Nurse practitioner smiling with patients in a medical office.

FNP vs. PMHNP: Comparing Nursing Specializations

Nursing: Nurse Practitioner

As the U.S. population agesand more physicians retire, the demand for advanced degree nurse practitioners increases. Nurses who specialize in specific aspects of care can provide more robust, comprehensive services to patients. In addition, they can bridge the gap between traditional nursing responsibilities and those of physicians. Nurses who transition into a specialized role also can gain independence,  professional confidence and professional advancement.

Both family nurse practitioners (FNPs) and psychiatric mental health nurse practitioners (PMHNPs) are highly skilled medical professionals. As leaders in their field, FNPs and PMHNPs can take on more responsibility and leadership roles, often earning an increased salary and valuable job autonomy. Nurses looking to pursue an advanced degree, such as a Master of Science in Nursing, need to understand the differences between an FNP vs. a PMHNP to determine which is better suited to their skills and professional goals..

What Is a Family Nurse Practitioner?

FNPs are advanced practice registered nurses (APRNs) qualified for a broad range of family-focused health care services. As primary care practitioners, FNPs specialize in delivering care across their patients’ lifetimes and can build relationships with the individuals for whom they care. FNPs work with a wide patient demographic and can implement various routine care strategies, including the treatment of acute and chronic illnesses. Their responsibilities often include maintaining patient records; performing examinations; providing diagnoses; and, in states granting full authority, prescribing medication.

What Is a Psychiatric Mental Health Nurse Practitioner

PMHNPs assess, diagnose, and treat patients’ mental health. Services can include advanced care to patients with diverse mental health concerns, including substance abuse problems and psychiatric disorders. Using a patient-centered and therapeutic approach to care, PMHNPs often work alongside specialty and primary care providers to create individualized and comprehensive wellness plans for their patients.

PMHNPs use advanced knowledge and strong communication skills to deliver comprehensive care in difficult and sensitive cases. Care encompasses physical and psychosocial assessments, treatment evaluations, and emergency psychiatric care. In states that grant full practicing authority, PMHNPs also may prescribe medication for their patients.

Differences Between an FNP and a PMHNP

Challenges and responsibilities of an FNP and a PMHNP vary greatly. By understanding the work involved in each specialization as well as the steps required to earn the qualifications for them, future nurse leaders can decide which direction is best suited to their needs, skills, and professional goals.


Both FNPs and PMHNPs should complete a Bachelor of Science in Nursing (BSN) program as well as either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP) program—BSN to MSN or BSN to DNP programs. To qualify as an FNP and a PMHNP, students must complete their programs, a minimum of 500 faculty-supervised clinical hours, and pass the certification tests for their specializations.

The MSN curriculum varies between institutions; however, it is not uncommon for students to complete a series of foundational courses before proceeding to their specializations. Students pursuing an FNP specialization take courses focused on family practice and provide primary care to patients of all ages. In contrast, PMHNP students take specialty courses on the signs and symptoms for mental health diagnosis of patients and the effective delivery of psychiatric care.


While many of the steps to licensing and certification are the same for an FNP vs. a PMHNP, the  the processes vary. After graduating with an MSN, practitioners must complete board certification exams administered by organizations such as the American Nurses Credentialing Center (ANCC) for their specialty. For both FNPs and PMHNPs, these post-graduate certifications are valid for five years, after which time practitioners must successfully renew their credentials to continue practicing legally. 

FNPs have the option to take their board certification exam through two organizations, the ANCC to gain their Family Nurse Practitioner-Board Certified (FNP-BC) credential, or the FNP credential from the American Association of Nurse Practitioners (AANP). Examinations from both organizations are competency-based and require candidates to show clinical-knowledge to effectively care for patients throughout their lifetime by testing their ability to assess, diagnose, evaluate, and treat patients.

PMHNPsalso must complete a competency-based PMHNP board certification examination from the ANCC that tests practical abilities as well as theoretical understanding.  Candidates that prove they have the foundational skills and clinical knowledge required to examine, diagnose, and assist patients with psychiatric care earn the credential of Psychiatric-Mental Health Nurse Practitioner-Board Certified (PMHNP-BC).

Work Environments

While FNPs vs. PMHNPs work environments differ, both specializations can work in settings with traditional work hours, aside from potential on-call duties. For most FNPs, the nature of their specialization means a high likelihood of finding themselves in community health centers, private practices, public health care facilities, or universities.

PMHNPs often deal with emergent or traumatic cases, making their top practice settings health or addiction clinics, psychiatric mental health facilities, and private practices. However, with the knowledge and skills to address critical, chronic, and long-term cases, PMHNPs may find themselves in a wider variety of practices or medical institutions than FNPs.


Between an FNP and a PMHNP, the average level of experience required to practice full time varies and is reflected in the expected salary for each specialization. FNPs earn a median annual salary of around $97,000 as of August 2021, according to the compensation website PayScale. After an average of 9.8 years of experience and including bonuses and incentives, they can earn a median annual salary of around $115,000, based on a 2020 survey by the AANP.

By contrast, PMHNPs have a median annual salary of about $99,200 as of August 2021, according to PayScale. With an average of 12.8 years of experience and accounting for the additional certifications required for psychiatric nurses, PMHNPs can earn a median annual salary of $137,000 as of 2020, according to the AANP.

Making a Difference as a Nurse Practitioner

NPs play an essential role in our health care system. With advanced knowledge and skills, nurse leaders make life-changing decisions every day. For those looking to advance their careers, nursing specializations could provide opportunities for more responsibility and leadership roles. To take their nursing careers to the next level, nurses should understand the differences between an FNP vs. a PMHNP and which specialization is  right for them.

The right advanced education can help future nurse leaders open various exciting doors and excel in their careers. With its small class sizes, streamlined residencies, and four start times per year, Norwich University’s online Master of Science in Nursing: Nurse Practitioner program could be a good steppingstone to help you succeed. The program offers Family Nurse Practitioner and Psychiatric Mental Health Nurse Practitioner tracks that allow you to gain expertise in a specific focus area.

Discover what you can do with an advanced nursing specialty.  



Recommended Readings

Student’s Guide to 7 Nurse Practitioner Specialties
The Role of the Family Nurse Practitioner in Primary Care
What Is a Psychiatric Mental Health Nurse Practitioner? A Look at the Key Care Specialty


Nursing Shortage, National Center for Biotechnology Information
Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners, U.S. Bureau of Labor Statistics
Are You Considering a Career as a Family Nurse Practitioner?, American Association of Nurse Practitioners
Are You Considering a Career as a Psychiatric Mental Health Nurse Practitioner?, American Association of Nurse Practitioners
Issues at a Glance: Full Practice Authority, American Association of Nurse Practitioners

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