and explained that my real interest and training were in psychotherapy, the psych nursing department head who was showing me around for the day told me flat out that no one in that state would hire me to be a therapist, because I was much more "valuable" as someone who could write Rxs, and the only jobs I would get offered would be doing med management. Bottom line, the main value of psych NPs to most (all?) employers is that they can write scrips (and cost less than an MD). Is that what you're looking for when you write about taking "a more comprehensive approach to patient care?"
I'm sure you're aware that advanced practice psych nurses (whether Css or NPs) make a whole lot more money than MSWs, but have you really investigated the difference in the roles and what would be expected of you in school and practice? I've talked to quite a number of MSWs (and psychologists) over the years who have been interested in becoming a psych NP or CS because they have the idea that it would mean doing the same thing they've been doing, but getting paid more money for doing it (I don't meant to sound offensive, and I'm not drawing any conclusions about you or your motivations -- I'm just describing honestly my own personal experience.) Becoming a psych NP through a 3-year, direct-entry program like you mention would mean going through at least a year of general, basic nursing education ("regular" nursing, not psych nursing) -- getting very intimate with people's physical problems and providing for all their physical needs. You would take the same licensing exam that every RN working as a staff nurse on a hospital medical-surgical unit takes, and be held legally accountable for all the same knowledge and skills as every other RN ...
I am not trying to talk you out of anything, but would encourage you to investigate thoroughly what you would be getting into and whether that is something that seriously interests you. And this is just one person's opinion/experience; there may be others here on the board with entirely different views, and I'm sure you'll hear from some of them. Best wishes on whatever you decide! :)

Thank you for sharing such great information. I am very interested in medication management, and I would love working with a psychiatrist. I can't wait to become a psychiatric nurse practitioner. I would greatly appreciate your opinion on my last post. Thanks Krisssy

Bluespruce · Aug 1, 2005

Thank you for sharing such great information. I am very interested in medication management, and I would love working with a psychiatrist. I can't wait to become a psychiatric nurse practitioner. I would greatly appreciate your opinion on my last post. Thanks Krisssy

I'm a new RN, but I had a great teacher who was a psych NP. She also had years of experience as a regular RN on psych floors. She did, it seemed, from her stories do counseling & med managment. This is in WA state where I believe NPs have quite a bit of autonomy. I think here in WA state they don't even have to work under a doctor as they do in many other states.

JRmsw · Aug 2, 2005

A hearty and sincere "thank you" to everyone who took the time to respond to my inquiry. I greatly appreciate all the terrific advice and encouragement.

To expand upon my motivation: my graduate training in social work will have included, in addition to coursework, one year doing mostly long-term psychodynamic therapy, with some short-term and crisis intervention thrown into the mix, and one year of inpatient psych doing groups on the unit, discharge planning, family work, etc. I also have previous experience (during college and immediately thereafter - I'm 25 now) in psychiatric rehab and psychiatric research. During this time period, I have come to appreciate social work skills and values tremendously, and I do believe they would be of value regardless of setting. I am not interested in doing long term therapy. From a psychotherapy perspective, my interests are more in short term work, specifically solution oriented and cognitive behavioral modalities. I have become increasingly interested in, and appreciative of, the importance of pharmacological treatments and I think I would like to be able to incorporate that learning into education and ultimately be able to make use of it in a clinical setting. Inpatient work and medication management does interest me. This is all, as you can imagine, at an inchoate stage.

Regarding salary. Honestly it had not occurred to me that there would be a salary differential and in any case, shifting into an area that I did not find enjoyable and interesting for the sake of making more money would not occur to me either.

I am not familiar with the differences between an NP and a CNS. I did a quick search but I am still not entirely clear. Hopefully someone would not mind educating me regarding this.

Krissy, honestly I do not know enough about the ins and outs of this whole process do be able to give you any sound advice. I am sure if this is really where your interest lies there is a way for you to shift into the speciality, and I wish you every luck doing that!

Thanks again, everybody, for the great advice.

JR

Bluespruce · Aug 2, 2005

A hearty and sincere "thank you" to everyone who took the time to respond to my inquiry. I greatly appreciate all the terrific advice and encouragement.
To expand upon my motivation: my graduate training in social work will have included, in addition to coursework, one year doing mostly long-term psychodynamic therapy, with some short-term and crisis intervention thrown into the mix, and one year of inpatient psych doing groups on the unit, discharge planning, family work, etc. I also have previous experience (during college and immediately thereafter - I'm 25 now) in psychiatric rehab and psychiatric research. During this time period, I have come to appreciate social work skills and values tremendously, and I do believe they would be of value regardless of setting. I am not interested in doing long term therapy. From a psychotherapy perspective, my interests are more in short term work, specifically solution oriented and cognitive behavioral modalities. I have become increasingly interested in, and appreciative of, the importance of pharmacological treatments and I think I would like to be able to incorporate that learning into education and ultimately be able to make use of it in a clinical setting. Inpatient work and medication management does interest me. This is all, as you can imagine, at an inchoate stage.
Regarding salary. Honestly it had not occurred to me that there would be a salary differential and in any case, shifting into an area that I did not find enjoyable and interesting for the sake of making more money would not occur to me either.
I am not familiar with the differences between an NP and a CNS. I did a quick search but I am still not entirely clear. Hopefully someone would not mind educating me regarding this.
Krissy, honestly I do not know enough about the ins and outs of this whole process do be able to give you any sound advice. I am sure if this is really where your interest lies there is a way for you to shift into the speciality, and I wish you every luck doing that!
Thanks again, everybody, for the great advice.
JR

Just one more thing...the initial shock of nursing school w/buttwiping and some aweful smells sights may scare you away, but I tell you the more you get exposed to it the more desensitized you'll become because most likely you'll have to go through this in becoming an RN initially.

spaniel · Aug 5, 2005

Hi all- I was particularly struck by elkparks' concise answer. I do very much agree with what she said. (Although I must say I do know one psych NP who does well doing both psychotherapy and med management, and another who seems on her way to doing this successfully). I guess I'm wondering why more psych NP's don't try the independent route. Yes, I know one must have a collaborative arrangement with a psychiatrist in most cases-i.e. NY state.

The other issue is that there just don't seem to be many psych CNS positions around- that to me would be the most interesting (rather than seeing umpteen patients in one day).

I too am licensed to provide psychotherapy but have been "on the fence" about getting the NP...I definitely don't want to do the corporate medical route at my advanced age of 52! There is a shortage of psychiatrists in the one area that I work ( a rather rural, demographically "poor" area of upstate NY).

tineann · Aug 8, 2005

I have really appreciated the information that this thread has provided. I am at a crossroads in my career. I have worked the last 8 years on an inpatient psych unit in CT. I enjoy the work and am good at it but am finding that I am feeling a little stunted lately.... Have been considering going back to school for either an NP or CNS. Am almost decided on a year in Australia after my daughter enters college and then a relocation West where I would return to school(not exactly sure where in the West - Colorado is #1 choice right now).

Here is where I am stuck - what exactly IS the difference between a psych CNS and an NP? Is it possible to obtain the "other" title by taking an exam or are they mutually exclusive?

I really appreciated your input, elkpark. The med management issue is something I really struggle with. I would not mind doing "some" med management but am probably more interested in psychotherapy. I fear that my approach to medication would not be mainstream enough to make me the most desirable partner. In general I find meds overprescribed and I find that decisions regarding meds to be a little too hastey. Of course I work on an inpatient unit and so much of our work is insurance driven...time is of the essence and so that is a huge factor in med titration. I DO think meds are important and I think I have quite a bit of experience already in med titration as the unit that I work on has had some good docs who like to teach - so, I am interested in doing some work in this area - but what you describe elkpark, is not really what I want. Can a NP or CSN operate somewhat independently - ie have a private practice?

Lastly, does anyone have any inside knowledge on UCHSC's program? Any other thoughts on good programs in the "West"?

Where in the West are advance practive psych nurses most in demand? Where I live now, they are very much in demand but not sure if this is the case nationwide.

Any thoughts or suggestions are most welcome!

Christine