Here is a message I wrote on the APNA Member's Bridge today regarding the dilemmas faced by Psych Mental Health APRN's. I hope you visit the APNA website and become a part of the conversation...
I wanted to share my views about a conversation that has come up sporadically over time...
First I would like to start with a Thank you to the APNA group that examined the issue of advanced practice preparation, and made recommendations regarding our future. I think you tackled one important part of the many questions that have arisen since LACE came out. I agree that an important starting place for Advanced Practice Psychiatric Nursing in the future is to have one base of preparation and certification that is unified, and that prepares nurse clinicians for basic (i.e. beginning) competence and practice in the roles of psychotherapist, pharmacotherapy, and consultation-liaison work. I agree that the education should be across the lifespan if we seek to have a basic level of unified certification. Calling this clinician a Psychiatric Mental Health Nurse Practitioner (PMHNP) is fine with me. I thank the group for finding consensus around this issue.
There are 2 extremely important issues that relate to LACE that require further planning in my view. They are: 1. What happens to already certified, practicing Advanced Practice PMH nurses, particularly those with CNS certification. (but also in the future depending on whether separate 'family' vs. 'adult' PMHNP certifications remain - i.e. whichever certification goes by the wayside, that group could be potentially disenfranchised as well).
2. Who will be deemed eligible to educate, precept, 'train' new Advanced Practice PMH nurses.
In my view APNA needs a very clear plan that is very careful not to disenfranchise all of the highly experienced, practicing Advanced Practice PMH nurses. We need careful planning beyond a statement like,
'in 2015 or 2020 we will have 'enough' PMH NP certified APRN's to educate the new PMHNP's'
'in 2015 or 2020 all of the practicing, certified and licensed CNS's will have retired'
The problem here is that I have not seen a workforce analysis that truly indicates we will ever 'have enough' nursing faculty. I know I currently do not have enough practicing APRN's certified as CNS's and NP's to cover the number of students we would like to admit to our program.
I agree we will have more PMHNP's by 2020, but that does not mean CNS's should retire at that time.
We need some way to use our experienced APRN's in psych that is inclusive of both types of certification.
(and I do not expect that all CNS's should be required to return to school for the 3- P's and 500 clinical hours like I just finished to a cost of between $8000 - $10,000).
We need to issue continued clear statements that in PMH nursing the roles of the CNS and NP are nearly identical (i.e. was it 95% or 98% the same (per the logical job analysis paper by Rice & MOller I believe)).
To not be inclusive of both types of certification will risk that our current expert nurse faculty are out of their jobs... or preceptors will no longer be 'eligible to precept' (who by the way with CNS certification developed the role of PMHNP and educated our current group of PMHNP's... so I suspect they know something about the role and how to teach students to be PMHNP's.)
I do not want to get into a conversation about who is better or which certification is 'better'.
I completely agree that perhaps the better title today is Psych NP.
I do see individuals sharing opinions about who is better or differences in role that are typically state-bound. Meaning that in some states the board of nursing does not allow one kind of certified psych nurse to do the same thing as the other. We need to recognize that this does vary from state to state. Just because CNS's in one state can't prescribe and NP's can prescribe does not mean that in other states both CNS's and NP's can prescribe.
In my view the education and training for CNS's and NP's are (like the role/job) nearly identical. If anything the CNS has more role components in their education. In today's school of nursing, the preparation should be nearly identical. This however does mean that some clinicians can also choose not to prescribe and that is fine with me. Just as some clinicians may not choose to do family therapy. If that role or responsibility is not wanted by a clinician, I don't think we should force them to.
As for who can precept a student being prepared to be a PMHNP. I would hope we keep our heads about this matter too. I believe that the student should be precepted by certified and licensed APRN's in their clinical work. (this means certified as a psych CNS or psych NP) I believe that whoever precepts should be competent to perform and/or supervise the objectives that are part of the course that the student is taking. I believe that that APRN can also call upon other clinicians they work with - whether MD's, psychologists, MSW's, or RN's - to offer experiences that are coordinated and reviewed in the APRN's supervision with the student.
In a state where there is role delineation that does not allow prescribing by a CNS, then I think the faculty should work to be sure that a student is guided to learn the prescribing role either from an NP or MD.
I think we need to be careful to not divide up the PMH Advanced Practice role in a way that is blind to the full areas of practice available at the Advanced Practice level.
My final thought: Let us be very careful to understand that being educated in a lifespan way is very different from being an expert in child or being an expert in adult. That requires specific focus and training. Some programs do offer this (I believe ours is a good example). In my view we also need to be careful in what we are really saying when we identify what we mean by beginning competence, a lifespan approach, and expertise with particular age groups.
Thanks for letting me have my say,
Joanne
Here is a link to the APNA member bridge where this was posted... and where the conversation is continuing... http://community.apna.org/APNA/APNA/eGroups/DigestViewer/Default.aspx?GroupId=7&UserKey=82d60e30-46b4-40dd-b96b-77c0b0f2bd19
Here is the link to APNA's statement on Advanced Practice PMH roles: http://www.apna.org/i4a/pages/index.cfm?pageid=4354
Here is the link to the LACE document that has created controversy regarding roles:
http://www.apna.org/i4a/pages/index.cfm?pageid=3498
I hope you all make your voices heard!!!
Subscribe to:
Post Comments (Atom)
Bravo!
ReplyDeleteelena seitz
Looks amazing!!!! /I look forward to your feedback /thanks for this man it was very helpful.
ReplyDeleteCISSP Certification
I disagree with the lifespan focus of psych NPs. Because adults needing psychiatric care far outnumber children, it makes no sense to me. Especially with the aging of the population. The ANCC has kept the adult focus in primary care and added geriatrics to it. That makes sense. The ANCC has also kept the primary care pediatric NP. I have to assume that the makers of the LACE document and the ANCC think there is something inherently different in psychiatric/mental health. Again, I disagree.
ReplyDeleteI do not need certification in my state to practice. I have certified in the past to keep current, but was grandfathered in as the laws changed. I am even completing the DNP. But this change is one too many. I do not plan to re-certify when my Adult PMHNP certification expires. I will no longer precept students. The ANCC has made my specialty obsolete and has managed to disenfranchise this experienced NP and many others I've spoken with. Removing the option to retest to re-certify may compromise some NP's livelihoods. With the aging of the nursing force, it may be necessary for NPs to take time off of work for treatment for serious illnesses such as cancer. It certainly put a crimp in my plans to teach. Many times its difficult for nursing instructors to obtain enough clinical hours to re-certify. The testing option is an important one. I'm getting too old to keep playing these games based on the whims of nursing leaders. They have no evidence that this will lead to better practice. I wonder how long it will be before the ANCC will change again and realize the need for a more specialized population based focus?
Oh, I so hope you don't do this... We so need experienced preceptors for our students. If you have the certification, you will be able to renew it. The problem is that once they retire the exams for the retired certifications, then we will all need to maintain a careful watch on meeting the requirements for renewal of certification.
ReplyDeleteI agree that most professionals like us choose a population group to work with (adult or child/adol) and that the specific certifications do line up well with that. I suspect in the future there may be a 'market' for specialization certification in 'adult' or 'child'.
For now, I am hopeful that this plan (Family PMHNP certification) for lifespan certification will decrease the confusion in the world about all the different ways we are certified in our specialty. For those graduating in the future, there will hopefully not be the angst of whether one will be deemed eligible for renewal or recertification.
I just hope that all this turmoil won't drive the most experienced from the field.
Joanne, So nice to find your blog! ;) I agree with the need for unification and title clarification joined with the realization that there is a cadre of experienced CNS practitioners that are essential to practice and training current students. This is none the more true than in child psychiatry. Most child psych advanced nurses at this point likely hold a child psych CNS rather than family psych NP certification. Both of the preceptors who trained me were psych CNS's and I am incredibly grateful for what they added to my education and training. I do wonder how, as a profession, we will now recognize the basic additional competencies necessary to work with children in mental health. I believe the family-focused guidelines as they now exist do not provide new family psych NPs the skills or confidence necessary to work with the child population. In addition, while the family focus attempts to provide lifespan preparation, it does not necessarily guide providers on how to work better with families, as opposed to working with individual members at different chronological ages. Until we truly integrate our approach to recognize that mental illness is often an intergenerational experience, we haven't made much progress in changing our credential.
ReplyDeleteTina, I am glad you enjoyed it. I do believe that the experienced CNS's have led the field and 'brought up' the Psych NPs in most cases. We really need to remember to honor this and not just 'discard' the expertise because it has a different path to credentialing.
ReplyDeleteAs for the child expertise. We have had many passionate discussions at our school specialty meetings regarding the need for specific learning and mentoring/supervision for helping students gain knowledge and expertise with specific populations (whether child, adolescent, young adult, adult, older adults...) there are important differences in skills used which of course are most obvious when you consider how to manage a child vs. an adult or an older person vs. an adult. In some ways the use of 'family' is a misnomer. It will be interesting to see how things evolve over time...