State Regulations for Psychiatric Mental Health Nurse Practitioners
The American Nurses Association Joint Task Force met in April 2012, intending to review and revise the first version of Psychiatric-Mental Health Nursing: Scope and Standards of Practice for publication in 2013 (Kane, 2022). Given the considerable shift in the numerous settings and venues of PMH advanced nursing practice, the task force conducted extensive study and deliberation.
In June 2014, the second edition was released. The 2014 PMH Scope and Standards of Practice (ANA, 2014) presents an up-to-date outlook on PMH advanced practice nursing that considers the impacts of the Patient Protection and Affordable Health Care Act, serves as a framework for reconfiguring practice toward rehabilitation models, and guides the PMH advanced practice nurse clinician forward into strategic opportunities inherent in incorporated physical and mental health care models (Kane, 2022).
The updated scope takes into consideration the current healthcare transition in the United States to assist PMH nurses in recognizing the ongoing shift as a platform for continued growth and enhancement of quality healthcare delivery systems. In this paper, we shall discuss the scope of practice of advanced psychiatric mental health nurses and the challenges they face in their scope of practice.
Kane (2022) shows that Kentucky outperforms the rest of the country in terms of mental illnesses. Kentucky has 81 underrepresented counties and areas. Promoting access to health care is critical to improve Kentuckians’ health. Nurse practitioners have demonstrated their ability to offer high-quality care at a low cost. Nurse practitioners (APRNs) are advanced practice registered nurses who provide main and specialized health care.
They work in outpatient clinics, acute care, and long-term care settings. They also work as consultants and researchers (Lopes-Júnior, 2021). Nurse practitioners are specialists in mental health promotion and prevention of adverse outcomes, as well as diagnosing and treating acute and chronic health problems. Nurse practitioners order and interpret diagnostic tests and prescribe drugs, therapies, and therapeutic devices.
Medicaid recognizes Kentucky NPs as primary care providers, and they may have hospital privileges. Nurse practitioners in Kentucky are licensed, independent providers. They offer health care services to patients autonomously and recommend patients for special treatment as appropriate. In Kentucky, NPs are not required to practice under the supervision of a physician (Chapman, 2022). They are now simply obliged to communicate with a physician to prescribe drugs. The partnership requirement only applies to medicine prescriptions.
The PMHNP learns advanced medical evaluation skills to do a diagnostic and physical examination, as well as episodic evaluations, develop initial physical diagnoses, and refer patients to primary care when necessary. The PMHNP is exceptionally qualified to give clients holistic treatment that crosses the gap between overall health care and mental health.
A PMHNP working in a community mental health clinic, for example, might provide focused psychiatric therapy while screening for, detecting, and managing co-morbid medical issues such as hypertensive patients or diabetes mellitus that are being managed by a primary medical care provider (Kane, 2022).
It is frequently the PMHNP who has built a long-term relationship with a client suffering from serious mental illness who first finds and recognizes underlying medical concerns. The PMHNP successfully elicits the client’s participation in seeking additional medical therapy and coordinates with the client’s primary medical care provider in their treatment.
In rural locations, the PMHNP works with a community psychiatrist to promote continuity of treatment and avoid needless psychiatric hospitalizations by following patients in the clinic, office, and inpatient psychiatric wards (Kane, 2022). The PMHNP expands the availability of cost-effective mental health treatment in places with few psychiatrists.
The PMHNP works in inpatient psychiatric units or in the Emergency Room to provide 24-hour/day psychiatric evaluation and treatment services in big metropolitan and/or teaching hospitals. As a member of the Psychiatric Consultation Service team/leader.
Regulations Related To Prescriptive Authority
Since 2006, APRNs in Kentucky have had the ability to prescribe prohibited medications under a “collaborative agreement for prescriptive authority-controlled substances,” or CAPA-CS. They can prescribe a 3-day prescription of a Schedule II medicine, and HB 354 would not change that. A measure was enacted to allow Kentucky’s advanced practice registered nurses to independently prescribe banned medications (Chapman, 2022).
Webber’s House Bill 354 would enable an APRN to prescribe controlled medications without a cooperative accord with a doctor after 4 years of practice under such an arrangement and clearance from the Kentucky Board of Nursing (Chapman, 2022).
As per the Kentucky legislature, if the board determines that an APRN is misusing this authority, it might order them to return under a collaborative agreement or take further measures. The most recent iteration of the legislation would subject independently prescribing APRNs to a similar quality of care as other practitioners and would establish a Controlled Substance Prescribing Review Panel to oversee them (Chapman, 2022).
The House voted against dismissing its rules to allow for the amendment to reintroduce the stipulation that an APRN is certified to practice for a year before prescribing controlled substances, acquire a certificate of registration from the Drug Enforcement Administration, and pass each constituent of the federal licensing exam in three attempts, just like physicians.
Challenges That Might Confront Regarding State Regulations for Psychiatric Mental Health Nurse Practitioners
Unfortunately, hurdles to practicing the full extent of PMHNP nurse education and training exist. This is especially troubling in locations where PMHNPs are desperately required. In Kentucky, PMHNPs work independently and can ultimately create their own private practice, and have been legally prescribing routine drugs and restricted pharmaceuticals since 1996 and 2006, respectively (EKU, 2022).
However, in Kentucky, collaborative agreements for prescriptive power with a physician are still required to prescribe routine drugs (CAPA-NS) and restricted pharmaceuticals (CAPA-CS). The physician is not required to oversee the agreements. They merely mention that the doctor will be accessible for collaboration as needed. This places the responsibility of obtaining a physician willing to enter into the agreements and paying any associated costs on the physician.
A CAPA-CS (Collaborative Agreement Prescriptive Authority- controlled substance) is required by the Drug Enforcement Agency (DEA) for a license. A DEA license is required to order critical medical supplies such as antipsychotics. Without the capacity to get essential supplies, it is very difficult for PMHNPs without a CAPA-CS to begin their own practice, whether or not they intend to prescribe prohibited medications (EKU, 2022). This restriction has a direct and harmful impact on patients and access to healthcare in many rural or underprivileged regions that rely on PMHNP for health care.
While all evidence indicates a continued strong and rising need for PMHNPs in Kentucky and around the country, rural and underserved regions continue to have the highest demand. By removing practical impediments such as prescriptive authority agreements, PMHNPs may be used to their full educational and training potential, providing them with the ability to better fulfill the healthcare requirements of the Kentucky communities they serve.
Chapman, H. (2022). House passes bill to allow APRNs to prescribe controlled substances after a four-year collaborative agreement with doctor. Uky.edu. https://ci.uky.edu/kentuckyhealthnews/2022/03/14/house-passes-bill-to-allow-aprns-to-prescribe-controlled-substances-after-a-four-year-collaborative-agreement-with-doctor/
EKU. (2022). The important role and challenges for nurse practitioners in Kentucky healthcare. EKU Online; Eastern Kentucky University Online. https://ekuonline.eku.edu/nursing/the-important-role-and-challenges-for-nurse-practitioners-in-kentucky-healthcare/
Kane, C. F. (2022). The 2014 scope and Standards of practice for Psychiatric Mental Health Nursing: Key updates. Online Journal of Issues in Nursing, 20(1), 1. https://doi.org/10.3912/ojin.vol20no01man01
Lopes-Júnior, L. C. (2021). Advanced Practice Nursing and the expansion of the role of nurses in Primary Health Care in the Americas. SAGE Open Nursing, 7, 23779608211019492. https://doi.org/10.1177/23779608211019491
State Regulations for PMHNP
Write a paper using APA 7th edition discussing practice authority for PMHNPs in the state of Kentucky USA, including regulations related to prescriptive authority. What challenges do foresee that might confront you regarding entering into practice, relative to the current practice climate in your state?