Psychiatric-Mental Health Advanced Practice Registered Nursing

North Carolina Nurses Association Position Statement onPsychiatric-Mental Health Advanced Practice Registered NursingThis position statement does not imply endorsement of any piece of relatedlegislation.Statement of the IssueTraditionally, the psychiatric-mental health advanced practice Registered Nurse in NorthCarolina has functioned as a master’s prepared Psychiatric-Mental Health Clinical NurseSpecialist (PMH-CNS) and has, in addition to other role functions, providedpsychotherapy services to individuals, families and groups. In North Carolina, all ClinicalNurse Specialists practice under the sole authority of the NC Board of Nursing.In contrast, at the present time in this state, the performance of specific medical acts,including prescriptive authority, is granted to Nurse Practitioners who function under thejoint auspices of the Board of Nursing and the Medical Board.The continuing presence of the PMH-CNS and the introduction of the psychiatric-mentalhealth nurse practitioner (PMH-NP) in North Carolina has prompted the need to clarifythe necessary educational preparation and credentialing requirements, the scope andfunctions of practice and the authority to practice under psychiatric-mental healthadvanced practice titles designated by the state and recognized by the profession at thenational level.BackgroundIn the Scope and Standards of Psychiatric Mental Health Nursing, the American NursesAssociation, the American Psychiatric Nurses Association, and the International Societyof Psychiatric-Mental Health Nurses identified a single scope of practice and a blendedrole for the psychiatric-mental health advanced practice psychiatric nurse (APRN-PMH).This national document defines the APRN-PMH as “a licensed Registered Nurse who iseducationally prepared either as a clinical nurse specialist or a nurse practitioner at leastat the master’s degree level in the specialty of psychiatric-mental health nursing.” (1,p.19) The document further states that “Psychiatric-mental health advanced practicenursing involves the delivery of comprehensive primary mental health care in a variety ofsettings.” (1, p.15).The document identifies the following functional parameters of the advanced practicerole in the specialty (1, pp. 19-23):• carrying out health promotion activities including general health teaching• designing and conducting mental illness preventive interventions• conducting health screening and evaluation• eliciting a history appropriate to the patient, presentation, and setting• completing a health assessment/examination• formulating differential diagnoses based on clinical findings• ordering, conducting, and interpreting pertinent laboratory and diagnostic studies andprocedures• conducting individual, family, group, and network psychotherapy

A nurse in North Carolina who uses the title of Psychiatric-Mental Health NursePractitioner:• must be currently registered to practice nursing in this state• must hold a master’s degree or have completed formal academic post-master’spreparation from an accredited university in the specialty of psychiatric- mental healthnursing• must be currently certified as either an Adult Psychiatric and Mental Health NursePractitioner or a Family Psychiatric and Mental Health Nurse Practitioner (RN,CS orAPRN, BC) and• must meet the requirements of the North Carolina Board of Nursing for approval as anurse practitioner.References1. American Nurses Association, American Psychiatric Nurses Association, InternationalSociety for Psychiatric-Mental Health Nurses (2007). Scope and Standards ofPsychiatric Mental Health Nursing Practice. Washington, D. C.: American NursesPublishing.2. American Psychiatric Nurses Association (2011). Position Statement: LACEImplementation. Endorsement of the APNA/ISPN Joint Task Force Recommendationson the Implementation of the “Consensus Model for APRN Regulation: Licensure,Accreditation, Certification & Education.” Downloaded from APNA.org on March 14,2011.3. National Panel for Psychiatric-Mental Health Nurse Practitioner Competencies (2003).Psychiatric-Mental Health Nurse Practitioner Competencies. Washington, DC: NationalOrganization of Nurse Practitioner Faculties.4. NC General Assembly (2003). Title 21 NCAC 36.0228, Clinical Nurse SpecialistPractice. Raleigh, N.C5. NC General Assembly (2009). Title 21 NCAC 36.0227, Approval and PracticeParameters: Process for Approval to Practice. Raleigh, N.C6. NC General Assembly (2004). Title 21 NCAC 36.0802, Approval and PracticeParamaters: Scope of Practice. Raleigh, NC.HistoryAdopted: 06/1/04 Council of Psychiatric/Mental Health Nurses in Advanced Practice;NCNA Board of DirectorsRevised: 04/29/2011 Council of Psychiatric/Mental Health Nurses in Advanced Practice;Commission on Standards and Professional Practice; NCNA Board of Directors