How to Collaborate Effectively with Psychiatric Nurse Practitioners: Understanding These Clinicians' Training and Skills Can Improve Patient Care

By Casher, Michael L.; Kuebler, Julie et al. | Current Psychiatry, November 2012 | Go to article overview

How to Collaborate Effectively with Psychiatric Nurse Practitioners: Understanding These Clinicians' Training and Skills Can Improve Patient Care


Casher, Michael L., Kuebler, Julie, Bastida, Maria, Chipps, Suzanne, Current Psychiatry


Psychiatrists who are accustomed to working with "med/surg" or psychiatric nurses may be less familiar with how to collaborate with more specialized psychiatric-mental health nurse practitioners (PMHNPs). These clinicians play an important role in delivering mental health services, which is likely to continue because of the physician shortage in the United States (1) and increasing mental health care needs from passage of the Affordable Health Care Act and the Mental Health Parity Act. (2) These specialty trained, master's level nurses work with psychiatrists in outpatient clinics, hospital consultation and liaison services, psychiatric emergency services, inpatient units, and geropsychiatric consultation. (3-5) PMHNPs can fill gaps of coverage in underserved areas, supplement and complement busy and overburdened psychiatrists, and add an important dimension of holistic care.

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This article reviews issues related to a successful psychiatrist-PMHNP collaboration, including:

* PMHNP's training and scope of practice

* their skill and competency development in inpatient and outpatient settings

* the principles and dynamics of collaboration, hindrances to cooperation, and keys to relationship-building for PMHNPs and psychiatrists.

Rigorous requirements

PMHNPs enroll in an accredited graduate nursing program that takes 16 to 24 months to complete and builds on the competencies of their undergraduate nursing education and clinical experience. All programs meet standards set by national nursing accrediting agencies. The typical graduate-level curriculum for a PMHNP includes core bio-behavioral theory, research courses, advanced physiology and pathophysiology, advanced physical and psychiatric health assessment, pharmacologic and nonpharmacologic interventions, and managing health care delivery systems. For graduation and certification, PMHNPs must complete 500 supervised clinical hours focused on psychiatric and mental health care.

Each certified PMHNP must pass a national certification examination and obtain a license to practice as an advanced practice nurse (APN). To maintain certification, every 5 years PMHNPs must complete 75 to 150 continuing education credits and accrue 1,000 practice hours. The Psychiatric Mental Health Nursing Scope and Practice Standards developed by the American Nurses Association in conjunction with the American Psychiatric Nurses Association and the International Society of Psychiatric-Mental Health Nurses includes the following competencies: (6)

* comprehensive psychiatric evaluation

* formulation of a differential diagnosis

* ordering and interpreting diagnostic tests

* prescribing pharmacologic agents

* conducting individual, couple, group, or family psychotherapy using evidence-based approaches.

In May 2012, the Centers for Medicare and Medicaid Services finalized rules that affirmed an equal role for physicians and nurse practitioners in hospital medical staff affairs, and allowed nurse practitioners to work to the full extent of their educational preparation. (7)

PMHNPs also are responsible for recognizing the limits of their knowledge and experience, planning for situations beyond their expertise, and providing appropriate referral to other health care providers when indicated. (8)

Successful collaborative practice requites a clear definition and understanding of roles. (9) This is particularly important for collaborating psychiatrists and PMHNPs because there has been confusion among physicians and the general public related to the nurse practitioner's role. Psychiatrists who work with PMHNPs need to be familiar with state regulations that govern levels of physician supervision and prescriptive authority for nurse practitioners. Eleven states and the District of Columbia allow nurse practitioners to prescribe independently, including controlled substances. …

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