There are two professionals in the mental health world who can prescribe medication—the psychiatrist and the psychiatric nurse practitioner. That is not the only thing they have in common, but there are differences as well. Many people do not really understand the two professions, what people with these two different degrees can do, and how they are alike or different.  

Since Fairwinds—Nantucket’s Counseling Center has recently hired a psychiatric nurse practitioner, often abbreviated to “psych NP,” essentially doubling the number of our staff who can both diagnose and prescribe medication, this seemed like a good time to clarify what these two professionals do, how they are similar, and what the differences are.

What Psych NPs and Psychiatrists Have in Common

A psychiatric nurse practitioner is a certified advanced practice nurse. A psychiatrist is an MD who specializes in psychiatry. They both are trained (though on different paths) and licensed (also differently) to provide medical and mental health services, diagnose mental health disorders, and prescribe medication.

What else?
Both of these specialists:
·       Can work in hospitals, substance use treatment programs, group or private practices, schools, prisons, and mental health clinics.
·        Have in-depth knowledge of human behavior and mental health conditions that they call upon to help patients manage symptoms associated with mental health and substance use disorders
·        Use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose their clients
·        Follow evidence-based treatment protocols and develop treatment plans that may include therapy, medication, or sometimes hospitalization
·        Order diagnostic testing as needed to help with challenging diagnoses or monitor treatment

How Are They Different?

The main differences have to do with the educational path each professional takes and the licenses they are required to have. Some of the licensing differs state to state.

Education and training:

·        A psych NP first earns a nursing degree and becomes an RN after passing the National Council Licensure Examination for Registered Nurses. They can pursue a program to become an advanced practice nurse after two years working as an RN. They can receive masters or doctorate level degrees.
·        A psychiatrist attends medical school after college, then pursues a medical residency where they specialize in psychiatry.
·        It takes a bit longer to become a psychiatrist than a psych NP.

Certification and licensure:

·        A psychiatric nurse practitioner must be licensed as both APRN (advanced practice RN) and have a master’s in nursing(MSN) or higher through an accredited nurse practitioner graduate program. Finally, national accreditation as a nurse practitioner is required, for example through the American Nurses Credentialing Center (ANCC).  
·        Psychiatrists receive certification through the American Board of Psychiatry and Neurology once they have all the necessary education, training, and experience.

Despite any differences in training and certification, many states are giving nurse practitioners full practice authority which includes the ability to prescribe autonomously. Massachusetts was the 23rdstate to move in this direction, which happened in January of 2021.  

Two Psychiatric Professionals under One Roof

Fairwinds is thrilled that funding from the Community Foundation for Nantucket’s Nantucket Fund has enabled us to add Joy Brown, psychiatric NP, to our staff. Working alongside our double-board certified psychiatrist and medical director Dominic Maxwell, MD, Joy, currently part-time, is adding substantial value to our clinical offerings. In addition to psychiatry, she is also a certified family practice NP, bringing her understanding of medicine and people of all ages to her work at Fairwinds. Dominic Maxwell, MD, our psychiatrist and medical director says, “The decision to bring Joy Brown on board has probably been the best and single most consequential decision I have been a part of since joining Fairwinds in 2014.”

Joy says, “I look at the whole person, not just the psychiatric symptoms. If you don’t rule out organic causes, you can easily misdiagnose.” She tells a story of a past client (not from Fairwinds) who presented with anxiety, inability to focus, and severe insomnia. A few red flags in the client’s demeanor and other details led Joy to ask more questions and finally get the young woman testing specifically for diabetes. Her suspicions were correct. Once the client was treated for her type I diabetes her mental health symptoms abated. Just as physical ailments can lead to mental health symptoms, mental health disorders affect physical health. Looking holistically at a person rather than at their symptoms is something those with both medical expertise and psychiatric training, our psychiatric NP and our psychiatrist, can do for our clients.

We all agree with Dr. Maxwell who said, “Joy Brown brings a breadth of clinical expertise, compassion, and a can-do attitude to Nantucket. We are excited to expand our delivery of high-quality care and reduce waiting lists for medication management.”