Expanding the Role of Psychiatric Mental Health Nurse Practitioners in a State Psychiatric System: The New Hampshire Experience

Abstract

Psychiatric mental health nurse practitioners (PMHNPs) are assuming increasing clinical responsibilities in the treatment of individuals with mental illness as the shortage of psychiatrists and their maldistribution continues to persist in the United States. States vary widely in their statutes and administrative rules delineating PMHNP's scope of practice. This column describes the legislative process of incremental changes in New Hampshire statute and rules changes over the past 15 years that have significantly expanded PMHNP's ability to treat individuals with mental illnesses in the state mental health system. PMHNPs have worked closely with physician leaders and policy makers to allow this to occur.

Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey

“…A sense of PMH APRN roles and activities can be gleaned from practice reports where PMH NPs address service gaps. For instance, state reports exist on the effectiveness of using PMH NPs to help address the shortage of psychiatrists noting the ability of PMH NPs to provide mental health services, particularly to the seriously mentally ill (de Nesnera & Allen, 2016). A similar study emerged from North Carolina that reports on the use of PMH NPs to address the severe shortages of providers, particularly those who prescribe (K.…”

Psychiatric Mental Health Nurse Practitioners Meeting Rural Mental Health Challenges

“…Given the state of rural mental health affairs, PMHNPs and physician colleagues are equipped to organize and advocate politically for PMHNP full scope of practice (i.e., independent practice) and challenge constraining mandated physician supervision (Andrilla, Patterson, Moore, Coulthard, & Larson, 2018; Chapman, Toretksy, & Phoenix, 2019; de Nesnera & Allen, 2016; Delaney et al, 2018; Spetz, Skillman, & Andrilla, 2017). Mandated supervision is financially costly, falsely justifies unequal reimbursement for comparable work, supports inequitable professional relations, increases administrative burden, and overall decreases mental health access to services from all involved providers (Chapman et al, 2019; de Nesnera & Allen, 2016). While political efforts for PMHNP independent practice rights may be slow and painstaking in the workplace and courthouse, collaborative strategic efforts have been effective in the past (de Nesnera & Allen, 2016).…”

“…Mandated supervision is financially costly, falsely justifies unequal reimbursement for comparable work, supports inequitable professional relations, increases administrative burden, and overall decreases mental health access to services from all involved providers (Chapman et al, 2019; de Nesnera & Allen, 2016). While political efforts for PMHNP independent practice rights may be slow and painstaking in the workplace and courthouse, collaborative strategic efforts have been effective in the past (de Nesnera & Allen, 2016).…”

Survey to child/adolescent psychiatry and developmental/behavioral pediatric training directors to expand psychiatric‐mental health training to nurse practitioners

“…All states currently allow PMHNPs to prescribe medications and provide clinical care to patients (American Psychiatric Nurses Association, ). PMHNPs work in a variety of settings, such as emergency rooms, hospital consultation and liaison services, outpatient settings, home‐based care settings, nursing homes, and psychiatric inpatient units (de Nesnera & Allen, ). Across the 50 states, there are many differing clinical and legislative mandates that NPs must adhere to, depending on the state where they practice (de Nesnera & Allen, ).…”

“…PMHNPs work in a variety of settings, such as emergency rooms, hospital consultation and liaison services, outpatient settings, home‐based care settings, nursing homes, and psychiatric inpatient units (de Nesnera & Allen, ). Across the 50 states, there are many differing clinical and legislative mandates that NPs must adhere to, depending on the state where they practice (de Nesnera & Allen, ). There continue to be outdated regulations, biases, and policies that prevent all APRNs from practicing to the full extent of their education, skills, and competencies (Institute of Medicine, ).…”