Imagine being a person who awakens with anxiety every day, the darkness in your spirit unabated by the bright sunshine outside. Or believing you are an old woman one day but a little girl the next. Or being unable to remember if you took your medication—or feeling so good you don't think you need it and skip it. Or a young man harming yourself to silence the voices in your head. Or wishing you could stop drinking or inhaling, even as you hand over money to buy a fix. Now imagine being the nurse practitioner who makes a difference in the lives of people who suffer such mental illness and addiction, helping them not only deal with their current conditions but find their footing and even recover in same cases.
The American Psychiatric Nurses Association (APNA) says psychiatric-mental health nursing is a specialty; in addition to basic RN functions, mental health nurse practitioners (MHNPs) “assess, diagnose, and treat individuals or families with psychiatric problems/disorders or the potential for such disorders.” They have patient credibility through their specialty work in such areas as child/adolescent mental health, geriatrics, forensics, or substance abuse. Practice settings include hospitals, private clinics, psychiatric and addiction facilities, prisons, public health agencies, and nursing homes.
Lori K. Fox, MSN, ARNP, works in an inpatient geriatric medical psychiatric unit in New Hampshire. She says, “One of the biggest challenges I face in working with older patients is their attitudes and beliefs about mental health issues. Many seniors that I care for grew up at a time when mental health issues were not recognized, talked about, or treated. Seniors are often not comfortable talking about and taking medications for mental health problems. Providing acceptance and education becomes an equally important part of their treatment.”
The APNA envisions a “mental healthcare delivery system that provides for access and parity for mental health services; considers the needs and strengths of the individual, family, group, and community; and embeds quality, safe, evidence-based, interprofessional practice and cultural competence as essential dimensions of consumer-focused, 21st century mental healthcare delivery and professional practice.” How does this vision translate into everyday practice? Fox says, “I collaborate on a daily basis with a team of specialists that includes psychiatrists, social workers, and occupational, physical, recreational, and speech therapists. I depend on direct input from the nurses and nursing assistants when formulating and evaluating treatment plans for my patients. “I am proud to be a part of a team that delivers comprehensive and coordinated care with compassion, dignity, and respect for our patients.”
What professional and personal skills are essential for MHNPs? Fox says, “First, they must be clinically competent; the ability to perform thorough, comprehensive assessments is essential. Problem solving and critical thinking skills are required to deal with patients' complex mental and physical issues. MHNPs need to be able to use innovative, evidence-based practices. They must also have the ability to listen to patients, family members, and all the other team members. MHNPs must have excellent communication skills and empathy.”
Savvy prescribing skills also are required. A white paper from the International Society of Psychiatric-Mental Health Nurses says, “Pharmacotherapeutic prescription entails a complex array of information synthesis and clinical decision making that assumes a baseline of detailed knowledge of a wide range of biological data. In working with the mentally ill, effective prescription practices are predicated on a knowledge of anatomy and physiology, an understanding of pharmacologic principles, legal awareness, advocacy, interpretation of laboratory findings, knowledge of concomitant and co-morbid health states, and an ability to stay current in related topical areas such as advances in genetics, immunology, and other biologically based sciences.” Psychopharmacology medications have the potential to improve the quality of life, but these drugs are also some of the most toxic and require sophisticated skills to use them appropriately.
According to the APNA, hot topics for MHNPs include translational science, trauma and violence, access to care, safety, quality of care, psychopharmacology, evidence-based psychiatric nursing practice, complementary/alternative medicine, legislative/policy issues, and innovative practices of psychiatric nursing.
Fox advises those considering a mental health practice to be open-minded. “So many people in many different types of settings can benefit from your help. Isn't that why we became nurses in the first place?” The jobs listed in the following pages may be just right for an MHNP.
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