During her sophomore year in college, Namieka Salabie nursed her grandmother through pneumonia. Although her college major at the time was biological sciences, she didn’t find that as fulfilling as the time she spent caring for her grandmother.

After this experience, Salabie, a veteran of the U.S. Navy, did a veteran work-study where she shadowed a nurse. That experience convinced her that helping veterans with mental health issues was what she wanted to do.

Upon completion of a Master’s of Science in Nursing at Fairfield University in Connecticut, she interviewed for several jobs. She indicated her willingness to work in underserved areas and, found her skills were in such high demand, that she was offered a job at each place she interviewed for.

Outlook for psychiatric-mental health nurse practitioners

The need for nurses specializing in psychiatric-mental health and substance abuse care is great, says Jeffery Ramirez, Ph.D., a psychiatric nurse practitioner and an associate professor of nursing in the School of Nursing and Human Physiology at Gonzaga University in Spokane, Washington.

“Of all nurse practitioners, psychiatric-mental health nurse practitioners (PMHNPs) are the No. 1 in demand,” Ramirez says.

A recent report prepared by the University of Washington Center for Workforce Studies and the Washington Center for Nursing (WCN) found a total of 8,650 Advanced Registered Nurse Practitioners (ARNPs) in this state. However, far too few of those specialize in working with mental health or substance use disorder patients.

There has always been a need for these types of nurse practitioners and that need continues to grow today. Events such as the coronavirus pandemic only shine a light on critical gaps in access to mental health care for Washingtonians. According to a Washington Department of Health Briefing published in August 2020, in response to COVID-19, over three million individuals in Washington State are predicted to develop either depression (1.9 million) or anxiety (1.4 million) over the next three months. Considering the total population of Washington is about 7.6 million, those numbers represent a substantial percentage of the state’s residents.

Basics taught in nursing schools

In Washington State, ARNPs have full practice authority, which means ARNPs can practice without physician oversight and prescribe medication and treatment. ARNPs can serve as primary care providers and hold private practices. ARNPs can create care plans, order and interpret diagnostic tests, write referrals, diagnose patients, and prescribe therapies, the use of medical equipment, and medicines.

Working as a PMHNP requires at minimum a master’s degree in psychiatric mental health nursing from an accredited university. In Washington State those schools include the University of Washington, Washington State University, Seattle University, Pacific Lutheran University and Gonzaga University. Students can also obtain a Doctor of Nursing Practice, or for ARNPs who want a research degree, a Ph.D. in nursing science.

Ramirez says education requirements for PMHNPs include advanced pathophysiology, advanced health assessment and advanced pharmacology courses. Then they move their studies into their specialty areas.

“We teach all of the ways mental health disorders are treated like medication management and psychotherapy, treatment of substance abuse, crisis management, intervention, grief counseling and individual family therapy modalities,” says Ramirez. “To cover all the courses, a master’s degree takes 3-5 years while a doctorate requires 5-7 years and we are moving toward the doctorate level for every practitioner.”

Ramirez, who was recently honored as a Fellow in the American Association of Nurse Practitioners, also notes that instructors do struggle with balancing all the nurse practitioner content with psychotherapy into their programs where they want it.


“The profession has a very strong position about therapy and believes it’s one of the most valuable skills a graduate should have,” says Ramirez. “Even with this small gap, the program is very comprehensive and meets the needs of our health care system now.”

Another gap currently being addressed is the lack of diversity in the nursing workforce. Nurses from different cultural backgrounds, who themselves are LGBTQ, who identify as male, or who have served in the military are in demand. This diverse representation in nursing is a critical aspect of providing optimal care for a diverse population.

Salabie, for example, is putting her experience in the Navy to work. She currently works for the Veterans Administration in Primary Care Mental Health Integration at a community-based health clinic in Federal Way. She treats veterans with PTSD, depression, anxiety and insomnia, with some mild alcohol abuse disorders. She manages medications and offers supportive psychotherapy.

“Being a nurse practitioner in mental health offers so many options in practice settings,” says Salabie. Those options are widening, as the need for nurses with diverse backgrounds and experiences and the specialized skills needed for psychiatric and substance abuse care continues to grow.

To learn more about starting a career in nursing, advanced registered nurse practitioners, or Washington’s nursing workforce, visit www.wcnursing.org