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According to the American Psychiatric Nurses Association, psychiatric nursing occurs at two levels—psychiatric registered nurses and advanced practice psychiatric nurses. Psychiatric registered nurses work primarily with patients needing mental health or psychiatric care. Advanced practice psychiatric nurses are also registered nurses but they have earned certification as certified nurse specialists or have taken graduate courses to become clinical nurse specialists or nurse practitioners, or psychiatric nurse practitioners (PNPs). Some of these specialists may work in supervisory or administrative positions and may, depending on their state's laws, be able to provide psychotherapy services and prescribe medications. Psychiatric nurses in this second, more advanced group may sub-specialize in areas such as child-adolescent mental health nursing, geropsychiatric nursing, forensic nursing, or substance abuse nursing.