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Enhancing Psychiatric Mental Health Nurse Practitioner Practice: Impact of State Scope of Practice Regulations

      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.

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      • Conflict of Interest Compliance Article 4
        Journal of Nursing Regulation Vol. 12Issue 2
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          As is standard in scholarly publishing, NCSBN’s Journal of Nursing Regulation (JNR) requires its authors to disclose any potential conflicts of interest (COI). Although COI information has always been collected by our staff in order to support editors’ review of the paper, it was not our standard practice to publish COI statements in each article. In this issue, JNR is retrospectively publishing the COI statements, which were collected with the below papers at submission, in order to make potential COI’s transparent to readers, as well as editors.
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