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NUR 513 Week 2 Discussion Questions

NUR 513 Week 2 Discussion Questions

NUR 513 Week 2 Discussion Questions

What are the core concept definitions of each nursing model? Are there commonalities between the models? If so, what are they? What are the differences, if any?What are some theorists



In the United States, the advanced practice registered nurse, or APRN, position has steadily grown in importance. This is due to the enormous role they play in bridging the gap between physicians and the general public. It is a well-known fact that the number of practicing physicians is nearly inversely proportional to the population they are supposed to serve. A rigorous accredited postgraduate course in their specialty NUR 513 Week 2 Discussion Questions is required to become an advanced practice nurse. As the entry level to practice, this postgraduate degree is currently recommended to be a PhD. Following completion of these educational requirements, the psychiatric-mental health nurse practitioner (PMHNP), for example, must be certified by the American Nurses Credentialing Centre (ANCC) (ANCC, N.D.) and obtain state licensure to practice. Given that many socioeconomically disadvantaged communities cannot afford the expensive health services provided by the country’s physicians, the role of APRNs has grown in importance. What these populations require is affordable healthcare delivered to them in a convenient location. This is primary health care (PHC), and the APRNs are the frontline clinicians who will champion it in the future. This paper will look at the future roles and scope of the nurse practitioner (in this case a PMHNP), the regulatory framework governing their practice, accreditation and credentialing, nursing professional organizations they can join, and one controversial issue related to PMHNP practice.

Scope of Future Role as a PMHNP, Regulation, Accreditation and Credentialing

At present, the role of the nurse practitioner and its scope are very much a factor of the state legislation and regulations that govern nurse practitioner practice. In states that guarantee full autonomy of practice (full practice authority or FPA), the PMHNP evaluates mentally ill patients, diagnoses, orders investigations and interprets them independently before ordering appropriate treatment and making follow up (Maryville University, 2019). This is the full scope of the role that the PMHNP will be practicing in the future, because the movement to have universal full practice authority across states is unstoppable. Regulation of practice of PMHNPs and by extension all other APRNs is done through state legislation. Different states have different regulatory structures for APRNs (AANP, 2018). Across the fifty states, there are those whose regulatory structure is that of full practice authority. However, other states still have a regulatory structure of either reduced practice or restricted practice (AANP, 2018). These last two regulatory structures are restrictive and prohibitive to the nurse practitioner, preventing them from exercising their knowledge and training to the full extent of their abilities.

As stated above, full practice authority regulatory structure permits the nurse practitioner to practice without any supervision or hindrance. Reduced practice, on the other hand, requires that the nurse practitioner enters into a collaborative agreement with a practicing physician so that they can effectively practice under them NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper. Lastly, the worst regulatory framework is the restricted practice arrangement. In the states with this kind of APRN regulation, the nurse practitioner is only allowed to do a few things which also have to be done under the supervision of a physician (AANP, 2018). There are a total of 23 states that have a full practice authority regulatory structure as at 2017. These include Idaho, Iowa, Maryland, Hawaii, Washington D.C., New Mexico, and so on. The remaining are either reduced or restricted practice. Reduced practice states for APRNs include Ohio, Illinois, Wisconsin, Utah, Louisiana, and so on. Lastly are the worst states to practice in as APRNs. These have licensure laws that only allow restricted practice which give the APRN very little room to flourish. These states include Florida, Texas, Michigan, Georgia, and California, amongst others (Maryville University, 2019; AANP, 2018). NUR 513 Week 2 Discussion Questions

The future of the PMHNP and other APRNs however looks bright and their traditional role as seen above is definitely set to expand. This is because there is a shortage of physicians as they move to the super specialties leaving disciplines like family medicine with severe shortages of manpower. APRNs are the cadre that will fill this vacancy (Maryville University, 2019). After education and training the PMHNP is expected to get certification before applying for a practicing licence from the state in which they intend to practice. In the case of the PMHNP, the agency tasked with this certification is the American Nurses Credentialing Centre or ANCC (ANCC, n.d.). All that the graduated nurse practitioner needs to do is to sit for a competency examination that tests for clinical acumen, knowledge, and skills. After passing the examination and the board certification (BC) is awarded, the official title of the nurse practitioner changes to PMHNP-BC (ANCC, n.d.). The certification lasts for five years, after which it needs to be renewed.

On the matter of accreditation, it is the particular course that the PMHNP does at the university that needs to be accredited. Accreditation of courses and institutions takes place both at the regional level and the national level (EDsmart, n.d.). There is preference, however, for the regional accreditation of courses as it is easy to transfer credits to another institution this way. Some of the regional accreditation bodies include the Higher Learning Commission (which is recognized by the US Department of Education) and the Northwest Commission on Colleges and Universities. In summary, the process therefore starts with enrolling in a duly accredited postgraduate course. After completion of the course, the nurse practitioner applies for board certification and sits for the competency examination. If successful, they then apply for a practice license as per the state’s licensure laws. The licence that they will then get will depend on the state as discussed above and will be for full practice autonomy, a reduced practice, or a restricted practice.

Three Professional Nursing Organizations

Professional organizations are an important component for the advance practice nurse professional. This is especially true considering the challenges with the disparate regulatory structures seen above. Policies and their formulation by their very nature are political processes. Political processes require masses and one voice, if anything is to change. This is the reason why PMHNPs must come together in professional bodies so that they can champion their professional causes. Therefore, professional organizations provide a platform and forum on which psychiatric-mental health nurses can stand and articulate their issues (Catallo et al., 2014). These issues include lobbying state legislators for policy changes towards the granting of full practice authority in the states that still do not have it. Professional bodies also help in the exchanging of professional ideas for better and improved practice. NUR 513 Week 2 Discussion Questions

Three of the most prominent professional organizations for the PMHNP are the American Psychiatric Nurses Association (APNA), the International Society of Psychiatric-Mental Health Nurses (ISPN), and the American Association of Nurse Practitioners (AANP). The ISPN builds capacity by way of mentorship and sharing of ideas, while at the same time helping with sharing professional ideas. The APNA fosters knowledge dissemination and professional support for its members (Adams &Black, 2016). For instance, by the year 2016 it had come up with a short online course to help its members seal some identified knowledge gaps. The program was titled American Psychiatric Nurses Association Transitions in Practice (ATP) (Adams & Black, 2016). The American Association of Nurse Practitioners (AANP) on its part provides professional support and encouragement by conferring Fellowship status to those members that have done something remarkable to the profession. NUR 513 – Benchmark – Future Scope, Role, and Professional Obligations Paper The Fellowship status is only by nomination. Thus those who have received this prestigious recognition carry the title of Fellow of the American Association of Nurse Practitioners (FAANP) (Rossiter et al., 2017).

Controversial Issue

The most important controversial issue for a PMHNP at the moment is the matter of evidence-based practice. It is only psychiatry and mental health that is lacking behind in implementation of evidence-based practice in all of medicine. This is because of long-held traditions that have proved hard to drop completely (Alzayyat, 2014).

  1. Adams, S.M., & Black, P. (2016). American Psychiatric Nurses Association –Transitions in practice certificate program: Bridging the knowledge gap in caring for psychiatric patients within the general nursing workforce.
  2. Nursing Administration Quarterly, 40(3), 225-236. Doi: 10.1097/NAQ.0000000000000168
  3. Alzayyat, A.S. (2014). Barriers to Evidence-Based Practice Utilization in Psychiatric/Mental Health Nursing. Issues in Mental Health Nursing, 35, 134-143. Doi: 10.3109/01612840.2013.848385
  4. American Association of Nurse Practitioners [AANP] (2018). State practice environment. Retrieved 14 September 2019 from
  5. American Nurses Credentialing Centre [ANCC] (n.d.). Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC). Retrieved 14 September 2019 from
  7. Catallo, C., Spalding, K. & Haghiri-Vijeh, R. (2014). Nursing professional organizations: What are they doing to engage nurses in health policy? SAGE Open, 1-9. Doi: 10.1177/2158244014560534
  8. EDsmart (n.d.). Regional vs. national accreditation  theres a huge difference. Retrieved 14 September 2019 from
  9. International Society of Psychiatric-Mental Health Nurses [ISPN] (2019). International Society of Psychiatric-Mental Health Nurses. Retrieved 13 September 2019 from
  10. Maryville University (2019). States granting NP full practice authority. Retrieved 14 September 2019 from
  11. Rossiter, A.G., Sabol, V.K. & Hicks, R.W. (2017). So you want to be a Fellow in the American Association of Nurse Practitioners: Navigating the Fellowship process to ensure your success. Journal of the American Association of Nurse Practitioners, 29, 501-505. Doi: 10.1002/2327-6924.12508

 NUR 513 Week 2 Discussion Questions

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