Evidence-Based Reviews

How to collaborate effectively with psychiatric nurse practitioners

Current Psychiatry. 2012 November;11(11):49-54

References

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8. APRN Consensus Work Group, National Council of State Boards of Nursing APRN Advisory Committee. Consensus model for regulation: licensure accreditation, certification & education. https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf. Published July 7, 2008. Accessed August 21, 2012.

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The patient’s comfort level

Collaborating PMHNPs and psychiatrists need to be prepared for a patient who expresses disappointment with being treated by a PMHNP or a preference to see “a doctor.” Psychiatrists who have not worked through their own ambivalence about the collaboration or who lack confidence in the PMHNP’s abilities may find themselves consciously or unconsciously aligning with the patient’s stance. They may neglect to explore the basis and meaning of the patient’s preference, which may be related to the patient’s lack of knowledge about the PMHNP’s role and training. The PMHNP who encounters such a patient has a more challenging task—namely, how to calmly address the patient’s concern while the patient is challenging the PMHNP’s competence. Both the PMHNP and psychiatrist need to be alert to the possibility of “splitting” in the treatment of axis II-disordered patients.

Clinical Point

PMHNPs and psychiatrists need to be prepared for a patient who expresses disappointment with being treated by a PMHNP

Studies of patient satisfaction have found that patients generally have favorable views of treatment received from nurse practitioners.^14,15 These findings have been confirmed for PMHNPs.^16,17

Barriers to collaboration

From the PMHNP perspective, barriers to a collaborative relationship include referring to PMHNPs by a less preferred term or title, instead of a nurse practitioner or APN, which can hinder the relationship. Although physician assistants and NPs have been grouped together under the term “mid-level providers,” the American Academy of Nurse Practitioners notes that this term suggests a lower level of care or service is being provided.¹⁸ “Physician extender” is another term that fails to recognize the PMHNP’s separate and unique role and the PMHNP’s view of their role as complementary to medicine, rather than an extension of a physician’s practice.

Clinical Point

Collaboration can be impeded by referring to PMHNPs by less preferred terms, not understanding their role, or territorial issues

Another barrier is the psychiatrist’s lack of understanding regarding the PMHNP’s role. Because hospitals employ PMHNPs without providing psychiatrists formal direction explaining their role, background, or educational requirements, psychiatrists may ignore the PMHNP’s full potential. Sometimes, a psychiatrist may categorize an experienced PMHNP as a trainee rather than a highly skilled, trained professional. Although PMHNPs may gain knowledge and supervisory help from an attending psychiatrist, they have—unlike psychiatric residents—completed their formal training.

Territorial issues can impede collaborative relationships. Psychiatrists who resist collaborating will be less effective than those who welcome a PMHNP and readily delegate specific tasks and portions of the workload, whereas psychiatrists who value the help will be more likely to build a collaborative partnership, leading to better patient care.

Autonomy is a critical determinant of professional satisfaction for PMHNPs. A PMHNP’s autonomy can be impeded by organizational constraints and physician perceptions.¹⁹ PMHNPs require autonomy to self-direct patient diagnosis and treatment within the scope of their practice, and many find this relative independence essential to delivering high quality patient care. Lack of autonomy can lead to breaks in workflow in the outpatient setting and increased length of stay for hospitalized patients. In addition, an autonomously functioning, experienced PMHNP can increase efficiency in hospital settings where psychiatrists can be in short supply, preoccupied with administrative matters, or require help on weekends.

Related Resources

American Psychiatric Nurses Association. www.apna.org.
International Society of Psychiatric-Mental Health Nurses. www.ispn-psych.org.
American Nurses Association. www.nursingworld.org.

Disclosures

Dr. Casher is a speaker for Sunovion Pharmaceuticals and receives royalties from Cambridge University Press.

Ms. Kuebler, Ms. Bastida, and Ms. Chipps report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.