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The Psychiatric Mental Health Workforce in Nebraska:

Progress and Potential

Gail W. Stuart, PhD, RN, FAANDean, Medical University of South Carolina, College of Nursing

Board President, Annapolis Coalition for the Behavioral Health Workforce

2nd Annual Psychiatric Nursing Workforce SummitNovember 1, 2017

Your Strengths

• The BHECN is a valuable resource to Nebraska in moving forward this agenda.

• Policy makers in Nebraska see the value of nurses and the need to advance their knowledge, training, employment opportunities and overall utilization in Nebraska’s health care system.  

Your Strengths• The Nebraska Action Coalition is a strong and effective force in the state. 

• NAC is a national model for assessing, planning, implementing and evaluating nursing consistent with the IOM report.

• These Psychiatric Nursing Summits!

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• Big data

http://www.investingreece.gov.gr/default.asp?pid=167&la=1

Personalized Medicine Population Health Health

Technology

http://www.healthcareitnews.com/news/data‐key‐population‐health‐management

Emerging Impacts on Healthcare 

And on the Horizon• Pharmacy robots

• Digestible/imbedded sensors

• Artificial intelligence

• Watson diagnostics

• https://www.youtube.com/watch?v=3qYJ_8hbPSs

Emerging Impacts in Behavioral Health 

• Integrated care

• Populations in need – especially the young and elderly

• Locus of care – hospital vs. community

• Care delivery methods

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Continuum of Physical and Behavioral Health Care Integration

Coordinated Care Colocated Care Integrated Care

Screening

Navigators

Care & Case Managers

Colocation

Health Homes

System‐Level Integration

Opportunities for Better Utilizing Nurses – RN and APRN

Provide true integrated carePhysical and Behavioral

Decrease stigma Screen, triage, brief interventions 

and refer

Nursing Activities • Promote and maintain health managing the 

effects of illness through teaching and counseling

• Provide care for patients with both physical and psychological problems 

• Manage and coordinate systems of care integrating the needs of patients, families, staff, and regulators

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Specifically….• Make culturally sensitive biopsychosocial health 

assessments

• Design and implement treatment plans for patientswith complex health problems and comorbid conditions

• Organize, access, negotiate, coordinate, and integrate services and benefits for individuals and families

• Provide a “health care map” to guide them to community resources

Suicides Continue to Climb 

Domestic Violence Unabated  • Every 9 seconds a woman is assaulted or beaten

• Domestic violence is the leading cause of injury to women

• Up to 10 million children witness some form of domestic violence annually

• Everyday in the US, more than three women are murdered by their husbands or boyfriends

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Natural and Man‐Made Disasters

• Hurricanes

• Earthquakes

• Fires

• Mass shootings

Emerging Impacts in Education 

• Proliferating healthcare professions programs

• New technology– https://www.youtube.com/

watch?v=SKpKlh1‐en0

• Exploding information

Emerging Impacts in Education• Rising costs of tuition and indebtedness

• Diminishing resources – impacted by Costs, Volume and Price

• Depressed faculty salaries – how low can you go?

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Emerging Impacts in Education• Eulogy for the demise of the textbook – cost, unread content and timeliness

Implications for our Specialty

• Too few qualified psychiatric nursing faculty

• Too few students interested in our specialty

• Too few behavioral health clinical sites

• Too few preceptors

• Too much to teach/learn!

The Challenges We Face• Tradition – “I’ve always done it this way”

• Faculty who are Debbie Downers‐ “you can try it but it won’t work”

• Adverse to piloting new approaches 

• Accrediting/regulating/licensing boards –champions of the status quo

• Lack of adequate workforce reports 

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Strategic and Operational  

• Calculated risk‐taking

• Digital and technology expertise

• Data analysis and interpretation

• Collaboration and team building

• Quality management

• Creative thinking and desire to experiment

Formulate a Strategic Plan

Strategies/Actions Expected Outcome/Benchmarks

Target Date

Responsible Party(ies)

Data Source(s) Periodicity

Actual Outcome

Evaluation/Modification

Goal:

Objective:

Strategy – Internal and  External

• Professional associations – APNA, APA, MHA, Annapolis Coalition, NCBH

• “Follow the money” – state dollars?  

• Is there state funding for residencies?

• Federal dollars ‐ HRSA, SAMSHA

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Operational ‐ Education

• Who are your faculty, clinical preceptors and practice role models?

• What are you teaching?

• How are you teaching?

• Where are you teaching?

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Who Are Your Faculty, Clinical Preceptors/Practice Role Models? Teaching faculty must be prepared in our specialty – are yours?

What professions can serve as preceptors?

How do you assess your practice role models?

Are your faculty passionate about psych nursing?

Who Are Your Faculty, Clinical Preceptors/Practice Role Models?

What do you offer your clinical faculty and clinical preceptors?

Can academic faculty work in the clinical setting for a 2‐way exchange of knowledge and expertise (nurse to nurse collaboration)?

What Are You Teaching?• Pre‐licensure – are you teaching?

How to screen, triage and refer – “6th vital sign

Mental Health First Aid – like CPR and BLS

Motivational interviewing

Risk assessment

Crisis intervention and de‐escalation

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What Are You Teaching?

• Pre‐licensure – are you teaching?

Care coordination and case management

Suicide prevention

SBIRT

CBT basic elements

When and how to seek consultation

What Are You Teaching?

• Graduate – are you teaching?

Integration of psych content into all NP tracks

Not separating out psych nursing content –pharmacology vs. psychopharmacology

Only evidence‐based interventions

How to treat via telehealth

What Are You Teaching?

• Graduate – are you teaching?

Telephone triage

Proficiency in stepped care decisions

Only evidence‐based interventions

How to treat via telehealth

How to engage challenging populations

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What Are You Teaching?• Graduate – are you teaching?

Team‐based models of care

Team leadership

How to provide consultations

Business aspects of advanced practice

How to enact “full scope of practice”

Policy and advocacy

How Are You Teaching?

Are you scaffolding the psych content? Do you use lectures or flipped classrooms? Are you still teaching in specialty and 

disciplinary silos and not IP? Are you utilizing technology for anytime, 

anywhere learning? 

How Are You Teaching?

How are you using simulation?

Are you comfortable teaching motivational interviewing, de‐escalation, SBIRT, CBT basic elements?

Do you know what clinical practices your students actually see in the clinical setting?

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Where Are You Teaching? What has been the impact of DEUs?

Can you create “virtual learning pods”?

Where are your clinical placements?

Are you using telehealth to supervise students?

Are you involved in nurse internship and residency programs?

Operational ‐ Practice• Are you:

Practicing to the top of your license?

Using simplified screening tools?

Are these tools standardized across settings?

Triaging patients based on symptom severity and type and intensity of service needed?

Specify treatment pathways/interventions?

Operational ‐ Practice• Are you:

Using clear referral guidelines?

Developing and using algorithms to level care?

Developing and monitoring care metrics?

Designing population health initiatives?

Implementing quality improvement?

Leading collaborative teams?  

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Operational ‐ Practice• Also for your “to do” list:

Track and monitor where your psych NPs are practicing – rural vs. urban, underserved, etc

Describe and evaluate models of integrated care being implemented in Nebraska and the current and potential role of nurses (both basic and advanced) in these models

STRATEGIC PLAN TEMPLATE

Goal:

Objective 1:

Strategies/Actions Expected

Outcome/Benchmarks Target Date

Responsible Party(ies)

Data Source(s)

Periodicity

Actual Outcome

Evaluation/ Modification

BIBLIOGRAPHY – GAIL W. STUART

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