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Week 1 Nurse Practitioner Professional Issues Paper
Week 1 Nurse Practitioner Professional Issues Paper
Psychiatric-mental health nurse practitioners are committed to the assessment, diagnosis, and treatment of psychiatric disorders in individuals and groups through psychotherapy and medication. Since the role of the PMHNP carries such responsibility, it is no surprise that there is a rigorous path to obtain and maintain your PMHNP certification and licensure.
PMHNPs currently have only one choice for certification, which is through the American Nurses Credentialing Center (ANCC). The ANCC offers the “psychiatric/mental-health nurse practitioner (across the lifespan)” board certification (PMHNP-BC). In many states, board certification is a necessary prerequisite to receiving an NP license. Even if board certification is not a requirement for state licensure, it may be a requirement to receive privileges in various hospitals and other health care facilities. Malpractice insurance providers may also require board certification prior to issuing coverage to NPs.
This week, you will review your state specific PMHNP certification and licensure requirements and scope of practice, as well as prescriptive authority issues.
Week 1 Nurse Practitioner Professional Issues Paper Learning Objectives
Summarize nurse practitioner certification and licensure processes
Explain state-specific scope of practice for psychiatric-mental health nurse practitioners
Explain state-specific restrictions or limitations for practice
Explain nurse practitioner prescriptive authority and DEA registration processes
Required Readings (click to expand/reduce)
American Association of Nurse Practitioners. (2020). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment
On the map on the webpage, click on your state and review. After you complete the PMHNP Program, pass the certification exam, and get a job, you will need to revisit this website to apply for the privilege to practice as an APRN with your state Board of Nursing.
American Psychiatric Association. (2020). Telepsychiatry. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry
Buppert, C. (2021). Nurse practitioner\’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
Chapter 1, “What Is a Nurse Practitioner?”
Chapter 2, “Nurse Practitioner Scope of Practice”
Chapter 3, “State Regulation of the Nurse Practitioner Practice”
Chapter 4, “Federal Regulation of the Nurse Practitioner Profession”
Chapter 5, “Prescribing”
Centers for Disease Control and Prevention. (2020). Using telehealth to expand access to essential health services during the COVID-19 pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html
Centers for Medicare & Medicaid Services. (2019). National provider identifier standard (NPI). https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.
Drug Enforcement Administration Diversion Control Division. (2020). Registration. https://www.deadiversion.usdoj.gov/drugreg/index.html
This site contains information about applying for your DEA registration number. This number is required for writing prescriptions.
After completing PMHNP Program and passing the PMHNP certification exam, complete the DEA application to request prescriptive privileges. Your DEA number will be renewable every five years.
National Panel for Psychiatric Mental Health NP Competencies. (2003). Psychiatric-mental health nurse practitioner competencies. National Organization of Nurse Practitioner Faculties (NONPF). https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/imported/PMHNPcomps03.pdf
Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.
Chapter 1, “Historical Perspectives: The Art and Science of Nurse Practitionering”
Nurse Practitioner Core Competencies
Nurse Practitioners’ Unique Role
Chapter 13, “Quality, Safety, and Prescriptive Authority”
Substance Abuse and Mental Health Services Administration. (2020). Become a buprenorphine waivered practitioner. https://www.samhsa.gov/medication-assisted-treatment/buprenorphine-waiver-management/apply-for-practitioner-waiver
This site contains information about applying for a practitioner waiver to prescribe or dispense buprenorphine under the Drug Addiction Treatment Act of 2000 (DATA 2000).
After you obtain a Drug Enforcement Agency (DEA) number and completed 24-hour medication-assisted treatment (MAT) waiver training, you may apply to Substance Abuse and Mental Health Services Administration (SAMSHA) for MAT waiver to be able to prescribe Schedule III, IV, or V opioid drugs for the maintenance and detoxification treatment of opioid use disorders relapse prevention.
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
Chapter 2, “The Role of the Psychiatric-Mental Health Nurse Practitioner: Regulations and Scope of Practice”
Chapter 3, “Theoretical Foundations of Care and Nonpharmacological Therapies”
Consult these professional organization websites as needed.
American Psychiatric Nurse Association (APNA) https://www.apna.org
International Society of Psychiatric-Mental Health Nurses (ISPN) www.ispn-psych.org
National Alliance on Mental Illness (NAMI) https://www.nami.org
National Council for Behavioral Health (NCBH) www.thenationalcouncil.org
National Institute of Mental Health (NIMH) https://www.nimh.nih.gov/index.shtml
Substance Abuse and Mental Health Services Administration (SAMHSA) www.samhsa.gov
PMHNP Study Support Lounge
The PMHNP Study Support Lounge is offered throughout the course as a place of academic refuge, where you can ask questions, offer insights, and interact with your peers. Your Instructor may also weigh in to provide collective feedback to the group based on trends, common problems, and common strengths in student posts.
Photo Credit: [Jacob Ammentorp Lund]/[iStock / Getty Images Plus]/Getty Images
As a peer, you are encouraged to provide constructive helpful feedback. Advanced practice nurses always benefit from the feedback of others. Your Study Support Lounge posts may be procedural (“How do I attach a Kaltura video to a Discussion post?”), conceptual (“How does this relate to the other therapy approaches we have studied?”), or analytical (“What do these diagnostic results actually mean in the context of this specific patient case?”). Although not mandatory, this is an opportunity to interact and study together as you navigate the assignments, so you are highly encouraged to take part in this activity. Full participation in activities like this is a statistically significant predictor of success. Week 1 Nurse Practitioner Professional Issues Paper
To Participate in this Optional Discussion:
PMHNP Study Support Lounge
Practicum Manual Acknowledgment
The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.
Field Experience: MSN Nurse Practitioner Practicum Manual
Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.
Discussion: Certification and Licensure Plan
Now that you are in the final course in your program, it is time to turn in earnest to preparing for certification and licensure. You will need to take and pass the national PMHNP certification exam. Once certified, you will then be eligible to apply for licensure as an advanced practice registered nurse (APRN) in the state desired. It will be up to you to ensure you are knowledgeable about the practice agreements, scope of practice, and prescriptive authority in your state.
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Although a movement called the APRN Consensus Model is attempting to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish an independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement.
Another important area to consider and plan for is prescriptive authority. The appropriate board, which may be the medical board, state board of pharmacy, or nursing board, grants prescriptive authority under state law for the appropriate state licensure. The federal government grants the authority to write for a controlled substance, and the Drug Enforcement Administration (DEA) verifies this action through by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.
In this Discussion, you will locate and review the practice agreements in the state in which you plan to practice, identify potential collaboration requirements in your state, and understand the certification and licensing process that you will need to follow.
To Prepare for Week 1 Nurse Practitioner Professional Issues Paper:
Review practice agreements in your state.
Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are.
Research the following:
How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?
What is the application process for certification in your state?
What is your state’s board of nursing website?
How does your state define the scope of practice of a nurse practitioner?
What is included in your state practice agreement?
How do you get a DEA license?
Does your state have a prescription monitoring program (PMP)?
How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
By Day 3 of Week 1
Post a summary of your findings on your state based on the questions listed above. Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state. Be specific. Also, describe what surprised you from your research.
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond to at least two of your colleagues on 2 different days in one or more of the ways listed below.
Share an insight from having viewed your colleagues’ posts.
Suggest additional actions or perspectives.
Share insights after comparing state processes, roles, and limitations.
Suggest a way to advocate for the profession.
Share resources with those who are in your state.
Note: For this Discussion, you are required to complete your initial post before you can view and respond to your colleagues’ postings. Begin by clicking on the \”Post to Discussion Question\” link, and then select \”Create Thread\” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
To access your rubric:
Week 1 Discussion Rubric
Post by Day 3 of Week 1 and Respond by Day 6 of Week 1
To Participate in this Discussion:
Week 1 Discussion
Photo Credit: Getty Images/Blend Images
Telehealth provides a method to increase timeliness of care and access to care for individuals in a variety of different circumstances. Of all the disciplines, psychiatric-mental health care lends itself most easily to this format. For example, a patient who lives far away from medical services can still receive psychotherapy via videoconference. A nurse may be in a remote office coordinating that individual’s treatment plan, managing their medication regimen, or ordering diagnostics or follow-ups. This type of care is evolving in nature and growing in popularity. The role of the PMHNP will continue to emerge in this setting.
Review this week’s resources on telehealth, and consider possible avenues for professional development in this area.
What\’s Coming Up in Week 2?
In Week 2, you will explore the relationships among documentation, coding, and billing in advanced practice nursing as you understand how diagnostic codes and criteria relate to patient service documentation. Additionally, you will revisit the study plan that you created in NRNP 6665 in order to evaluate the progress you have made in your program and develop additional goals to help you prepare for your national certification examination. Week 1 Nurse Practitioner Professional Issues Paper
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Psychiatric Mental Health Nurse Practitioner Sample Approach
Mental well-being is included in the World Health Organization’s definition of health. The definition depicts the significance of mental health as a spectrum of life wholesomeness. Psychiatric mental health nurse practitioners, in addition to psychiatrists, are invaluable healthcare workers who strive to improve mental health care and the overall status of communities (Phoenix, 2019). Appropriate PMNHP certification, licensure, and accreditation are thus required prerequisites before granting PMHNPs the mandate to perform their duties. This paper discusses the certification and licensure process for PMHNPs, the state-specific scope of practice, and practice restrictions or limitations.
Certification and Licensure
While the two terms are frequently used interchangeably, they are not synonymous. Certification indicates that a PMHNP is competent to care for patients in a specific setting. In contrast, licensure indicates that the nurses are legally permitted to practice in a specific state or residence (American Association of Nurse Practitioners, 2020). The nursing boards in each state list the requirements for certification and licensure, and nurses must follow the stated provisions. Nurse practitioners can obtain certification in psychiatric mental health after earning a Master’s of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP). The American Nurses Credentialing Center certifies graduates who have a registered nurse license, have worked 500 supervised clinical hours in the PMHN program, have completed courses in advanced health assessment, advanced pathophysiology, and advanced pharmacology, and have studied content in health promotion, differential diagnosis, and disease management (American Psychiatric Association, 2020). A PMHNP is awarded the credential and is fully licensed, depending on the state, after meeting the eligibility requirements to sit for the certification exams and successfully pass them.
State-Specific Scope of Practice for PMHNP
A PMHNP’s responsibilities are diverse. In Texas, a PMHNP, in addition to the general functions of an advanced nurse practitioner, diagnoses and treats common psychiatric conditions and crises (Rice et al., 2019). Mood disorders, psychotic conditions, substance abuse disorders, and stress-related conditions are all possible. Furthermore, PMHNPs must manage patients’ medications in collaboration with psychiatrists. This necessitates collaborative practice in healthcare, particularly in a mental health setting where many other healthcare providers may be involved in managing a single patient at the same time. The PMNHP in Texas state continues to provide a variety of non-pharmacological management services, including individual, group, and family psychotherapy (Rice et al., 2019). Moreover, the PMHNPs counsel patients with various psychiatric conditions, provide comprehensive patient-family mental health education, perform age-appropriate screening procedures, advocate for family psychiatric mental health clients, and promote wellness-oriented self-care (Rice et al., 2019). The education and experience gained by PMNHPs enable them to perform the various duties listed as well as practice in a variety of settings. As a result, it is critical for PMHNPs to be adaptable to changes in the environment, as well as willing to learn and collaborate with other professionals.
State-Specific Restrictions and Limitations for Practice
The restrictions on PMHNP practice in Texas are minimal. First, before becoming a PMHNP, the written practice agreement specifies the nurse practitioner’s prescribing authority; however, a physician is frequently required to review it (American Association of Nurse Practitioners, 2020). Similarly, PMHNPs are free to practice with few restrictions, except that they should always work alongside psychiatrists to avoid medicolegal issues. The freedom to practice is essential because it allows mental health patients to receive care anywhere without being referred to a psychiatrist. As a result, the majority of mental health care workers in Texas state are PMHNs, and if a problem persists, they consult psychiatrists.
PMHNP’s Prescriptive Authority and the DEA Process
The state of Texas recognizes the value of PMHNPs in the delivery of mental health care. The written practice agreement in Texas states that PMHNPs have full prescribing authority. They can prescribe schedule II-IV controlled substances (Centers for Medicare & Medicaid Services, 2019). They also dispense and administer controlled substances and therapeutic devices in addition to prescribing. However, before PMHNPs are granted prescriptive authority, they must first complete the previously mentioned rigorous training, accreditation, and licensure.
The Drug Enforcement Administration (DEA) is a series of letters and numbers assigned by the DEA to a healthcare provider. It comprises six numbers, two letters, and a check digit. The first letter identifies the provider’s type, while the second letter is the first letter of the provider’s last name (Centers for Medicare & Medicaid Services, 2019). Before applying for a DEA number, the nurse must be licensed to practice in the stated state. The application requires a visit to the DEA’s website and the following information: social security number, state license information, and credit card information (Centers for Medicare & Medicaid Services, 2019). There are about six sections to fill out, which require information about the nurse’s personal and practice details, prescribing authority and limitations, business activity, and the background and payment (Centers for Medicare & Medicaid Services, 2019). The DEA numbers allow the DEA to track who is prescribing controlled substances and how much is being prescribed.
Patients’ mental well-being is just as important as their physical well-being. While some people consider mental health to be a lesser aspect of health, the definition of health is incomplete without it. PMHNP fills the gap in the number of mental healthcare workers. Being accredited and licensed as a PMHNP requires MSN or DNP training. PMHNPs are mandated to diagnose and treat various psychiatric disorders, both pharmacologically and non-pharmacologically, in addition to the general functions of advanced nurse practitioners. In the visible world, where people’s mental health is despised, precautions must be taken to avoid the annual increase in the incidence and morbidity from psychiatric conditions.
American Association of Nurse Practitioners. (2020). State Practice Environment. American Association of Nurse Practitioners. https://www.aanp.org/advocacy/state/state-practice-environment
American Psychiatric Association. (2020). Telepsychiatry. Psychiatry.Org. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry
Centers for Medicare & Medicaid Services. (2019). National Provider Identifier Standard (NPI). Cms.Gov. https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand
Phoenix, B. J. (2019). The current psychiatric mental health registered nurse workforce. Journal of the American Psychiatric Nurses Association, 25(1), 38–48. https://doi.org/10.1177/1078390318810417
Rice, M. J., Stalling, J., & Monasterio, A. (2019). Psychiatric-mental health nursing: Data-driven policy platform for a psychiatric mental health care workforce. Journal of the American Psychiatric Nurses Association, 25(1), 27–37. https://doi.org/10.1177/1078390318808368