How Psychiatric NPs Can Broaden Their Career Horizons

“Since we are now the predominant workforce in the United States, I urge all of our fellow [psychiatric] PMHNPs to consider what it would be like to level up and begin contributing to the field within leadership, academia, and research,” said Chelsie Monroe, PMHNP-BC, APN, ahead of her preconference session, “Navigating NP Career Pathways: Employment, Private Practice, and Leadership,” presented alongside Desiree Matthews, PMHNP-BC, Psych Congress NP Institute Steering Committee Member, at the 2025 Psych Congress NP Institute in Orlando, Florida.

In this insightful interview, both Monroe and Matthews, reflect on the lessons they wish they had learned earlier in their NP careers and offer practical advice for those whose interests lie beyond traditional clinical settings.

Whether you’re a new graduate interested in additional education, veteran in the field looking to shake things up, or an NP simply seeking a path that aligns with your values, this conversation provides grounded guidance for building a fulfilling and flexible future in psychiatry.

For more conference insights, visit the NP Institute Annual Meeting newsroom. 

Editors' note: This interview has been lightly edited for clarity.

Psych Congress Network: What are some pieces of career advice you wish you had received while still in school and/or early in your career? 

Desiree Matthews, PMHNP-BC: I wish there were more discussions on how to prepare for practice and how to negotiate onboarding as a new PMHNP graduate, such as knowing which questions to ask during an interview process. It is really easy to feel so grateful to be given a 'chance' that you may not also keep in mind what you need to thrive and be successful. Asking about graduated caseloads, more time for office visits, and discussion about what supervision and/or available mentorship are all key topics I wished I had asked about!

Chelsie Monroe, PMHNP-BC, APN: I wish someone would have told me all the various career aspects of a PMHNP there were out there beyond patient care that also make a significant difference in the field. I also wish I would have had a mentor give me reassurance and remind me that it would take years before I felt competent enough to see complex patients, and not feel nervous about what I was doing. 

PCN: Which considerations would you recommend that fellow NPs keep in mind when weighing their potential career pathways? 

Matthews: One of the great things about nursing is the myriad of opportunities and flexibility that you have. In nursing, your career can evolve with you as you grow and change as a person. As a new graduate, what I wanted was consistency and direction. Now, I crave flexibility and the opportunity to wear multiple hats, such as being involved with the Psych Congress NP Institute as an educator. 

Monroe: You can have it all if you choose. First, identify your values and what matters to you. Is it freedom? Variety? Passions with a particular patient population? Career growth? Money? There are a variety of career aspirations out there that can fit your needs; you need to first identify your values and then seek out opportunities that align with your values.

There are also numerous ways to get involved in psychiatry beyond the nursing field. These include clinical leadership pathways, education in and out of university settings, and entrepreneurial, research, and leadership opportunities. PMHNPs are now the predominant workforce in psychiatry, and all of these pathways will continue to help us step up and shape the future of mental health care. 

PCN: What kind of unique challenges do psychiatric NPs face, and how might clinicians early in their careers counteract some of these? 

Matthews: One challenge I still see semester after semester is the difficulty APRN students have securing clinical rotation sites. We may not always get all the exposure we want or still feel like we need experience with a variety of patient populations, such as geriatrics, pediatrics, or even various care settings (e.g., ACTT, psychiatric ER, long-term or residential treatment facilities). It's hard to cover all of that.

I know that I personally had to really work hard to get comfortable with seeing patients under the age of 18. It took me several years into clinical practice before I felt comfortable enough to start a mentorship program to tackle that. Mentorship alongside attending conferences and engaging with continuing education helped me overcome some of these learning gaps. 

Monroe: Our empathy plays a big role in what we do as nurse practitioners. Patients love our style as a result. But this can have devastating consequences if we can't balance care for ourselves and others. Being early in your career also comes with a lot of personal pressure to learn as much as you can so that you feel competent in your practice. This requires long hours to study and stay committed outside of patient-facing time.

Find ways to ease into that process while not sacrificing the learning experience. Balance will leave us with a long career in this, rather than burning out quickly. 

PCN: There is increasing discussion about the doctor shortage in the United States. How do you anticipate this might shape NP careers over the next couple of decades?  

Matthews: States are expanding full practice, and as our healthcare needs as a country change, it's important that nursing professionals respond to this with a solid foundation in education, leadership development, and providing mentorship to our colleagues. I would love to see more consistency when it comes to licensing per state because that can be a big challenge, and, as I found out personally, the process varies from state to state. I think that's a real challenge when it comes to APRN licensing and being available more broadly via telehealth to areas that need us the most!

Monroe: I think this moment is really a call to action for us. We can and do see patients just as competently as our colleagues, especially if we continue to learn and stay on top of evidence-based practice. However, many of our leaders in the psychiatric field will soon begin retiring, thus not contributing to the scientific advancements in the field. We're seeing this clinically, but what will this do for our field if we don't have as many researchers? Consultants? Academicians?

Since we are now the predominant workforce in the United States, I urge all of our fellow PMHNPs to consider what it would be like to level up and begin contributing in the field within leadership, academia, and research. The doors are open, and I've had a welcoming experience from my psychiatry colleagues. Opportunities are available for these, we just need to embrace them!

Desiree Matthews, PMHNP-BC, is a board certified psychiatric nurse practitioner with expertise in treating patients living with severe mental illness. Beyond clinical practice, Desiree has provided leadership in advocating for optimal outcomes of patients and elevating healthcare provider education. Desiree is the founder and owner of Different MHP, a telepsychiatry practice founded with the mission of providing affordable, accessible precision focused, integrative psychiatry to patients through a rich and comprehensive mentorship of the health care providers within the company.

Chelsie Monroe, PMHNP-BC, APN, is a board-certified psychiatric mental health nurse practitioner and founder of a group private practice, Balanced Mental Wellness in Englewood, Colorado. She has over 15 years of experience working in a variety of settings including inpatient, outpatient, psychiatric emergency services, forensics, community mental health, and private practice settings. She specializes in complex trauma, addiction, and severe mental illnesses. Chelsie is board certified in Integrative Psychiatry, and is an expert in ketamine-assisted psychotherapy (KAP) and psychedelic therapies.