ChallengesandOpportuni2esFacingthePsychiatricMentalHealthNursing

Workforce

KathleenRDelaney,PhD,PMH-NP,FAANRushCollegeofNursing,Chicago

ThankYou!

TopicsWeWillCoverToday•  OverviewofthePsychiatricMentalHealth(PMH)

AdvancedPrac2ceRegisteredNurse(APRN)workforce:itssize,characteris2cs,distribu2on,educa2onalprepara2onandpoten2alforgrowth.

•  Challengestheworkforcefacesincluding:clarifyingmisconcep2onsaroundthecapacityofPMHAPRNstoalleviatementalhealthworkforceshortagesandaddressinganevolving,narrowdefini2onofourdisciplineasalterna2veprescribers.

•  Opportuni2esforPMHRNsandAPRNsincludingusingtheircapabili2estoaddressaccesstocare,tobuildeffec2veandefficientinterprofessionalteamsandtoaddressissuesaroundserviceengagement.

OverviewofthePMHAPRNWorkforce

PMHAdvancedPracGceRegisteredNurses(APRNs):BasicDescriptors

•  PsychiatricMentalHealth(PMH)APRNsholdanRNandaPMHgraduatenursingdegree

•  NaGonallycerGfiedaseitherPMHClinicalNurseSpecialists(CNS)orPMHNursePracGGoner(NP)

•  Thereare15,046cerGfiedPMHAPRNs–  4,768PMHCNSsand10,278PMHNPs(duplicatecerGficaGons

removed)•  63%ofallPMHCNSsworkindirectcarerolesandprescribe(AmericanPsychiatricNursingAssociaGon(APNA),2016NaGonal

Survey)

WhoarePMH-APRNs:DemographicsFromtheAPNA2016PMHAPENSurvey:•  PMHAPRNworkforceislargelyfemale(90.1%);male(9.9%)•  Largelywhite•  Averageageof54•  TheCNSgroupisslightlyolder(x=61)versusNP(x=48.9)•  PreparaGonatMSNlevel(82%),Postmasterslevel(25%)•  32%ofrespondentscompletedtheireducaGonmorethan20

yearsago(from1970-1994)

0

50

100

150

200

250

300

350

25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89

numbe

r

AgeofPMHAPRNs

PMHNPEducaGonalTrainingisConsistentacrossPrograms:DirectedbyNaGonalCompetencies

•  PMHNPprogramsfollowNaGonalOrganizaGonofNursePracGGonerFaculGes(NONPF)competencies

•  118PMHNPgraduateprograms-bothMastersandDoctorofNursingPracGce(DNP)level*

•  PMHNPgraduateprogramseducatestudentsin-ConducGngcomprehensivepsychiatricassessments-Diagnosis,treatmentplanning,evaluaGon-Deliveryofawiderangeofevidence-basedtherapyintervenGons,includingprescribingpsychotropicmedicaGons-PaGenteducaGon,parGcularlywithinarecovery-orientedframe

*Note:InlinewithAPRNConsensusModel:since2014allAPRNsnowgraduatefromPMHNPprograms

•  PMHNPsareeducatedacrossthelifespan

GiventhePMHNPEducaGonalPipelinetheSpecialtyAnGcipatesConsiderableGrowth

•  Currently6377studentsenrolledinaPMHNPprogramatthemastersordoctorallevel:– 43%increaseinenrolledstudentsfrom2012-2013– 24%increaseinenrolledstudentsfrom2013-2014– 63%increaseinenrolledstudentsfrom2015-2016

•  ThisenrollmentrateputsthespecialtyontargettoreachtheHRSA(2015)esGmatethatby2025thePMHNPworkforcewillbe17,900.

AvailabilityofPMHNPProgramsandStatePracGceRegulaGonsImpactsAPRNDistribuGon

DetailsaboutPMH-APRNworkforce:UpcomingPsychiatricServicesPublicaGon

ChallengesFacingthePMHAPRNWorkforce

Challenges:IncreasingWorkforceDiversityandDistribuGonofPMHAPRNs

4%

1% 2% 4%

1%

78%

10%

RacialdemographicsPMHAPRNs

From2016APNAsurvey

Hispanic/LaGno

AmericanIndian/AlaskaNaGve

Asian

Black/AfricanAmerican

NaGveHawaiian/OtherPacificIslander

White

0%2%4%6%8%

10%12%14%16%18%20%

CommunitysizewhereprincipalAPNpracEceis

located

Challenge:DisseminaGngInformaGonabouttheCapabiliGesofthePMHAPRNWorkforce

PMHAPRNscapabiliGeshaveliglevisibilityinWorkforceReports/Researchonworkforceplanning.InformaGonaboutthespecialtyisohenincorrect;thisimpedeseffecGveworkforceplanningandaddressingMHPSA.

Challenge:BuildinganUnderstandingofStateLawsWhichDeterminePMHAPRNsPracGceParametersandRegulaGonsFullPracGceAuthoritytoRestricted

RetrievedFromhgps://www.ncsbn.org/5407.htm

Challenge:BuildinganAccuratePictureand

UnderstandingofPMHAPRNScopeofPrac2ce

MostPatients SomePatients FewPatients NoPatients

55.2% 13.5% 8.2% 4.5%

866 404 122 178

69.1% 3.8% 0.9% 2.1%

1086 269 65 15214.4% 2.2% 3.9% 12.4%223 159 276 889

42.0% 6.1% 2.3% 4.2%

655 440 163 303

71.4% 1.4% 0.6% 4.3%

1119 100 43 306

21.3% 3.8% 4.0% 9.3%

331 271 288 6636.3% 1.9% 2.7% 15.6%98 133 195 1119

83.0% 2.2% 0.5% 1.0%1303 159 34 7452.3% 6.4% 1.9% 2.1%819 461 137 148

42.6% 8.2% 2.3% 2.0%667 591 164 142

Diagnosis, treatment, and management of acute illnesses

Diagnosis, treatment, and management of chronic illnesses

Provide care coordination

Make referrals

Conduct physical examinations

Order, perform, and interpret lab tests, x-rays, EKGs, and other diagnostic studies

Prescribe drugs for acute and chronic illnesses

Provide preventative care, including screening and immunizations

Perform procedures

Educate patients and families

PMH-APRNsareEducatedCerGfiedandLicensedtoProvidethefullrangeofMentalHealthServices

Datafrom2016APNAsurveyofPMHAPRNs

ThisskillsetisfoundaGonaltointegratedmodelsofcareandprovidingservicestocomplex,ohenunderservedpopulaGons

PMHAPRNsProvideaRangeofServicesBeyondPrescribing:SkillsthatcanoverlookedintheRushtofillPrescribingRoles

OpportuniGestoImproveAccessandQualityviatheEffecGveuseofthePMHAPRNWorkforce

PMHAPRNsPracGceinVirtuallyEverySelngsWhereHealthCareisDelivered

159

230

11584

4498

28

129 132

17 3685

0%

5%

10%

15%

20%

25%Break-downofambulatoryandhospitalseIngs

TransportabilityofskillsbringsopportunitytoimproveaccesstocareandalsobringcaretowherePrevenGonshouldoccur(e.g.schools)andwhereBehavioralHealthcareneedsemerge(e.g.correcGons)

OpEmizinguseofPMHRNs•  Screeningformentalhealth/

substanceusecondiGons•  CareManagement•  Useoftriageskills•  OversightofPrevenGon•  Proficiencyinsteppedcare

intervenGonmodel•  Deliverbasicbehavioral

healthintervenGons(IOM)•  WellnessIniGaGves•  BuildingServiceEngagement

OpportunityforIncreasingEffecGveness:BuildingTeamsWhereMembersWorktotheTopoftheirEducaGonandScopeofPracGce

Oftheapproximately3.3millionprofessionallyAcEveRNs,4%pracEceinPMHRNroles

OpEmizinguseofPMHAPRNs

•  Developingalgorithmstolevelcare•  Monitoringmeasurement-basedcaremetrics•  DesigningpopulaGonhealthiniGaGves•  QualityimprovementparGcularlyaroundagriGon•  DirectcaredeliveryofcomplexpaGents•  LeadingcollaboraGvecareteams

OpportunitytoImproveServiceEngagementowingtoPMHAPRN/RNDisciplinaryFoundaGoninInterpersonalEngagement

Acomplexmixofperceivedneedfortreatmentandbarrierswhichlimitaccesstoservicesresultsinpoorserviceengagementorprematurewithdrawalfrommentalhealthservices.

From:Russinova,Rogers,&Ellison,2006

CompetenciestoachieveengagementgobeyondrelaGonshipskills

RecoveryorientedcaredemandsagenGontotheindividual’snarraGve

ForpeoplewithpsychiatricdisabiliGes,theactoftellingone’snarraGvecanfacilitateahealingprocessthatincreasescopingabilityasoneintegratesthetraumaexperiencedinconjuncGonwithsymptomsandsGgmaGzaGonintoasenseofselfbroadenedratherthanlimitedbyexperience. Onken,Craig,Ridgway,Ralph&Cook,2007

NarraGveAgunementEmpathyPresence

InterpersonalProcess

InaPMHnursingframe,toapprehendthenarraGvedemandsacapacitytobepresent,assumeacompassionatestancetotheindividual’sconcerns,agunewithone’sownongoingresponse,forgeacommonunderstandingoftheindividual’sdefiniGonofhealthandrecovery

DetailsontheseIssuesinUpcoming-JournalofBehavioralHealthCareResearchandPrac2ce

EffecGveuseofPMHAPRNsandRNinBehavioralHealthCare:PolicyImplicaGons•  FromtheseChallengesandOpportuniGesseveralPolicyimplicaGonsemerge–  SupportresearchonRNandAPRNrolesineffecGveintegratedteammodelsofcare

–  Collectdataonstateleveladequacyofmentalhealthproviders,considerPMHAPRNsasproviderstomiGgateMentalHealthCareHPSAs(currently4,627)

–  EliminatebillingpoliciesthatcontributetotheinvisibilityofPMHRNsandAPRNs(incidenttobilling)

– AdvocateforallAPRNstopracGcetothefullextentoftheirlicense

QuesGonsorComments

References•  AmericanHealthInsurancePlans(2016).Newdatabrieffindsphysicianshortagesleadtonetworkadequacychallenges.

Retrievedfromhgps://ahip.org/new-data-brief-finds-physician-shortages-lead-to-network-adequacy-challenges/•  AmericanNursingCredenGalingCenter(2016).2016ANCCcerGficaGondata.Retrievedromhgp://

www.nursecredenGaling.org/CerGficaGon/FacultyEducators/FacultyCategory/StaGsGcs/2016-CerGficaGonStaGsGcs.pdf•  Delaney,K.R.(2016).PsychiatricmentalhealthnursingworkforceagendaopGmizingcapabiliGesandcapacitytoaddress

workforcedemands.JournaloftheAmericanPsychiatricNursesAssocia2on,22,122-131.•  deNesnera,A.,&Allen,D.E.(2016).ExpandingtheroleofpsychiatricmentalhealthnursepracGGonersinastate

psychiatricsystem:TheNewHampshireexperience.PsychiatricServices,67,482–484.•  Durbin,A.,Durbin,J.,Hensel,J.M.,&Deber,R.(2016).BarriersandenablerstointegraGngmentalhealthintoprimarycare:

Apolicyanalysis.JournalofBehavioralHealthServices&Research,43,127-139.•  Fang,D.,Li,Y.,Kennedy,K.A.,&Trautman,D.E.(2016).2015-2016Enrollmentandgradua2onsinBaccalaureateand

GraduateProgramsinNursing.WashingtonDC:AACN.•  Graves,J.A.,Mishra,P.,Digus,R.S.,Parikh,R.,Perloff,J.,&Buerhaus,P.I.(2016).RoleofgeographyandNursePracGGoner

Scope-of-PracGceineffortstoexpandprimarycaresystemcapacity:Healthreformandtheprimarycareworkforce.Medicalcare,54,81-89.

•  HealthResourcesandServicesAdministraGon(2015)Projec2ngtheSupplyofNon-PrimaryCareSpecialtyandSubspecialtyClinicians:2010-2025.Retrievedfromhgp://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/clinicalspecialGes/index

•  Miller,C.J.,Grogan-Kaylor,A.,Perron,B.E.,Kilbourne,A.M.,Woltmann,E.,&Bauer,M.S.(2013).CollaboraGvechroniccaremodelsformentalhealthcondiGons:cumulaGvemeta-analysisandmeta-regressiontoguidefutureresearchandimplementaGon.MedicalCare,51(10),922-930.

•  NaGonalOrganizaGonofNursePracGGonerFaculGes(NONPF)(2013).Popula2onFocusedNursePrac22onerCompetencies.Retrievedfromhgp://www.pncb.org/pGstore/resource/content/about/PopulaGon_Focused_NP_Core_Comptencies.pdf

•  Phoenix,B.J.,Hurd,M.,&Chapman,S.A(2016).ExperienceofPsychiatricMentalHealthNursePracGGonersinpublicmentalhealth.NursingAdministra2onQuarterly,40,212-224.

•  Russinova,Z.,Rogers,E.S.,Ellison,M.L.,&Lyass,A.(2011).Recovery-promoGngprofessionalcompetencies:perspecGvesofmentalhealthconsumers,consumer-providersandproviders.PsychiatricRehabilita2onJournal,34(3),177-185.

•  StaffCare(2015).Behavioralhealth:Thesilentshortage.Retrievedfrom hgp://www.staffcare.com/uploadedFiles/StaffCare/Content/Resources/Blogs/white-

•  XueY&Intrator,O.(2016)CulGvaGngtheroleofNursePracGGonersinprovidingprimarycaretovulnerablepopulaGonsinaneraofhealth-carereform.PolicyPoli2csNursingPrac2ce,17,24-31

•  Xue,Y.,Ye,Z.,Brewer,C.,&Spetz,J.(2016).ImpactofstatenursepracGGonerscope-of-pracGceregulaGononhealthcaredelivery:SystemaGcreview.NursingOutlook,64,71-85.