A Message from the President
Carole Farley-Toombs, MS, RN, NEA-BC
I was recently reminded of our pioneering history when I opened a psychiatric nursing textbook authored by Madeline Leininger, Basic Concepts in Psychiatric Nursing (1960), and read the following introduction: “The patient centered approach is a shift from ‘doing to’ to a focus on understanding the patient, his/her problems, illness and other factors that have a bearing on his or her progress toward recovery.” The current national health care agenda incorporates health promotion, patient-centered care, and recovery - Psychiatric mental health nursing established the primacy of these concepts over fifty years ago!
Today psychiatric registered nurses often work in environments that pose significant challenges to implementing the full scope of their practice. The transition from custodial care and state funding to community-based treatment and third party reimbursement in the latter part of the 20th century resulted in a shift towards the utilization of hospitals for intermittent stabilization of acute symptoms with reduced lengths of hospital stays. Patients now enter acute psychiatric hospitals at later stages in their illness, often in crisis, with severe symptoms and disturbed behaviors. These hospitalizations are often perceived as coercive events by patients who may be admitted involuntarily or treated over their objections. In the context of diminished reimbursement for acute psychiatric care, psychiatric registered nurses are often relegated to supervisory roles that isolate them from close interactions with patients. Frequent use of seclusion and restraint to control patient behaviors exacerbates an already alienating environment.
APNA published the first position statement on seclusion and restraint standards in 2000 (it was revised in 2007). This statement focused on patient safety and the reduction and elimination of the use of these measures. The language from this position statement was adopted almost verbatim by the Joint Commission. Thus, standards initially established by psychiatric nursing to improve psychiatric inpatient care became national standards. The rich discussion in APNA’s All Purpose Discussion Forum on Member Bridge reflects the ongoing commitment of psychiatric registered nurses to be innovators in creating safe, therapeutic, and healing acute inpatient environments and to engage patients with acute psychiatric symptoms in a trusting partnership towards recovery. In seeking to maintain patient and staff safety without compromising personal dignity and integrity, psychiatric registered nurses are identifying and addressing common practices that leave patients and nursing staff feeling afraid, dehumanized, powerless or isolated. This commitment embodies Hildegard Peplau’s assertion that “there is a significant difference between taking responsibility for the care of patients and being therapeutically responsive to each patient…Every professional contact with a patient, however brief, is an opportunity to engage”.
Like psychiatric registered nurses, psychiatric advanced practice nurses are often stymied in their ability to execute the full scope of their professional practice due to inconsistency in state regulations, confusion about titles and multiple national certification exams. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (LACE) was a collaborative effort among APRN education, certification, and licensure bodies to achieve clarity and uniformity in APRN regulation. This goal aligns completely with the Institute of Medicine’s Report on the Future of Nursing’s position that the advancement of a successful national healthcare agenda requires that nurses function to the full extent of the scope of their practice. The APNA and ISPN Boards of Directors unanimously accepted the APNA/ISPN LACE task force recommendations that in the FUTURE, psychiatric mental health nursing advanced practice will consist of one title - PMH-NP - and one certification examination for licensure with a scope of practice, including psychotherapy, across the lifespan. To achieve that future, currently certified PMH-CNSs must be able to continue to practice and play important roles in Psych APRN graduate programs. APNA is actively engaged in multiple venues to assure the growth of PMHN APRN graduate programs to meet the mental health needs of the population in the future, and to ensure that our current APRN workforce maintains its vital role in the practice and education to achieve that goal.
Our ongoing dedication to meeting current and future mental health needs with patient-centered safe and effective care puts psychiatric mental health nurses in a position to provide leadership in the evolving health care agenda. As noted above, we have challenges ahead of us, but APNA, the organization of professional psychiatric mental health nurses, provides the education, infrastructure, collaborative relationships and commitment to fulfill our promise. The future has its challenges but to paraphrase the mantra of a good friend, “We have, we can and we will.”
March 2011 Newsletter