What It Is, and Where Its At!

Here it is, the big, bad, position statement that has caused a lot of nurses to be very, well "nursey." The gist is, the psych CNSs and NPs competencies are nearly identical. Even though the CNS is 30 years older, the "NP" designation is the most publicly and professionally understood (using "understood" pretty loosely here). While the ANCC backs APRN as the single advanced practice nursing psych credential of the future, the APNA wants to ensure the CNSs who do not go back for their APRNs maintain their scope of practice and level of reimbursement.

APNA Position Statement: Psychiatric Mental Health Advanced Practice Nurses

The burgeoning mental health needs of the population demand access to highly qualified providers. Psychiatric Mental Health Advanced Practice Nurses (PMH-APRN) include both the Clinical Nurse Specialist and Nurse Practitioner. Both are prepared at the graduate level in research, systems, and direct patient care to provide psychiatric evaluations and treatment, including psychopharmacological interventions and individual, family and group therapy, as well as primary, secondary and tertiary levels of prevention across the lifespan. They are a vital part of the workforce required to meet increasing population mental health needs.


The PMH-CNS certification began in 1974. The introduction of the Psychiatric Nurse Practitioner certification examinations in the early 2000s created confusion regarding the scope of practice of the Psychiatric CNS and NP. This further became confounded with variances in state licensure and titles.


The position of the American Psychiatric Nurses Association is "psychiatric advanced practice nurses, whether they practice under the title of CNS or NP, share the same core competencies of clinical and professional practice. While the individual APRN-PMH may actually implement portions of the full scope and practice based on their role, position, description, and practice setting, it is importantly, the full breadth of their knowledge base that informs their practice." (Psychiatric-Mental Health Nursing: Scope and Standards of Practice (ANA, APNA, ISPN, 2007).


The following data lend further support to this position:

• The Essentials of Master's Education for advanced practice nursing requires the same core courses for both titles (AACN, 1995).
• The American Nurses Credentialing Center and the American Psychiatric Nurses Association conducted a Logical Job Analysis of the PMH-CNS and PMH-NP in 2005. Analysis of the existing role delineation studies of the PMH APRN revealed 99% of the identified competencies were shared between the two titles (Rice, Moller et. al., 2007, p.157).
• The ability of Psychiatric Mental Health Clinical Nurse Specialists to have title rights, prescriptive authority and direct care billing of CPT codes began in 1978 in the Pacific Northwest and has extended to 37 states and the District of Columbia.
• Medicare continues to reimburse ANCC certified Psychiatric Clinical Nurse Specialists for any CPT codes related to evaluation and treatment. Certified Psychiatric Nurse Practitioners were added in 2007.