Certification Standards for Advanced Practice Psychiatric Nursing

By Rice, Michael J. | Perspectives in Psychiatric Care, January 2000 | Go to article overview

Certification Standards for Advanced Practice Psychiatric Nursing


Rice, Michael J., Perspectives in Psychiatric Care


The first nurse practitioner role in the world was developed in 1946 and was titled the Psychiatric Clinical Nurse Specialist (CNS). Based on the work of Hildegard Peplau, the Psychiatric CNS set standards for advanced practice nursing, including requiring a master's degree as minimum preparation. Yet, in a bold move, the American Nurses Credentialing Center (ANCC) has developed a new set of criteria for board certification of advanced psychiatric nursing practice that establishes a fragmentation of advanced practice psychiatric nursing and does not allow for any grandfather clauses.

Eligibility criteria for a new psychiatric nurse practitioner (PNP) exam were released after the first ANCC Test Development Committee (TDC) meeting in February 1999. The criteria are based on National Organization of Nurse Practitioner Faculties (NONPF) and Master's Essentials of Nursing Education guidelines (TDC, 1999). These standards establish a more generalized nurse practitioner education as the standard and eliminate the psychotherapeutic orientation. The criteria do state that preparation "shall include evidence of supervised clinical training in at least two psychotherapeutic treatment modalities" (TDC, p. 2).

The new eligibility criteria's most distressing aspect is. the minimization of psychotherapy. The new ANCC role description does include the "prescription and/or performance of non-pharmacological treatment such as psychotherapy" (TDC, 1999, p. 2). "The heart and soul of advanced practice psychiatric nursing is the development, maintenance and maturation of the nurse-client relationship. These are not 15-minute slam/bam/thank you ma'am, here's your Prozac visits" (Mary Moller ARPN, CS, Personal Communication, February 1999). Psychotherapy is not an either/or role in advanced practice psychiatric nursing. Minimizing psychotherapy skills makes the psychiatric CNS indistinguishable from a general nurse practitioner.

ANCC's fragmentation of psychiatric advanced practice nursing certification raises immediate concerns for the psychiatric CNS. Medicare's Health Care Finance Authority (HCFA) regulations recently attempted to suggest that Psychiatric CNSs were not eligible for reimbursement unless they are supervised or collaborating with a physician, a position heartily endorsed by the American Psychiatric Association (1997). Because HCFA regulations define many third-party reimbursement standards, once the exams exist, CNSs may not be able to maintain their independent reimbursement status unless classified by the nurse practitioner label, a position also endorsed by the APA. Overnight, the Psychiatric CNS may be a product without a viable market.

The issues with the psych NP exam and role description exist because of ANCC's application of the NONPF educational guidelines to advanced psychiatric nursing practice. The NONPF guidelines state that the curriculum contain essential knowledge that meets the "unique needs of the population served and the competencies necessary for safe practice" (Curriculum, 1995, p. 7). Yet, the NONPF guidelines do not address psychiatric nursing and are contradictory when applied to this issue. …

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