The Impact of the APRN Consensus Model on APRN Practice
The professional training of medical personnel is carried out in many areas, among which nursing is diverse. Different staff qualifications allow hospitals to allocate workloads and shape work processes adequately. Nurses at different levels study for different years, their programs are more complex and highly specialized, and licensing and examination rules are differentiated from state to state. This provides insight into how the institution of health care and education works.
The Differences between Advanced Nursing Practice (ANP) and Advanced Practice Registered Nursing (APRN)
Advanced Nursing Practice (ANP) and Advanced Practice Registered Nursing (APRN) are similar levels of nursing proficiency. ANP is a post-graduate education for nurses who specialize in solving complex clinical problems. APRNs are legally valid nursing qualifications earned after completing post-graduate education. APRNs are essential to the healthcare system because they are licensed (registered) to perform services based on clinical practice (Schober et al., 2020). Although an ANP is similar to an APRN, it is nevertheless the APRN that allows to order tests and prescribe medications; in addition, nurses can do advanced practice work (Kumar et al., 2020). APRNs perform a differentiated approach and often go into specialization: for example, clinical research only, anesthesiology practice, or obstetrics. The consensus model for regulation, licensure, accreditation, and certification indicates moving away from the concept of ANP and using only APRNs (Schober et al., 2020). This recommendation is probably justified by the unconditional need for registration as a qualification stage. Based on this, it is better to assume that there are no critical differences between ANPs and APRNs that would define personnel behavior.
Population in the APRN Role
My primary role as an APRN is Psychiatric Mental Health Nurse Practitioner (PMHNP). It is possible to become a PMHNP after completing post-graduate education and successfully obtaining a registered nurse license. PMHNPs receive their role after passing their master’s or doctoral degree (DNP) exams (Schober et al., 2020). PMHNPs are pretty diverse in their practice, and the leading qualities for the job are emotional stability and an understanding of the specifics of professional practice. PMHNPs may specialize depending on the type of illness they treat or the population’s age group.
PMHNPs provide therapeutic care for patients with mental disorders. Different age groups fall primarily under the jurisdiction of PMHNPs: the pediatric and gerontological profiles should be considered the most complex. All groups require PMHNPs to have additional training and depth in profile disorders. Kumar et al. (2020) believe that the role of PMHNPs is best seen in providing care to the pediatric population. This may be due to the growth of younger PMHNPs, who have an easier time building a dialogue with children and adolescents who are willing to trust them. Second, the population is generally divided into groups based on the presence of non-substance use disorders. PMHNPs address both types, but it should be understood that there are differences in urban and rural populations. For example, Finley (2019) believes that rural populations would receive more mental health prevention if PMHNPs were developed using the experiences of urban populations. Nevertheless, this differentiation improves the outcomes of PMHNP mental health interventions.
Opportunities for Certification
PMHNP certification is available in various areas, including individual and family practice and treatment of specific disorders. The initial certification is PMHNP-BC, which can be earned by passing the ANA (American Nursing Association) exam. This is the primary nursing certificate, which allows nurses to work and conduct advanced practice (“About psychiatric nursing graduate programs”, 2019). All subsequent certifications are an extension of the PMHNP clinical practice, which clarifies qualifications and identifies the primary area of practice. ANA is awarded certification by grading for patient age: ANP-BC can provide care and assistance to adults. In addition, the ANA assigns certification to family nurse practitioners, and the ANCC (American Nurses Credentialing Center) offers certification in care across the lifespan. In both cases, certification allows PMHNPs to conduct clinical research on family history, including family relationships and medical history, in evaluating and diagnosing disorders.
PMHNP certification now goes beyond obtaining a master’s degree in nursing. It is to be expected that ANCC will begin recommending a doctoral degree (DNP), which will bridge the subordinate gaps between physicians and nurses. DNPs can expand nursing practice and take it to the next level. PMHNPs can influence health care directly and change academic principles of care. This suggests that there will be more certification options for this specialty in the future.
Licensure, Accreditation, Certification, and Education Plan
The PMHNP plan includes several sequential steps to get the education and prove knowledge through licensure and certification:
- PMHNP belongs to post-graduate education, so initial training is required. Initial training consists of a standard four-year bachelor’s degree in nursing. Other options include an associate’s degree or diploma in nursing (“About psychiatric nursing graduate programs”, 2019). At this stage, one needs to learn the initial practices and knowledge that will allow one to move on to PMHNP. Upon completing the first level of education, a Registered Nurse (RN) license must be surrendered.
- The RN license is available upon completing the NCLEX exam. Depending on which program was chosen for initial training, the RN or PN exam category is selected. To receive the PMHNP, one must take the NCLEX-RN exam, which allows one to work as a nurse in clinics and hospitals. Upon completing the exam, nurses are issued a registered nurse license, after which specialization in the psychiatric profile begins.
- PMHNP programs are available at specific educational institutions that are accredited. Institutions offer a master’s (MNS) or doctoral (DNP) program, which the Commission must approve on University Nursing Education or the Commission on Accreditation of Nursing Education. Both organizations review the universities’ programs for compliance with national nursing requirements and educational standards. During the program, the RN’s tasks include hands-on experience in the specialty under faculty supervision.
- The final step is to obtain the PMHNP certificate, which will be available after completing the master’s or doctoral program. The ANCC issued the certificate, after which it must be renewed every five years to verify that nursing qualifications are met.
Implications for the PMHNP in California
The regulation of nursing care has recently become increasingly strict. According to Phoenix and Chapman, (2020), this leads to more limited access to care and higher healthcare costs. They report a problem in California using PMHNPs and their expertise. In particular, confusion over applying NP rules to PMHNPs leads to vacancies and job descriptions not being paid correctly. According to APRN consensus implementation status (2021), PMHNPs in California also prohibit independent practice and prescribing. The exception is for nurses with CRNA:3 certification, but licensure to practice is not available in general (“APRN consensus model by state”, 2022). Nurses are available to practice as specialists in psychiatry, but their facility must have facilities for the practice of higher-category staff. PMHNPs must be supervised by at least one consulting physician, in which case practice and prescribing are available. These limitations mean the need for PMHNPs is high, but their practice and development conditions are not entirely in place.
References
Schober, M., Lehdaldt, D., Rogers, M., Steinke, M., Turale, S., Pulcini, J., Roussel, J., & Stewart, D. (2020). Guidelines on Advanced Practice Nursing 2020. ICN – International Council of Nurses.
Kumar, A., Kearney, A., Hoskins, K., & Iyengar, A. (2020). The role of psychiatric mental health nurse practitioners in improving mental and behavioral health care delivery for children and adolescents in multiple settings. Archives of Psychiatric Nursing, 34(5), 275–280. Web.
Finley, B. A. (2019). Psychiatric mental health nurse practitioners meeting rural mental health challenges. Journal of the American Psychiatric Nursing Association, 26(1). Web.
Phoenix, B. J., & Chapman, S. A. (2020). Effect of state regulatory environments on advanced psychiatric nursing practice. Archives of Psychiatric Nursing, 34(5), 370–376. Web.
About psychiatric nursing graduate programs. (2019). American Psychiatric Nursing Association. Web.
APRN consensus implementation status. (2021). NCSBN. Web.
APRN consensus model by state. (2022). NCSBN. Web.