Role Delineation Study

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Role Delineation Study

National Survey Results

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(2)

About this Report

This report pertaining to the practice of psychiatric-mental health nurse practitioners was

based on the results of a 2011 national study of practice of psychiatric-mental health nurse

practitioners.

(3)

2011 Role Delineation Study: Psychiatric-Mental Health Nurse Practitioner – 2 National Survey Results

ABOUT THIS REPORT ... 1

ACKNOWLEDGEMENTS ... 3

BACKGROUND ... 4

R

OLE

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ELINEATION

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TUDY

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VERVIEW

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PDATED

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ONTENT

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UTLINE FOR

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ENTAL

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RACTITIONER

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OLE OF THE

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ONTENT

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XPERT

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ANELS

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SURVEY METHODOLOGY ... 5

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URVEY

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HRONOLOGY

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URVEY

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EVELOPMENT AND

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EASURES

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AMPLE

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ELECTION

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ATA

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OLLECTION

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ATA

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NALYSIS

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SURVEY RESULTS ... 9

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EMOGRAPHIC

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NFORMATION

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RACTICE

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ESCRIPTIONS

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APPENDICIES

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ORK

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CTITIVIES

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TATEMENTS

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EMOGRAPHIC

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UMMARY

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CTIVITIES

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ESCRIPTIVE

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TATISTICS

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RITICALITY

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2011 Role Delineation Study: Psychiatric-Mental Health Nurse Practitioner – 3

Acknowledgements

The American Nurses Credentialing Center (ANCC) wishes to thank a number of

content experts who served on the 2011 ANCC Psychiatric-Mental Health Nurse Practitioner Role

Delineation Study panel for sustaining this effort and producing a role delineation study of such

high caliber. Without their numerous hours of input and feedback, the study would not be

possible.



Andrea J. Adimando, MSN, PHMNP-BC



Margaret H. Brackley, PhD, PHMNP-BC



Kathleen Theresa McCoy, DNSc, PMHNP-BC



Pamela G. Lusk, DNP, MSN,PMHNP-BC



Carol D. Aunan, MSN, PMHNP-BC



Afshin M. Gutierrez, MSN, PMHNP-BC



Elizabeth Ann Skov, MSN, FNP, PMHNP-BC



Kristin L. Carleton, MSN, PMHNP-BC



Jeffery L. Ramirez, Ph. D, PMHNP-BC



Jolyn A. Zeller, MS, PMHNP-BC

We also would like to thank the ANCC staff who also spent numerous hours working to

make this study possible:



Christine DePascale, MS (Project Manager)



David Paulson, PhD, CAE



Chie Ohba, PhD



Cheray Jones

Finally, we would like to thank the ANCC-certified psychiatric-mental health nurse

practitioners who supported this study by completing the survey questionnaire.

(5)

Background

The American Nurses Credentialing Center (ANCC), which was incorporated in 1991 as

a subsidiary of the American Nurses Association, is the largest nursing credentialing organization

in the United States. Its vision is to be a transformational force for global quality healthcare

through excellence in credentialing. Currently, ANCC offers 25 examinations at various levels

including diploma and associate degree, baccalaureate, and advanced practice for nurse

practitioners, clinical nurse specialists, and other disciplines. More than 14,000 candidates take

an ANCC certification examination each year. In addition to certification, ANCC provides services

such as the Magnet and Pathways to Excellence recognition programs for hospitals and other

facilities that demonstrate excellence in nursing services, accreditation of continuing education

programs, education and consultation services, and outreach to nursing organizations around the

globe.

Role Delineation Study Overview

Role delineation or job analysis studies are typically carried out at the national level with

the goal of describing current practice expectations, performance requirements, and

environments. ANCC has a current goal of conducting a study of nurse practitioners

approximately every three years in order to capture changes in work activities and the knowledge

and skill areas required to perform those activities. The findings are used to update the content

of its respective certification examinations.

The 2011 Psychiatric-Mental Health Nurse Practitioner Role Delineation Study involved

two sets of processes or activities that ran more or less concurrently: a national web-based

survey and a linking activity. The national survey was designed to collect information on the work

activities psychiatric and mental health nurse practitioners actually perform in practice, while the

linking activity identifies the major knowledge and skill areas required to perform the work

activities listed in the survey. The results of both of these processes were used in the

development of the test content outline for the ANCC Psychiatric-Mental Health Nurse

Practitioner examination.

Updated Test Content Outline for Psychiatric-Mental Health Nurse Practioner

The test content outline for the Psychiatric-Mental Health Nurse Practitioner examination

was updated using the results of this role delineation study. Examinations forms produced based

on this updated test content outline are scheduled to go into effect August 6, 2013. A copy of the

test content outline is available on the American Nurses Credentialing Center website.

Role of the Content Expert Panels

The American Nurses Credentialing Center invited professionals in practice and

educators who teach courses relevant to psychiatric-mental health nurse practitioner practice to

serve on a panel of content experts for this study. They developed the work activities and

demographic items for the survey, linked knowledge and skill areas to the work activities list, and

finalized the test content outline. All of the content experts serving on the panel held an ANCC

Family Psychiatric and Mental Health Nurse Practitioner certification and were invited to serve on

the panel based upon expertise in the specialty.

(6)

Survey Methodology

The purpose of the development and administration of the national survey was to collect

information on the work activities psychiatric-mental health nurse practitioners actually perform in

practice. The role delineation study panel met for three days in May 2011 to draft a pilot version

of the survey and to construct the initial map of knowledge and skill areas relevant to the work

activities included in the survey.

Survey Chronology

The survey development and administration timeline was as follows:

May - June 2011



The role delineation study panel along with staff from ANCC drafted the survey.



The survey was pilot tested and revised.

July - August 2011



The final survey was administered on the web.

September - October 2011



The survey activity results were analyzed, and activity weights were determined.



The role delineation study panel met to review the survey results and activity

weights.

Survey Development and Measures

On May 2-4, 2011, the role delineation study panel met in Silver Spring, MD in order to

draft the national Psychiatric-Mental Health Nurse Practitioner Role Delineation Study survey for

the 2011 role delineation study. The panel members reviewed the work activities which had been

used in the ANCC's 2008 Family Psychiatric and Mental Health Nurse Practitioner Role

Delineation Study Survey as well as the following documents:



Consensus Model for APRN Regulation (APRN Consensus Workgroup and NCSBN

APRN Advisory Council, 2008)



ANA Psychiatric-Mental Health Nursing: Scope and Standards (2007)



Nurse Practitioner Core Competencies (NONPF, 2011)



Psychiatric-Mental Health Nurse Practitioner Competencies (NONPF, 2002)



The Essentials of Master’s Education in Nursing (AACN, 2011)



Appendix A from The Essentials of Doctorate of Nursing Practice Education for Advanced

Practice Nurses (AACN, 2006)

During the meeting, they discussed any additions, deletions, and changes they would make to

update the 2008 work activity list to reflect current practice of primary care nurse practitioners

working within any of the three population areas. The goal of this process was to create a

comprehensive list of relevant work activities that were potentially performed by nurse

practitioners in any one of the population areas, regardless of whether it was performed in the

others. As a result of this meeting, the panel reached consensus on a list of 95 work activities to

be used in the 2011 survey. These work activities were divided into six domains: Assessment,

(7)

Diagnosis, Plan of Care and Outcome Identification, Implementation, Evaluation and Professional

Role. The complete text of the work activities list is presented in Appendix A. The workgroup

also identified and finalized a set of 21 demographic questions. (See Appendix B).

During the same meeting, the workgroup reviewed and approved three scales that

respondents would use to rate the work activities listed in the survey—Frequency (the frequency

with which a work activity is performed), Performance Expectation (how soon on the job the

performance of an activity is expected), and Consequence (the consequence of performing an

activity incorrectly). The performance expectation scale was specifically designed to distinguish

entry-level skills. These three questions and the instructions for answering them are presented in

Table 2.

Table 2. Survey Questions for Rating Work Activity Statements

When responding to each item, please consider the newly certified psychiatric and mental health nurse practitioner. Please respond to each activity with three separate responses, one response in each category. When considering a response for one category, do not consider the other categories. For example: When considering the consequences of incorrect performance of an activity, do not worry about whether a newly certified psychiatric and mental health nurse practitioner performs or is expected to perform the activity; the possibility exists that an activity has severe consequences, even if newly certified psychiatric and mental health nurse practitioner never expected to perform it.

Performance Expectation:When is a newly certified psychiatric and mental health nurse practitioner first expected to perform this activity?

-- Within the first 6 monthsof working within the role and population. -- After the first 6 months of working within the role and population. -- Never expected to perform this activity within the role and population.

Frequency:How often does a newly certified psychiatric and mental health nurse practitioner perform this activity (consider within a one year period)?

-- Frequently

-- Often

-- Occasionally

-- Seldom

-- Never

Consequences: Does incorrect performance of this activity cause the patient: -- Little or no physical or psychological harm

-- Moderate physical or psychological harm -- Severe physical or psychological harm

The study design included combining each respondent’s responses to each of the three

rating scales in a hierarchical manner into one overall ranking of criticality. To select a procedure

for combining the three scales, the role delineation study panel discussed the importance of each

scale to the performance of the work activity. The panel determined that the performance

expectation scale should be regarded as more critical than the other two scales for representing

entry-level practice. The consequence scale was then regarded as more critical than the

frequency scale. Therefore, the panel agreed to combine the scales so that a particular value on

the performance expectation scale would outweigh or outrank all values on the consequence and

frequency scales. This hierarchical scheme emphasized the work activities that are required of

new practitioners immediately on the job and have the greatest impact on public health or safety.

Thus this scheme was selected as the organizing mechanism for combining the responses from

the three survey scales into an overall measure of criticality.

(8)

Sample Selection

On May 26, 2011, there were a total of 1,469 actively certified ANCC Family Psychiatric

and Mental Health Nurse Practitioners. One hundred were randomly selected to participate in the

pilot survey and 1,342 nurse practitioners were selected to participate in the national survey.

Table 1 presents the number of ANCC-certified Family Psychiatric and Mental Health Nurse

Practitioners selected to participate in the national survey per region.

Table 1. Number of ANCC-certified Psychiatric-Mental Health Nurse Practitioners Invited per Geographic Region

Geographic Region Number certified (percent of total pop.) Northeast – NY, CT, MA, NJ, ME, PA, NH, VT, RI 235 (17.5%)

South – TN, MS, TX, FL, LA, AL, GA, AR, OK, VA, MD, SC,

DC, NC, WV, DE, KY 565 (42.1%)

Midwest – IA, NE, KS, OH, MO, MN, SD, ND, MI, IL, IN, WI 225 (16.8%)

West – WA, AZ, CA, OR, CO, AK, ID, NM, UT, HI, NV, WY,

MT

314 (23.4%)

Other 3 (0.2%)

Total 1342 (100%)

Data Collection

Pilot Testing. Using the same procedures intended for administering the national data

collection, the survey was piloted in May and June 2011. One hundred ANCC-certified Family

Psychiatric and Mental Health Nurse Practitioners randomly selected from across the nation were

invited to take the pilot survey. Twenty-nine (29 percent) of those invited to take the pilot survey

responded. The panel members revised the survey based on the results of the pilot survey and

finalized 95 work activities to be used in the final survey. The complete text of the work activities

are presented in Appendix A.

National Survey. In July and August 2011, the 1,342 ANCC-certified Family Psychiatric

and Mental Health Nurse Practitioners who were selected to take the national survey were sent

three notifications via the United States Postal Service: an alert letter, and two follow-up

reminders. The alert letter explained the purpose and importance of the study, the eligibility

criteria of the study, and stated how to access the survey via the internet. The letter indicated

that the participant’s responses would be kept confidential. The letter also notified that

respondents completing the survey would receive a 5 hour reduction of their continuing education

requirement for their next ANCC recertification.

The first follow-up reminder letter was sent approximately two-weeks after the alert letter.

It thanked recipients if they had already submitted their completed survey and encouraged them

to do so if they had not already.

The final follow-up reminder letter was sent out only to those who had not yet responded

to the survey and was sent out approximately two-weeks prior to the end of the survey.

Data Analysis

The three rating scales were combined into a single measure of overall criticality using a

hierarchical method. As agreed by the initial study workgroup, the three rating scales were

combined into a single measure in such a manner that a particular value on the performance

(9)

expectation scale would outweigh or outrank all values on the consequence and frequency

scales, and that a particular value on the consequence scale would outweigh or outrank all values

on the frequency scale.

Table 3 displays how the values of the overall criticality rating were constructed according

to all the possible survey response patterns that might be given to rate an individual work activity

by its frequency, performance expectation, and consequence. For example, if a respondent

indicated that a particular work activity was expected to be performed within the first six months of

assuming the role of a psychiatric-mental health nurse practitioner, could cause severe harm to

the patient if it was performed incorrectly, and is performed occasionally, the overall criticality

rating for that response pattern would be 29. A score of 22 suggests that a work activity is

generally expected to be performed within the first six months of assuming the role of a

psychiatric-mental health nurse practitioner and have moderate consequences if incorrectly

performed. Therefore, work activities with scores of 22 or higher on the overall criticality variable

may be considered as highly critical. When a work activity was rated as never expected on the

performance expectation scale, it would receive an overall criticality score of 1 as the bottom row

in Table 3 indicates.

Table 3. Construction of the Overall Criticality Variable

Survey Response Options Overall Criticality Score Performance Expectation Consequence Frequency

Within first 6 months Severe Frequently 31

Often 30 Occasionally 29 Seldom 28 Never 27 Moderate Frequently 26 Often 25 Occasionally 24 Seldom 23 Never 22 Little or no Frequently 21 Often 20 Occasionally 19 Seldom 18 Never 17

After first 6 months Severe _Frequently 16

Often 15 Occasionally 14 Seldom 13 Never 12 Moderate Frequently 11 Often 10 Occasionally 9 Seldom 8 Never 7 Little or no Frequently 6 Often 5 Occasionally 4 Seldom 3 Never 2

(10)

Survey Results

The total sample size of the national survey included 1,342 ANCC certified Family

Psychiatric and Mental Health Nurse Practitioners. A total of 466 valid responses were returned

for a total usable response rate of 35 percent.

Table 4 shows the percent of surveys returned in each geographic region compared to

the number of ANCC-certified Family Psychiatric and Mental Health Nurse Practitioner invited

within each region.

Table 4. Number of Surveys Returned per Geographic Region for Psychiatric-Mental Health Nurse Practitioners

Geographic Region

Number Invited (percent of

total pop.) Number Return (percent of total pop.)

Northeast – NY, CT, MA, NJ, ME, PA, NH, VT, RI 235 (17.5%) 75 (16.1%)

South – TN, MS, TX, FL, LA, AL, GA, AR, OK, VA, MD, SC, DC, NC,

WV, DE, KY

565 (42.1%) 196 (42.1%)

Midwest – IA, NE, KS, OH, MO, MN, SD, ND, MI, IL, IN, WI 225 (16.8%) 87 (18.7%)

West – WA, AZ, CA, OR, CO, AK, ID, NM, UT, HI, NV, WY, MT 314 (23.4%) 108 (23.2%)

Other 3 (0.2%) 0 (0.0%)

Total 1342 (100%) 466 (100%)

Demographic Information

Appendix B details

the responses to the survey’s demographic questions which included

inquiry on the psychiatric-mental health nurse practitioner’s background and practice setting.

Demographic Background

Approximately 88 percent of the respondents were female and approximately 86 percent

reported to be white. Approximately 64 percent of the respondents fell into the age group, 45 - 64

years of age. Seventy-six percent of respondents indicated that they held a Masters in Nursing

as one of their highest degrees.

The average number of years of experience the psychiatric-mental health nurse

practitioner respondents had as an RN was 20 years. The respondents also reported on average

nearly 5 years working as a family psychiatric-mental health nurse practitioner.

Practice Settings

Approximately 40 percent of the respondents indicated that they practiced in cities

(population between 50,000 - 249,999). Towns (population between 2,500 - 49,999) came in

second with approximately 30 percent of respondents.

(11)

In terms of practice setting, the highest percentage of respondents indicated they practice

in a Community/Public Health (city/county/stat/federal agency (23 percent). Ambulatory Care --

Private practice came in second with 19 percent.

Practice Descriptions

Descriptive statistics (means, standard deviations, and medians) for the three ratings of

all 95 work activities—performance expectation, consequence, and frequency—and overall

criticality are listed in Appendix C. The scales were highly reliable. Cronbach’s coefficient alpha

estimates for the performance expectation, consequence, and frequency scales were 0.9250,

0.9715, 0.9482, respectively. (Cronbach's coefficient alpha, a measure of internal stability,

ranges in value between 0 and 1.)

In Appendix D, the mean overall criticality statistics are presented in rank order of

criticality. As indicated in Table 5, fifty-five work activity statements were rated by the

respondents as being highly critical (with a mean overall criticality rank of 22 or above).

Table 5. Number of Work Activities by Mean Overall Criticality for Psychiatric-Mental Health Nurse Practitioners Mean Overall Criticality Score

27.0 and

above 22.0 and 26.9 Between 17.0 and 21.9 Between 12.0 and 16.9 Between Between 7.0 and 11.9 6.9 and below

Total number above 22.0 Number of Work Activities 13 42 20 12 8 0 55

Table 6 and 7 displays the 20 highest-ranking and the 20 lowest-ranking work activities

by overall criticality.

Table 6. Top 20 Work Activities Ranked by Overall Criticality for Psychiatric-Mental Health Nurse Practitioners

Work Activity Number and Name Criticality Overall

5 Performs an on-going risk assessment (e.g., suicide, homicide, abuse, violence) 30.0

53 Prescribe pharmacologic treatment for psychiatric symptoms 29.0

55 Monitor pharmacologic treatment for psychiatric symptoms 29.0

15 Formulates a comprehensive current medication list, including complementary and alternative medications

29.0 29 Plan psychopharmacologic strategies based on individualized needs with consideration to potential

barriers and/or facilitators to adherence and potential side effects and/or medication interactions

28.9 2 Performs an initial age-appropriate comprehensive psychiatric evaluation that includes evaluation of

mental status, risk for violence to self or others, substance use, level of functioning, health behaviors, trauma, sexual behaviors, and social and developmental history

28.3

43 Treat acute psychiatric disorders and mental health problems 28.1

44 Treat chronic psychiatric disorders and mental health problems 27.9

18 Orders and interprets findings from relevant age-appropriate diagnostic, screening, and laboratory

tests 27.4

74 Arrange for follow-up to evaluate patient response to treatment 27.1

13 Assess patient’s willingness to adhere to prescribed regimens 27.0

72 Documents patient responses to treatment strategies 27.0

16 Assess patient’s current level of capacity to make decision for self 27.0

19 Differentiate presenting symptoms between psychiatric and other disorders 26.9

11 Assess the appropriate level of care 26.9

65 Process informed consent for treatment 26.7

3 Performs a problem-focused psychiatric evaluation 26.5

26 Plan with patient and/or family for least restrictive care to optimize safety 26.3

75 Serve as a patient advocate 25.9

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2011 Role Delineation Study: Psychiatric-Mental Health Nurse Practitioner – 11 Table 7. Bottom 20 Work Activities Ranked by Overall Criticality for Psychiatric -Mental Health Nurse Practitioners

Work Activity Number and Name

Overall Criticality

62 Use external databases to track controlled substances 16.5

34 Develop hospital/inpatient facility discharge plan 16.5

32 Plan to minimize risk and adverse events relating to procedures/devices (e.g., VNS, ECT, rTMS)

16.2

56 Monitor pharmacologic treatment for general medical problem 15.8

92 Implement quality improvement initiatives 15.7

83 Collaborate with health advocacy groups 15.5

86 Provides psychiatric/mental health services during community disasters or crises 15.0

80 Provide peer review/reflection in the promotion of improved practice 14.3

79 Mentors and fosters professional growth in other nursing colleagues 14.2

39 Conducts family psychotherapies 13.9

51 Provide direct care through use of multi-media technology 13.4

40 Conducts group psychotherapies 13.4

38 Conducts couples psychotherapies 11.9

42 Conducts play therapy 11.5

54 Prescribe pharmacologic treatment for general medical problems 11.3

87 Evaluate patient populations and available community resources for emerging trends in health care

10.9 91 Provide psychiatric and mental health care expertise to decision makers to affect health

care policy

10.7 85 Respond or testify in legal proceedings regarding psychiatric/mental health issues 10.2

77 Precepts nursing students 8.6

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2011 Role Delineation Study: Psychiatric-Mental Health Nurse Practitioner – National Survey Results

Appendix A

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Appendix A A-2 2011 Role Delineation Study: Psychiatric-Mental Health Nurse Practitioner –

Task List for Final Survey

I. Assessment and Diagnosis

1. Performs a comprehensive health history, including review of systems

2. Performs an initial age-appropriate comprehensive psychiatric evaluation that includes evaluation of mental status, risk for violence to self or others, substance use, level of functioning, health behaviors, trauma, sexual behaviors, and social and developmental history

3. Performs a problem-focused psychiatric evaluation 4. Conducts a multigenerational family assessment

5. Performs an on-going risk assessment (e.g., suicide, homicide, abuse, violence)

6. Performs a physical examination with emphasis on the mental status exam and neurological exam 7. Collect assessment data from multiple sources (including patient, family, other health care providers, collateral

information and past health care records) 8. Assess the impact of diagnosis on patient and family

9. Assess patient’s knowledge and utilization of wellness activities 10. Assess strengths and needs

11. Assess the appropriate level of care 12. Assess patient’s motivations for treatment

13. Assess patient’s willingness to adhere to prescribed regimens

14. Evaluates health impact of multiple life stressors within the context of family life cycle

15. Formulates a comprehensive current medication list, including complementary and alternative medications 16. Assess patient’s current level of capacity to make decision for self

17. Conduct an ongoing developmental assessment

18. Orders and interprets findings from relevant age-appropriate diagnostic, screening, and laboratory tests 19. Differentiate presenting symptoms between psychiatric and other disorders

20. Establish and prioritize differential diagnoses 21. Develop a multi-axial diagnosis

22. Diagnosis common complications associated with mental health problems and psychiatric disorders

II. Planning/Outcomes

23. Choose appropriate standardized measurement tools to evaluate treatment outcome 24. Develop a prioritized problem list to optimize outcomes

25. Identify measurable goals, objectives and desired outcomes for treatment 26. Plan with patient and/or family for least restrictive care to optimize safety

27. Plan collaboratively with individuals, families, schools, and/or groups identifying resources available

28. Modify plan based on current evidence and clinical knowledge congruent with client presentation and preferences 29. Plan psychopharmacologic strategies based on individualized needs with consideration to potential barriers and/or

facilitators to adherence and potential side effects and/or medication interactions

30. Plan non-pharmacologic strategies based on individualized needs with consideration to potential barriers and/or facilitators to adherence

31. Plan appropriate psychotherapy based on patient needs and capacity

32. Plan to minimize risk and adverse events relating to procedures/devices (e.g., VNS, ECT, rTMS) 33. Admitting patients to inpatient units

34. Develop hospital/inpatient facility discharge plan 35. Negotiate with client for preferred course of treatment

III. Interventions

36. Conducts a motivational interview 37. Conducts individual psychotherapies 38. Conducts couples psychotherapies 39. Conducts family psychotherapies 40. Conducts group psychotherapies 41. Conducts psychoeducation interventions 42. Conducts play therapy

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National Survey Results

Task List for Final Survey

43. Treat acute psychiatric disorders and mental health problems 44. Treat chronic psychiatric disorders and mental health problems 45. Treat psychiatric emergencies

46. Provide crisis intervention therapies

47. Manage patients that are actively withdrawing from substances 48. Provide substance use disorder therapies and treatments 49. Provide coordination of care and referrals

50. Provide anticipatory guidance to promote health and reduce risk 51. Provide direct care through use of multi-media technology 52. Use physical or chemical restraints

53. Prescribe pharmacologic treatment for psychiatric symptoms 54. Prescribe pharmacologic treatment for general medical problems 55. Monitor pharmacologic treatment for psychiatric symptoms 56. Monitor pharmacologic treatment for general medical problem 57. Recommend/order non-pharmacologic treatments

58. Activate protective services network

59. Establish an individualized therapeutic environment 60. Document in an electronic health record

61. Use an electronic prescribing system

62. Use external databases to track controlled substances 63. Provide trauma-informed care

64. Provide care using interpreters or assistive communication tools 65. Process informed consent for treatment

66. Promote neuro-protective behaviors

67. Interpret research findings for patients and families

IV. Evaluation

68. Evaluate effectiveness of treatment based on identified outcome measures and indicated timelines

69. Collect data from the patient, family or significant others, and other health care clinicians in the outcome evaluation process

70. Revise treatment strategies using ongoing assessment data

71. Evaluate significant trends and patterns regarding patient responses to treatment 72. Documents patient responses to treatment strategies

73. Assesses barriers and/or facilitators of adherence to plan of care 74. Arrange for follow-up to evaluate patient response to treatment

V. Professional Role/Practice

75. Serve as a patient advocate

76. Promote advanced practice psychiatric and mental health nursing through participation in professional organizations 77. Precepts nursing students

78. Provide clinical training for other disciplines

79. Mentors and fosters professional growth in other nursing colleagues 80. Provide peer review/reflection in the promotion of improved practice 81. Use peer review to improve own practice

82. Translating research into practice 83. Collaborate with health advocacy groups

84. Advocate for improved access, quality, and cost effective health care

85. Respond or testify in legal proceedings regarding psychiatric/mental health issues 86. Provides psychiatric/mental health services during community disasters or crises

87. Evaluate patient populations and available community resources for emerging trends in health care 88. Evaluates clinical practice in relation to best available evidence

89. Evaluates clinical practice in relation to current professional scope and standards of practice 90. Evaluates clinical practice in relation to relevant statutes and regulations

(16)

Task List for Final Survey

92. Implement quality improvement initiatives

93. Seeks consultation regarding practice issues outside of professional experience 94. Bill and code for services according to regulations and procedures

(17)

2011 Role Delineation Study: Psychiatric-Mental Health Nurse Practitioner – National Survey Results

Appendix B

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Appendix B– Demographic Data Summary B-2 2011 Role Delineation Study: Psychiatric-Mental Health Nurse Practitioner –

1. What is the Zip code of your primary place of work?

Recruitment Respondents

Count Percent Count Percent

Northeast 235 17.5% 75 16.1% South 565 42.1% 196 42.1% Midwest 225 16.8% 87 18.7% West 314 23.4% 108 23.2% Other 3 0.2% 0 0.0% Total 1,342 100% 466 100%

2. What is your gender?

_Count _Percent Female 408 88.3% Male 54 11.7% Total 462 100% (Not Answered) 4

3. What is your age?

Count Percent

Under 25 years old 0 0.0%

25 - 34 years old 55 11.9% 35 - 44 years old 100 21.6% 45 - 54 years old 158 34.1% 55 - 64 years old 137 29.6% 65 and older 13 2.8% Total 463 100% (Not Answered) 3

(19)

4. What is your racial/ethnic background?

_Count _Percent

_White ₃₉₉ _86.0%

Black or African American 25 5.4%

American Indian and Alaska Native 3 0.7%

Asian 7 1.5%

Native Hawaiian and other Pacific Islander 1 0.2%

Hispanic or Latino 18 3.9% Middle Eastern 2 0.4% Other 9 1.9% _Total ₄₆₄ _100% (Not Answered) 2

5. Indicate your highest degree(s) earned. (Mark all that apply)

_{Master's in Nursing} ₃₅₃ _75.8%

Post-Masters Certificate in Nursing 143 30.7%

Ph.D. in Nursing 5 1.1%

DNS/DSN/DNSc 4 0.8%

DNP 32 6.9%

M.A./M.S. in Program Other than Nursing 35 7.5%

MBA 6 1.3%

Ph.D. in Program Other than Nursing 9 1.9%

Ed D. 0 0.0%

Other 25 5.4%

The percentage is computed using “Total = 466”

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6. Which best describes your current primary employment setting? (Mark all that apply.)

_{Community/Public Health (city/county/state/federal agency)} ₁₀₉ _23.4% Ambulatory Care – Private Group Practice 90 19.3%

Other 86 18.5%

Hospital, Inpatient 67 14.4%

Ambulatory Care – Private Individual Practice 58 12.5%

Ambulatory Care Setting – Hospital Based 45 9.7%

Addiction Services 37 8.0%

Federally Funded Health Clinic 24 5.2%

Psychiatric Forensic 20 4.3%

Correctional Nursing 18 3.9%

Day Treatment Center 17 3.7%

Rehabilitation Facility 8 1.7%

Consulting Firm 2 0.4%

Hospice/Palliative Care 2 0.4%

Ambulatory Care Setting – Surgical Center 1 0.2%

Home Health Care 1 0.2%

_{(Not Answered)} ₃

_{The percentage is computed using “Total = 466”}

7. What is the size of the population that your primary practice setting services?

_{Rural (population less than 2,500)} ₄₆ _9.9% Town (population between 2,500 - 49,999) 141 30.3%

City (population between 50,000 - 249,999) 188 40.3%

Metropolitan (population between 250,000 - 999,999) 74 15.9%

Greater Metropolitan (population greater than 999,999) 54 11.6%

Other 6 1.3%

(21)

8. How many years of experience do you have as:

A Registered Nurse?

Family Psychiatric and Mental Health Nurse

Practitioner As Another APRN

Years Count Percent Count Percent Count Percent Less than 1 5 1.1% 21 4.5% 191 54.1% 1 to 9 101 21.8% 395 85.1% 60 17.0% 10 to 19 121 26.1% 43 9.3% 75 21.2% 20 to 29 111 24.0% 3 0.7% 18 5.1% 30 to 39 107 23.1% 2 0.4% 8 2.3% 40 to 49 17 3.7% 0 0.0% 1 0.3% 50 to 59 1 0.2% 0 0.0% 0 0.0% Total 463 100% 464 100% 353 100.0% (Not Answered) 3 2 113 Mean 20.2 4.8 Median 20 4

(22)

9. The percentage of time that you provide direct health care for patient/clients in each of the age groups listed

Infant

(birth to 1 year) (2 to 4 years) Preschool (5 to 12 years) School Age (13 to 17 years) Adolescent (18 to 64 years) Adult (65 to 74 years) Young-Old

% of time Count Percent Count Percent Count Percent Count Percent Count Percent Count Percent

0% 452 97.0% 349 74.9% 172 36.9% 114 24.5% 20 4.3% 109 23.4% 1% to 19% 13 2.8% 113 24.3% 148 31.8% 154 33.1% 66 14.2% 294 63.1% 20% to 39% 1 0.2% 3 0.6% 89 19.1% 134 28.8% 71 15.2% 52 11.2% 40% to 59% 0 0.0% 0 0.0% 44 9.4% 44 9.4% 80 17.2% 6 1.3% 60% to 79% 0 0.0% 0 0.0% 12 2.6% 11 2.4% 100 21.5% 4 0.9% 80% to 100% 0 0.0% 1 0.2% 1 0.2% 9 1.9% 129 27.7% 1 0.2% Valid Responses 466 100% 466 100% 466 100% 466 100% 466 100% 466 100% (Not Answered) Mean percent

spent with each 0.2% 1.5% 13.9% 17.9% 53.1% 8.6%

age group

(

continue) A p p en d ix B – D emo g ra p h ic D ata S u mmar y B -6 2011 R o le D el in eat io n St u d y: Psych iatr ic -M e n ta l H ea lth N u rse Pr act iti o n e r – N ati o n al Su rvey R esu lts © Co p yr ig h t 2 0 1 2 A m e ric a n Nu rse s C re d e n tia lin g Ce n te r, A ll Ri g h ts Re se rve d

(23)

9. The percentage of time that you provide direct health care for patient/clients in each of the age groups listed (Continued)

Middle-Old (75-84

years) Oldest-Old (85 years and older)

% of time Count Percent Count Percent

0% 215 46.1% 315 67.6% 1% to 19% 230 49.4% 145 31.1% 20% to 39% 19 4.1% 6 1.3% 40% to 59% 2 0.4% 0 0.0% 60% to 79% 0 0.0% 0 0.0% 80% to 100% 0 0.0% 0 0.0% Valid Responses 466 100% 466 100% (Not Answered) Mean percent

spent with each 3.6% 1.4%

age group A p p en d ix B – D emo g ra p h ic D ata S u mmar y B -7 2011 R o le D el in eat io n St u d y: Psych iatr ic -M e n ta l H ea lth N u rse Pr act iti o n e r – N ati o n al Su rvey R esu lts © Co p yr ig h t 2 0 1 2 A m e ric a n Nu rse s C re d e n tia lin g Ce n te r, A ll Ri g h ts Re se rve d

(24)

10. Approximately what percentage of your work time (during the average week) is spent in each of the following activities?

Direct Care

Management, Supervision,

Administration Teaching Research

Consultation with Other

Professionals Precepting

spent with each 77.2% 5.9% 5.6% 1.8% 6.7% 2.1%

age group (Continued) A p p en d ix B – D emo g ra p h ic D ata S u mmar y B -8 2011 R o le D el in eat io n St u d y: Psych iatr ic -M e n ta l H ea lth N u rse Pr act iti o n e r – N ati o n al Su rvey R esu lts © Co p yr ig h t 2 0 1 2 A m e ric a n Nu rse s C re d e n tia lin g Ce n te r, A ll Ri g h ts Re se rve d

(25)

10. Approximately what percentage of your work time (during the average week) is spent in each of the following activities? (Continued

Other

% of time Count Percent

0% 385 82.6% 1% to 19% 67 14.4% 20% to 39% 12 2.6% 40% to 59% 1 0.2% 60% to 79% 1 0.2% 80% to 100% 0 0.0% Valid Responses 466 100% (Not Answered) Mean percent

spent with each 1.8%

age group A p p en d ix B – D emo g ra p h ic D ata S u mmar y B -9 2011 R o le D el in eat io n St u d y: Psych iatr ic -M e n ta l H ea lth N u rse Pr act iti o n e r – N ati o n al Su rvey R esu lts © Co p yr ig h t 2 0 1 2 A m e ric a n Nu rse s C re d e n tia lin g Ce n te r, A ll Ri g h ts Re se rve d

(26)

11. Think of the times you provided psychotherapy and psychopharmacologic management within the past year. Estimate the percent of that time you spent in each of the following activities?

% of time Medication Management NOT Including Psychotherapy

Individual Psychotherapy Including Psychopharmacologic

Management

Group Psychotherapy including Psychopharmacologic Management Individual Psychotherapy NOT Including Psychopharmacologic Management

Count Percent Count Percent Count Percent Count Percent

0% 27 5.8% 82 17.6% 414 88.8% 262 56.2% 1% to 19% 63 13.5% 121 26.0% 47 10.1% 158 33.9% 20% to 39% 55 11.8% 105 22.5% 5 1.1% 34 7.3% 40% to 59% 52 11.2% 50 10.7% 0 0.0% 6 1.3% 60% to 79% 66 14.2% 54 11.6% 0 0.0% 3 0.6% 80% to 100% 203 43.6% 54 11.6% 0 0.0% 3 0.6% Valid Responses 466 100% 466 100% 466 100% 466 100% (Not Answered) Mean percent

spent with each area 59.1% 30.9% 0.8% 5.8%

(continue)

A p p en d ix B – D emo g ra p h ic D ata S u mmar y B -10 2011 R o le D el in eat io n St u d y: Psych iatr ic -M e n ta l H ea lth N u rse Pr act iti o n e r– N ati o n al Su rvey R esu lts © Co p yr ig h t 2 0 1 2 A m e ric a n Nu rse s C re d e n tia lin g Ce n te r, A ll Ri g h ts Re se rve d

(27)

11. Think of the times you provided psychotherapy and psychopharmacologic management within the past year. Estimate the percent of that time you spent in each of the following activities? (Continued) % of time Group Psychotherapy NOT Including Psychopharmacolo gic Management

Marital Therapy NOT Including Psychopharmacologic

Management

Family Therapy NOT Including Psychopharmacologic

Management

Count Percent Count Percent Count Percent

0% 412 88.4% 400 85.8% 351 75.3% 1% to 19% 47 10.1% 66 14.2% 105 22.5% 20% to 39% 6 1.3% 0 0.0% 8 1.7% 40% to 59% 0 0.0% 0 0.0% 2 0.4% 60% to 79% 0 0.0% 0 0.0% 0 0.0% 80% to 100% 1 0.2% 0 0.0% 0 0.0% Valid Responses 466 100% 466 100% 466 100% (Not Answered) Mean percent

spent with each area 1.1% 0.6% 1.9%

A p p en d ix B – D emo g ra p h ic D ata S u mmar y B -11 2011 R o le D el in eat io n St u d y: Psych iatr ic -M e n ta l H ea lth N u rse Pr act iti o n e r – N ati o n al Su rvey R esu lts © Co p yr ig h t 2 0 1 2 A m e ric a n Nu rse s C re d e n tia lin g Ce n te r, A ll Ri g h ts Re se rve d

(28)

12. Within your practice do you perform physical assessments? _Count _Percent Yes 150 32.5% No 311 67.5% Total 461 (Not Answered) 5

If the answer to <<the question above>> is “Yes” (N=150)

Think of the times you spent conducting physical assessments within the last year. Estimate the percent of time that was focuesed on assessming each of the following body systems:

Head, Eyes, Ears, Nose

and Throat Respiratory System Cardiovascular System Gastrointestinal System Genitourinary System Musculoskeletal System

spent with each 5.8% 6.4% 10.8% 4.8% 3.3% 6.3%

age group

(Continued) If the answer to <<the question above>> is “Yes” (N=150)

A p p en d ix B – D emo g ra p h ic D ata S u mmar y B -12 2011 R o le D el in eat io n St u d y: Psych iatr ic -M e n ta l H ea lth N u rse Pr act iti o n e r – N ati o n al Su rvey R esu lts © Co p yr ig h t 2 0 1 2 A m e ric a n Nu rse s C re d e n tia lin g Ce n te r, A ll Ri g h ts Re se rve d

(29)

13. Think of the times you spent conducting physical assessments within the last year. Estimate the percent of time that was focuesed on assessming each of the following body systems: (Continued) Neurological System (including psychiatric conditions) Endocrine System (including metabolic

disorders) Hematopoietic System Immune System Integumentary System

% of time Count Percent Count Percent Count Percent Count Percent Count Percent

0% 3 2.0% 23 15.3% 67 44.7% 72 48.0% 72 48.0% 1% to 19% 28 18.7% 112 74.7% 83 55.3% 78 52.0% 78 52.0% 20% to 39% 40 26.7% 12 8.0% 0 0.0% 0 0.0% 0 0.0% 40% to 59% 25 16.7% 2 1.3% 0 0.0% 0 0.0% 0 0.0% 60% to 79% 18 12.0% 1 0.7% 0 0.0% 0 0.0% 0 0.0% 80% to 100% 36 24.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Valid Responses 150 100% 150 100% 150 100% 150 100% 150 100% (Not Answered) Mean percent

spent with each 45.3% 8.3% 2.5% 2.2% 4.4%

age group A p p en d ix B – D emo g ra p h ic D ata S u mmar y B -13 2011 R o le D el in eat io n St u d y: Psych iatr ic -M e n ta l H ea lth N u rse Pr act iti o n e r – N ati o n al Su rvey R esu lts © Co p yr ig h t 2 0 1 2 A m e ric a n Nu rse s C re d e n tia lin g Ce n te r, A ll Ri g h ts Re se rve d

(30)

Appendix B– Demographic Data Summary B-14 2011 Role Delineation Study: Psychiatric-Mental Health Nurse Practitioner–

14. Which of the following conditions do you typically treat clients for:

Count Percentage

Substance Use 273 58.6%

Bipolar Disorder 440 94.4%

Depression 461 98.9%

Anxiety Disorders 453 97.2%

Acute Conditions Requiring Hospitalization 209 44.9%

Post Traumatic Stress 395 84.8%

Eating Disorders 166 35.6%

AD/HD 367 78.8%

Thought Disorders 343 73.6%

General Medical Conditions 68 14.6%

Cognitive Disorders 238 51.1%

Personality Disorders 304 65.2%

Autism Spectrum Disorder 248 53.2%

Developmental Delay 164 35.2%

(Not Answered) 2

15. Consider your patient visits within the past year. Estimate the percent of patients for which you prescribed/managed medications within each of these drug agent categories.

Number/Percent of Respondents Who Prescribed or Managed Medications within the Drug Agent Category during one or more percent of patient visits

Count Percent

Antiinfective 88 18.9%

Antiinflammatory 126 27.0%

Autonomic Nervous System 216 46.4%

Cancer 7 1.5% Cardiovascular 134 28.8% Emergency 113 24.3% Endocrine 130 27.9% Gastrointestinal 143 30.7% Herbal 139 29.8% Immunologic 26 5.6%

Neurologic and Neuromuscular 259 55.6%

Pain 112 24.0%

Psychiatric 446 95.7%

Reproductive and Gender-Related 63 13.5%

Respiratory 78 16.7%

Urologic 67 14.4%

(31)

16. Do you have privileges to prescribe medications in your current practice setting?

_Count _Percent Yes 449 97.0% No 14 3.0% Total 463 (Not Answered) 3

17. Do you have privileges to prescribe schedule II in your current practice setting?

18. Do you require a Cosign to prescribe medications?

(32)

19. Do you have hospital privileges in your current practice setting?

_Count _Percent _Yes ₁₅₁ _32.6% No 312 67.0% Total 463 (Not Answered) 3

20. Are you required by your state to have a physician collaborator/supervisor?

Count Percent _Yes ₃₅₄ _76.6% No 108 23.4% Not Applicable _Total ₄₆₂ (Not Answered) 4

21. Are you required by your job to have a physician collaborator/supervisor?

Count Percent _Yes ₃₂₇ _71.2% No 132 28.8% Not Applicable _Total ₄₅₉ (Not Answered) 7

(33)

2011 Role Delineation Study: Psychiatric-Mental Health Nurse Practitioner– National Survey Results

Appendix C

(34)

A p p en d ix C – W o rk A cti v iti es D esc ri p iveStat isti cs C -2 2011 R o le D el in eat io n St u d y: Psych iatr ic -M e n ta l H ea lth N u rse Pr act iti o n e r – N ati o n al Su rvey R esu lts © Co p yr ig h t 2 0 1 2 A m e ric a n Nu rse s C re d e n tia lin g Ce n te r, A ll Ri g h ts Re se rve d

Psychiatric-Mental Health Nurse Practitioner (N=466)

Survey Order

Performance Expectation Consequence Frequency Overall Rank Mean Std

Dev Median Mean Dev Std Median Mean Dev Std Median Mean Dev Std Median

1 Performs a comprehensive health history, including

review of systems 1.9 0.4 2 1.2 0.7 1 3.1 1.0 3 25.3 6.5 26

2 Performs an initial age-appropriate comprehensive psychiatric evaluation that includes evaluation of mental status, risk for violence to self or others, substance use, level of functioning, health behaviors, trauma, sexual behaviors, and social and developmental history

2.0 0.2 2 1.6 0.6 2 3.6 0.6 4 28.3 4.2 30

3 Performs a problem-focused psychiatric evaluation 2.0 0.2 2 1.3 0.6 1 3.5 0.7 4 26.5 4.5 26

4 Conducts a multigenerational family assessment 1.7 0.6 2 0.6 0.6 1 2.5 1.1 3 18.9 8.3 20.5

5 Performs an on-going risk assessment (e.g., suicide, homicide, abuse, violence)

2.0 0.2 2 1.9 0.4 2 3.8 0.5 4 30.0 3.2 31

6 Performs a physical examination with emphasis on the mental status exam and neurological exam

1.6 0.7 2 1.1 0.7 1 2.2 1.3 2 20.7 10.1 24

7 Collect assessment data from multiple sources (including patient, family, other health care providers, collateral information and past health care records)

2.0 0.2 2 1.1 0.6 1 3.2 0.7 3 25.2 4.6 25

8 Assess the impact of diagnosis on patient and family 1.9 0.3 2 1.0 0.6 1 3.4 0.7 3 24.2 5.4 25

9 Assess patient’s knowledge and utilization of wellness activities

1.9 0.3 2 0.7 0.6 1 3.3 0.7 3 23.1 5.3 25

10 Assess strengths and needs 2.0 0.2 2 0.9 0.6 1 3.5 0.6 4 24.4 4.3 25

11 Assess the appropriate level of care 1.9 0.2 2 1.4 0.6 1 3.6 0.6 4 26.9 4.9 26

12 Assess patient’s motivations for treatment 2.0 0.2 2 0.9 0.6 1 3.6 0.6 4 24.4 4.7 26

13 Assess patient’s willingness to adhere to prescribed regimens

2.0 0.2 2 1.4 0.6 1 3.7 0.5 4 27.0 4.5 26

14 Evaluates health impact of multiple life stressors within

the context of family life cycle 1.9 0.4 2 1.0 0.6 1 3.2 0.8 3 23.0 6.7 25

15 Formulates a comprehensive current medication list,

including complementary and alternative medications 2.0 0.2 2 1.7 0.5 2 3.8 0.5 4 29.0 3.6 31

16 Assess patient’s current level of capacity to make decision for self

(35)

Performance expectation response options: 0 = never, 1 = after first 6 months, 2 = within the first 6 months; Consequences response option: 0 = little or none, 1 = moderate, 2 = severe; Frequency response options: 0 = never, 1 = seldom, 2 = occasionally, 3 = often, 4 = frequently

A p p en d ix C – W o rk A cti v iti es D esc ri p iveStat isti cs C -3 2011 R o le D el in eat io n St u d y: Psych iatr ic -M e n ta l H ea lth N u rse Pr act iti o n e r – N ati o n al Su rvey R esu lts © Co p yr ig h t 2 0 1 2 A m e ric a n Nu rse s C re d e n tia lin g Ce n te r, A ll Ri g h ts Re se rve d

Psychiatric-Mental Health Nurse Practitioner (N=466)

Survey Order

Performance Expectation Consequence Frequency Overall Rank Mean Std Dev Median Mean Std Dev Median Mean Std Dev Median Mean Std Dev Median

17 Conduct an ongoing developmental assessment 1.8 0.4 2 0.8 0.6 1 2.8 0.9 3 21.7 6.8 25

18 Orders and interprets findings from relevant

age-appropriate diagnostic, screening, and laboratory tests 1.9 0.3 2 1.6 0.5 2 3.3 0.7 3 27.4 5.3 30

19 Differentiate presenting symptoms between psychiatric

and other disorders 1.9 0.3 2 1.6 0.6 2 3.6 0.5 4 26.9 5.9 30

20 Establish and prioritize differential diagnoses 1.9 0.3 2 1.2 0.6 1 3.6 0.6 4 25.3 5.6 26

21 Develop a multi-axial diagnosis 2.0 0.2 2 1.1 0.6 1 3.7 0.6 4 25.4 4.7 26

22 Diagnosis common complications associated with

mental health problems and psychiatric disorders 1.9 0.3 2 1.3 0.6 1 3.4 0.6 4 25.3 6.1 26

23 Choose appropriate standardized measurement tools to

evaluate treatment outcome 1.7 0.5 2 0.7 0.6 1 2.7 0.9 3 19.6 8.1 24

24 Develop a prioritized problem list to optimize outcomes 1.8 0.5 2 0.8 0.6 1 3.1 0.9 3 21.9 7.3 25

25 Identify measurable goals, objectives and desired outcomes for treatment

1.9 0.3 2 0.9 0.6 1 3.3 0.8 3 23.3 6.0 25

26 Plan with patient and/or family for least restrictive care

to optimize safety 1.9 0.3 2 1.4 0.6 1 3.3 0.9 3 26.3 5.7 26

27 Plan collaboratively with individuals, families, schools,

and/or groups identifying resources available 1.8 0.4 2 0.8 0.5 1 2.8 0.8 3 21.0 7.6 25

28 Modify plan based on current evidence and clinical knowledge congruent with client presentation and preferences

1.9 0.3 2 1.1 0.5 1 3.4 0.7 3 24.0 6.5 25

29 Plan psychopharmacologic strategies based on individualized needs with consideration to potential barriers and/or facilitators to adherence and potential side effects and/or medication interactions

2.0 0.2 2 1.8 0.4 2 3.8 0.4 4 29.0 4.4 31

30 Plan non-pharmacologic strategies based on individualized needs with consideration to potential barriers and/or facilitators to adherence

1.9 0.3 2 1.0 0.6 1 3.4 0.7 3 24.6 5.2 25

31 Plan appropriate psychotherapy based on patient needs and capacity

Role Delineation Study

201



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Role Delineation Study

National Survey Results

0$5&+ 2012

About this Report

This report pertaining to the practice of psychiatric-mental health nurse practitioners was

based on the results of a 2011 national study of practice of psychiatric-mental health nurse

practitioners.

Table of Contents

ABOUT THIS REPORT ... 1

ACKNOWLEDGEMENTS ... 3

BACKGROUND ... 4

R

D

S

O

... 4

U

T

C

O

P

-M

H

N

P

... 4

R

C

E

P

... 4

SURVEY METHODOLOGY ... 5

S

C

... 5

S

D

M

... 5

S

S

... 7

D

C

... 7

D

A

... 7

SURVEY RESULTS ... 9

D

I

... 9

P

D

... 10

APPENDICIES

W

A

S

... A

A

D

D

S

... A

B

W

A

D

S

... A

C

W

A

O

C

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