Psychiatric Nurses Concentrated in Northeast, Leaving Shortages Elsewhere

All of these exam names will come in use, some day
All of these exam names will come in use, some day
Strategies to encourage better distribution of advanced practice psychiatric nurses to lower-resourced areas must be developed to address the workforce shortages.

Although advanced practice psychiatric nurses are essential in addressing a workforce shortage in areas where psychiatric specialists are few, they are currently unevenly distributed, with most concentrated in the northeastern states, according to a study published the Journal of the American Psychiatric Nurses Association.

The authors of the study used data from the American Nurses Credentialing Center to determine the volume and distribution of the advanced practice psychiatric nurse workforce compared with the total psychiatry workforce and to understand whether the majority of nurses are working in areas with higher or lower behavioral health specialists.

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Approximately 66,740 providers comprised the entire psychiatric workforce: 71% were psychiatrists, 26% were psychiatric nurses, 2% were physician assistants, and 1% were psychiatric pharmacists. Data suggested that the majority of providers were concentrated in the northeastern United States. The states with the highest concentration of all providers per 100,000 residents included the District of Columbia (63.84), Massachusetts (54.14), Connecticut (48.91), Rhode Island (47.66), and Vermont (46.66), whereas the states with the lowest concentration were Nevada (9.67), Oklahoma (9.77), Idaho (12.17), Indiana (12.61), and Alabama (12.64).

Of the 17,534 certified psychiatric nurses, 46% were mental health psychiatric nurse practitioners (NPs), 27% were adult psychiatric clinical nurse specialists, 22% were adult psychiatric NPs, and 5% were child psychiatric clinical nurse specialists. Similar to the distribution of all practitioners, the highest ratio of psychiatric nurses per 100,000 population were concentrated in the Northeast: Maine (22.01), Massachusetts (17.61), Rhode Island (16.61), Connecticut (16.22), and Vermont (14.91). States with the lowest ratio per 100,000 population included Oklahoma (1.53), California (2.15), West Virginia (2.48), Nevada (2.77), and Illinois (2.79).

Nearly 31% of the total psychiatric provider-to-population ratio was made up of psychiatric nurses, although 15 states had a greater concentration, and therefore made up more than 31% of the population in these areas.

“The findings of this study show no consistent pattern of how psychiatric nurses are distributed relative to the rest of the workforce, but reinforce the idea that they are essential in addressing care needs in areas with low concentrations of psychiatry specialists,” the authors wrote.

The investigators added that the distribution of advanced practice psychiatric nurses was unrelated to graduate programs, as the top 10 psychiatric nursing programs were spaced across 9 states. Although more research is needed to understand these distribution patterns, some potential contributing factors may be the number of restrictions on a state’s scope of practice and the number of other behavioral health specialists in the region.

“Psychiatric advanced practice nurses are essential in addressing care needs in areas with low concentrations of psychiatry specialists—especially if they have full practice authority,” the authors said. “Strategies to encourage better distribution to lower-resourced areas must be developed to address the aforementioned workforce shortages.”


Beck AJ, Page C, Buche J, Gaiser M. The distribution of advanced practice nurses within the psychiatric workforce [published November 21, 2019]. J Am Psychiatr Nurses Assoc. doi:10.1177/1078390319886366

This article originally appeared on Clinical Advisor