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ANCC PMHNP CHAPTER 2 PSYCHIATRIC-MENTAL HEALTH NURSE
PRACTITIONER ROLE, SCOPE OF PRACTICE, AND REGULATORY
PROCESS
All nurse practitioners upon graduation are expected to meet - --NURSE PRACTITIONER ADVANCED PRACTICE CORE CONTENT a set of core competencies Specialty competencies, such as the Psychiatric-Mental Health Nurse Practitioner Competencies, are then built upon these core competencies (NONPF, 2013). Nurse Practitioner Core Competencies are based on "THE Q SLIPP" - --*Technology and Information Literacy *Health Delivery System *Ethics *Quality
- Scientific Foundations *Leadership *Practice Inquiry *Independent Practice *Policy What are the 3) MHNP Leadership Competencies - --Leadership Competencies 1)Participates in and evaluate community/population-focused programs that: promote mental health
prevent or reduce risk of mental health problems 2)Advocates for complex client and family medicolegal rights and issues 3)Collaborates with colleagues about advocacy, policy to reduce health disparities and improve outcomes for populations Quality Competencies - --Quality Competencies Evaluates the appropriate uses of seclusion and restraints in the care process Policy Competencies - --Policy Competencies Employs opportunities to influence health policy to reduce the impact of stigma on services for prevention and treatment of mental health problems and psychiatric disorders Independent Practice Competencies - --Independent Practice Competencies Develops age-appropriate treatment plans Includes differential diagnosis Assesses impact of acute and chronic medical problems on psychiatric treatment
Uses self-reflection to improve care Provides consultation to healthcare providers and others to enhance quality and cost Guides the client in evaluating the appropriate use of complementary and alternative treatment Uses individualized outcome measure to evaluate psychiatric care Manages psychiatric emergencies Refers clients appropriately Facilitates the transition of clients across levels of care Uses outcomes to evaluate care Attends to the client-NP relationship as a vehicle for change Maintains a therapeutic relationship over time with individuals and groups Therapeutically concludes the client-NP relationship Demonstrates ability to address sexual and physical abuse, substance abuse, sexuality, and spiritual conflicts
Applies therapeutic relationship strategies based on theory and research Applies principles of self-efficacy, empowerment, and others to effect change Identifies The NP role was introduced in what year by whom? discuss HX - --HISTORY OF THE NP ROLE introduced in 1965 by Loretta C. Ford, EdD, and Henry K. Silver, MD, at the University of Colorado (Mirr Jansen & Zwygart-Stauffacher, 2006). They identified new roles in which experienced registered nurses (RNs) with advanced education and skills were performing clinical duties traditionally reserved for physicians. Universities were slow to implement NP programs at the master's level. However, RNs embraced the new role and rushed into continuing education programs of varying length, quality, and focus to accomplish the necessary educational preparation for this new role. As part of the LACE model, Psychiatric-Mental Health was identified as a population focus. The American Psychiatric Nurses Association (APNA) and International Society of Psychiatric Nurses (ISPN) recommendation was for psychiatric-mental health nurse practitioners (PMHNPs) to be prepared across the life span (APNA, 2011). As of 2015 APRNs in psychiatric-mental health nursing have one certification examination, PMHNP-Life Span, with the American Nurses Credentialing Center (ANCC, 2015). All previous psychiatric-mental health advanced practice certification examinations have been retired as of December 2015 (ANCC, 2015).
*Growing competition in job market in general for NPs *Reimbursement struggles with Medicare and private insurance companies *Overlapping scope of practice with other NPs *Increased concerns over reimbursement fraud and abuse (e.g., issues of coding and billing for services) *Scope of practice and need for formal supervisory or collaborative relationships with physicians Regulatory and Statutory Dimensions of the NP Role State legislative statutes & The Nurse Practice Act - --Regulatory and Statutory Dimensions of the NP Role State legislative statutes
- Grant legal authority for NP practice The Nurse Practice Act of every state
- Provides title protection (who may be called a nurse practitioner)
- Defines advanced practice
- Prevailing state laws that define scope of practice (what NPs may do)
- Places restrictions on practice
- Sets NP credentialing requirements (e.g., educational requirements, certification)
- States grounds for disciplinary action: ** Practicing without valid license ** Falsification of records ** Medicare fraud
** Failure to use appropriate nursing judgment ** Failure to follow accepted nursing standards ** Failure to complete accurate nursing documentation
- May specifically require that an NP develop a collaborative agreement with a physician ** Collaborative agreement: Also known as a protocol that describes what types of drugs might be prescribed and defines some form of oversight for NP practice Regulatory and Statutory Dimensions of the NP Role Statutory law, Licensure, Credentialing, Certification - --Regulatory and Statutory Dimensions of the NP Role Statutory law
- Rules and regulations differ for each state
- May further define scope of practice and practice requirements
- May provide restrictions in practice unique to specific state Licensure
- A process by which an agency of state government grants permission to persons to engage in the practice of that profession
- Also prohibits all others from legally doing protected practice Credentialing
- Process used to protect the public by ensuring a minimum level of professional competence Certification
- Reflect professional agreement focused on the minimum levels of acceptable performance
- Can be used to legally describe the standard of care that must be met by a provider
- May be precise protocols that must be followed or more general guidelines that recommend actions PROFESSIONAL ROLE RESPONSIBILITIES Confidentiality - --PROFESSIONAL ROLE RESPONSIBILITIES Confidentiality
- The client's right to assume that information given to the healthcare provider will not be disclosed
- Protected under federal statute through the Medical Record Confidentiality Act of 1995 (S.
- Pertains to verbal and written client information
- Requires that the provider discuss confidentiality issues with clients, establish consent, and clarify any questions about disclosure of information
- Requires that provider obtain a signed medical authorization and consent form to release medical records and information when requested by the client or another healthcare provider PROFESSIONAL ROLE RESPONSIBILITIES HIPAA - --PROFESSIONAL ROLE RESPONSIBILITIES HIPAA
- The first national comprehensive privacy protection act
- Guarantees clients four fundamental rights:
- To be educated about HIPAA privacy protection,
- To have access to their own medical records,
- To request amendment of their health information to which they object, and
- To require their permission for disclosure of their personal information. PROFESSIONAL ROLE RESPONSIBILITIES The Health Information Technology for Economic and Clinical Health Act (HITECH) - -- PROFESSIONAL ROLE RESPONSIBILITIES The Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 (Health Resources and Services Administration [HRSA], 2013)
- Incentive payments for sharing specific electronic health record (EHR) data
- Meaningful use incentives
- Electronic health records can improve both individual and population-based health outcomes (Friedman, Parrish, & Ross, 2013).
- Electronic health records can improve quality, safety, efficiency, effectiveness, and outcomes (U.S. DHHS, Office for Civil Rights, 2013).
- E-prescribing
- Computerized physician order sets
- Tracking care and avoiding duplication of services PROFESSIONAL ROLE RESPONSIBILITIES Telehealth - --PROFESSIONAL ROLE RESPONSIBILITIES Telehealth
- The use of telephone or videoconferencing tools to deliver mental health care to clients who reside in rural areas or who may otherwise not be able to access care
- The communication process between the provider and the client that results in the client's acceptance or rejection of the proposed treatment
- An explanation of relevant information that enables the client to make an appropriate and informed decision
- The right of all competent adults or emancipated minors ** Emancipated minors: Persons younger than 18 years old who are married, parents, or self- sufficiently living away from the family domicile
- Elements of informed consent ** Nature and purpose of proposed treatment or procedure ** Risks or discomforts and benefits of treatment ** Risks and benefits of not undergoing treatment ** Alternative procedures or treatments ** Diagnosis and prognosis
- Provider must document in the medical record that informed consent has been obtained from the client.
- PMHNP is responsible for ensuring that the client is cognitively capable of giving informed consent. PROFESSIONAL ROLE RESPONSIBILITIES Ethics - --PROFESSIONAL ROLE RESPONSIBILITIES
Ethics
- Important aspect of the NP role that deals with moral duties, obligations, and responsibilities
- What is right versus what is wrong
- Ethical principles that provide foundation and direction for complex decisions: ** Justice: Doing what is fair; fairness in all aspects of care ** Beneficence: Promoting well-being and doing good ** Nonmaleficence: Doing no harm ** Fidelity: Being true and loyal ** Autonomy: Doing for self ** Veracity: Telling the truth ** Respect: Treating everyone with equal respect
- In 2015 the American Nurses Association (ANA) published the Code of Ethics for Nurses with Interpretive Statements (ANA, 2015). Its nine provisions are:
- The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of everyone.
- The nurse's primary commitment is to the client, whether an individual, family, group, community, or population.
- The nurse promotes, advocates for, and protects the rights, health, and safety of the client.
- The nurse has the authority, accountability, and responsibility for nursing practice, makes decisions, and takes action consistent with the obligation to promote health and provide optimal care.
- Which option sacrifices the fewest high-priority values (a harm reduction approach)? Theoretical approaches to ethical decision-making
- Deontological Theory: An action is judged as good or bad based on the act itself regardless of the consequences.
- Teleological Theory: An action is judged as good or bad based on the consequence or outcome.
- Virtue Ethics: Actions are chosen based on the moral virtues (e.g., honesty, courage, compassion, wisdom, gratitude, self-respect) or the character of the person making the decision. Ethics of Disclosure by Providers - --Ethics of Disclosure by Providers
- Clients have a right to know what is happening during the course of their treatment.
- Providers have an ethical responsibility to disclose medical errors, accidents, injuries, and negative results to clients.
- As a result of the disclosure, a client may have legal right to compensation for harm suffered due to medical misadventures (Sadock, Sadock, & Ruiz, 2015). Risk vs. Benefits of Disclosure of Disability Regarding Employment - --Risk vs. Benefits of Disclosure of Disability Regarding Employment
- The Americans with Disabilities Act (ADA) works to prevent discrimination by employers with 15 or more employees against qualified persons in hiring, firing, advancement, job training, compensation, and workplace conditions (Buppert, 2012).
- The ADA is federal legislation granting Americans who have disabilities, including mental illness, the opportunity for employment on an equal basis with the nondisabled.
- Employers are required to make reasonable accommodations for qualified applicants or employees with a disability. Risk of Disclosure - --Risk of Disclosure
- Employers may find ways to avoid hiring persons known to have a disability.
- Coworkers may harass or discriminate against persons with psychiatric illnesses.
- Assumption that persons with psychiatric illnesses may be less productive
- May limit an employee's chance for advancement in career
- Feedback for improvement may not be given to employee because others may attribute the employee's behavior to the psychiatric illness.
- Labeling oneself as "disabled" may affect one's beliefs or self-image. Benefits of Disclosure - --Benefits of Disclosure
- Able to request reasonable accommodations
- Opportunity to have a job coach come to the worksite and communicate directly with employer
- Employee can involve an employment service provider, employee assistance program, or other third party in the development of accommodations.
- Easier for employee to come to work during an exacerbation of symptoms
- May help with the recovery process
- Allows coworkers to offer personal support
- May empower another employee to disclose Legal Considerations - --Legal Considerations Malpractice insurance
*If a person is deemed incompetent, a court-appointed guardian will make healthrelated decisions for that person. Commitment - --Commitment
- Process of forcing a person to receive involuntarily evaluation or treatment
- Process may differ from state to state
- Basic criteria include ** Person has a diagnosed psychiatric disorder, ** Person is harmful to self or others as a consequence of the disorder, ** Person is unaware or unwilling to accept the nature and severity of the disorder, and ** Treatment is likely to improve functioning.
- Involuntary admission ** Admission to a hospital or other treatment facility against the person's will ** Clients maintain all civil liberties except the ability to come and go as they please ** Amount of time clients can be kept against their wishes varies by state
- Voluntary admission ** Admission to a hospital or other treatment facility that a person desires or agrees to ** Client maintains all civil liberties ** Client consents to potential confinement within the structure of a hospital setting ROLES OF THE PMHNP Scholarly Activities - --ROLES OF THE PMHNP
Scholarly Activities
- It is important for NPs to engage in the following scholarly activities: ** Publishing ** Lecturing or presenting ** Preceptorship ** Continuing education ROLES OF THE PMHNP Mentoring - --ROLES OF THE PMHNP Mentoring
- A process in which a more experienced NP agrees to guide and support a junior colleague in the role, competencies, and skills
- Requires mutual respect and an interactive process of learning
- Needs involvement by both the mentor and the mentee in the relationship ROLES OF THE PMHNP Client Advocacy - --ROLES OF THE PMHNP Client Advocacy
- Stand up for clients' rights and empower them to become their own advocates
