President's Report

Introduction

It is my pleasure to serve as president of APNA and to present my report, which covers the period November 1, 2011 through October 31, 2012. During this period, APNA has experienced positive growth in membership recruitment and retention. The Secretary’s report provides details on our membership status, which is at an all-time high with more than 8200 active members. Our recruitment this year averages more than 7 new members a day and our retention rate continues to rise as well.  In 2006 our retention rate was 60%; today it is over 80%. Our fiscal affairs are in order, with results from operations showing a positive bottom line. Our most recent audit is discussed in more detail in the Treasurer’s report.  On December 31, 2011, our bottom line from operations was plus $177,682. The results for our current year are expected to produce positive results as well. APNA’s relationships within the nursing field are strong and we have made inroads with many of the organizations that impact our specialty, our clients, and our field. In short, APNA is a strong and vibrant organization of professionals.

As we concluded last year, we were ending one cycle and beginning another in our strategic planning process, a dynamic process that aids the board in the governance of the association. As a result of input gathered from our members through surveys, commentary on our Member Bridge system; dialogue with our councils; and some research by the APNA Janssen Scholars, we produced a new strategic plan during the Board’s February meeting. The full plan can be found at: http://www.apna.org/i4a/pages/index.cfm?pageid=3287

Even though the plan is new, our actions relative to its goals are significant. The four goals established by the plan are listed here and I will use the balance of my report to update you on actions we have already taken toward  addressing these goals.

  1. APNA will be the indispensible resource for member networking and leadership and professional development.
  2. APNA will be the leader in creating strategic alliances with key stakeholders.
  3. APNA will be recognized as the expert voice for psychiatric-mental health nursing.
  4. APNA will be the leader in integrating research, practice, and education to address pressing psychiatric-mental health nursing care issues.

APNA will be the indispensible resource for member networking and professional development.

 When we ask our members what is it that they look for from APNA that they could not easily get from any other source, networking with other psychiatric-mental health nurses rises to the top of that list. Our Member Bridge system continues to provide a forum that facilitates communication amongst our members from across the nation and even world. The system is being expanded to include a Mentor Match program that will pair those with greater levels of expertise with those who are seeking to enhance their skills and careers. The system was recently released in beta test form and it has great promise. We appreciate the efforts of Kathy Lee, Michele Messina, and Charlene Roberson of the Administrative Council who helped bring the Mentor Match system to our members. More information on Mentor Match can be found at http://www.apna.org/i4a/pages/index.cfm?pageid=5090.  Activity on Member Bridge continues to thrive with over 120,000 logins over the past four months. The Secretary’s Report contains more details on the system. 

Our members also identified learning more about current events in APNA and psychiatric mental health nursing as a priority. We continue to employ our website to link our members to current issues and to keep them abreast of the latest changes in the field. Our site has over 1,000 visits each day. Detailed statistics on the APNA website can be found in Appendix D.

Our chapter system is a key component of our ability to bring members together, particularly at the local level. In recognition of its importance, the Board convened a group of nine members to study our current system and make recommendations to the chapters on structure and processes to augment the system and build on its strengths. This work is ongoing and a report is being presented at the chapter presidents meeting during the Annual Conference. Our thanks to our chapter summit team, whose names appear in the chapter section of the report in Appendix A.

Congratulations to the APNA Ohio Chapter and its president, Laura Dzurek, who piloted the first APNA Chapter Virtual Meeting. The meeting was held successfully and enabled attendees from areas throughout the state to participate without needing to travel.  This technology has the potential to address the problem of geography and distance – the travel required often precludes members from attending their chapters’ meetings.

In addition to our chapter system, for those members with a passion for a particular aspect of psychiatric mental health nursing, our Councils and Institutes provide a forum for exchange of ideas and a means to identify issues that impact the field. You can find individual reports on each of the Councils and Institutes in Appendix A. Note the many names of the members who participate in APNA’s Councils and Institutes. There are more than 1,800 members.

I am pleased to report that APNA was once again successful in securing funding for the APNA Janssen Scholars program. This program, which is managed by our APNA staff and guided by faculty advisor Merrie Kass, provides a means of professional development for the 30 scholars and also enables them to network which each other through our Member Bridge system. As noted earlier, the 2011 APNA Janssen Scholars played a role in the development of our strategic plan.  They produced four papers on key issues identified by the membership: quality indicators, seclusion and restraint, suicide prevention, and workplace violence. These papers can be found on the strategic plan web page: http://www.apna.org/i4a/pages/index.cfm?pageid=3287. Our thanks to Nancy Hanrahan, Diane Allen, David Sharp, Barbara Drew and John Repique, who served as advisors to the scholars in the development of these papers. This project signals an exciting expansion of the APNA Janssen Scholars Program that will engage the scholars throughout the year to enhance their learning experience and provide greater insight into how a professional association functions. Of course, the 15 undergraduate and 15 graduate scholars who were chosen this year had to be selected from a much larger pool of applicants. We thank and recognize our Awards and Recognition Committee, chaired by Niki Gjere for their work in reviewing the large number of applications we received this year.

Our members also indicated in surveys that education is high on the list of what they want from APNA. I am pleased to report that our education programs are robust and growing. Appendix B contains a full report on our educational activities. One aspect of our educational program, the APNA eLearning Center, is growing each day. Geared towards supplying continuing education at an affordable price, it is accessible 24 hours a day. In these difficult economic times when many travel and education budgets are being cut, APNA is providing our members with a bonus point system to defray the cost of our courses. Last year, in addition to bonus points for joining or renewing, APNA provided members free access to 8 sessions that offered a total of 6.5 contact hours. The eLearning Center now houses 159 courses, offering a total of 161 contact hours. We extend our thanks and recognition to the faculty who have provided content for our growing list of eLearning offerings. These faculty and the programs are listed in Appendix B.

As certification requirements for pharmacology become more demanding, APNA is responding with the Clinical Psychopharmacology Institute (CPI). This year more than 400 people attended and all the courses were made available online after the conference via our eLearning Center. The program success is a direct reflection of Julie Carbray, CPI Chair, and the full CPI committee’s expertise and commitment to excellence. Please see Appendix B for a more detailed report on CPI.

The Annual Conference remains the center piece of our educational program and is the premier event in psychiatric-mental health nursing continuing education. The 26th Annual Conference promises to be an outstanding program. Please refer to Appendix B for more information. We are particularly grateful to Tari Dilks, who chairs our Scholarly Review Committee. This committee, composed of 106 members who are listed in Appendix A, conducted a blind review of the more than 360 abstracts submitted to our conference. Also, a special thanks to Wendy Zubenko and the Pennsylvania chapter who are working with APNA staff to provide an enjoyable experience for all who attend the conference.

A cornerstone of our specialty is our scope of practice. “The Scope and Standards of Practice for Psychiatric-Mental Health Nurses” was last published in 2007 and APNA has joined with ISPN and ANA to review and update the document. Kris McLoughlin from APNA and Catherine Kane from ISPN are co-chairing this effort that will produce the next edition. Our specialty grows and evolves. The environment in which we practice and function is fluid. It is imperative that our scope and standards of practice be an accurate reflection of our responsibilities and functions. I am pleased to report that the work is nearing completion and that Kris McLoughlin will provide an overview of the new scope and standards document during the RN-PMH interactive panel at the Annual Conference. We are grateful to Kris, Catherine, and the entire Scope and Standards Task Force for their hard work.

APNA will be the leader in creating strategic alliances with key stakeholders.

APNA is actively building alliances both within nursing and in the mental health arena. Both are important and both help to maintain APNA’s position as an important entity in both nursing and mental health. At the top of the list of our nursing alliances is our affiliation with the ANA. APNA recognizes the need for a strong central voice for all of nursing and supports ANA in that role. At the same time, APNA believes that the issues that are specialty specific should remain the purview of the specialty organizations. Through this mutual understanding and our position as an Organizational Affiliate of the ANA, APNA is able to have access to conversations and organizations that might otherwise be difficult to achieve. One example is our newly developed relationship with the Office of the President of the United States through the Office of National Drug Control Policy (ONDCP) and its Deputy Director, David K. Mineta. Deputy Director Mineta accepted APNA’s invitation to attend one of its Board of Directors’ meetings, where he and the board enjoyed a significant conversation and exchange of ideas in the area substance use disorders.

As reported last year, one of the important activities that arises from our ANA affiliation is participation in the AMA RVS Update Committee (RUC). The RVS is the relative value system used by Medicare to set the Medicare reimbursement fee schedule. This work continues this year and we are grateful to Sandra Cadena from Florida who is the APNA representative and her alternate, Deborah Johnson of North Dakota.  This has been a long and very detailed process; the new codes and fee schedule are expected to be released in early November. APNA is working with ANA to develop a multi-module webinar to familiarize our members with the changes. Our relationship with the American Psychiatric Association, American Psychological Association, National Association of Social Workers and the American Association of Child and Adolescent Psychiatry provides us access to their expertise in the area of CPT coding and billing. This, along with the deep fund of knowledge of our own representatives, provides the information needed to help educate our members and keep them abreast of these changes.

A major effort throughout all of nursing and APNA is the Joining Forces initiative that is headed by First Lady Michelle Obama and Dr. Jill Biden. APNA was one of the organizations called to the table with the ANA and VA to create a call to action for all organizations to assure that our veterans and their families receive adequate support and treatment for PTSD and TBI. I had the privilege to represent APNA in this effort. The initiative not only provides a greater level of care to veterans and their families, it provides APNA the opportunity to expand its network of contacts within nursing and the health care system. Our participation in the Joining Forces program allows APNA to meet with people and organizations who can impact important decisions such as the issue of the PMH-CNS as qualified to practice as PMH-APRNs in both the VA and Uniformed Military Services.

APNA maintains its relationship as a community partner with the VA Office of Mental Health Services (OMHS). Through participation in OMHS meetings, APNA is able to provide its members with updates on available mental health services to members of the military community. APNA and the VAOMHS hope that this information supports APNA members in bringing the best mental health care possible to military service members and their families. 

This year Board Member-at-Large Gail Stern represented APNA at the national summit meeting of the National Association of Clinical Nurse Specialists (NACNS). We continue to affirm our support of all currently certified PMH-CNSs and have been asked to review the new CNS Core Competencies. This work is well underway.

We also continue to enjoy a working relationship with the National Council of State Boards of Nursing (NCSBN).  Through this relationship we are able to address issues regarding state changes to practice acts that are not in conformance with the Consensus Model. While the NCSBN does not control the states’ legislative or regulatory processes, they do wield considerable influence and have pledged to provide support when needed. To maintain continuity in our representation, Mary Johnson, of Illinois, meets with the NCSBN at their office in Chicago on a periodic basis, attending meetings and discussing issues related to PMH Nursing with NCSBN leadership.

APNA cultivates an excellent relationship with the ANCC. We recognize that the ANCC must maintain independence in its affairs as a certifying body, but we appreciate that they listen to our concerns. APNA was able to communicate to them the confusion created by using the term family to describe lifespan. As a result, the ANCC has notified us that the term will be dropped and the credential will now be simply PMH-NP. In addition, the term lifespan will be included in the explanation for the credential.

To ensure that the Institute of Medicine’s report on the future of nursing, and more specifically the aspect that deals with removal of barriers to scope of practice, is implemented, APNA supports the Coalition on Patient Rights. More on this activity is available on the their website at http://www.patientsrightscoalition.org/

This year the National Criteria for Evaluation of Nurse Practitioner Programs was due for review and revision.  Both APNA and ISPN were represented by Susie Adams and Victoria Soltis Jarrett, respectively, on the National Task Force (NTF) that was coordinated by the American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculty (NONPF). Both Susie and Victoria provided the NTF with the perspective of PMH Nursing. This resulted in revisions in the criteria to recognize PMH nursing’s current transition in the implementation of the Consensus Model. These changes affirmed that PMH-CNSs play a vital role in the education of PMH-NPs and are able to lead a PMH-NP track.

Until the APRN Consensus Model and LACE are fully implemented, APNA continues to participate in the LACE Network of organizations that have a similar interest in it. Patricia Cunningham of Tennessee and Tari Dilks of Louisiana monitor the LACE Network’s activity and regularly attend their virtual meetings.

As reported last year, when the American Medical Association formed a work group to study major depressive disorder, they contacted APNA and wrote: “Given the American Psychiatric Nurses Association's long history of work in depression and other psychiatric disorders, we thought it important that a representative from the APNA be included on the Work Group, if APNA agrees.  In particular, we would welcome someone with expertise in Major Depressive Disorder or other depression spectrum disorders.” APNA is pleased that Roberta Waite of Pennsylvania is able to continue to participate and provide a voice for PMH Nursing in the group, whose work will be released in the near future.

We place high value on our excellent working relationship with the International Society of Psychiatric Nurses. The presidents of both organizations talk on a regular basis to show our mutual support. It was my pleasure to attend this year’s ISPN meeting and I am delighted that ISPN President, Victoria Soltis Jarrett, has accepted APNA’s invitation to attend our Annual Conference.

The Nursing Organization Alliance (NOA), of which we are a member, is comprised of nurse specialty organizations. Their annual meeting provides an opportunity for elected leadership and senior staff to interact and build relationships. Our regular attendance at this meeting helps us maintain the relationships that we have with virtually every major nursing organization in the country.  The APNA Executive Director serves as treasurer for NOA and was invited to present on the topic of Board relationships and actions.

This year APNA participated in the SAMHSA Voice Awards as a sponsor and Jeannine Loucks of California attended the meeting, representing PMH Nurses. Each year the Voice Awards honor consumer/peer leaders in recovery from mental health and/or substance use disorders, as well as television and film professionals, for their efforts to educate the public about the real experiences of people with behavioral health problems.

APNA also once again participated in the National Alliance on Mental Illness annual conference. Patti Varley, Mary Ellen O’Keefe, and Karen Schepp served as our representatives.

The Institute of Mental Health Advocacy, co-chaired by Christine Tebaldi of Massachusetts and Margaret Halter of Ohio, provides commentary and recommendations to our board of directors on positions and support letters proffered by the Nursing Community and Mental Health Liaison Group. Participation with these groups maintains APNA’s visibility in the nursing and the mental health field and allows us to join our voice with other organizations in advocating for mental health and psychiatric mental health nursing.

APNA will be recognized as the expert voice for psychiatric-mental health nursing.

Our alliances with organizations significantly overlap with the lending of our expert voice to issues pertaining to PMH nursing. We have expertise to offer on many issues and having the opportunity to share that expertise is facilitated by our alliances. In the section above many of those instances have been outlined. There are some additional opportunities which we believe note special mention.  

Our relationship with the Emergency Nurses Association has resulted in APNA receiving an invitation to participate with other organizations such as the Emergency Room Physicians in a project on the Behavioral Health Assessment Standards in the emergency room. Christine Tebaldi of Massachusetts and I attend these sessions and provide psychiatric mental health nursing’s perspective.

APNA was invited to a special briefing with Mary Wakefield, Administrator of the Health Resources and Services Administration (HRSA), for a summary of HRSA’s programs in nursing. These programs total $128,700,000 and are part of the Affordable Care Act. Examples of their programs include the Faculty Loan Repayment and Advanced Nursing Education Programs.  APNA was asked to comment on those programs from the perspective of PMH Nursing. This meeting was closely followed by a listening session with Administrator Wakefield and Administrator Hyde of SAMHSA on the behavioral health workforce. The effect of our input at this meeting resulted in an ongoing dialogue with senior officials at HRSA to discuss workforce issue specific to PMH Nursing. These discussions are now ongoing and present the opportunity to demonstrate to HRSA the critical workforce needs for PMH nursing across the spectrum of practice and education.

The Congressional Research Service (CRS) recently contacted APNA, also to discuss workforce issues in PMH Nursing.  The CRS is bipartisan agency that works for Congress, preparing briefing papers for legislators and their staff as they draft new legislation. The APNA Executive Director and APNA member Nancy Hanrahan represented the association, providing the CRS staff with an overview PMH nursing needs in the area of workforce and also furnishing data to support our assertions.

The ANA approached APNA and requested information on the use of SBIRT to assess potential for alcohol abuse. Working with Madeline Naegle of New York, a recognized expert the area substance use disorders, APNA developed a position statement advocating for the implementation of SBIRT in all nursing settings to assess potential alcohol abuse. This position statement was endorsed by the ANA and can be found at http://www.apna.org/i4a/pages/index.cfm?pageid=5100

Under our Editor-in-Chief Karen Stein, the Journal of the American Psychiatric Nurses Association continues to grow - both in numbers of manuscripts submitted and in circulation. Currently JAPNA’s readership worldwide is 14,328. The journal continues to implement new features to stimulate interest - such as the column devoted to the APNA Board of Directors’ activities.

APNA will be the leader in integrating research, practice, and education to address pressing psychiatric-mental health nursing care issues.

APNA, through the American Psychiatric Nursing Foundation continues to fund research for our field and conducted by psychiatric mental health nurses. More information on the APNF grant program can be found at http://www.apna.org/i4a/pages/index.cfm?pageid=3282

APNA will pilot a full day of psychotherapy sessions on Wednesday at the 26th Annual Conference. The 4 two-hour sessions will include A Neuroscience Relationship-Based Framework for Psychiatric Nursing, Cognitive Behavioral Therapy, Motivational Interviewing and Psychopharmacology in Psychotherapy Practice. Outcomes from the pilot programs will be evaluated in an effort to assess member desire for future psychotherapy programs.

We are very proud of our group representing PMH nursing in the SAMHSA Contract for Recovery to Practice. Now in its third year, the group is concentrating on pilot testing an exciting new curriculum on implementing recovery-oriented principles into practice. Jeanne Clement, Kris McLoughlin,  Mary Moller and Eric Arauz have presented the new curriculum in Anaheim, CA, Dallas, TX and Greensboro, NC. Through the efforts of both the Recovery to Practice Contract and the Recovery Council, APNA is raising the bar on using the recovery model in providing care to persons who use mental health services.

APNA is also engaged in a research project lead by Kris McLoughlin and the Recovery to Practice faculty. The project was reviewed and approved by an external review board. A pre-test/post test design is being used to evaluate the use of the recovery curriculum as a learning intervention for implementing recovery into PMH nursing practice. Pre-test data have been collected at 3 sites; post test data collection will begin in November, 2012.

The APNA Provider Unit is currently working with the Continuing Education Workgroup lead by Barbara Limandri and George Smith to develop educational activities from topics highlighted in the 2010 APNA education survey. Ten workgroups have formed around selected topics.  Groups are currently developing evidence based content on the assessment and management of persons at risk for suicide, changes to and application of the DSM-5, and bipolar disorders with co-morbid conditions. Educational activities will inform PMH nursing practice by presenting education based on current research and evidence based standards that align with national initiatives and Healthy People 2020.

The Undergraduate Education Workgroup lead by David Sharp and Peggy El Mallakh are in discussion of how to support students and educators with evidence based foundations of psychiatric mental health nursing. The group is currently prioritizing the top two of ten identified topics for development of educational activities. Further research is being done by this group to build on previous data collected from APNA Janssen Scholars related to the recruitment of new nurses into PMH nursing.

Headed by Carole Shea and Genevieve Chandler, the Graduate Education Workgroup is in the midst of developing eLearning content that presents a comparison of DNP and PhD education for nurses who are considering graduate education. The group is also researching faculty practice models for PMH nursing practice.

Through an unrestricted education grant, APNA is producing an educational program Counseling Points: Shedding the Label of Schizophrenia through the Recovery Model. In addition to providing valuable information on recovery, the program will compare methods of delivering educational content. APNA will deliver this educational content in three formats using a live program, a web-based program, and a printable monograph. This will provide members with access to the educational content in flexible learning formats and it will allow APNA to compare outcomes from the same content delivered three ways.

Summary

As you can see, APNA is active in a variety ways and in a variety of arenas. All of this activity makes holding the office of president very exciting. While there are many things to do and keep track of, our structure and most of all our people make holding the office more than manageable. I am surrounded by a knowledgeable and supportive board. Our council and institute chairs are available for advice and guidance whenever needed. Our chapter presidents provide leadership at the local level and valuable input at the national level. Our staff is responsive and always willing to do what is needed to get the job done. But the most gratifying part of holding the office is the support, passion and commitment of our members. You are the energy and life force of our society. I have PMH nursing needs in the area of workforce heard that we are more than a professional association that we are an association of professionals. It is something that I always believed but until you see it from the vantage point of president, you cannot fully appreciate. Thank you for this honor! It has been a privilege to serve.

Respectfully Submitted,

Marlene Nadler Moodie, MSN, APRN, PMHCNS-BC
President