The Future of Advanced Practice Psychiatric Nursing

Article excerpt

A paradigm shift in the health field and in graduate education is changing the role of advanced practice psychiatric nurses. The trend away from clinical specialists (CNSs) and the move toward nurse practitioners (NPs) have raised significant questions:

* Will there be a role for clinical nurse specialists without prescriptive authority? Is it necessary for CNSs to get certified as a PNP in order to maintain their viability?

* Do PNPs have to take two exams (CS and NP) to be certified by ANCC?

* Given ANCC has developed a certification exam for PNP, does this mean CNSs need to take this exam in order to have prescriptive authority?

* Do we want a credential agency, like ANCC, governing our profession by deciding what credentials are necessary for advanced practice psychiatric nurses?

* Should CNSs be grandfathered in as PNPs without having to take another certifying exam?

* What does the "blended role" look like?

* What academic preparation is necessary to accommodate the changing needs in health care for advanced practice nursing?

United Behavioral Health (UBH), one of the three largest managed care organizations in the United States, is looking to use PNPs to do initial medication evaluations and treatment. UBH also is considering opening its provider lists to additional CNSs who provide outpatient therapy. The passage of parity legislation in the past year (AB88 in California; parity laws in several other states) will result in more clients receiving services for mental health care in 2001. Managed care organizations are experiencing a shortage of psychiatrists, and consumers are having to wait for appointments. Jerry Bayer, a consultant to the CEO of UBH, has contacted Bonnie Raingruber (a board member of PPC) to initiate a survey and possible research study on the efficacy of this plan. Both Bonnie and I have strongly suggested that UBH open its provider list to CNS therapists and at the same time invite PNPs to provide medication evaluation. The ideal advanced practice nurse would be a person with the theory and practice of psychotherapy (i.e., CNS training) who has the prescriptive authority of a PNP. One person then could do both roles: medication evaluation and ongoing in-depth psychotherapy. According to Bayer, PNPs are the wave of the future for managed care because they are a good solution to fewer psychiatrists, provide maximal access to care, and are cost-effective treatment.

The issues identified concerning PNPs include:

* Each state has a different nurse practice act with different requirements. This leads to confusion and an inability to move easily from one state to another. Standardization is extremely difficult when tracking 50 states with varying nurse practice acts. In some states nurses with prescriptive authority may practice autonomously without medical supervision. About 23 states do not require a collaborative agreement with a psychiatrist. In other states nurses with prescriptive authority need to be supervised by a psychiatrist.

* Confusion about the two roles among other psychiatric disciplines and the public. Many psychiatric nurses do not understand the difference between a PNP and a CNS because there are several ways to obtain that title, depending 'on which state you live in. If we expect others to be clear about our roles, what to expect from us, and how best to use our training and expertise, we as a profession must have clarity on it.

* Expectations beyond the trained role. …