Vol 5. Crossing Borders: Pathways to Becoming a Consultation-Liaison Psychiatry Nurse Practitioner.

By Dr. Starr Montalvo, DNP, PMHNP-BC

Introduction: Bridging Two Worlds

Consultation-Liaison Psychiatry (CL-Psychiatry)—previously known as psychosomatic medicine—is where psychiatry meets the medical floor. It’s a specialty built for those who thrive in fast-paced hospital settings, enjoy complex diagnostic puzzles, and are passionate about whole-person care.

For Psychiatric-Mental Health Nurse Practitioners (PMHNPs), CL-Psychiatry offers an offbeat and intellectually rich career path—but one that doesn’t always have a clearly marked trail. Unlike more traditional psychiatric roles, CL-Psychiatry requires both psychiatric expertise and medical literacy, as well as the ability to consult across disciplines in high-acuity settings.

So, how do you become a CL-Psychiatry nurse practitioner? Let’s break it down.

My Path

I took a circuitous path to my second career in nursing. During my early career I crafted my skills by obtaining both, a bachelor’s and master’s degree in psychology and worked as a mental health and addiction counselor and an auricular acupuncturist in NYC hospitals and clinical settings. After many years of counseling experience, I later returned to complete my undergraduate studies in nursing.  As a registered nurse with an interest in both general medicine and psychiatry, I spent many years between working in the organized chaos of the emergency medicine department and a multitude of psychiatry settings; CPEP (psychiatric emergency), Outpatient psychiatry, inpatient psychiatry, inpatient detoxification, outpatient chemical dependency and ECT.

As a nurse practitioner, I was academically trained in psychiatry from Stony Brook University with a second master’s degree. It was at my extensive psychiatric nurse practitioner CL-Psychiatry training at NYU-Winthrop Hospital where I developed my interest and compassion to sub-specialize in Consultation-Liaison Psychiatry. I soon gained employment at a renowned NYC cancer hospital in the C-L Psychiatry/ Psycho-Oncology department, where I continue to learn and have honed my skills. C-L Psycho-oncology is a unique branch of medicine which focuses on the interface of oncology, general medicine and psychiatry and treats mental health symptoms in medically ill patients. I have since returned back to school to complete my Doctorate of Nursing Practice (DNP).

Step 1: Become a Registered Nurse (RN) (4-6 years)

The journey begins with becoming a licensed RN. Whether you take the ADN or BSN route, bedside nursing experience in medical-surgical, ICU, ED, or oncology settings will later serve you well in the world of CL-Psychiatry.

Pro Tip: Work in a hospital where psychiatric consults are common. Observe how mental health integrates into medical care. This early exposure is gold.

Step 2: Obtain gainful employment as a registered in nurse for years, preferably in medical and psychiatric settings

Step 3: Earn Your Psychiatric-Mental Health Nurse Practitioner (PMHNP) Degree (3-4 years)

To practice independently in psychiatric settings, you must become a board-certified PMHNP. This means earning a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) (3-5 years) with a specialization in psychiatric-mental health.

During your program, aim to:

• Choose diverse clinical rotations, including inpatient psychiatry, emergency psychiatry, and if possible, a consultation-liaison setting.

• Seek out mentors who practice in hospital-based psychiatric roles.

• Do a DNP project related to integrated care, delirium management, or psycho-oncology if you’re on a doctoral track.

  
  

Step 4: Gain Clinical Experience in Medically Complex Settings

Once board-certified, not all PMHNPs jump straight into CL-Psychiatry. Many start in inpatient psychiatry, behavioral emergency response teams, or ED psych consults. These settings build the critical skills needed for CL-Psychiatry work:

• Rapid risk assessment

• Medical-psychiatric knowledge

• Interdisciplinary communication

• Crisis de-escalation

  
  

Alternatively, some PMHNPs work on med-surg or oncology floors in hybrid roles, slowly building their CL-Psychiatry niche.

Optional Step: Pursue Additional Training or Fellowships (1-2 years)

CL-Psychiatry remains an emerging area for NPs, so there are limited fellowship programs. However, you can carve your own learning path:

• Seek mentorship from CL psychiatrists or advanced practice nurses already working in CL-Psychiatry.

• Join professional organizations, like the Academy of Consultation-Liaison Psychiatry (ACLP) or the American Psychiatric Nurses Association (APNA).

• Attend CL-Psychiatry and psycho-oncology conferences to network and learn best practices.

• Consider post-grad certificates in integrated care, palliative care, or oncology nursing, depending on your area of interest.

  
  

Subspecialize Within CL-Psychiatry: Psycho-Oncology, Palliative Psych, and More

Once in CL-Psychiatry, you may find yourself naturally gravitating toward specific patient populations:

• Psycho-oncology (mental health care for cancer patients)

• Delirium management in ICU

• Neuropsychiatry (e.g., post-stroke depression, seizures)

• Ethics and capacity evaluations

• Behavioral rapid response teams

  
  

Some nurse practitioners develop hybrid roles where they round with oncology, surgical, or critical care teams as embedded psychiatric providers.

What Makes a Great CL-Psychiatry Nurse Practitioner?

• Medical curiosity: You’re not afraid of labs, scans, or SOAP notes with 10 comorbidities.

• Calm under pressure: You thrive in crisis and bring calm to chaos.

• Teaching mindset: You educate teams about mental health and reduce stigma.

• System savvy: You know how hospitals work—and how to work within them.

• Heart-forward approach: You see the suffering behind the symptoms.

  
  

Closing Thoughts: Trailblazing with Purpose

There’s no one-size-fits-all path into Consultation-Liaison Psychiatry for PMHNPs—but that’s what makes it exciting. Whether you’re a new grad or a seasoned nurse looking for a pivot, this specialty invites creativity, collaboration, and a commitment to treating the whole person.

In CL-Psychiatry, every day is different. Every consult is a new puzzle. And every patient is a reminder that mental health doesn’t stop at the unit door—it travels with the body wherever it goes.

If you’re looking for a specialty that sits at the intersection of heart, science, and systems—this might just be your path.