The shortage of mental health care providers is a crisis, but psychiatrists have a potentially powerful ally.
For more on this topic, see Psychiatry 2021: Team Psychiatry, by John J. Miller, MD, editor in chief of Psychiatric TimesTM. -Ed
Psychiatrists and mental health nurse practitioners should be natural allies. Unfortunately, national initiatives and some agencies have encouraged an us vs them mentality, pitting psychiatrists against nurse practitioners and other advanced care providers. Competitive language is hurtful and, worse, counterproductive to good care. Psychiatric-Mental Health Nurse Practitioners (PMHNPs) and psychiatrists share the goal of caring for patients in need of psychiatric treatment. It is important to appreciate nuances and recognizing that training, degree, or certification alone does not translate to a good provider. It is a great task to meet the mental health needs of Americans, and we all can play important roles and support each other in this vital mission
Key To Addressing Care Shortages
PMHNPs can play a critical role in addressing shortages of mental health providers.1 A report published by the United States Department of Health and Human Services Health Resources and Services Administration projects that the mental health field will be short 250,000 mental health professionals by 2025.2 The need is most significant in rural areas, where 111 million Americans currently reside—areas without sufficient mental health professionals.2 For instance in New Hampshire, where I live and practice, there are significant shortages of psychiatrists and other mental health providers.2,3 In states with independent practice authority for nurse practitioners, such as New Hampshire, PMHNPs are able to provide significantly more mental health services when compared with nurse practitioners (NPs) who practice in states without independent practice authority for NPs.4
Psychiatry-mental health is one of the fastest growing, non-physician specialties in the health care field.5 In my experience, PMHNPs greatly value working as a team with our colleagues within the field—psychiatrists, clinical psychologists, therapists, etc. We greatly value our collaboration with physicians and appreciate the many psychiatrists who have offered their expertise and time to PMHNP students by precepting, and with PMHNPs in clinical practice via formal or informal collaboration, along with supervision, mentorship, and support. A holistic, patient-centered approach translates favorably to patient outcomes and collaboration.
In fact, patients report favorable experiences working with nurse practitioners.6 Findings from the Kippenbrock et al study determined that patients had greater satisfaction with their care provided by nurse practitioners when compared with their MD colleagues.6 A systematic review by Stanik-Hutt et al evaluated published literature over a period of 19 years and evaluated quality, safety, and effectiveness of care provided by Masters-prepared nurse practitioners.7 Investigators found that patient outcomes from nurse practitioners working independently or with MD collaboration had similar outcomes, when compared with the patients working with MDs alone.7
Education and Scope of Practice
Every PMHNP has a unique journey leading them to pursuing the specialized education, training and subsequent national certification to practice. Nurse practitioner practice authority varies from state to state, with variations of full practice, reduced practice, and restricted practice.8 Many states require collaboration with a physician for nurse practitioners to practice. Advocacy for expanding the role of the nurse practitioner is continually occurring on a state level. Massachusetts recently joined the rest of the New England states by passing legislation to grant nurse practitioners full practice authority.4 This made Massachusetts the 23rd state to pass full practice authority for nurse practitioners.
PMHNPs can provide excellent care due to their extensive education and training. They are first and foremost Registered Nurses (RNs). The advanced practice, masters-prepared role for nurses was first the Clinical Nurse Specialist, and later shifted to the Advanced Practice Registered Nurse (APRN) in the early 1990s.9 Today, once they have obtained RN licensure, RNs are eligible to pursue further degrees on both a Masters and Doctoral level.
In addition to nurse practitioner role courses, advanced pathophysiology, pharmacology, and health assessment courses, PMHNPs complete intensive coursework and clinical practicum experiences. Students obtain 500-1000 clinical hours and complete coursework in neurobiology, psychotherapeutic modalities, differential diagnosis, and psychopharmacology. Change is on the horizon in nursing education, as the plan to transition into doctoral-level education for all nurse practitioners is in the pipeline. This is important to align advanced practice nurses with our colleagues in other professions that have also shifted to doctoral-level preparation. Nurse practitioner students will obtain additional clinical hours along with added coursework, further preparing nurses as advanced practice clinicians and health care leaders.
Upon completion of an accredited program, students are eligible to sit for the board certification exam through American Nurses Credentialing Center (ANCC) to obtain PMHNP certification. Board-certified PMHNPs are required to renew national certification every 5 years and must complete 75 continuing education units (CEUs) along with additional tasks to meet criteria for maintaining certification. Nurse practitioners maintain certification renewal by completing requirements and engaging in ongoing efforts to pursue education, in demonstrating continued competence.10 Additionally, all PMHNPs must meet specific state-level requirements for maintaining state licensure as both an RN and an NP, and many states require renewal of these licenses every 2 years.
Partnering for Success
As a PMHNP for 6 years, I have had the pleasure of working with many incredible patients and clinicians. In this vein, I am thrilled to be the first Nurse Practitioner Liaison for Psychiatric TimesTM. My fellow PMHNPs and I leverage our nursing background and complement it with the art and science of psychiatry to provide patients with evidence-based, sound clinical care. And we are glad to work together with you.
As the liaison, I look forward to sharing stories, exchanging perspectives, and helping each other meet the noble goal of addressing the mental health needs of Americans. Within the current health care climate and many stresses related to patient acuity, reimbursement, productivity, and prior authorizations, it is refreshing and energizing to talk to each other about why we are here, and what led us to this profession. Comments and suggestions for articles are welcomed and can be sent to PTEditor@mmhgroup.com.
Ms Robinson is a psychiatric-mental health nurse practitioner in the Seacoast, New Hampshire area; and clinical assistant professor & program director of the Post-Masters Psychiatric-Mental Health Nurse Practitioner Certificate Program, Department of Nursing, University of New Hampshire, Durham, NH.
1. Yang BK, Trinkoff AM, Zito JM, et al. Nurse practitioner independent practice authority and mental health service delivery in US community health centers. Psychiatr Serv. 2017;68(10):1032-1038.
2. US Department of Health and Human Services. Health Resources and Services Administration, Bureau of Health Workforce. National Projections of Supply and Demand for Behavioral Health Practitioners: 2013-2025. November 2016. Accessed January 25, 2021. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/behavioral-health-2013-2025.pdf
3. New Hampshire Department of Health and Human Services: Bureau of Behavioral Health New Hampshire 10-year mental health plan. January 2019. Accessed January 25, 2021. https://www.dhhs.nh.gov/dcbcs/bbh/documents/10-year-mh-plan.pdf
4. Massachusetts Coalition of Nurse Practitioners. Massachusetts NPs granted full practice authority! Published January 1, 2021. Accessed January 25, 2021. https://mcnp.enpnetwork.com/nurse-practitioner-news/212292-massachusetts-nps-granted-full-practice-authority-
5. American Psychiatric Nurses Association. Expanding mental health care services in America: the pivotal role of psychiatric-mental health nurses. April 2019. Accessed January 25, 2021. https://www.apna.org/files/public/Resources/Expanding_Mental_Health_Care_Services_in_America-The_Pivotal_Role_of_Psychiatric-Mental_Health_Nurses_04_19.pdf
6. Kippenbrock T, Emory J, Lee P, et al. A national survey of nurse practitioners' patient satisfaction outcomes. Nurs Outlook. 2019;67(6):707-712.
7. Stanik-Hutt, J, Newhouse RP, White KM, et al. The quality and effectiveness of care provided by nurse practitioners. Journal for Nurse Practitioners. 2013;9(8),492-500.
8. American Association of Nurse Practitioners. State practice environment. January 1, 2021. Accessed January 25, 2021. https://www.aanp.org/advocacy/state/state-practice-environment
9. Drew BL. The evolution of the role of the psychiatric mental health advanced practice registered nurse in the United States. Arch Psychiatr Nurs. 2014;28(5):298-300.
10. American Nurses Credentialing Center. 2017 certification renewal requirements. June 1, 2016. Accessed January 25, 2021. https://www.nursingworld.org/~4ac164/globalassets/certification/renewals/RenewalRequirements