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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
*Leadership
*Practice Inquiry
*Independent Practice
*Policy
What are the 3) MHNP Leadership Competencies - --Leadership Competencies
- Participates in and evaluate community/population-focused programs that:
promote mental health
prevent or reduce risk of mental health problems
Advocates for complex client and family medicolegal rights and issues
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
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
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
- 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
** 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.
** 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
** 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
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
