PMHNP or FNP? Which Should I Become?

As a longtime nurse practitioner, I frequently hear the question: “Should I become a PMHNP or an FNP? I just don’t know.” Yes, a psych mental health nurse practitioner (PMHNP) versus a family nurse practitioner (FNP). Both are great professions, but very different. So, let's talk about some of those differences.

Becoming a Provider: A Big Step
First and foremost, consider whether becoming a provider is the right fit for you. Transitioning from registered nurse (RN) to provider is a significant shift with increased responsibility. You'll be directing care and making diagnoses. Self-reflection is crucial to ensure this path aligns with your aspirations, abilities, and your personality. Once you’re certain that being a PROVIDER is a good fit, then let's move on! ✅
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Matching Your Passion to Your Path
As you likely know, an FNP can prescribe some psych medications, but if Psych really is your thing ✅, if you love Psych ✅, if those are “your people” ✅, I would encourage you to get your PMHNP. On the other hand, if psych isn’t really your thing, if you're more of a generalist, and you like the idea of seeing a variety of things and taking care of a lot of different kinds of patients, a little bit of everything, then perhaps being an FNP is a better fit.

PMHNP Preceptor Experience: Varied Opinions
Do you need experience as a psych RN to become a PMHNP? While I've heard preceptors give different responses to this question, most recommend that you have psych experience either as an RN or in a related field. This will help ensure that you know this population really is who you want to spend your career caring for. But just the other day, I spoke with a PMHNP who said she preferred students with no psych experience so she could “shape them.” However, the majority of our preceptors recommend having some professional psych experience.

FNPs Working in Psych: Yes or No?
What about being an FNP and working in Psych? Yes, as an FNP, you can prescribe psych medications, and in primary care, you will likely prescribe some psych meds. But we do want to try to stay within our scope of practice. If you really love psych, become a PMHNP. Many of our FNP preceptors have decided to become dual certified as both an FNP and PMHNP. 

Diverse Work Environments for PMHNPs
PMHNPs work in both inpatient and outpatient settings. Inpatient settings can include locked psychiatric facilities, skilled nursing facilities, correctional institutions, and residential treatment programs. Outpatient settings encompass mental health services in clinical settings. Patients often transition between these settings during their care journey.

The Rise of Telepsych
One positive outcome of the COVID-19 pandemic is the widespread adoption of telepsych, offering flexibility for both providers and patients. Many PMHNPs are leveraging telepsych and obtaining licenses in multiple states to expand their reach. This trend may present exciting opportunities for PMHNPs, with some even starting their own practices, particularly in Full Practice Authority (FPA) states. We’ll talk a lot more about the Considerations and Implications of Telepscych for PMHNPs in future articles. Watch our blog for updates!

FNP Work Settings and Specialties
FNPs typically work in outpatient settings, such as primary care, internal medicine, geriatric medicine, and urgent care. However, they can also venture into specialty areas like cardiology, sleep medicine, endocrinology, integrative medicine, or neurology, often pursuing additional training. Some FNPs work in emergency rooms, frequently after obtaining additional Emergency Nurse Practitioner (ENP) certification. There are many different things FNPs can do, but those are some of the most common settings. 

Compensation Considerations
While nurse practitioners generally earn competitive salaries, the exact amount varies depending on location and demand. To date (2024), PMHNPs typically command slightly higher salaries than FNPs, but salary shouldn't be the sole deciding factor.  Additionally, I am hearing from our PMHNP colleagues that salaries are starting to flatten as the field becomes more saturated. Research potential job markets to avoid entering oversaturated areas. Additionally, a review of the many NP Facebook pages will reveal that some NPs have returned to working as RNs again. Whether the reason is a lack of job opportunities, burnout as a provider, a preference for bedside nursing, or something else, it’s a disturbing trend. 

Making an Informed Decision
Ultimately, the choice between PMHNP and FNP hinges on many factors, including your passion, preferred patient population, and desired work environment. I wish you the very best in your decision to become a nurse practitioner. Keep on learning! 

By Lynn McComas, DNP, ANP-C
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