Nurse Practitioner Professional Issues

Psychiatric-mental health nurse practitioners are committed to the assessment, diagnosis, and treatment of psychiatric disorders in individuals and groups through psychotherapy and medication. Since the role of the PMHNP carries such responsibility, it is no surprise that there is a rigorous path to obtain and maintain your PMHNP certification and licensure.

PMHNPs currently have only one choice for certification, which is through the American Nurses Credentialing Center (ANCC). The ANCC offers the “psychiatric/mental-health nurse practitioner (across the lifespan)” board certification (PMHNP-BC). In many states, board certification is a necessary prerequisite to receiving an NP license. Even if board certification is not a requirement for state licensure, it may be a requirement to receive privileges in various hospitals and other health care facilities. Malpractice insurance providers may also require board certification prior to issuing coverage to NPs. 

This week, you will review your state specific PMHNP certification and licensure requirements and scope of practice, as well as prescriptive authority issues. 

Learning Objectives

Students will:

  • Summarize nurse practitioner certification and licensure processes
  • Explain state-specific scope of practice for psychiatric-mental health nurse practitioners
  • Explain state-specific restrictions or limitations for practice
  • Explain nurse practitioner prescriptive authority and DEA registration processes 

Learning Resources

Required Readings (click to expand/reduce)American Association of Nurse Practitioners. (2020). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environmentOn the map on the webpage, click on your state and review. After you complete the PMHNP Program, pass the certification exam, and get a job, you will need to revisit this website to apply for the privilege to practice as an APRN with your state Board of Nursing.American Psychiatric Association. (2020). Telepsychiatry. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry

Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.

  • Chapter 1, “What Is a Nurse Practitioner?”
  • Chapter 2, “Nurse Practitioner Scope of Practice”
  • Chapter 3, “State Regulation of the Nurse Practitioner Practice”
  • Chapter 4, “Federal Regulation of the Nurse Practitioner Profession”
  • Chapter 5, “Prescribing”

Centers for Disease Control and Prevention. (2020). Using telehealth to expand access to essential health services during the COVID-19 pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.htmlCenters for Medicare & Medicaid Services. (2019). National provider identifier standard (NPI). https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStandThe National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.Drug Enforcement Administration Diversion Control Division. (2020). Registration. https://www.deadiversion.usdoj.gov/drugreg/index.htmlThis site contains information about applying for your DEA registration number. This number is required for writing prescriptions.After completing PMHNP Program and passing the PMHNP certification exam, complete the DEA application to request prescriptive privileges. Your DEA number will be renewable every five years.National Panel for Psychiatric Mental Health NP Competencies. (2003). Psychiatric-mental health nurse practitioner competencies. National Organization of Nurse Practitioner Faculties (NONPF).  https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/imported/PMHNPcomps03.pdf

Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.

  • Chapter 1, “Historical Perspectives: The Art and Science of Nurse Practitionering”
    • Nurse Practitioner Core Competencies
    • Nurse Practitioners’ Unique Role
  • Chapter 13, “Quality, Safety, and Prescriptive Authority”

Substance Abuse and Mental Health Services Administration. (2020). Become a buprenorphine waivered practitioner. https://www.samhsa.gov/medication-assisted-treatment/buprenorphine-waiver-management/apply-for-practitioner-waiverThis site contains information about applying for a practitioner waiver to prescribe or dispense buprenorphine under the Drug Addiction Treatment Act of 2000 (DATA 2000).After youobtain a Drug Enforcement Agency (DEA) number and completed 24-hour medication-assisted treatment (MAT) waiver training, you may apply to Substance Abuse and Mental Health Services Administration(SAMSHA) for MAT waiver to be able to prescribe Schedule III, IV, or V opioid drugs for the maintenance and detoxification treatment of opioid use disorders relapse prevention.

Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.

  • Chapter 2, “The Role of the Psychiatric-Mental Health Nurse Practitioner: Regulations and Scope of Practice”
  • Chapter 3, “Theoretical Foundations of Care and Nonpharmacological Therapies”

Recommended Resources

Consult these professional organization websites as needed. American Psychiatric Nurse Association (APNA)  https://www.apna.orgInternational Society of Psychiatric-Mental Health Nurses (ISPN)  www.ispn-psych.orgNational Alliance on Mental Illness (NAMI)  https://www.nami.orgNational Council for Behavioral Health (NCBH) www.thenationalcouncil.orgNational Institute of Mental Health (NIMH) https://www.nimh.nih.gov/index.shtmlSubstance Abuse and Mental Health Services Administration (SAMHSA) www.samhsa.gov


PMHNP Study Support Lounge

As a peer, you are encouraged to provide constructive helpful feedback. Advanced practice nurses always benefit from the feedback of others. Your Study Support Lounge posts may be procedural (“How do I attach a Kaltura video to a Discussion post?”), conceptual (“How does this relate to the other therapy approaches we have studied?”), or analytical (“What do these diagnostic results actually mean in the context of this specific patient case?”). Although not mandatory, this is an opportunity to interact and study together as you navigate the assignments, so you are highly encouraged to take part in this activity. Full participation in activities like this is a statistically significant predictor of success.To Participate in this Optional Discussion:PMHNP Study Support Lounge


Acknowledgment

Practicum Manual Acknowledgment

The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program.


Discussion: Certification and Licensure Plan

Although a movement called the APRN Consensus Model is attempting to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish an independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement.

Another important area to consider and plan for is prescriptive authority. The appropriate board, which may be the medical board, state board of pharmacy, or nursing board, grants prescriptive authority under state law for the appropriate state licensure. The federal government grants the authority to write for a controlled substance, and the Drug Enforcement Administration (DEA) verifies this action through by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.

In this Discussion, you will locate and review the practice agreements in the state in which you plan to practice, identify potential collaboration requirements in your state, and understand the certification and licensing process that you will need to follow.

To Prepare:
  • Review practice agreements in your state.
  • Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are.
  • Research the following:
    • How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?
    • What is the application process for certification in your state?
    • What is your state’s board of nursing website?
    • How does your state define the scope of practice of a nurse practitioner?
    • What is included in your state practice agreement?
    • How do you get a DEA license?
    • Does your state have a prescription monitoring program (PMP)?
    • How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
By Day 3 of Week 1

Post a summary of your findings on your state based on the questions listed above. Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state. Be specific. Also, describe what surprised you from your research.

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days in one or more of the ways listed below.

  • Share an insight from having viewed your colleagues’ posts.
  • Suggest additional actions or perspectives.
  • Share insights after comparing state processes, roles, and limitations.
  • Suggest a way to advocate for the profession.
  • Share resources with those who are in your state. 

Note: For this Discussion, you are required to complete your initial post before you can view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

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