Understanding the Many Faces of Nursing: A Guide to Various Roles

Advanced Practice Psychiatric Nurses and Psychiatric Nurse Practitioners: Minding Mental Health

The high prevalence of mental illnesses in the US has increased the demand for comprehensive mental health services nationwide. PMHNPs possess the right skill set to meet this demand since they are educated and trained at the master’s or doctorate level. They provide a broad range of mental health services, including assessments, diagnosis, psychotherapy, and prescribing medication.

1. Definition and Role of Psychiatric-Mental Health NPs

Advanced practice psychiatric nurses are health care practitioners licensed as specialists in psychiatric-mental health nursing. PMHNPs: 

• Diagnose, treat, and manage acute illnesses 
• Offer psychotherapy 
• Educate patients and families
• Prescribe medication
• Make referrals
• Coordinate care 
• Order, perform, and interpret lab tests 
• Provide preventive care services 

2. Role of PMHNPs in Diagnosing Patients

PMHNPs can diagnose patients with psychiatric and mental health illnesses. All states allow PMHNPs to diagnose mental health disorders, offer psychosocial treatment, and prescribe medications. Diagnosis allows them to understand patients’ underlying conditions and formulate appropriate treatment plans to address those needs. 

3. Where PMHNPs Work

PMHNPs can work in diverse healthcare settings, including primary care settings alongside other providers to provide patients with a wide range of mental health care services. An interdisciplinary approach to mental health care results in better patient outcomes than practicing independently, and it allows these professionals to know and establish strong relationships with patients because they interact with a relatively small patient population. 

PMHNPs can also work in community mental health centers, conducting assessments, providing psychotherapy services, and giving medications to individuals with various mental illnesses. This setting allows PNPs to interact with a diverse patient population, exposing them to various mental health conditions and experiences.

PNPs can also work at correctional facilities, offering mental health care to incarcerated individuals with mental illnesses.

4. Are PMHNPs in Demand?

Psychiatric nurse practitioners are in high demand. There’s a high demand for healthcare professionals who can deliver all essential psychiatric services, such as assessments, diagnoses, psychotherapy, and medication therapies. They have the appropriate education, training, and licensure to meet this demand and mitigate the current shortage of mental health professionals nationwide. The longstanding stigma against mental illnesses and psychiatric mental health nursing may discourage many people from pursuing the discipline. Breaking this barrier is critical to meeting the growing demand for PMHNPs across the country.

Sussan Nwogwugwu, a board-certified PMHNP at Done, reveals that the emotional burden of dealing with individuals with complex mental health needs is the biggest challenge of her job. At the same time, it’s gratifying to help people with mental illness to achieve optimal health, she says. 

“I remember a patient who was struggling with severe depression and showed minimal improvement despite trying several treatment approaches. Seeing the patient continue to suffer, I felt helpless and frustrated, which affected my emotions. To address this challenge, I consulted my senior colleagues. They offered me invaluable support and suggested alternative strategies to manage the patient’s condition and overcome my emotions as well,” Nwogwugwu told NursingColleges.com.

Certified Nurse Midwives (CNMs): Guiding Life’s Most Precious Moments

Certified nurse midwives hold a unique and vital role in the healthcare system, providing care to women during pregnancy, childbirth, and beyond. The duties of a CNM extend to general women’s health, family planning, and even primary care. Discover the responsibilities of CNMs, their prescribing authority, and other insights into this specialized field.

1. Duties and Responsibilities of Certified Nurse Midwives

Certified nurse midwives specialize in obstetrics, gynecology, and newborn care. Their comprehensive approach includes:

• Prenatal care: Monitoring the health of both mother and baby, offering support and education
• Labor and delivery: Guiding women through childbirth, whether in hospitals, birthing centers, or homes
• Postpartum care: Supporting mothers in the critical period following childbirth
• Family planning and reproductive health: Providing counseling, education, and care related to contraception, fertility, and menstrual health
• Primary care services: Including well-woman exams, preventive screenings, and management of common health concerns

2. Can a Certified Nurse Midwife Prescribe Medication?

Yes, CNMs typically have the authority to prescribe medications, including:

• Prenatal vitamins and supplements
• Antibiotics
• Birth control
• Pain management medications during labor

CNMs may write prescriptions in all 50 United States and the District of Columbia. Prescriptive authority for CNMs is regulated by individual state agencies and regulatory boards. 

Certified nurse midwives offer a holistic approach to women’s healthcare, seamlessly integrating medical expertise with emotional support and personalized care. Their ability to prescribe medication adds a layer of autonomy and responsiveness to their practice. Whether guiding a new life into the world or supporting women in their healthcare journey, CNMs embody the essence of nurturing care at the heart of nursing.

“The most rewarding things about being a nurse are making a difference in patients’ lives and building meaningful connections. Nurses impact patients’ lives profoundly, providing care and support during vulnerable times,” Shandra Scruggs, a CNM and doula told NursingColleges.com. “Building trustful relationships with patients and families creates a sense of purpose and fulfillment. These aspects inspire nurses to continue making a positive impact on others’ lives, making nursing a truly gratifying career.”

Clinical Nurse Specialists (CNSs): Pioneers in Specialized Care

Clinical nurse specialists hold master’s or doctorate degrees in nursing, focusing on improving patient care and serving as innovators who may develop policies and procedures. They’re trained in advanced physiology, physical assessment, pharmacology, and their area of specialty. Like other APRNs, clinical nurse specialists can diagnose, treat, and prescribe as allowed by their state’s regulations.  

1. Understanding the Role of a Clinical Nurse Specialist

Clinical nurse specialists work within a specialized area of medicine, such as neonatal, pediatrics, or geriatrics. They function as:

• Clinical experts: Providing advanced expertise and mentoring to nursing staff.
• Consultants: Advising healthcare teams on evidence-based practices.
• Educators: Teaching patients and families about managing specific health conditions.
• Researchers: Working on studies to improve patient outcomes and healthcare efficiency.

2. Can Clinical Nurse Specialists Prescribe Medication?

Yes, CNSs often have the authority to prescribe medications within their specialty area. Their prescription rights may include:

• Initiating and adjusting medications related to their specialization
• Managing ongoing therapies in collaboration with physicians

Prescription authority varies by state and may require additional certification.

3. Where Do Clinical Nurse Specialists Work?

CNSs can be found in diverse settings, including:

• Hospitals: Specializing in departments like surgery, cardiology, or intensive care
• Community health clinics: Providing specialized care in local settings
• Educational institutions: Teaching future nurses or conducting research
• Private practices: Offering specialized consultations and care

Danielle Baldino, a CNS who specializes in adult-gerontology, spoke to NursingColleges.com. She was a U.S. Navy Nurse Corps officer who worked in psychiatric nursing. After working alongside a CNS, she decided to make the switch. She now works as a CNS in Acute and Intensive Mental Health Services at the VA: “I played a vital role in opening the new Therapeutic Neuromodulation Clinic and relied on my education from my CNS program to guide me through everything from staff education to writing policy and procedures,” she says.

Nurse Anesthetists: Masters of Precision and Care

Certified registered nurse anesthetists (CRNAs) play a crucial role in surgical teams, delivering anesthesia and monitoring patients during surgery. This specialty is known for its significant responsibilities, deep expertise, and often, a level of independence in practice. 

1. Role and Responsibilities of Nurse Anesthetists

Nurse anesthetists are responsible for the following:

• Preoperative assessment: Evaluating patients before surgery to plan appropriate anesthesia
• Administering anesthesia: Providing general, regional, or local anesthesia as required
• Monitoring during surgery: Continuously tracking vital signs and adjusting anesthesia accordingly
• Postoperative care: Managing pain and monitoring recovery after surgery

The precision and attention to detail required in these responsibilities make nurse anesthetists essential to successful surgical outcomes.

2. Can Nurse Anesthetists Practice Independently?

Yes, in many jurisdictions, nurse anesthetists have the autonomy to practice independently. Their work may include:

• Independent practice: Working without supervision in various healthcare settings, depending on the state
• Collaboration with physicians: Partnering with surgeons and other medical professionals in hospital environments
• Rural and underserved areas: Often, CRNAs are the primary providers of anesthesia in rural hospitals

The ability to practice independently varies by state regulations, facility policies, and individual credentials. Thirty states and the District of Columbia allow CRNAs to practice independently, but states like Florida and South Carolina (and others) require physician supervision of CRNAs. 

Kris Rohde, who had an educational background in exercise science, pursued nursing after growing bored at her desk job and receiving encouragement from friends. Initially, she thought anesthesia would be too stressful. After finishing school and working for a few years as a travel nurse, she decided she loved the pace and rigor of the ICU. She applied to graduate school in nursing and was accepted. Now, after becoming a CRNA, she told NursingColleges.com, “This job has made me become a better clinician, use critical thinking more, and remember how much I love adrenaline at times.” She calls it the most challenging, yet rewarding job she’s ever had.

Embrace the Diverse Faces of Nursing

The world of nursing is as varied and dynamic as the patients it serves. From the focused expertise of family nurse practitioners to the nurturing guidance of certified nurse midwives, nursing’s many faces reflect a profession rich in opportunity and impact.

This look into a handful of the diverse roles within nursing highlights a field in constant evolution. The growing demand for specialized nursing roles is a testament to the complex needs of modern healthcare and the instrumental part nurses play in meeting those needs. 

Each specialty brings unique challenges and rewards that touch lives profoundly.

The journey into nursing’s many specialties involves exploration, discovery, and connection.