There is a shortage of psychiatrists in the U.S., but some states are in greater need of psychiatrists than others.
Psychiatric mental health nurse practitioners — PMHNP — are starting to help to fill those gaps.
One example is the state of Washington, which has only met its need for psychiatrists for its population size, by just more than 11%, according to a recently published report by the Kaiser Family Foundation. The state needs a minimum of 165 more psychiatrists to remedy its current shortage.
“The shortage has greatly impacted the state of Washington and parallels with the shortage of medical doctors in general,” said Susan Caverly, PhD, ARNP-BC, director of psychiatric services and the integrated cognitive therapies program at Seattle-based Therapeutic Health Services.
For 12 years, Caverly also has been involved with the recruitment of PMHNPs. One of the challenges Caverly faces when recruiting the PMHNP role for community mental health is competition with other employers.
“Hospitals often have higher salary structures when compared to community mental health,” she said. “Given the cost of a college education, new NPs come out of school with high loan burdens so choose an employer that pays the highest salary. Also given that PMHNPs and all NPs in Washington have full practice authority, many find it more lucrative to go into private practice.”
Texas is another state with a deficit of psychiatrists.
Jon Stevens, MD, MPH, chief of child and adolescent psychiatry and chief of outpatient services at the Menninger Clinic in Houston, who recruits and hires PMHNPs, said psychiatric NPs are valuable members of the care team in mental health.
“In the last 10 years we’ve seen a rise in the number of psychiatric NPs and they are part of the solution to this shortage,” he said. “However, there is a shortage of PMHNPs too.”
PMHNP shortage decreases mental healthcare access
The impact of the psychiatrist shortage in mental health affects access and creates long wait times for psychiatry, especially in ambulatory settings, said Camellia Herisko, DNP, MSN, RN, PMHCNS-BC, CRNP, chief nursing officer, vice president of operations and patient care services at the University of Pittsburgh Medical Center’s Western Psychiatric Hospital in Pennsylvania.
“As an academic center we’re more successful in recruiting and hiring psychiatrists, although it remains a challenge even for us,” she said. “The larger struggle presents with our community settings. As the need for behavioral health services continues to expand, access becomes an issue and the use of NPs can assist with getting needed behavioral health services to people in need of those services.”
Herisko said it can be challenging to recruit PMHNPs as there are not enough — only limited numbers graduate each year — and demand is high.
“I’ve heard more psychiatric nurse practitioner programs will be offered soon by colleges and universities,” Herisko said. “I believe that this is a great way to address the shortage.”
Providing working nurses with flexible schedules so they can attend NP school could help increase their numbers, Herisko said.
“I believe more nurses would continue their education in this field if they had a flexible schedule from their current employers to begin such a program,” she said. “At Western Psychiatric Hospital we are very flexible and accommodating with school schedules.”
Strategies to successfully recruit psychiatric NPs
Having a background in psychiatric nursing first, prior to completing a PMHNP program, can help prepare a new grad PMHNP for practice, Stevens said.
“We can’t fill this gap with just anyone,” he said. “When PMHNPs practice to the highest level of their NP license, training and experience, it’s good for patients and an organization.”
Stevens points out when hiring a PMHNP it’s important to have them interview with their co-workers first. If that goes well and the team likes the candidate, the next step of the process is typically an interview with Stevens and other leaders.
“This is important as a new hire may have a good interview with me and other key leaders,” Stevens said. “However, may not click with their colleagues and people they’ll actually be working with on a day-to-day basis.”
Meeting the needs of patients is the goal and one way to achieve this is by using the skills and talents of PMHNPs along with all other mental health staff, including MDs, psychologists and social workers, Stevens said.
“Focusing on what a person can bring to the practice, building on their strengths, and not focusing on their deficits is a good strategy for successful hiring,” he said.
Finding the right person for a job who has a passion for this specialty, can empathize with their patients who are many times in the darkest moments of their lives, as well as building on that person’s talents, can also help with retention, Stevens said.
Herisko said NPs want to start practicing to the full scope of their license upon graduation so look for some independence in practice.
“They want to make clinical decisions and manage patients independently,” Herisko said. “This will require a shift in how programs operate and also the comfort level of having a NP lead the treatment planning.”
Additional recruitment perks to provide PMHNPs
Other recruitment strategies Herisko suggested are providing a thorough orientation program, continuing education and financial support for continuing education.
“New hire support and mentoring are very important,” Herisko said. “Transitioning from a nurse to a nurse practitioner can be challenging for new graduates. Additionally, NPs are required to obtain continuing education credits each year and having these paid for by an employer is very enticing to recruits.”
Herisko said in addition to offering competitive salaries, offering a comprehensive and competitive benefits package is also important. “Scholarship programs or tuition forgiveness programs are also great ways to support nurses returning to obtain this degree.”
Kristine Highlander, MSN, ARNP, PMHNP-BC, who works for Lakeside Milam Recovery Centers in their residential treatment program in Kirkland, Wash., is president-elect of the Association of Advanced Practice Psychiatric Nurses.
“Offering residencies can be an attractive opportunity for new PMHNPs,” she said.” I’ve seen these offered to new graduates, but if an organization is looking for a seasoned provider, it could be reasonable to also tailor these opportunities to PMHNPs who are transitioning from one specialty to another, such as moving from a private practice focused on pediatric patients, to hospital-based acute care of adults.”
With the variety of work settings to choose from, including private practice, employers need to set themselves apart, Highlander said.
“Most important is making sure employers are aware of ARNP scope of practice in Washington state, and ensuring that job opportunities utilize this full scope,” Highlander said. “Creating stable work environments, investing in patient care including maintaining multidisciplinary teams, and offering flexible work hours are some additional strategies that may be effective for recruiting psychiatric ARNPs.”
