Heroism in Nursing Practice: Interviews with Five PMHNPs

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“We are trained to treat the whole person: physical, psychological, spiritual, and sociocultural.”
Dr. Nancy Birtley, University of Missouri (2017)

Psychiatric mental health nurse practitioners (PMHNPs) make up 5.4 percent of all nurse practitioners (AANP 2016). PMHNPs offer a holistic approach to illness, paying thought to both physical and mental health considerations; diagnosing psychiatric problems and illnesses; prescribing medications; offering counseling and therapy; developing multi-pronged treatment plans; coordinating care between varied healthcare professionals; and educating patients and families on psychiatric conditions. Despite mounting evidence that nurse practitioners (NPs) provide safe, cost-effective healthcare, there has still been significant opposition—particularly from physician groups—against expanding full practice authority (FPA) to NPs across the country.

FPA allows PMHNPs to practice autonomously to the extent of his or her education without physician oversight. This model was adopted by the Department of Veterans Affairs (Dec. 2016) in order to expand healthcare access for its patients nationwide. Notably, the FPA for NPs is supported by many eminent organizations such as the National Academy of Medicine (formerly the Institute of Medicine), the Bipartisan Policy Center, the Federal Trade Commission, the National Council of State Boards of Nursing, the AARP, and many others. While 21 states and the District of Columbia offered FPA rights to NPs as of February 2017, there are still 29 states which needlessly hinder NPs from providing full care to patients.

To draw attention to the everyday heroism of PMHNPs and the importance of granting full practice authority, this piece features five interviews with prominent PMHNP professors across the country. They share stories of how psychiatric NPs have changed people’s lives and detail their views on the continued fight for FPA nationwide.

Interviews with Five Influential PMHNP Professors

Five outstanding psychiatric nurse practitioner professors from around the country graciously agreed to share anecdotes about heroism in their profession and their thoughts on expanding full practice authority to NPs nationwide. They hail from states with varied regulatory environments.

The Case for Granting PMHNPs Full Practice Authority

“This dynamic is analogous to a high performance engine. Presently, many states have practice acts that restrict NP practice autonomy. This is like placing a restrictor plate on a high performance engine and then complaining about the horsepower.”
Dr. Sean Convoy, Duke University (2017)

Psychiatric mental health nurse practitioners provide invaluable healthcare services throughout the country. Unfortunately, there are still 29 states where PMHNPs legally cannot practice to the full extent of their education and training, despite the overwhelming evidence showing that NPs offer cost-effective, quality treatment and expand patient access to care. With soaring rates of anxiety, depression, opioid abuse, and other psychophysiological illnesses, the United States needs fully empowered PMHNPs more than ever.

Drawing from the wisdom of the five professors above and research from high-impact scholarly journals, here is a summary of the reasons why full practice authority should be extended across the country:

1) There’s a startling projected shortage of primary care providers into the future.

2) Nurse practitioners improve patient outcomes while keeping costs down.

3) Over-restrictive practice environments for NPs lead to confusion and a bureaucratic waste of time and resources.

4) The national move toward FPA for nurse practitioners is supported by many prominent organizations—the AARP, VA, NGA, BPC, FTC, and others as mentioned in the introduction—and opposed primarily by one contingent: physicians’ organizations. In a 2017 interview with Nurse Practitioner Schools, Dr. Hershey of Michigan State University poignantly stated, “The biggest challenge in this fight is getting the physician groups to understand that we are not in competition with them; as NPs, we are members of a healthcare team, which includes our physician colleagues and other healthcare professionals the patient may need. As a team, we need to work collaboratively in order to improve the health of our patients.”

Finally, for further edification on this crucial issue, here is Dr. Nancy Birtley’s excellent compendium of scholarly research supporting the case for full practice authority:

  • Association of American Medical Colleges. (2016). New research confirms looming physician shortage.
  • Harrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324(6), 819-823. doi: 10.1136/bmj.324.7341.819
  • Laurant, M., Reeves, D., Hermens, R., Braspenning, J., Grol, R., & Sibbald, B. (2005). Substitution of doctors by nurses in primary care (review). Cochrane Database of Systematic Reviews, 2005(2). doi: 10.1002/14651858.CD001271.pub2
  • Lentz, E. R., Mundinger, M. O., Kane, R. L., Hopkins, S. C., & Lin, W. X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow up. Medical Care Research and Review, 61(3), 332-351. doi: 10.1177/1077558704266821
  • Newhouse, R. P., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G. (2011). Advanced practice nurse outcomes 1990-2008: A systematic review. Nursing Economics, 29(5), 1-22.
  • Sackett, D. L., Spitzer, W. O., Gent, M., Roberts, R. S., Hay, W. I., Lefroy G. M.., . . . McAuley, R. G. (1974). The Burlington randomized trial of nurse practitioner: Health outcomes of patients. Annals of Internal Medicine, 80(2), 137-142.
  • Swan, M., Furguson, S., Chang, A., Larson, E., & Smaldone, A. (2015). Quality of primary care by advanced practice nurses: A systematic review. International Journal for Quality in Health Care, 27(5), 396-404. doi: 10.1093/intqhc/mzv054

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Jocelyn Blore

Jocelyn Blore

Editor

Jocelyn Blore is the Managing Editor of NursePractitionerSchools.com. After graduating from UC Berkeley, Jocelyn traveled the world for five years as freelance writer and English teacher. After stints in Japan, Brazil, Nepal, and Argentina, she took an 11-month road trip across the US, finally settling into lovely Eugene, OR. When Jocelyn isn’t writing about college programs or interviewing professors, she satirizes global politics and other absurdities at Blore’s Razor (Instagram: @bloresrazor). Thank you for being interested.