summer 2023 week 15 response

Response 1     

 

Thank you for your post as you highlight the myriad of reasons PMHNPs are needed and can fill the gaps in care and access to care, especially in the minority populations, as you reported. PMHNPs can also fill the gaps in mental health care for those covered by medicare. It has been well-documented that the number of psychiatrists in the U.S. does not meet the needs of those seeking their services (Cai et al., 2022). One study that reviewed the years 2011 throught 2019 found that PMHNPs and psychiatrists treated approximately similar patients providing similar treatments and prescriptions (Cai et al., 2022). During this time period, the number of PMHNPs who served Medicare recipients grew by 162% while the number of psychiatrists providing services to these beneficiaries dropped by 6% (Cai et al., 2022).

 

     Additionally, PMHNPs can bridge the mental health care gap in rural populations. I found it very interesting that there are 3,075 rural communities in the U.S. and 55% of these do not have mental health care providers (Talarico, 2021). One study revealed that PMHNPs can help increase medication adherence, compliance with follow up appointments, and patient satisfaction scores in this population by implementing psychiatric telehealth visits (Talarico, 2021).

 

     Thank you again for your post as it provides me with additional reassurance regarding the path we have embarked upon!

 

 

References (Please note, hanging indentation may not have been retained in Moodle platform)

 

Cai, A., Mehrotra, A., Germack, H. D., Busch, A. B., Huskamp, H. A., & Barnett, M. L. (2022). Trends In Mental Health Care Delivery By Psychiatrists And Nurse Practitioners In Medicare, 2011-19. Health Affairs, 41(9), 1222–1230. https://doi.org/10.1377/hlthaff.2022.00289

 

Talarico, I. (2021). The use of telehealth to increase mental health services access and promote medication adherence in rural locations. Journal of the American Association of Nurse Practitioners, 33(11), 1074–1079. https://doi.org/10.1097/JXX.0000000000000495

 

 

Response 2

 

I enjoyed reading your post. I agree that there is a real need for more providers. When Covid became our new reality, it caused healthcare to change and adapt to help as many people as possible. I think that we saw healthcare change before our eyes and what once was not even considered quickly became the norm. We see this in almost every area of our lives, work, school, clinical, etc. When Covid began, we learned we could see patients and offer care via telehealth. Telehealth has been proven to be of great benefit to those that have the resources to access telehealth services easily. There is not as much evidence for those in lower-income countries and those without internet resources. Also, with telehealth continuing to offer services, protocols on prescribing, services, and limitations need to be determined as this mode of delivery continues to be used, especially in the psychiatric field (Doraiswamy et al., 2020).

 

I also agree with your comment about the need for nurse practitioners to be aware of changes in policy and specialty. Although the number of psychiatric nurse practitioners is growing, there is little research on their role in the field. Although for many nurse practitioners can practice independently, there is no clear role of the PMHNP in the specialty area.  Even though the number of programs has increased recently, enrollment has not risen that dramatically. There is still a stigma associated with the psychiatric specialty. In other areas, however, the trend is increasing for PMHNPs in both the community and inpatient settings (Delaney & Vanderhoef, 2019).

 

As new practitioners, we must advocate and educate ourselves in the field when we enter into practice. We must keep up with practice changes and advocate for the patients we care for.

 

References                                                                                                              

 

Delaney, K. R., & Vanderhoef, D. (2019). The psychiatric mental health advanced practice registered nurse workforce: Charting the future. Journal of the American Psychiatric Nurses Association, 25(1), 11-18.

 

Doraiswamy, S., Abraham, A., Mamtani, R., & Cheema, S. (2020). Use of telehealth during the COVID-19 pandemic: scoping review. Journal of medical Internet research, 22(12), e24087.

 

 

 

Response 3

     Thank you so much for your informative post as it really put so much together in terms of addressing limited access to care due to financial strain and how we, as PMHNPs, can mobilize to address access to care challenges since we “know” our populations best. An additional access to care challenges includes the fact that not all states allow full practice for PMHNPs which leads to the burden of constant documentation by a supervising physician thereby adding cost and decreasing accessibility (Chapman et al., 2019). Allowing full PMHNP practitioner practice authority is a more cost effective efficient use of PMHNPs and provides more access to mental health services for those that need it.

 

     As you pointed out, when NPs engage in advocacy for their patient populations, the healthcare delivery system is enhanced. PMHNPs can also serve as advocates for mental health patients who need long acting injectable (LAI) medications. For example, patients with schizophrenia often demonstrate nonadherence to their medication regimens and this increases readmission rates (Vonderhaar & Snyder, 2020). One study found that advocating for the use of LAIs can increase adherence and PMHNPs are in a position to do this (Vonderhaar & Snyder, 2020).

 

     PMHNPs should engage in the promotion of population health and can do so in a variety of ways. Our profession can engage in policy-making by assessing and identifying problems, looking at and interpreting the evidence that guides our practice, and paying careful attention to public policy and programs that impact our patients (Myers, 2020). PMHNPs are in a position to shape policy but need to be brave and find ways to get involved to impact positive change for our patients.

 

Thank you again for your post. It was very informative.

 

References

 

(Please note hanging indentation may not have been retained in Moodle platform)

 

Chapman, S. A., Toretsky, C., & Phoenix, B. J. (2019). Enhancing Psychiatric Mental Health Nurse

 

     Practitioner Practice: Impact of State Scope of Practice Regulations. Journal of Nursing

 

     Regulation, 10(1), 35–43. https://doi.org/10.1016/S2155-8256(19)30081-X

 

Myers, C. R. (2020). Promoting Population Health: Nurse Advocacy, Policy Making, and Use of

 

     Media. Nursing Clinics of North America, 55(1), 11–20. https://doi.org/10.1016/j.cnur.2019.11.001

 

Vonderhaar, B., & Snyder, M. (2020). Nursing advocacy and long acting injectables to reduce

 

     high readmission rates: Quality initiative. Journal of the American Psychiatric Nurses

 

    Association, 26(4), 389–393. https://doi.org/10.1177/1078390319865333

 

 

 

 

 

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