Redefining the Education of the Advanced Practice Psychiatric Nurse

Perspectives in Psychiatric Care, Nov 2006 by Paquette, Mary

The world of nursing education is in the process of change to keep up with the demands of the mental health care profession, the shortage of nurses and physicians, and the expansion of technology. Being in alignment with the emerging paradigms of the 21st century requires an ongoing examination of the way schools have traditionally trained advanced practice nurses.

Preparing a nurse to become a Psychiatric Nurse Practitioner requires the acquisition of a multitude of skills and knowledge. A great deal of time, thought, and energy went into defining the psychiatric/mental health (PMH) core competencies and reaching a consensus that this is what we expect the APRN to learn, integrate, and perform during their postgraduate education (National Panel for Psychiatric-Mental Health NP Competencies, 2003).

The next logical step is to ask HOW will the schools incorporate the competencies into a curriculum that is already saturated with required courses? How do the faculty choose which competencies to include and which ones to leave out? If we call them core competencies, can any be really left out? How will schools who are dealing with a national faculty shortage locate experienced instructors who are prepared to design new and innovative curriculum? What if existing faculty expertise is more heavily weighted to one advanced practice focus rather than another? How can we expect schools to undertake substantial curriculum revision given that funding sources may not increase?

Are the schools looking to implement every single competency in their master's program such as "conducts individual, group, and/or family therapy" (National Panel for Psychiatric-Mental Health NP Competencies, 2003, p. 7)? Is there enough time to teach both psychotherapy and pharmacology management in depth? Is therapy being taught at anything but at a superficial level? And if so, can it really be called therapy? How many units and contact hours on the average are devoted to clinical experience providing individual, group and family therapy in graduate programs in psychiatric mental health nursing? Should there be a required clinical minimum for therapy hours for all PMHN programs corresponding to the minimum clinical hour requirements seen in nurse practitioner programs? Will the graduate who does not have the clinical background to navigate complex client situations do less and less therapy in their own practice if sufficient hours have not been required during their master's preparation? Will clients and family members receiving care suffer as a result?

Taking a quick look at the competencies raises some serious questions. First of all, there are 60 psychiatric competencies on top of Core Competencies of Nurse Practitioner Practice that need to be addressed, usually in a 2-year program. The core competencies propose an organizing curriculum for the accrediting body to look at, but how that translates to actual content covered in each course is a much different matter. For instance, competency #17 under Domain 1: Management of Patient and Disease Prevention says, "Evaluates and counsels the patient on the use of complementary alternative therapies for safety and potential interactions" (National Panel for Psychiatric-Mental Health NP Competencies, 2003, p. 16). We need this competency given that one third of our healthcare dollars are spent out of pocket on complementary alternative medicine (CAM). Are our schools paying attention to this fact and incorporating required classes into the master's level? How do nurse educators who are designing the curriculum decide on the amount of time to devote to teaching CAM, and exactly what information is necessary so the graduate can competently evaluate and counsel a patient? Is a one 3-hour lecture sufficient? Or does it require a semester course? How much time in class does it take to become knowledgeable about the vast number of supplements that address mental health issues and the plethora of treatments like acupuncture, Reiki, reflexology, and aromatherapy, etc.? Would a new graduate be able to discuss the proper dosage, merits, and disadvantages of St. John's Wort, SAMe, and 5-HTP for depression?

A call for papers was put out for Nursing Educators to share their "best practices" in education and communicate how they are implementing the core competencies recently adapted by NONPF in 2005. The papers in the issue are the result of that request. I was surprised that after posting the call on PPCs Web site, hand-delivering several letters at both ISPN and APNA conferences, and making several telephone calls and sending numerous emails, that I received a total of six manuscripts. Given that these papers constitute the response to the call for innovative program descriptions, can we conclude that most master's programs are not making major revisions to their curriculum? Will it be immediately apparent during accreditation visits whether substantial curriculum revision has occurred? How will our profession evaluate the extent to which curriculum revision has taken place following the National Panel's recommendations?