The past few years have been uniquely tumultuous for healthcare and the broader world. While we can’t predict the future, we can look at trends and make projections to gain insights into the upcoming year. As we enter 2024, let’s delve into the key areas shaping the future of psychiatric nurse practitioners and navigate the evolving landscape together.
1. Will job availability remain stable for psychiatric nurse practitioners?
As the landscape of healthcare evolves, accelerated by the COVID-19 pandemic, one common question is whether job availability will remain stable for psychiatric nurse practitioners.
There will always be a need for services in the healthcare industry. In the context of current times, spending on healthcare is increasing, the U.S. population is aging, and the shortage of physicians is growing. These factors magnify the need for healthcare providers, psychiatric nurse practitioners included.
Nurse practitioners, and specifically psychiatric nurse practitioners, can expect job stability in 2024.
Is the psychiatric nurse practitioner job market saturated?
You might be thinking, that’s great that job stability will remain but what about market saturation – is the PMHNP job market saturated?
Data from a 2018 HRSA report suggest “the U.S. will have a sufficient supply of psychiatric NPs to meet projected growth in demand for NP services in 2030”. In fact, the report suggests a possible oversupply (between 2,500 and 5,000) of psych NPs, by 2030.
It should be noted, however, that this data was collected pre-pandemic, which does not factor in the increased demand for mental health services it precipitated. A recent study of insurance claims showed a sustained increase in demand for mental health services that was 39% higher than pre-pandemic levels.
On a positive note, the job market for nurse practitioners is clearly growing – nurse practitioners are the second fastest growing occupation in the entire U.S. economy and the fastest growing healthcare profession, according to the U.S. Bureau of Labor Statistics. This growth is accompanied by a clear demand for services with a reported 26,000 job openings per year for nurse practitioners.
Where is the demand for nurse practitioners greatest in the United States?
While we know the job market for nurse practitioners is rapidly growing, let’s delve into which states will have the highest demand for nurse practitioners.
NP job demand is not the same across the United States. Factors like geography and access to healthcare influence job growth. For example, Arizona’s projected job growth is a staggering 101% from 2020 to 2030.
But regardless of rate of growth variability, all states will see an increasing need for nurse practitioners over the next decade. Alaska, Rhode Island, and Idaho will all see an estimated job growth of 14-20% over the next few years, still far above the 3% national average for all jobs.
The map below shows nurse practitioner occupation growth projections from 2020 to 2030 in each U.S. state.
NP occupation growth projections, 2020-2030
Map by author. Source: Projections Central, 2021
2. Are psychiatric nurse practitioners at risk for automation?
In the current landscape, artificial intelligence (AI) is quickly becoming more commonplace to make our lives and jobs easier. The increased prevalence of AI leads one to wonder which jobs are at risk for automation. Rest assured that psychiatric nurse practitioners are not at high risk for automation.
It’s hard to automate the job of a nurse practitioner where treatment is individualized and patient presentations vary and can be quite complex. Additionally, patients generally prefer to speak with a healthcare professional about their health; according to David Dranove, a professor at Northwestern University’s Kellogg School of Management, there’s “a need for compassion…that AI is unable to contribute”.
This is even more true for patients seeking mental health assistance. Talking to an empathetic professional where rapport, trust, and support is developed cannot be easily replaced.
The role of AI in healthcare
While the psychiatric nurse practitioner role isn’t at risk for automation, AI will play a larger role in assisting providers with providing more streamlined care. AI has already been prevalent in practice with dictation devices to help facilitate more efficient charting for providers.
AI will continue to be used more frequently to support providers in healthcare. One key application where AI will continue to advance is assisting in diagnosis and treatment recommendations. Specifically within precision medicine which involves predicting what treatment protocols are most likely to succeed for a patient based on various patient attributes and the treatment context.
What does this mean for psych NPs?
These advances are unlikely to take a dramatic shift in 2024 but the field is progressing more rapidly than many expected and AI will continue to have a larger role in our jobs as nurse practitioners.
AI will continue to help make healthcare operations more efficient, improve efficiency in healthcare diagnoses, and facilitate better health monitoring and preventative care. It’s safe to say that psychiatric nurse practitioners will not be replaced by AI, at least not anytime soon.
3. Is a DNP going to be more valuable?
Whether the DNP will be a required degree for nurse practitioners or preferred for practice depends on the position – if you’re a nurse practitioner seeking a faculty position in academia, you’ll likely need a doctoral degree.
A study led by the American Association of Colleges of Nursing (AACN) conducted in-depth interviews with employers to gain a better understanding of the perceptions and experiences of DNP graduates. The study found that employers had difficulty identifying differences between NPs holding MSN degrees versus DNP degrees. Granted, the study interviewed only 13 employers but it found that “most [employers] could not readily identify differences in the provision of direct patient care by MSN and DNP-prepared nurses. Furthermore, academic leaders could not identify differences in clinical skills between MSN and DNP-prepared nurses.”
Trend of DNP-prepared nurse practitioners
According to an analysis of the AACN survey data from 2005 to 2020, there was a 442% increase in enrolled DNP students between 2010 and 2020 – this shows an incredible growth in demand from students, either in anticipation of further career growth or required by a specific career track.
The number of enrolled DNP students (both BSN-to-DNP track and MSN-to-DNP track) increased from 6,599 in 2010 to 35,755 in 2020. This rapid increase, particularly BSN-to-DNP programs, suggests that nursing schools recognize this demand, even for brand new nursing students, and are working towards fulfilling the need.
DNP outlook overall
Overall, the number of DNP program and DNP enrollees is increasing over time. However, if we define value as the ability to get a lucrative job providing direct patient care as an NP, obtaining a DNP is not necessarily the way to be the most competitive candidate.
You might be wondering, what about two candidates who look the same on paper with the exception of one being a DNP and the other MSN, is that a reason to pursue the DNP?
Not necessarily. While a doctoral degree is one measure of competence, there are so many others – your past clinical experiences, your job interview, as well as recommendations from other providers. Your future employer’s role in interviewing you is assessing your competence and your ability to be productive to the company. If you can demonstrate those things (and show personability as well), you will be a competitive candidate.
Now, if your goal is to work in academia as a faculty member, having a DNP is likely required; if your goal is the pursuit of knowledge, research, and obtaining the terminal degree of a nurse – it could be a good option for you.
4. Will the higher-ed faculty shortage and difficulty finding preceptors remain?
An ongoing trend that is likely to continue is the shortage of nursing and nurse practitioner faculty in higher education. Budget constraints, an aging faculty, and higher salaries in direct clinical care are all factors contributing to this shortage.
The faculty shortage is a significant problem. According to an AACN report, U.S. nursing schools turned away nearly 92,000 “qualified applications from baccalaureate and graduate nursing programs in 2021 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.”
This lack of faculty limits the number of students entering programs and it limits the availability for clinical preceptors as well. There aren’t enough clinical preceptors willing or able to train nurse practitioner students. This gap widens as the number of students seeking training increases.
5. What’s the current trend in U.S. states attaining full scope of practice for nurse practitioners?
Each year, more states are granting full scope of practice to nurse practitioners. The implications of this are huge, as more patients can receive access to care and more nurse practitioners will have fewer barriers to providing care.
In states that reduce or restrict full practice authority, NPs are required to have career-long collaborative agreements with physicians in order to provide patient care.
As of November 2023, 29 states in the U.S. have granted full scope of practice. Utah was the most recent state to obtain full practice status in March 2023. Five states have granted full practice authority since 2020 and California and Missouri both eased restrictions in 2023. Continuing this growing trend, at least nine states are currently, or have considered expanded or full practice authority since 2021. Wisconsin’s senate just passed a bill granting full practice authority this past October.
NP scope of practice, November 2023
Source: Author, various sources, including AANP, Nurse Journal, and Campaign for Action
*In 2020, Florida granted full scope of practice for family medicine, general pediatrics, and general internal medicine
Also, of note is that no states have ever rescinded their increased level of practice authority to NPs. This suggests that increasing NP scope of practice is resulting in positive patient outcomes and improved access to quality care.
Benefits of increasing NP scope of practice
Increasing scope of practice to nurse practitioners has many benefits – patients not only have greater access to care but a reduction of healthcare costs occurs.
One study aimed to estimate the impact of expanded NP scope of practice regulations on the costs of total outpatient visits and prescription drugs. Findings were positive all around: compared to states with reduced scope of practice, states with full practice authority had 17% lower outpatient costs and 11% lower prescription drug costs.
6. Will telehealth providers still be permitted to practice as they have been through the pandemic?
The Consolidated Appropriations Act was first implemented in response to the COVID-19 public health emergency. This act has been extended several times, expanding telehealth flexibility waivers, most recently the act was extended through December 31, 2024.
Important changes to Medicare telehealth coverage and reimbursement include removing geographic restrictions for patients or providers and allowing all health care providers who are eligible to bill Medicare to bill for telehealth services, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). The flexibility of Medicare reimbursement for telehealth visits has allowed for more patients to be seen. (It should be noted that Medicare policies for telehealth continue to evolve so be sure to check for most recent telehealth policy changes.)
As of August 2022, mental health utilization was up 39% versus pre-pandemic levels which is a sizable increase. This suggests that the need and demand for telehealth services will remain.
7. Will the prescription of controlled substances via telehealth change in 2024?
The global pandemic shifted how controlled substances are prescribed. Providers have been able to prescribe controlled substances to patients virtually without having in person visits. Prior to this, providers were required to see patients in person one time before prescribing a controlled substance such as a stimulant, buprenorphine, or a benzodiazepine.
In 2024, authorized providers will continue to be able to prescribe controlled substances via telehealth through December 31, 2024 to avoid lapses in care for patients.
Summary
In 2024, psychiatric nurse practitioners can expect
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- Job stability and a low risk for job replacement, even as artificial intelligence continues to quickly develop
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- For direct patient care, the DNP will not improve in necessity, as it does not appear to add value that NPs must have to continue to practice
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- Finding clinical preceptors will continue to be a struggle, as will entry into quality NP programs, as the number of nurse educators remains low in proportion to the number of students enrolling
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- Scope of practice will continue to expand in more states
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- Telehealth flexibility will remain in place (through at least December 31,2024) so that patients can continue to receive accessible, convenient care
Overall the future looks pretty bright for psychiatric nurse practitioners, and nurse practitioners in general!
