Ever Heard of Psychiatric Nurse Practitioners The Nursing Specialty You May Not Know

Ever Heard of Psychiatric Nurse Practitioners? The Nursing Specialty You May Not Know

An interview with Erin Walczykowski, Psychiatric Nurse Practitioner at MBI Health Services

Q: What is the difference between a nurse practitioner, physician's assistant, and MD?

A psychiatric nurse practitioner (psych NP) specializes in psychiatry. We focus on diagnosing mental health disorders and managing medication. We can also offer therapy, but that depends on where we work and the population we treat.

State laws affect how much autonomy we have and whether we can practice alone, or need to officially collaborate with a psychiatrist.

To become a nurse practitioner, you need a Bachelor of Science in Nursing first. Then, you get either a Master of Science in Nursing or go for a Doctorate. For those already trained as a nurse practitioner in another specialty, there's a postmaster's certificate to switch to psychiatry.

Some states have rules that give psychiatrists more abilities than psych NPs. Psychiatrists go to medical school, complete their residency, and therefore have certain abilities that psych NPs may not have. For example, in Washington DC, only a psychiatrist can renew committed outpatient status for certain clients. I have clients under this status, and while I can see them regularly, a psychiatrist has to perform the yearly assessment for renewal. 

Physician's assistants, on the other hand, must work under a physician's license. They receive broad training covering a range of illnesses and specialties.

Q: What is the difference between the nursing model and the physician model?

I'm a nurse first, trained under the nursing model. It's different from the medical school's physician model. Our focus is still nursing, but we specialize in psychiatry. We learn to diagnose mental disorders and manage medication safely. And yes, we can offer therapy. In my program at UPenn, we covered some therapy, but if you really want to get deep into therapy, you'll probably need more training. That could come from a specialized institute or maybe on-the-job training.

Your preference as a psych NP really guides what you do. Some psych NPs love the therapy part and incorporate it into their practice. Others focus more on medication management and refer out for therapy to a psychologist, a licensed clinical social worker, or an LPC. The level of therapy training you get varies, depending on the school and how much effort you put in.

Q: How long does it take to become a psych NP?

It takes about two years of additional education to become a psych NP after you’ve received your Bachelor of Science in Nursing (BSN). If you go part-time, it might take a bit longer.

Q: What kind of training is required to graduate?

We have to complete clinical hours, just like other healthcare students. Typically, you're paired up with a preceptor (the skilled professional who guides the student's clinical learning experience), and you go out and see clients. Every program sets a minimum number of hours you need to finish before graduating.

I wish there were more consistency across schools. Everyone should meet the same standards, whether it's for getting into a program or graduating from it. This is a hot topic among psych NPs. We're talking about how to make the care we offer more standard and not dependent on schooling or geography.

Q: What are the different career paths available to students in this field?

There are lots of different career paths available to psychiatric NPs. It's all about finding what fits with your personality, interests, and passion. That should guide you in choosing the right path for you.

You can run your own psychiatric private practice, or you can join someone else's practice as a contractor. You could also work at outpatient facilities. For example, I work in a community mental health center, where we serve a lot of patients with schizophrenia and bipolar disorders. Our goal is to stabilize them so they don't keep getting readmitted to the hospital.

Psychiatric NPs could also work at substance use disorder clinics. The focus of the work there would be more on substance use, rather than treating underlying psychiatric issues. In that type of situation, you might be helping to quit opiates and placing patients on medications like suboxone or methadone.

Besides these, there are other outpatient facilities. You could work in telemedicine or ketamine clinics. If you prefer inpatient work, there are hospitals and longer-term psychiatric facilities. You could also work in correctional facilities. I used to work in a jail, for example.

Let's not forget teaching. If you're interested, you could become a professor or an adjunct, training the next generation of nurses. The field needs more people who are willing to precept NP students.

The great thing about nursing, and especially becoming a psych NP, is the variety. There are so many different areas you could work in, which can help prevent burnout. If you've been in one area for a while and feel like you need something new, you can switch to another area based on what interests you. You could work with children or adolescents in residential facilities or even in research and pharmaceuticals.

Pay can differ based on demand. For example, there's a high need for providers in child and adolescent care, so you might find higher pay there. It really depends on where you are in the country and what population you want to serve.

Q: How do psych NPs work day-to-day?

I often joke that it's rare to find a psych NP or a psychiatrist working just one job in one place. That's one of the great things about psychiatry—it gives you flexibility and helps avoid burnout.

For example, if you have challenging patients, it might be draining to see them five days a week for years on end. If you work with them maybe just two days a week and spend the other days with a less intense patient group, that can help create balance. It gives you a bit of a break, so you're not dealing with heavy stuff every single day.

We've got to remember that we're human. Naturally, we're going to take on whatever is thrown our way, both the good and the bad.

Q: Speaking of being human, how else can you prevent burnout in this profession?

We always say self-care is key. Keep your life outside of work balanced, and try not to take work stress home with you. Pay attention to how you're feeling. If you're getting worn out, maybe it's time for a vacation, or maybe scale back from full-time to part-time at one job and pick up something different somewhere else. 

Remember, most people get into psychiatry because they want to help others. But you can't do that well if you're not first taking care of yourself. Make sure your own foundation is solid. This is why many people in the field, myself included, recommend having a therapist. I think most people could benefit from some form of therapy, especially when they connect with the right therapist. For us in psychiatry, having someone to talk to, to help us process what we're going through, is really valuable.

Psychiatry makes you more aware of yourself, too. The issues your patients talk about might not be all that different from what you've gone through. We call it transference and countertransference—sometimes, our own feelings and experiences can get mixed up with our patients. Knowing this helps you understand what kinds of patients you work best with and where your limits are. It's all about creating the most helpful environment for your patients while keeping yourself in good shape, too.

Q: What advice would you give to someone who is trying to figure out what path to take?

Whether it's becoming a psych NP, a psychologist, or even a social worker, you've got options. My advice? Talk to someone who's already doing what you think you want to do. Shadowing can be tricky because of privacy rules, but even a good conversation can offer a lot of insight.

Separately, many people believe you should work as a nurse first before becoming an NP. I agree. Your undergrad years and clinicals in a BSN program will expose you to different specialties. That's your chance to figure out what really gels with you. It could be psychiatry, or it could be something else. Pay close attention during those clinicals and follow up with more research and conversations with people in the field.

Once you decide to go on to a Master's, you've got more choices. If you're not aiming to be a Family Nurse Practitioner, which is generally outpatient, then you'll want to specialize. Make sure you're making a choice that fits you well. This decision will help you avoid that burnout we talked about earlier, because it'll align better with your interests and skills.

Think long-term. Can you see yourself doing this for 30-40 years? Maybe yes, maybe no. I have friends who are in other industries where they worked for 10-15 years, and next thing you know, they're doing something completely different. 

So the main point here is to do your homework. Talk to people in the field, because you’re investing time, money, and energy into this.

Life changes, and so do you. Maybe this job fits your life now but won’t later. That's okay. Just be open to where the path may lead.

Financially speaking, school is expensive. If you can, get grants or scholarships. If you’re taking out loans, be extra sure this is a good investment, not just in terms of money you'll earn but also the energy you'll put in.

Q: Tell us a bit about your journey

It's funny. I was an art major in undergrad, so I have a BFA. My first undergrad degree focused on graphic design, and then I decided to go back for nursing. I did my research online. I did have some girlfriends who did nursing in undergrad, so they were good resources to find out about the prerequisites and the classes to take. 

It's important to know what you like before diving into a career, especially in healthcare. I knew I wanted to be a psych NP because I enjoyed my BSN psych clinical portion. I talked to the program director to learn more, and that helped me make up my mind. I did my master’s part-time while working as a nurse to gain experience.

Some say you should work in med-surg for a year. I did just six months, but I knew it wasn't for me. That’s when I went into inpatient psych and worked there until I finished the master's program.

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