Behavioral or mental health nurses are never short on opportunities. According to experts in the field, they play a significant role in psychiatry, and there’s a dire need for their services.
“Entering the mental health field as a nurse armed with a holistic model of care puts you at an advantage,” said Nicholas Hatcher, DNP, APN, AGACNP-BC, PMHNP-BC, DBT-C. “Starting at the beginning of nursing school, we are all trained to use the biopsychosocial model and incorporate several factors that impact physical and mental health. The complex nature of physical and mental illness comes as no surprise to a nurse who is accustomed to navigating through patient care operating on this model.”
What’s more, the need for behavioral health is everywhere, said Connie Vogel, PhD, RN, CNE.
“I think experienced nurses would agree … that anxiety, depression, PTSD, psychosis, and personality disorders can be found in any medical specialty area,” Vogel said. “Often, these conditions have to be managed along with a pertinent acute medical condition, and nurses in all settings do need an understanding of behavioral health conditions.”
To help address patients’ mental health needs, a single nurse might work in several settings, and Hatcher is an example of this.
He primarily practices outpatient psychiatry in a community health setting and owns and operates Catharsis Health, a private practice dedicated to providing virtual psychiatric services in Washington State looking to potentially expand its reach.
“[I am] hoping for expansion to other full-practice authority states in the near future,” Hatcher, who also works PRN (as needed) at a local hospital as a hospitalist/intensivist, explained.
Career Options From Private Practice to the Bedside
In inpatient psychiatric nursing settings, the nurse manages acute, urgent, and emergent psychiatric illness, such as acute suicidal or homicidal ideation, forensic examinations, acute withdrawal and detoxification, acute psychosis, etc.
In outpatient settings, nurses manage chronic and some acute psychiatric illnesses.
Career options in nursing can be narrowed down by population of interest. For instance, nurses might focus on an adult or child/adolescent population, according to Hatcher.
“I was told as a student that you could choose a specific psychiatric illness or subset of illnesses and succeed in a subspecialty practice given the severe shortage in mental health providers across the United States,” said Hatcher who, in addition to his other professional roles, is an adjunct professor of nursing at Cleveland State Community College in Cleveland, Tennessee, and at Husson University in Bangor, Maine. “So, if you wanted to specialize in the management of attention-deficit/hyperactivity disorder, trauma disorders, substance use disorders, mood disorders, etc., you could certainly advance your understanding of this population and focus on the management of these specific conditions.”
Hatcher said psychiatric nurses work in several settings, including:
- Outpatient general psychiatry
- Inpatient psychiatry
- Detoxification units
- Addiction and rehabilitation
- Forensic nursing
- Nurse-driven counseling and coaching
- Child and adolescent psychiatry
- Consult-liaison psychiatry
- Psychosomatic medicine
- Geriatric psychiatry
Academia is another career option for mental health nurses. Today, Vogel is faculty at Capella University’s School of Nursing and Health Sciences. She teaches classes in the MSN specialization, psychiatric/mental health nursing specialty, and writes continuing education programs in her specialty areas, including geriatric mental health and substance abuse issues.
Vogel has had a diverse mental health nursing career. She has been a clinical nurse specialist working in private psychiatric practice, has worked in a mental health center and Veteran’s Affairs facilities, and has done psychiatric/mental health consulting in long-term care.
The Shortage Puts Mental Health Nurses in the Driver’s Seat
There is a significant shortage of mental health providers across the United States, and the situation has become more pronounced with the pandemic, according to Hatcher.
“There has certainly been a rise in the number of individuals seeking help for psychiatric illness and symptoms,” Hatcher said. “This provided me with the opportunity to branch out and start my own practice, so that I may increase the access to psychiatric services to those in need.”
In psychiatry, it is easier for nurses to practice to the full extent of their licenses and training, said Hatcher.
“Because of this, I find psychiatry to be very rewarding, especially in that it provides the level of autonomy I prefer,” he said.
For nurse practitioners or those who are interested in pursuing the practice, there is a tremendous need for behavioral health providers, Vogel said.
“Psychiatrists are in short supply outside of major population centers and ARNPs who can manage psychotropic medications and treatment plans in behavioral health settings are in demand,” Vogel said.
For nurses who are not NPs, psych nurses are always needed in inpatient units, according to Maria Ingalla, DNP, PMHNPBC, PMHC, who owns and practices at Paperflower Psychiatry in Phoenix, Arizona, and is a nursing mental health professor at Arizona State University.
Acute care isn’t the only setting scrambling to accommodate patients. Many facilities and practices are also facing the staffing challenge.
In Arizona, for example, demand for inpatient psych RNs is going up, but hospital bed availability is not, Ingalla said. She explained, “There are not enough beds, so patients are being turned away and pushed into outpatient.”
Many mental health patients are waiting months to get appointments with psychiatric NPs, according to Ingalla.
“To get an evaluation at a community mental health center can take weeks or months. I was always booked out four to eight weeks when I was working in those settings. And that was in the beginning of the pandemic,” Ingalla said. “Now that I am in private practice, I have had about 400 referrals in the past four months [and] have hired another NP.”
Time is Another Challenge
Ingalla wrote about the flaws she experienced in community mental health settings in a blogpost on the Mad in America site.
“I did work in the community mental health setting for a little while,” Ingalla said. “Not a big fan … you are essentially a pill pusher. There are about four patients per hour for follow-up and very prompt evaluations between 30 and 60 minutes, which are not very comprehensive. That’s one of the places where psych NPs start and end up burning out.”
Meeting the demand without sacrificing quality is a challenge for today’s mental health nurse.
“I think meeting the demand in a quality way is really difficult because I could see all the patients pretty quickly, but we do 90-minute evaluations and 30-minute follow ups, and we answer emails and try to make sure everyone feels supported,” Ingalla said. “That takes a lot of time.”
Ingalla, who recently gave birth, said that trying to balance family and work is an added burden in this busy time.
“What I found to be the most helpful is I’ve been taking on [nurse practitioner] students in my private practice. I precept them so they get the experience seeing patients. And they can see patients during the day while I have my baby or while I supervise them,” Ingalla said.
Teaching also gives Ingalla a fresh outlook and time away from direct patient care.
“I love [teaching]. It is a break from reality sometimes to be with people who are excited about learning,” she said. “We have a huge need for nurses who are experienced in mental health to teach. I would highly recommend going to apply for just a simulation or a clinical instructor role and start there. Then you can get integrated and work your way up.”
To be a clinical instructor in nursing, many schools require only an associate’s or a bachelor’s degree. Those who want to teach didactic courses usually need a doctorate, according to Ingalla.
The Path Toward a Career in Mental Health
Nurses considering a career change into a mental health setting benefit from further education, according to Vogel.
The certification credential offered by the American Nurses Credentialing Center is the Psychiatric–Mental Health Nursing board certification, or PMH-BC.
This is a competency-based certification for entry level practice in psychiatric/mental health nursing. The requirements are 2,000 hours of clinical practice in mental health, 30 CEUs in the topic area and successful completion of the exam, according to Vogel.
Psychiatric nurse practitioners can become certified as ARNPs with a specialization in psychiatric/mental health care, Vogel said.
Ingalla said that after getting a bachelor’s degree in nursing, the master’s is another year or two of education and about 600 hours of precepting.
“After that, you are cleared to prescribe medications, diagnose mental health conditions, and treat those in different settings where you decide to work,” Ingalla said.
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