Introduction
Shortages of behavioral health providers, particularly prescribing clinicians, are
widespread nationally. Although rapidly increasing numbers of psychiatric mental health
nurse practitioners (PMHNPs) could increase access to behavioral health services,
state limitations on scope of practice may restrict their ability to do so.
Aim
The purpose of this comparative case study was to assess how state scope of practice
regulations impact PMHNP practice in five states with different levels of nurse practitioner
autonomy (full, reduced, and restricted), as categorized by the American Association
of Nurse Practitioners.
Methods
Site visits and interviews were conducted with 94 key informants, including state
board of nursing staff, PMHNP practitioners and educators, behavioral health agency
directors, and psychiatrists. State scope of practice regulations were reviewed. Thematic
analysis was used to analyze qualitative data.
Results
Findings indicated that scope of practice regulations affected settings and arrangements
in which PMHNPs practiced. In states where physician supervision is required, PMHNPs
and agency leaders reported costs and administrative burdens related to obtaining
and documenting supervision. PMHNP practice was sometimes constrained by institutional
restrictions not required by law.
Conclusion
Mandated physician supervision of PMHNPs adds cost and diminishes accessibility to
both psychiatrists and PMHNPs. Full nurse practitioner practice authority allows for
more efficient utilization of PMHNPs and may increase access to services.
Keywords
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Biography
Susan A. Chapman, PhD, MPH, RN, FAAN, is Professor, University of California, San Francisco (UCSF), School of Nursing, Department of Social & Behavioral Sciences.
Biography
Christopher Toretsky, MPH, is Senior Analyst, UCSF Philip R. Lee Institute for Health Policy Studies.
Biography
Bethany J. Phoenix, PhD, RN, FAAN, is Professor, UCSF School of Nursing, Department of Community Health Systems.
Article Info
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© 2019 National Council of State Boards of Nursing. Published by Elsevier Inc. All rights reserved.
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