The
Graduate Nursing
PSYCHIATRIC MENTAL
HEALTH NURSE PRACTITIONER (PMHNP)
FAQs
Q. What
is an Psychiatric Mental Health Nurse Practitioner
(PMHNP)?
A. A psychiatric and mental health nurse
practitioner is an advanced practice registered nurse who has completed a
graduate education program (Master of Arts or Master of Science) in
nursing. Like other nurse practitioners
who specialize in Family Health, Adult Health, Geriatric Health, Women’s
Health, Pediatric Health or Acute Care, the PMHNP has followed a specialty
track in Mental Health and is certified by a professional nursing organization
to exercise advanced nursing competencies including (a) mental health promotion
and (b) the diagnosis and treatment of acute and chronic psychiatric
conditions. In their capacity as direct
primary mental health care providers, psychiatric and mental health nurse
practitioners collaborate with physicians, seeking consultation when necessary
and referring patients to other providers (physicians or nurse practitioners in
other specialties) when the patient’s physical or mental health condition
requires it.
The American
Nurses Credentialing Center (ANCC) defines a psychiatric and mental health
nurse practitioner (PMHNP) as “a registered nurse with a graduate degree in
nursing who is prepared for advanced primary mental health care through the
life span in accordance with ANA’s scope and
standards of psychiatric and mental health nursing. The practice includes independent and
interdependent decision making and direct accountability for clinical
judgment. The role of the PMHNP includes
comprehensive physical assessment, diagnosis, and medication management, in
addition to psychotherapeutic interventions.
Graduate preparation expands the comprehensiveness of the PMHNP role to
include participation in and use of research development and implementation of
health policy, leadership, education, case management and consultation” (ANCC,
2001, p. 13).
Q. Where
do Psychiatric Mental Health Nurse Practitioners Practice?
A. PMHNP’s can practice in a wide variety of settings,
including community mental health centers, psychiatry clinics, family practice
clinics, acute care psychiatric settings, home health, nursing homes, and
private practice. It is essential only
that the PMHNP practice within an arrangement that provides for consultation,
collaborative management, and referral as indicated by the health status of the
patient.
Q. What
is the scope of practice of the Psychiatric Mental Health Nurse Practitioner?
A. The scope of practice of the PMHNP is
determined by (a) the statutes governing advanced practice registered nursing
in the state in which the PMHNP resides; and (b) the American Nurses
Association’s (2000) Scope and
Standards for Psychiatric-Mental Health Nursing Practice. In reality, scope of practice is also
determined by the context in which the PMHNP practices and, very importantly,
by the PMHNP’s competence and specific expertise.
According to the ANA (2000) Scope and Standards for Psychiatric-Mental Health Nursing Practice,
the professional parameters of advanced practice psychiatric nursing include
the complete delivery of direct primary mental health care services including,
but not limited to:
·
Carrying out health promotion activities including
general health teaching.
·
Designing and conducting mental illness preventive
interventions.
·
Conducting health screening and evaluation.
·
Eliciting a history appropriate to the patient,
presentation, and setting.
·
Completing a health assessment / physical examination.
·
Formulating differential diagnoses based on clinical
findings.
·
Ordering, conducting, and interpreting pertinent
laboratory and diagnostic studies and procedures.
·
Formulating, implementing, and evaluating an
outcome-based treatment plan.
·
Conducting individual, family, group, and network
psychotherapy.
·
Directing and providing home health services to mental
health patients.
·
Prescribing, monitoring, managing, and evaluating
psychopharmacological and related medications.
·
Providing integrated mental health services in general
health settings.
·
Facilitating psychiatric rehabilitation.
This is a
holistic practice that includes the responsibility to (a) collaborate with
patients, families, and other clinicians; and (b) to refer the patient to other
providers for services that fall outside the PMHNP’s
practice parameters (e.g., direct management of medical conditions unrelated to
the patient’s psychiatric or mental health condition).
According to
the ANA (2000) scope and standards, the advanced practice psychiatric-mental
health nurse is limited to the provision of primary mental health care services to those at risk for mental
disorders or presently in need of psychiatric-mental health services. This practice does not extend to the
provision of primary care services unless the PMHNP is dually prepared and
certified in another nursing specialty.
In general,
the PMHNP practices in accordance with the Minnesota Nurse Practice Act [
Q. What is a collaborative practice agreement?
A. A collaborative practice agreement is a
mutually agreed upon plan between an advanced practice registered nurse and one
or more licensed physicians that designates the scope of collaboration
necessary to manage the care of patients with whom the advanced practice
registered nurse and licensed physician(s) have similar expertise. In other words, for purposes of optimal
patient care, it is desirable that the ANP have a collaborative practice
agreement with a physician. Collaborative practice agreements for nurse
practitioners in the state of Minnesota are mutually drafted by the nurse
practitioner and collaborating physician(s) in accordance with the Minnesota
Nurses Association / Minnesota Medical Association’s Memorandum of Understanding For Written Prescribing Agreements Between
an Advanced Practice Registered Nurse and a Collaborating Physician. The
certified registered nurse practitioner and the collaborating physician have
the responsibility to jointly determine the amount of autonomy that will be
delegated specific to the prescribing, monitoring and managing of drugs.
Clinical nurse specialists in psychiatric and mental
health nursing who have obtained prescriptive authority have a separate and
distinct Memorandum of Understanding
based on standards established by the Minnesota Nurses Association and the Minnesota
Psychiatric Society.
Q. How is a PMHNP different from a Psychiatric
Mental Health Clinical Nurse Specialist?
A. Depending on the practice site, the
psychiatric-mental health nurse practitioner and the psychiatric-mental health
clinical nurse specialist who has obtained prescriptive privileges may practice
in similar, even identical roles.
However, prescriptive authority and the educational preparation required
for expertise in prescribing are built into PMHNP programs. Unlike clinical nurse specialist programs,
ANCC reviews nurse practitioner programs for core content in (1) advanced
health assessment, (2) pharmacology, (3) pathophysiology,
(4) health promotion and disease prevention, and (5) differential diagnosis and
disease management. Until recently, many
clinical specialist programs did not require core content in advanced health
assessment, pathophysiology (including
neurophysiology), and advanced pharmacology.
Unlike some psychiatric clinical nurse specialists, the PMHNP is
educationally prepared to conduct complete physical examinations of patients
with psychiatric disorders, order and evaluate the appropriate laboratory
tests, initiate a course of psychotropic medication, evaluate medical
conditions secondary to psychiatric treatment, case manage psychiatric clients
with complex medical comorbidities, and provide
ongoing psychotherapeutic and medication management to a broad spectrum of
mental health clients.
Q. How are PMHNP’s
reimbursed for their services?
A. PMHNP’s are eligible
for third-party reimbursement for psychiatric services. They are credentialed and placed on provider
panels in the same manner as all other health care providers and advanced
practice nurses. In the State of
Q. What are the certification requirements for
a Psychiatric Mental Health Nurse Practitioner?
A. The
·
The
·
Hold a currently active professional license in the
·
Hold a master’s or higher degree in nursing.
·
Have graduated from an accredited institution that
grants graduate-level academic credit for all course work, includes both
didactic and clinical components and includes a minimum of 500 hours of
supervised clinical practice in the specialty area and role.
·
Have graduated from an accredited master’s or
post-master’s program that prepared the candidate as either an Adult or Family
Psychiatric and Mental Health Nurse Practitioner (PMHNP), which includes:
o
Advanced health assessment (to include both physical
and mental health. [Pediatric and
adolescent physical and mental health assessment is required for the
PMHNP-Family exam.]
o
Pathophysiology (or
neurophysiology/biophysiology).
o
Pharmacology and/or psychopharmacology (both
preferred).
o
Diagnosis and medication management of psychiatric
illness (clinical practicum); AND
·
Have supervised clinical training at the graduate or
post-graduate level in two (2) psychotherapeutic treatment modalities
The
Certification guidelines are available
at:
http://nursingworld.org/ancc/certification/exams.html
More information is available from the
More information is available from the
following websites:
More information for Psychiatric Mental
Health Nurse Practitioners is available from the following websites:
American
Psychiatric Nurses Association http://www.apna.org
International
Society of Psychiatric Mental Health Nurses http://www.ispn-psych.org