Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey

Transcription

1 Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey Kathleen R. Delaney, PhD, PMHNP BC Barbara L. Drew, PhD, PMHCNS BC Amy J. Rushton, MSN, PMHCNS BC Conflict of Interest Statement We have no conflicts of interest to report Objectives for Presentation Describe the characteristics of the Psychiatric Mental Health (PMH) Advanced Practice Registered Nurse (APRN) workforce, its size, characteristics and major activities. Identify critical differences between the PMH APRN workforce and other APRN specialty groups. Explain, based on the data presented, implications for PMH APRN workforce development; particularly in light of its current capacity and mental health service needs. Amy J. Rushton, MSN, PMHCNS BC 1

2 Survey Intent, Design and Delivery The survey was intended to gather data from certified PMH APRNs in the United States. It designed in line with the national nursing workforce minimum data set questions, essential to nursing workforce surveys. Additional questions were added relevant to PMH nursing and psychotherapeutic interventions. The survey was delivered on line during March A survey link and invitation to participate were sent to lists of PMH APRNs derived from three sources. Data is Presented Here in 3 Sections Questions Encouraged between Sections 1,761 certified PMH APRNS responded to survey Respondents: PMH CNSs (867) and PMH NPs (1049)* 70 respondents were PMH APRNs who did not hold certification Percent holding certifications Psych/mental health adult CNS Psych/mental health child and Psych/mental health adult NP Psych/mental health family/lifespan adolescent CNS NP *These numbers contain duplicates; individuals holding two certifications Who are PMH APRNs: Demographics Racial demographics Hispanic/ Latino American Indian/ 1% 4% Alaska Native 2% 4% 1% Asian Black/ African American Native Hawaiian/ Other Pacific 78% Islander White We are largely female (90.1%); male (9.9%) Largely white Average age of 54 The CNS group is slightly older (x=61) versus NP (x= 48.9) Preparation at MSN level (82%) Post masters (2) 32% of respondents completed their education more than 20 years ago (from ) No response Amy J. Rushton, MSN, PMHCNS BC 2

3 Stability of our Work Force 5 When do you plan to retire? In years 3 5 years 6 10 years more than 10 years APRNs are Largely Employed in Clinical Practice: Why Important? Employment Areas for Certified PMH APRNs 2% 1% 4% 8% 86% APN in Clinical Practice Faculty requiring an APN credential Researcher requiring an APN credential Administrator requiring an APN credential Other (specify) Majority have Prescriptive Authority Some Differences in CNSs vs NPs NP: Do you have prescriptive authority CNS: Do you have prescriptive authority? 3.8% 96.2% Yes No 36% 64% Yes No Amy J. Rushton, MSN, PMHCNS BC 3

4 PMH APRNs Practice in a Variety of Settings Including Community Arena 2 Break down of ambulatory and hospital settings % of Respondents Report Income Between $95, ,000 16% 2015 pre tax earnings from primary position 14% 12% 8% 6% 4% 2% Section 2: Workforce Roles This is what we do Most Patients Some Patients Few Patients No Patients Diagnosis, treatment, and management of acute illnesses Diagnosis, treatment, and management of chronic illnesses Conduct physical examinations Order, perform, and interpret lab tests, x-rays, EKGs, and other diagnostic studies Prescribe drugs for acute and chronic illnesses Provide preventative care, including screening and immunizations Perform procedures Educate patients and families Provide care coordination Make referrals 55.2% % % 3.8% 0.9% 2.1% % 2.2% 3.9% 12.4% % 2.3% 4.2% % 1.4% 0.6% 4.3% % 3.8% % % 1.9% 2.7% 15.6% % % 6.4% 1.9% 2.1% % 8.2% 2.3% Amy J. Rushton, MSN, PMHCNS BC 4

5 If you conduct psychotherapy, what type of psychotherapy do you use in your practice? PMH APRNs Provide a Complex Mix of Services APRNs deliver services to a range of patients in terms of diagnostic categories and age APRN reported most treated disorders Age Most Some Few None (4%) 157 () 149 (14%) 721 (67%) () 351 (31%) 466 (4) 220 (19 %) (18%) 793 (62%) 166 (13%) 81 (6%) (62%) 358 (27%) 65 () 83 (6%) (13%) 560 (44%) 412 (32%) 133 (11%) Amy J. Rushton, MSN, PMHCNS BC 5

6 Section 3: Satisfaction and Provider Relationships % Satisfaction: Autonomy % Very Satisfied Satisfied Dissatisfied Very Dissatisfied 2.3% PMH APRNs are Largely Satisfied With Most Aspects of Role Save Two Elements Satisfaction: amount of administrative support Very Satisfied Satisfied Dissatisfied Very Dissatisfied Billing and Use of NPI aligns with National Rates 5 Current Billing Arrangement Bill under my provider Bill under my Bill under a physician s No billing, cash only number clinic/facility number provider number No billing, grant supported/free clinic Other (specify) Amy J. Rushton, MSN, PMHCNS BC 6

7 Implications for Practice: Size of the Workforce and Potential for Growth Potential for Growth as Providers: Barriers and Facilitators Addressing issues of Geographic Maldistribution: Use of RN Workforce Community size where principal APN practice is located 2 18% 16% 14% 12% 8% 6% 4% 2% 1,000 9,999 10,000 24,999 25,000 49,999 50,000 99, , , ,000 1,000,000 or 249, , ,999 more Amy J. Rushton, MSN, PMHCNS BC 7

8 PMH APRNs have Requisite Interpersonal Skills for Engagement: Dominant Services of Current Role? From: Russinova, Rogers, & Ellison, 2006 Conclusions PMH APRNs specialty has assumed activities that comprise primary mental health care for individuals dealing with serious mental illness, e.g., diagnosis and management, prescribing, education. Two thirds of the respondents are using psychotherapeutic approaches, it would seem in combination with prescribing since only of APRNs are delivering psychotherapy alone to most patients. APRNs prescribing/diagnosis and management activities are dominating the role. How much of this shift is in response to work place demands? Will PMH nurses continue to move forward with a somewhat narrow definition of their role within mental health services delivery? Age and geographic mal distribution are workforce issues. The specialty must actively devise and implement solutions to provide access for a wider span of individuals, some of these solutions may be utilization of service models such as tele psychiatry. References American Health Insurance Plans (2016). New Data Brief Finds Physician Shortages Lead to Network Adequacy Challenges. Retrieved from data brief finds physician shortages lead tonetwork adequacy challenges/ Burke, B. T., Miller, B. F., Proser, M., Petterson, S. M., Bazemore, & Phillips, R. L. (2013). A needs based method for estimating the behavioral health staff needs of community health centers. BMC Health Services Research, 13, 245. Delaney, K. R. (2016). Psychiatric Mental Health Nursing Workforce Agenda Optimizing Capabilities and Capacity to Address Workforce Demands. Journal of the, 22, de Nesnera, A., & Allen, D. E. (2016). Expanding the Role of Psychiatric Mental Health Nurse Practitioners in a State Psychiatric System: The New Hampshire Experience. Psychiatric Services, 67, 5, Durbin, A., Durbin, J., Hensel, J. M., & Deber, R. (2016). Barriers and enablers to integrating mental health into primary care: a policy analysis. The Journal of Behavioral Health Services & Research, 43(1), Fang, D., Li, Y., Arietti, R., & Trautman, D.E. (2015) Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Washington DC: AACN. Graves, J. A., Mishra, P., Dittus, R. S., Parikh, R., Perloff, J., & Buerhaus, P. I. (2016). Role of Geography and Nurse Practitioner Scope of Practice in Efforts to Expand Primary Care System Capacity: Health Reform and the Primary Care Workforce. Medical care, 54(1), Health Resources and Services Administration (2015) Projecting the Supply of Non Primary Care Specialty and Subspecialty Clinicians: Retrieved from Health Resources and Services Administration (January, 2016) HPSAs by State and County. Retrieved from 25 US Census Bureau. Staff Care (2015). Behavioral health: The silent shortage. Retrieved from paper behavioralhealth silent shortage.pdf Ying Xue Y & Intrator, O. (2016) Cultivating the Role of Nurse Practitioners in Providing Primary Care to Vulnerable Populations in an Era of Health Care Reform. Policy Politics Nursing Practice , first published on May 9, 2016 Amy J. Rushton, MSN, PMHCNS BC 8