What Is It Like to Be a Psychiatric Nurse Practitioner?: Duties, Challenges, and Rewards

psych mental health NP and patient
psych mental health NP and patient

Do you want to advance your nursing career in mental health care? Psychiatric-mental health nurse practitioners (PMHNPs) prevent, identify and treat mental illnesses in people of all ages, helping them achieve positive change and personal growth.

If you have asked yourself, “what is it like to be a psychiatric nurse practitioner?”, read on to explore the job duties, challenges and rewards of the PMHNP profession, plus the steps to become one.

What Is a PMHNP?

A PMHNP is an advanced practice registered nurse (APRN) educated to provide psychiatric and mental health care across the lifespan, from children to older adults.

Their patient population varies depending on where they work. The most common work settings for PMHNPs are behavioral health/addiction clinics, psychiatric-mental health facilities and private practices.

PMHNPs address a variety of mental health conditions, with examples ranging from ADHD and eating disorders to obsessive-compulsive disorder (OCD).

What Does a PMHNP Do?

PMHNPs assess, diagnose and treat mental health and substance abuse disorders. Full-time PMHNPs can see an average of 15 patients per day. Their specific job duties vary by state.

Each state board of nursing defines PMHNPs' scope of practice. Twenty-eight states permit full practice authority, where PMHNPs can practice independently to the full extent of their training. Other states limit the scope of practice, which means PMHNPs work under physician supervision.

Generally, the job responsibilities of PMHNPs include:

  • Conducting and interpreting health assessments
  • Developing diagnoses
  • Creating individualized treatment plans
  • Prescribing medications

PMHNPs regularly collaborate with other health care providers, including physicians and other mental health professionals.

How Do PMHNPs Assess Patients?

PMHNPs diagnose acute and chronic psychiatric disorders through patient assessment. Assessment involves collecting and analyzing information about patients' physical, psychological, intellectual and social well-being.

PMHNPs gather data through various methods—interviews, observation and standardized tests, to name a few.

Each day, PMHNPs may perform and interpret various assessments, including:

  • Physical Assessment: PMHNPs conduct physical exams, as well as order and analyze lab and diagnostic tests to evaluate patients’ physical well-being.
  • Psychological Assessment: Psychological assessment looks at symptoms of psychiatric illness and family psychiatric history. PMHNPs may interview patients and their family members, perform mental status exams and conduct psychological tests with screening tools.
  • Cognitive Assessment: PMHNPs perform cognitive assessments to evaluate patients' mental function. One example is the Mini-Mental State Examination (MMSE), which assesses memory, attention, calculation and language function.
  • Social Assessment: A psychosocial assessment looks at mental health and social well-being. PMHNPs review patients' lifestyles, cultures, family relationships and spirituality.

PMHNPs can make a diagnosis after completing the assessment process.

How Do PMHNPs Make Diagnoses?

PMHNPs can diagnose psychiatric and mental health disorders and assess the risk of developing one. They form diagnoses using assessment data, diagnostic reasoning and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Sometimes, the diagnosis is clear. But some patients' symptoms overlap with multiple disorders. In these cases, PMHNPs use differential diagnosis to develop a list of likely options. The process of confirming or ruling out each one may involve additional assessment.

PMHNPs address the nearly 300 disorders in the DSM-5. Some of the most common diagnosable mental health conditions among U.S. adults are:

  • Anxiety Disorders
  • Substance Abuse Disorders
  • Bipolar Disorder
  • Depression
  • Post-Traumatic Stress Disorder
  • Schizophrenia
  • Suicidal Thoughts

PMHNPs can diagnose certain disorders in as little as one patient visit. Other conditions take more time.

How Do PMHNPs Provide Treatment?

Following diagnosis, PMHNPs develop treatment plans with the patient and other health care providers. The type and duration of treatment depend on the nature and severity of the diagnosis.

PMHNPs educate patients and their family members about the treatment options. Then, they choose the appropriate plan based on critical factors, such as risks, benefits and patient preferences.

PMHNPs may have the following duties as part of treatment:

  • Conducting individual or group psychotherapy
  • Teaching self-care strategies
  • Providing health promotion and maintenance
  • Prescribing medications (depending on the scope of practice where they work)

The length of treatment varies by intervention. PMHNPs evaluate patients' responses and modify treatment plans as needed.

What Are the Challenges and Rewards of Becoming a PMHNP?

Like any profession, becoming a PMHNP comes with challenges and rewards. PMHNPs can enjoy the numerous benefits of this career path when they are aware of the potential difficulties and how to overcome them.


PMHNPs must manage the potential emotional overwhelm of dealing with patients in crisis. They must also handle client resistance and the mental health needs of an increasingly diverse society.

Emotional Overwhelm

It can be challenging to avoid the emotional toll of patients’ circumstances, from violence to discovering a serious illness. Constant exposure to patients’ problems can lead to stress and overwhelm, so PMHNPs need to monitor and treat their own mental health.

Patient Resistance

PMHNPs may encounter uncooperative patients. Patient resistance can be frustrating when the PMHNPs’ intention is to provide support for their mental health needs. Fortunately, there are evidence-based techniques that PMHNPs can use to overcome opposition.

Cultural Competence

Effective care integrates patients’ preferences, culture, values and beliefs. But the U.S. is becoming more culturally complex. PMHNPs must commit to lifelong learning about themselves and others so that they can empathize with and deliver on the mental health needs of every patient.


PMHNPs provide invaluable service to those with mental health needs, while benefiting from a strong employment outlook and a higher salary than RNs.

Making a Difference

PMHNPs can make a tremendous difference in people's lives because the need for mental health care is so great. Nearly 1 in 5 U.S. adults have a diagnosable mental disorder, and the coronavirus pandemic has exacerbated mental health problems. Because PMHNPs can care for patients across the lifespan, they can improve access to psychiatric and mental health care.

Strong Employment

The U.S. is facing a shortage of mental health care providers and a growing demand for their services. Almost half of the population lives in an area lacking mental health care providers. At the same time, providers have reported an increase in the number of patients with mental health disorders.

The increased demand for mental health care will likely continue for years. PMHNPs can address the gap while benefiting from a favorable employment outlook, with job opportunities estimated to grow 62% by 2030—over 20 times faster than the national average. PMHNPs have ample job opportunities, especially in underserved rural areas.

High Earning Potential

PMHNPs can earn significantly more than registered nurses (RNs). Full-time PMHNPs have a median annual income of $137,000—almost $56,000 higher than the median RN salary.

Learn more about RU's Online PMHNP Program

How to Become a Psychiatric Nurse Practitioner

The rewards of a PMHNP career illustrate why now is an ideal time to become a PMHNP. Here are the four steps for RNs with a Bachelor of Science in Nursing (BSN):

  1. Complete an accredited psychiatric nursing program: RNs with a BSN can become PMHNPs by earning an accredited master’s or doctoral degree in psychiatric nursing. A doctoral degree is the most advanced and takes longer. If becoming a PMHNP in less than three years is important to you, consider a master’s degree.
  2. Obtain PMHNP national board certification: Graduates of psychiatric nursing programs apply for the national board certification exam. A passing score earns candidates the Psychiatric-Mental Health Nurse Practitioner-Board Certified credential (PMHNP-BC™).
  3. Obtain state licensure: Board-certified PMHNPs apply for licensure in the state where they wish to practice. The eligibility requirements vary by state.
  4. Complete continuing education: Every few years, licensed PMHNPs must complete continuing education to renew their state license and national board certification.

Learn more about how to become a psychiatric mental health nurse practitioner.

Start Your Journey to Becoming a PMHNP at Rockhurst University

Through holistic psychiatric and mental health care, PMHNPs empower well-being and positive change for individuals, families and communities. In turn, PMHNPs benefit from a rewarding career with endless learning opportunities.

Do you want to address the need for mental health professionals through an advanced nursing career? Consider becoming a PMHNP through Rockhurst University’s online MSN-PMHNP program, delivered by the highly respected Saint Luke’s™ College of Nursing and Health Sciences.

The flexible, immersive program features:

  • 100% online coursework
  • Two immersions—one virtual and one on Rockhurst’s campus in the heart of Kansas City, Missouri
  • Hands-on clinical rotations in your local community, supported by complimentary placement services

Authorized by 23 states, including Missouri and Kansas, the accredited online MSN-PMHNP program prepares RNs with a BSN to pursue leadership as mental health advocates. Students develop as advanced practice nurses who care for the whole person.

Make a difference today with Rockhurst University’s online MSN-PMHNP program.

About Rockhurst University's Online Programs

In the heart of Kansas City since 1910, Rockhurst University is dedicated to learning, leadership and service in the Jesuit tradition, and today is the #1 Regional University in Kansas City (2021 U.S. News and World Report).

Rockhurst University’s online programs are delivered by the highly reputable Saint Luke’s ™ College of Nursing and Health Sciences and the School of Education. As an educational leader serving exceptional students in the field of health care and education, we are committed to preparing the workforce of tomorrow with our unique programs designed to prepare graduates to meet the needs of diverse populations and work in various organizations.

To learn more about our highly competitive online programs, please visit onlinedegrees.rockhurst.edu, or read more here: