Integrating Psychiatric Nurse Practitioners Into Psychiatric Practice Settings

Introduction by the column editors: This column is based on the use of an electronic mailing list (e-list) to generate a collaborative problem-solving process. For this column, Dr. Theccanat put together responses from himself and other e-list alumni of the Columbia University Public Psychiatry Fellowship to questions posed by Vanessa Bobb, M.D., who works at a free-standing licensed mental health clinic and for the first time wanted to hire a part-time psychiatric nurse practitioner to see adult clients. Dr. Bobb wanted to know what the typical salaries are for psychiatric nurse practitioners and the typical number of medication visits that they schedule per day. She also sought advice on places to advertise and to post announcements. Readers are invited to submit suggestions for e-list discussions of management problems to column editor Jules Ranz, M.D. (e-mail: [email protected]).

Advanced practice nurses (APNs), also known as psychiatric nurse practitioners, contribute significantly to contemporary mental health care in partnership with psychiatrists. Many psychiatric hospitals, agencies, and programs are integrating APNs into their psychiatric practice, and some people might be concerned about how to ensure the continuation of high-quality care to mental health consumers. A report by the Substance Abuse and Mental Health Services Administration described the severity of the shortage of mental health professionals, both prescribers and nonprescribers, and its effect on millions of people (1). A shortage of psychiatrists and an increasing need for mental health care have both been noted, and APNs have the potential to bridge this widening gap (2).

The American Psychiatric Nurses Association recognizes and promotes the integration of APNs with advanced skills in psychiatry into a variety of psychiatric practice settings. After an individual receives a graduate degree, the curriculum of the average APN program lasts approximately 16 to 24 months and includes 500 supervised clinical hours. By comparison, psychiatrists who provide services to adults require 48 to 60 months of supervised clinical hours and child psychiatrists require 60 to 72 months (2,3). A 2010 Carnegie Foundation report called for decreasing the time spent in medical education by standardizing learning outcomes and general competencies to provide greater options for individualized learning while maintaining high standards (4). Psychiatric nurse practitioners are prepared to uphold their clinical role in delivering mental health care yet are required to have a collaborative agreement with psychiatrists by most states’ regulatory standards. The newly trained APN also requires a degree of mentoring from either a psychiatrist or a seasoned APN. The responsibilities of the APN are established through review and evaluation with this mentor. In collaboration with the medical practitioner, these responsibilities include assessment and diagnosis of psychiatric disorders in complex psychiatric presentations, prescription of medications appropriate for treatment of mental disorders, and familiarity with all current medical terminology and with reimbursement and coding. The APN must perform these duties while maintaining the unique characteristics of humanism and the broad holistic view of the individual and his or her care needs that define nursing practice (5).