APNA Position: Psychotherapy and the Psychiatric-Mental Health Advanced Practice Registered Nurse Role

Abstract

The use of psychotherapy is an essential practice component of the psychiatric-mental health advanced practice registered nurse (PMH-APRN) role. It is a standard of practice for PMH-APRNs in the Psychiatric-Mental Health Nursing: Scope and Standards of Practice published by the American Nurses Association (ANA), the American Psychiatric Nurses Association (APNA), and International Society of Psychiatric-Mental Health Nurses (ISPN)¹ and is included in the PMH Nurse Practitioner (PMHNP) competencies developed by the National Organization of Nurse Practitioner Faculties (NONPF).² Psychotherapy content is part of the PMHNP certification examination delivered by the American Nurses Credentialing Center’s (ANCC).³ Though continuing education hours in psychotherapy are not specified in the renewal requirements for certification,⁴ PMH-APRNs should independently pursue continuing education in psychotherapy given its important role in PMH practice.

Introduction

The purpose of this paper is to describe how psychotherapy is integral to the PMH-APRN role, and to highlight the importance of psychotherapy continuing education for the role.

Discussion

Psychotherapy is a foundation of psychiatric care.⁵ The provision of psychotherapy is an essential component of psychiatric nursing, and is a standard of practice in the Psychiatric-Mental Health Nursing: Scope and Standards of Practice published by the American Nurses Association (ANA), the American Psychiatric Nurses Association (APNA), and International Society of Psychiatric-Mental Health Nurses (ISPN).¹ It is also included in the PMHNP competencies developed by the National Organization of Nurse Practitioner Faculties (NONPF).²

The first Advanced Practice Nursing roles were in the Psychiatric-Mental Health field, developed in the 1960s. From that time until now, PMH nurses have consistently provided a variety of psychotherapies to treat psychiatric-mental health conditions to a range of targeted recipients (individual, groups, couples, families) and settings (e.g. in patient and outpatient). These psychotherapies include humanistic, psychodynamic, cognitive-behavioral, and interpersonal approaches which have been incorporated into PMH practice.⁵ The selection of the psychotherapeutic approach is based on the needs of the care recipient, as well as the PMH-APRN’s knowledge of evidence-based research, and relevant biological, psychological and developmental theories.⁶

Similar to other mental health providers, PMH-APRN education includes supervised clinical educational experiences in psychotherapy. Specifically, PMH-APRNs must confirm training in two “psychotherapeutic treatment modalities” in order to sit for initial ANCC certification. ⁴ Though there are no specific requirements for additional hours of continuing education in psychotherapy for PMH recertification,⁷ competency in psychotherapeutic interventions is essential for effective treatment. Throughout the PMH-APRN career, achievement and maintenance of expertise is attained through continuing education in psychotherapy. Pursuing continuing education is also vital as the development of new psychotherapeutic treatments and novel uses of existing and modified psychotherapies become available through research and its dissemination, as well as through ongoing education and supervised practice.

Conclusion

Psychotherapy, whether practiced as an independent treatment intervention or in combination with medication management, is a core component of the PMH-APRN role.  The ANA, APNA, ISPN, NONPF, and ANCC all support PMH-APRNs using psychotherapy and psychotherapeutic modalities.^{1-4, 7} Given the importance of psychotherapy in PMH advanced practice nursing, PMH-APRNs should pursue lifelong learning in psychotherapy to expand their knowledge and demonstrate continuing competence. The acquisition of continuing education in psychotherapy supports the determination to work towards expertise and proficiency in various psychotherapeutic modalities.

Approved by the APNA Board of Directors December 2021.

References

1. American Nurses Association, American Psychiatric Nurses Association, & International Society of Psychiatric-Mental Health Nurses. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: Nursebooks.org.
2. National Organization of Nurse Practitioner Faculties. (2013). Population-focused nurse practitioner competencies. Retrieved from https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/populationpopulationfo2013.pdf
3. American Nurses Credentialing Center. (2018). Test content outline. Retrieved from https://www.nursingworld.org/~49eb43/globalassets/certification/certification-specialty-pages/resources/test-content-outlines/exam-35-pmhnp-tco-10-15-2018_for-webposting.pdf
4. American Nurses Credentialing Center. (2020). Validation of APRN education form. Retrieved from https://www.nursingworld.org/~49c402/globalassets/certification/certification-specialty-pages/APRN-Validation-Form
5. Caughill, A. (2016). Preserving the art and science of psychotherapy for advance practice psychiatric mental health nurses. Issues in Mental Health Nursing, 37(4), 268-272. doi: 10.3109/01612840.2016.1147625
6. Wheeler, K. (2013). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
7. American Nurses Credentialing Center. (2016). 2017 certification renewal requirements. Retrieved from https://www.nursingworld.org/~4ac164/globalassets/certification/renewals/RenewalRequirements
8. Delaney, K. R., Hamera, E., & Drew, B. L. (2009). National survey of psychiatric mental health advanced practice nursing: The adequacy of educational preparation: Voices of our graduates. Journal of the American Psychiatric Nurses Association, 15(6), 383-392.