The Distribution of Advanced Practice Nurses Within the Psychiatric Workforce

Abstract

OBJECTIVE: To examine the size and distribution of the advanced practice psychiatric nurse workforce relative to the total psychiatry workforce to determine whether nurses are predominantly working in areas with higher or lower levels of behavioral health specialists. METHODS: State-level data for psychiatric nurses were obtained from the American Nurses Credentialing Center, and included mental health psychiatric nurse practitioners, adult psychiatric nurse practitioners, child psychiatric clinical nurse specialists, and adult psychiatric clinical nurse specialists. Supply estimates of the full psychiatry workforce were calculated for comparison purposes. State population estimates were obtained from U.S. Census Bureau data. State workforce estimates were converted to a 1:100,000 provider-to-population ratio to analyze the density of providers across states. RESULTS: In 2018, the psychiatric workforce supply was estimated to be composed of 66,740 providers, including psychiatrists ( n = 47,046; 71%), psychiatric nurses ( n = 17,534; 26%), physician assistants ( n = 1,164; 2%), and psychiatric pharmacists ( n = 966; 1%). Overall, psychiatric providers appeared to be most densely concentrated in the northeast region of the United States. A dearth of providers was most pronounced within areas in the 12-state Midwest region, southern states, California, and Nevada. The average concentration of psychiatric workers was 22.61 per 100,000 population. CONCLUSIONS: The findings of this study find inconsistent pattern of how psychiatric nurses are distributed relative to the rest of the workforce, but reinforce the idea that they are essential in addressing care needs in areas with low concentrations of psychiatry specialists—especially if they are authorized to work to the full extent of their training/education.

National Trends in Outpatient Mental Health Service Use Among Adults Between 2008 and 2015

“…Many individuals may face high barriers to accessing mental health care, in part because of insufficient numbers of SMHPs (i.e., psychologists, psychiatrists, social workers, or counselors) (16,17). In 2018, the Health Resources and Services Administration estimated that the United States had 5,124 areas of shortage of mental health professionals (18). Furthermore, patients with serious psychological distress may not have timely access to SMHPs (12) and may experience delays in receiving recommended adjunctive psychotherapy or mental health counseling along with psychotropic medications (14).…”

Advanced Practice Registered Nurses Using Synchronous Telepsychiatry: An Integrative Systematic Review

“…There are 5,124 Health Resources and Services Administration–designated mental health shortage areas in the United States, and only 44.2% of Americans had adequate access to respective services (Beck et al, 2020; Kaiser Family Foundation, 2019). Furthermore, the shortages among advanced practice psychiatric nurses and psychiatrists alike are concerning, and there is a projected shortage of 16,450 psychiatric providers by 2030 (APNA, 2019; Beck et al, 2020; National Council for Behavioral Health, 2017).…”

“…To combat this growing mental health crisis across the United States, legislation has supported expanding the role of psychiatric mental health advanced practice registered nurses (PMH APRN), defined as graduate-level prepared, licensed professionals who can diagnose, prescribe psychotropic medications, provide psychotherapy, order laboratory tests, educate, and coordinate care for patients with mental health disorders (Phoenix, 2019). There are currently 17,534 PMH APRNs licensed in the United States (including psychiatric mental health nurse practitioners and certified nurse specialists), constituting about 26% of the psychiatric workforce with 47,046 psychiatrists (71%), 1,164 psychiatric physician assistants (2%), and 966 psychiatric pharmacists (1%; Beck et al, 2020; Phoenix, 2019).…”

“…The majority PMH APRNs work in mental health hospitals and community-based clinics, whereas they are found in higher ratios in New England and states with unrestricted practice authority (Beck et al, 2020; Phoenix, 2019). PMH APRNs have demonstrated a commitment to treating diverse patients across the lifespan and in urban underserved and rural areas (APNA, 2019; Ellington & Repique, 2013; Finley, 2019; Phoenix, 2019).…”

“…The common reasons why mental health treatment is not accessed are, among others, social and self-stigmatization, insufficient availability of care, lack of insurance parity for mental health coverage, significant provider shortages, and lack of political prioritization (Beronio et al, 2014;Corrigan et al, 2014;Rural Health Information [RHI] Hub, 2019;SAMHSA, 2013;Trautmann et al, 2016). There are 5,124 Health Resources and Services Administration-designated mental health shortage areas in the United States, and only 44.2% of Americans had adequate access to respective services (Beck et al, 2020;Kaiser Family Foundation, 2019). Furthermore, the shortages among advanced practice psychiatric nurses and psychiatrists alike are concerning, and there is a projected shortage of 16,450 psychiatric providers by 2030 (APNA, 2019;Beck et al, 2020;National Council for Behavioral Health, 2017).…”