Psychiatric/Mental Health CNS Versus Child Services Social Work

[dreamcatcher17, BSN]

Hi allnurses,

SO...how much counseling do CNS with a PMH focus do? The short summary of my question is that I am worried that I will just write pills and focus ONLY on the medical aspect of caring for at-risk youth. I want to do some counseling as well, as I believe this helps with the holistic model.

I was just accepted into nursing school, and while I am excited sometimes I worry if I chose the correct field. I want to work with the family dynamic and promote mental health so that children and families can flourish. I chose nursing because I felt it would give me more clout in promoting mental health policies in schools and in the community, but also so that I could consult on special cases and run my own group home or after school program one day. Genetics, A&P, Psychology, Statistics are also very interesting. I really want to work with at-risk youth, and foster a trusting client-professional relationship with them. I am interested in many topics of family development, which is why I have even considered social work. I have no interest in traveling to a client's home, etc. but rather to work with them in a school- based behavioral health center or group home.

Thank you for your advice!

[elkpark]

If you have just been accepted in nursing school, it doesn't really matter, the psych CNS role will not be an option for you. The ANCC is "retiring" the credential, and no applications for certification will be accepted after the end of this month.

The only remaining advanced practice psych credential in nursing will be the psychiatric nurse practitioner and, as you note, that role is primarily about pushing pills.

I am a child psych CNS, and my graduate program was focused on child/adolescent development and psychopathology, family dynamics and pathology, and individual, group, and family psychotherapy with children and adolescents. However, those programs don't exist anymore. All anyone cares about anymore in nursing is prescriptive authority.

[dreamcatcher17, BSN]

Thank you for your comment. WOW. I can't believe that an entire APRN specialty is going out the window! It sounds like your credentials were exactly what I was looking for in a degree. I am worried that I am entering the field only to push pills. If you don't mind me asking, will you keep your current job? Do you know of any other specialties (APRN or otherwise) that offer similar opportunities.

[elkpark]

Thank you for your comment. WOW. I can't believe that an entire APRN specialty is going out the window! It sounds like your credentials were exactly what I was looking for in a degree. I am worried that I am entering the field only to push pills. If you don't mind me asking, will you keep your current job? Do you know of any other specialties (APRN or otherwise) that offer similar opportunities.

There's nothing else in nursing that compares to the psych CNS role (and y'all are going to miss us when we're all finally gone!) Those of us who are already psych CNSs (and some other credentials that are also being "retired") will be able to maintain our certification, but the ANCC isn't going to be offering the certification exam and no new people will be able to become psych CNSs (or the other "retired" roles). My job isn't going anywhere.

[oceanblue52]

Are you just beginning nursing school? If so you have a long while to figure things out :-) I entered school with a similar intent of focusing on wellness and mental health, and I still think nursing school was a good choice for me. Do you have a Psych background? Consider working at a behavioral health hospital as a tech, it will give you a lot of insight and experience. Or look into volunteering with the public health department, homeless outreach, battered women's shelters, etc.

Some other thoughts: Once you graduate you can look into R.N. case management in a home health, outpatient, or other community health setting. It is not quite counseling focused, but you do a lot of care coordination similar to social work, and also do a lot of "soft" counseling to build rapport with your patients. Keep in mind too that medication management and helping patients stay compliant with their meds is an important part of therapy.

You say you are not interested in traveling to patient homes, but home health is a really important part of community mental health! I'm in home health currently and work with several patients with Psych diagnoses. Helping them "pop pills" has greatly improved their quality of life, and I am the one responsible for monitoring for side effects so they are getting the most benefit. It's been eye opening for me, and has given me a lot of transferable skills.

Some of the places I listed for volunteering will hire new grads with the right experience, and I think you can be successful with the right training. Hospice might be another option as you work a lot with family dynamics, but you would need to be comfortable with Med-Surg skills to do that. From reading these forums I think it is probably the case that you would do more med management than counseling as a Psych NP, if only because of insurance reimbursement. A lot of good threads regarding this topic if you do a search. Please feel free to PM me if you'd like to chat more, have been in the Psych field awhile and know people who went in all sorts of directions career-wise, nursing and otherwise.

[dreamcatcher17, BSN]

Unfortunately, I cannot send you a private message because I am fairly new to the forums. I have experience with helping children with coping skills in a school setting, but only at the volunteering level. I would like to shadow/volunteer more. There was a great article through NCBI about a pilot study completed a few years ago involving psychiatric nurses in foster care for older kids. That is more what I am looking into right now. For some reason, I am worried that I will realize I should have been in Social Work. After reading the article and surfing the web a bit, the psychiatric RN role is very much one of integrative service. Hopefully I can find a job that suits this.

Here is the article from NCBI 1) Pioneering the Psychiatric Nurse Role in Foster Care ()

[dreamcatcher17, BSN]

Hopefully (fingers are REALLY crossed) there will be a newer role for APRNs that come in, I have posted a link about a study promoting the need for a psychiatric RN in foster care services/ case managemen and patient history data collection. If you are willing to read into it, I would love to hear your opinion or if you have heard of other job opportunities that offer this. If not, then thank you so much for your advice because it threw me into research mode. I feel a little better about psych nursing even if the CNS role is being phased out.

[elkpark]

Psych nursing at the generalist ("regular" RN, not advanced practice) level offers a wide range of opportunities for promoting mental health in vulnerable populations of all ages in a wide range of settings.

I don't anticipate any new advanced practice roles with a psychiatric focus being developed; at least, not any time in the near future. But there is a lot more to nursing than advanced practice, esp. if you don't feel any particular desire to be writing scrips. :)

[MHDNURSE]

Based on what you described, it sounds like either social work or counselling might be more up your alley. My sister went back and got a Master's in social work and is a LICSW (Licensed clinical social worker). She got her PhD in social work 3 years ago. She does family counselling and specifically works with at-risk youth. She also teaches a class at a university in their social work program and sees private clients. With her degrees she is able to do everything you described.

My friend's husband got his BA in counselling and then went back and got his PsyD. He now sees private clients. He works with youth sex offenders and also does counselling for families in crisis.

Just a couple options to think about in terms of school path.