The certified psychiatric nurse practitioner: advanced practice psychiatric nursing reclaimed

During the decade of the 1990s, health care reform, market forces, population needs, new knowledge in neuroscience and changes in advanced practice regulation provided the impetus for the development of the role of the psychiatric nurse practitioner. Debate about issues of role, scope of practice, educational preparation, titling, and credentialing for the advanced practice psychiatric nurse (APPN) of the future intensified as the American Nurses Credentialing Center (ANCC) proceeded with its controversial decision to develop a certification examination for the psychiatric nurse practitioner-in advance of consensus among advanced practice psychiatric nurses about those widely debated issues. Ironically, now that the ANCC adult and family psychiatric nurse practitioner (PMHNP) examinations exist, with test content outlines that clearly identify the professional standards and scope of practice relevant to the role of the certified psychiatric nurse practitioner, those contentious issues of role, scope of practice, educational preparation and credentialing (if not titling) seem considerably less thorny. In fact, by credentialing the role of the psychiatric nurse practitioner sooner rather than later, ANCC may have saved advanced practice psychiatric nursing for psychiatric nurses. This article proposes to (1). explain that assertion, (2). clarify what the scope of practice relevant to the newly certified role means in terms of credentialing requirements for existing types of psychiatric nurse practitioner, and (3). identify some of the controversies that linger with the debut of the PMHNP certification examination(s).     

Psychiatric nurse practitioner versus clinical nurse specialist: moving from debate to action on the future of advanced psychiatric nursing.

The psychiatric nursing literature recently has included a proliferation of discussions regarding the nature and direction of change impacting the future of advanced practice psychiatric nursing. The debate has focused most commonly on the role of the clinical nurse specialist versus the role of the nurse practitioner. The debate has produced little in the way of outcomes other than an entrenchment of positions. The stalemate in psychiatric nursing is producing a slow but steady surrender of the boundaries of psychiatric nursing to other fields of nursing. Although advanced practice psychiatric nurses disagree on what to become and what to be called, people with conditions such as depression, anxiety disorders, and other psychiatric disorders are being treated increasingly by family nurse practitioners. The time for debate has ended. Unless consensus regarding what constitutes the domain of psychiatric nursing is reached soon, the discussions will be moot because few clients will remain to be treated. This article began as a discussion between colleagues. The two authors teach at a regional state university, but they share diverse opinions regarding the substance and nature of advanced practice psychiatric nursing. These diverse views led to discussions that have implications not only for faculty practice, but for curricular design, and for decisions regarding how to best educate future nurses. The discussion developed into a presentation at the 20th Southeast Conference of Clinical Nurse Specialists. It was presented as a point-counterpoint discussion regarding this debate; one author advocated the perspective of traditional clinical nurse specialist and one advocated the perspective of a psychiatric nurse practitioner role. We conclude with a projected model of a merged role, with delineation of traditional clinical nurse specialist and nurse practitioner that must be blended for the new role.     

Perceptions of role functions of psychiatric nurse specialists

Specialized and advanced psychiatric nursing practice is an innovative concept in the health care service in Hong Kong. A clear definition of the role and practice of psychiatric clinical nurse specialists (CNS) is important for the development of expert psychiatric nursing practice but is still in a formative stage. A qualitative exploratory study was conducted to identify the psychiatric CNS's perceptions of their role and to compare their perceptions with those of their clinical psychiatric nurse colleagues. The main themes emerging from interviews, observations, and personal diary data were compared and condensed. Eight CNSs and 24 clinical nurse colleagues from acute care and community psychiatric nursing units voluntarily participated in the study. A four-component framework, including clinical practice, organization, education, and professional role, was adopted from nursing literature and used for categorization. The findings showed similarities of role perceptions in the clinical practice, organization, and education components between the CNSs and their nursing colleagues. Differences in role perceptions, concerns about inadequate knowledge and autonomy, and limitations in professional role are discussed.     

Bridging Cultures for Latino Children: School Nurse and Advanced Practice Nurse Partnerships

TOPIC:  Barriers to use of mental health services by Latino families include stigma, service costs, and disparity of services with cultural values and traditions. School nurses are in key positions to recognize mental health needs of Latino children and form relationships that facilitate family connections with mental health services. Advanced practice psychiatric nurses may be contracted by school districts to provide consultation to school nurses or may be available to school nurses through connections with school-based health centers. Case examples are provided to illustrate the value of school nurse consultation with an advanced practice psychiatric nurse in promoting awareness of cultural influences on children's symptoms and behaviors and developing culturally sensitive approaches to engage Latino children and families in school and health services.
PURPOSE:  This paper aims to review literature on Latino mental health and present rationale for school nurse and advanced practice nurse partnerships to promote culturally sensitive approaches that facilitate Latino family access and utilization of health services.
SOURCES:  Published literature and case scenarios.
CONCLUSIONS:  With advanced practice nurse consultation, school nurses identify mental health needs of Latino children and develop culturally sensitive approaches that bridge Latino families' access to and utilization of health services.     

The nature of expert psychiatric nurse practice: a grounded theory study

• ? This study examines what psychiatric nurses regard as the nature of expert psychiatric nurse practice.
• ? The study focuses on the beliefs and principles of psychiatric nurses currently working within a psychiatric unit.
• ? Using grounded theory methodology, data were coded and analysed, producing an integrated framework of expert psychiatric nurse practice comprised of four core variables: ‘attitudes/philosophy’, ‘knowledge’, ‘skills’ and ‘roles’.
• ? It is suggested that the nature of expert psychiatric practice is an evolutionary concept and that as this practice develops the integrated theory presented will need to develop in parallel.

     

Barriers to practice and impact on care: an analysis of the psychiatric mental health nurse practitioner role

This paper is a retrospective review of the literature analyzing the role of the psychiatric mental health nurse practitioner in the community. Presented here is an appraisal of national and state mental health initiatives. Professional nursing regulations are reviewed, focusing on New York State advanced practice nursing. Barriers to practice are assessed with discussion on how barriers, such as statutory collaboration, impede access to treatment in the community for mentally ill psychiatric patients. The current New York State legislative agenda is featured. Clinical vignettes from a nurse practitioner's private community practice are presented to introduce and conclude how clinical practice barriers impede autonomous practice.     

The future of the psychiatric mental health clinical nurse specialist: evolution or extinction

The role of the psychiatric mental health clinical nurse specialist (PMHCNS) is now in a precarious position. At first glance, some may say it is on the verge of extinction. In this article, a brief history of the role of the PMHCNS is reviewed along with current education, practice, role, and American Nurses Credentialing Center certification of the PMHCNS. The future implications and considerations of the unique functions of the PMHCNS for an advanced practice registered nurse with a psychiatric mental health specialization are discussed.     

Using mindfulness-based therapeutic interventions in psychiatric nursing practice--part I: Description and empirical support for mindfulness-based interventions

Finding effective nursing interventions for the treatment of mental illness is a major concern for advanced practice psychiatric nurses (APPN). Increasingly, innovative psychotherapeutic treatment modalities are being used for the treatment of individuals with serious mental illness. One such innovative approach, mindfulness-based therapeutic interventions, has been shown to relieve distress for individuals with medical and psychiatric illnesses. In part one of this two-part article, the investigators describe principle concepts of mindfulness, review current research in the usefulness of mindfulness practice for treatment of psychiatric illnesses, and outline the theoretical basis for this treatment modality, including mindfulness-based cognitive therapy (MBCT). In Part II, the writers detail the therapy phases of MBCT and present a clinical case in which an advance practice psychiatric nurse integrates mindfulness-based psychotherapeutic approaches into her treatment. This clinical case may inform future clinical nursing research and advanced psychiatric nursing practice.     

The advanced practice nurse. Changing the practice law: what did we learn?

The nurse practice statute was changed in Connecticut during the 1999 Legislative session in an effort to more accurately reflect the current practice of advanced practice nurses. The effort to make changes began in 1990, when the psychiatric clinical nurse specialists organized and incorporated to improve the practice status of this nurse specialty group and to improve patient accessibility to their services. This article describes the changes that were made in the practice statute and the lessons that were learned along the way. It elaborates on the need for strong organizational identification, coalition building, choosing legal and lobbying support carefully, negotiating with the opposition, and grassroots lobbying. Compromise was reached and statutory changes were made so that advanced practice nurses moved from being under the direction of physicians to a mutually agreed-on collaborative relationship with physicians. The article provides insights and learning experiences that may help others moving along the road to more independent practice laws.     

Human trafficking: implications for the role of the advanced practice forensic nurse

Human trafficking is internationally recognized as a widespread violation of human rights. This article defines and gives a detailed historical account of the political and social issues surrounding human trafficking. The article explains the role of the advanced practice forensic nurse in recognizing and addressing the needs of victims of human trafficking. The developing roles of the advanced practice psychiatric forensic nurse in collaboration with law enforcement and health care professionals are described with the ultimate goal of restoring the lives of victims of human trafficking. J Am Psychiatr Nurses Assoc, 2009; 14(6), 462-470.     

Role diversification in the education of advanced practice psychiatric nurses

The mode, location, and focus of health care services are changing rapidly, especially delivery of psychiatric services. The high prevalence of psychiatric and medical comorbidity, the national shift in health care to a managed care arrangement with one professional designated as principle provider, and problems with access to comprehensive services for individuals with psychiatric problems interact to create a compelling need for a clear definition of advanced psychiatric-mental health nursing practice. This article is, in part, a response to the national dialogue and debate sparked by the beginning development of a psychiatric nurse practitioner certification exam. However, this debate will be used merely as a starting point to articulate and document the need for a flexible, diverse, and evolving definition of advanced psychiatric-mental health nursing practice that can inform and shape educational programs in the discipline.     

Steering a course towards advanced nurse practitioner: a critical care perspective

Aim: This article is a report of a study of the experiences of expert critical care nurses in their transition to the role of advanced nurse practitioner within an intensive care unit (ICU) setting. Background: The advanced nurse practitioner role was developed to support the ICU team and to undertake many of the roles traditionally associated with junior medical staff in this specialized area. The impetus for this study therefore was generated from the need to explore the role development experiences of trainee advanced nurse practitioners to inform future developments and practice. Methods: This study used grounded theory methodology to conduct and analyse data from 25 participants. The data were collected between March 2010 and August 2010, using interview format. Data collection and analysis was conducted simultaneously using methods associated with grounded theory, theoretical sampling and the constant comparative method. Results: ‘Staying the course to advanced nursing practice’ emerged as the core category, with four related major categories and substantive codes. In conjunction, the substantive theory explaining the essential processes involved comprised of three inextricably linked processes: situational, development and conceptual meaning. The developed conceptual model captures the unique experiences of expert critical care nurses during their transition to confident and competent advanced nurse practitioners. Conclusion: This study provides an account of the role transition from expert critical care nurse to advanced nurse practitioner, specifically the synthesis of expert nursing practice with traditional medical values. The conceptual model has the potential to be utilized as a framework for others embarking upon similar projects, informing advanced nurse practitioner roles within and out with critical care settings.     

The clinical nurse specialist and nurse practitioner roles: room for both or take your pick?

OBJECTIVE: The aim of this paper is to contribute to pertinent discussions regarding advanced practice nursing roles. In particular discussion will focus on the potential implications for the developing nurse ractitioner (NP) role on the existing clinical nurse specialist (CNS) roles. SETTING: The literature presented originates primarily from the United States of America (USA), United Kingdom and Australia. Specific emphasis is placed on the psychiatric/mental health nursing context. PRIMARY ARGUMENT: Amidst the confusion in terminology to describe and explain advanced, expanded or extended nursing roles, and to distinguish between the clinical nurse specialist and the nurse practitioner, there is a need to establish clarity. The need for both clinical nurse specialist and nurse practitioner roles has been hotly debated in the USA. CONCLUSIONS: The roles of clinical nurse specialist and nurse practitioner may be complementary but fulfil different functions. It is therefore important that both roles be maintained and implemented in response to consumer and health service needs.     

Nursing people who are suicidal on psychiatric wards in Taiwan: action/interaction strategies

Suicide is a major mental health problem in Taiwan. Estimations revealed that approximately 41% of people who committed suicide had a previous history of psychiatric inpatient care. To date, a suicide nursing care theory has not been developed. Consequently, the aim of this study was to formulate a suicide nursing care theory with the aim of enhancing and advancing the nursing care provided to people who attempt suicide or have suicidal thoughts. A qualitative approach using grounded theory was adopted. A total of 15 peoples who had either suicidal ideas or had attempted suicide and 15 psychiatric nurses were interviewed and observed. Data were analysed using open, axial and selective coding and the NUD*IST software program. A substantive theory of suicide nursing care was developed from the emergent findings. Four categories surfaced in the nursing care theory relating to the nurses' 'action/interaction strategies'. They were: the holistic assessment of people who are suicidal; providing protection; providing basic care; and providing advanced care. The findings from this study could be used to influence and advance nurse education and training, clinical practice, management and further research.     

How nurse practitioners make decisions regarding coronary heart disease risk: a social judgment analysis

PURPOSE: Understanding how nurse practitioners use clinical decision skills in practice has the potential to guide education programs to ensure safe, competent, and high quality advanced nursing practice. This study used the lens of social judgment theory to examine the clinical decision making of 60 nurse practitioners. METHODS: A three‐group pretest–posttest comparison design was used to evaluate how much insight nurse practitioners had into their clinical decision‐making process. FINDINGS: Nurse practitioners had modest insight into their clinical decision‐making process. CONCLUSION: Self‐insight has implications for enhancing nurses' decision making, improving education, and fostering agreement among advanced practice nurses. IMPLICATIONS FOR NURSING PRACTICE: Self‐insight has implications for developing professional decision making and promoting appropriate educational opportunities for advanced practice nurses.