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Challenges and opportunities in psychiatric-mental health nursing
Challenges and Opportunities in Psychiatric-Mental Health Nursing Nancy M. Valentine, RN, PhD, MPH, FAAN, FNAP
D
uring the past decade, an unprecedented number of changes have occurred in health care. Few specialties have been more impacted by the advent of managed care than psychiatry and the practice of psychiatric-mental health nursing. Never before has the specialty been as challenged with peril and opportunity. How will we boldly and constructively face these challenges? Understanding the trends in mental health care as well as the professional challenges in the nursing profession overall as these major shifts continue to influence the growth and development of the psychiatric-mental health nursing specialty is critical for nurses to make these trends their friends.
TRENDS IN MENTAL HEALTH FOR THE NEW MILLENIUM1
• Strategic partnerships will grow between managed care and community-based provider groups. • Privatization of health care will decline because of the lack of reimbursement rates to cover the costs for care, especially of the high-risk populations who require intense services and case management. • Focused factories that stress excellence, consistency, reliability, standards, and low cost will take the place of vertically integrated systems of care.2 • Focus on quality and outcomes will continue as federal, state, and local constituents scrutinize these areas. • Information superhighways will expand capabilities and create new challenges as health care environments increasingly depend on national databases of information for decision making and policy development in the area of purchasing decisions, policy making and public-private partnerships, and health care administration.3
• Advances in psychopharmacology and psychosocial treatments will expand rapidly. • Holistic, coordinated care activities will leverage the preoccupation with cure. Related to this will be helping patients assume greater responsibility for their own health. • Options for learning will expand beyond national boundaries as distance learning involving new communities of both professionals and consumers access one another for knowledge exchange via the Internet. • More opportunities for entrepreneurship will evolve as organizations contract for clinical services and educational and research support for their clients and employees. • Research opportunities will abound with emphasis on evidence-based practice outcomes that positively affect the management and financing of quality care. • Viability of the specialty in psychiatric-mental health nursing will be threatened because of aging of the workforce and few students who elect the field. • Number of APRNs will continue to increase, but with the closure of many psychiatric-mental health CNS programs and the opening of psychiatric-mental health NP and blended role CNS/NP programs, there will be a shift in the APRN educational background and the roles they are expected to fill in providing comprehensive primary care for the mentally ill as patients and payers seek an integrated approach. • Paradigm of scholarship in psychiatric-mental health nursing will continue to evolve in the areas of discovery of knowledge, integration across disciplines, application of knowledge to problem solving, and the dynamics of the faculty-student engagement in the process of learning.4
• Genetics and vulnerability markers will lead to new formulations of all illnesses, including mental illness.
CHALLENGES AND OPPORTUNITIES FOR PSYCHIATRIC-MENTAL HEALTH NURSING
Nancy M. Valentine is special assistant to the Secretary and advisor to the Undersecretary for Health, Department of Veterans Affairs, pastpresident, American Psychiatric Nurses Association, Washington, DC, and former treasurer and Board of Directors member of the American College of Mental Health Administrators, Pittsburgh, Pennsylvania.
• Rejuvenate and retool the current workforce. Develop pathways to new information sources and continuing education opportunities to inform and inspire the current workforce of the trends, changes, and rapidly emerging opportunities in psychiatric-mental health nursing. Transform the skills of nurses currently employed in the field to reflect the needs, trends, and proposed changes in the delivery of mental health care.
Nurs Outlook 2000;48:238-9. Copyright © 2000 by Mosby, Inc. 0029-6554/2000/$12.00 + 0 35/1/110604 doi:10.1067/mno.2000.110604
238
Valentine
• Expand the work settings and roles of both generalist and VOLUME 48 • NUMBER 5
NURSING OUTLOOK
Valentine
Challenges and Opportunities in Psychiatric-Mental Health Nursing
advances practice nurses. Seek opportunities to participate in developing quality and outcome measures and new roles in the emerging field of genetics and enhancing research opportunities in government and industry that afford all psychiatric-mental health nurses new venues. • Enhance recruitment efforts. Develop strategies to make psychiatric-mental health nursing an attractive option to recruit students into the field of nursing. Likewise, develop strategies for nursing students to select psychiatric nursing as a prime area of specialization in greater numbers on the basis of positive role models in practice roles.5 • Develop the business acumen of psychiatric-mental health nurses. Champion nurses to take advantage of small business loans and other vehicles to launch provider organizations, consulting services, and Internet services to clients and consumers. • Develop the role of the advanced practice nurse. Resolve titling and credentialing controversies between the clinical nurse specialists and the nurse practitioners in mental health. Foster the independent practice elements of the advanced practice nurse roles. Increase the number of
O
advanced practice nurses on health maintenance organization provider panels. • Encourage partnership development. Encourage integrating with other service providers through enhancement of a team approach to the delivery of services as well as increased outreach to consumers and consumer advocacy groups. • Develop a public health consciousness. Encourage nurse participation in social policy issues that affect the mental health of the United States. ■ REFERENCES 1. Shea CA, Pelletier LR, Poster EC, et al. Envisioning the future in mental health care. In: Shea CA, Pelletize LR, Poster EC, Stuart GW, Verey MP, editors. Advanced practice nursing in psychiatric and mental health care. St Louis (MO): Mosby; 1999. p 547-8. 2. Herslinger RE. Market driven health care: who wins, who loses in the transformation of America’s largest service industry. Reading (MA): Addison-Wesley; 1997. 3. Jones LD. Building the information infrastructure required for managed care. IMAGE: J Nurs Sch 1997;29:377-82. 4. Boyer EL. Scholarship reconsidered—priorities of the professorate. San Francisco: Jossey-Bass Publishers; 1990. 5. Psychiatric nursing…profiles in compassion [videotape]. Boston (MA): Fanlight Productions; 1999.
N THE MOVE? Send us your new address at least 6 weeks ahead
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NURSING OUTLOOK
SEPTEMBER/OCTOBER 2000
239
D
uring the past decade, an unprecedented number of changes have occurred in health care. Few specialties have been more impacted by the advent of managed care than psychiatry and the practice of psychiatric-mental health nursing. Never before has the specialty been as challenged with peril and opportunity. How will we boldly and constructively face these challenges? Understanding the trends in mental health care as well as the professional challenges in the nursing profession overall as these major shifts continue to influence the growth and development of the psychiatric-mental health nursing specialty is critical for nurses to make these trends their friends.
TRENDS IN MENTAL HEALTH FOR THE NEW MILLENIUM1
• Strategic partnerships will grow between managed care and community-based provider groups. • Privatization of health care will decline because of the lack of reimbursement rates to cover the costs for care, especially of the high-risk populations who require intense services and case management. • Focused factories that stress excellence, consistency, reliability, standards, and low cost will take the place of vertically integrated systems of care.2 • Focus on quality and outcomes will continue as federal, state, and local constituents scrutinize these areas. • Information superhighways will expand capabilities and create new challenges as health care environments increasingly depend on national databases of information for decision making and policy development in the area of purchasing decisions, policy making and public-private partnerships, and health care administration.3
• Advances in psychopharmacology and psychosocial treatments will expand rapidly. • Holistic, coordinated care activities will leverage the preoccupation with cure. Related to this will be helping patients assume greater responsibility for their own health. • Options for learning will expand beyond national boundaries as distance learning involving new communities of both professionals and consumers access one another for knowledge exchange via the Internet. • More opportunities for entrepreneurship will evolve as organizations contract for clinical services and educational and research support for their clients and employees. • Research opportunities will abound with emphasis on evidence-based practice outcomes that positively affect the management and financing of quality care. • Viability of the specialty in psychiatric-mental health nursing will be threatened because of aging of the workforce and few students who elect the field. • Number of APRNs will continue to increase, but with the closure of many psychiatric-mental health CNS programs and the opening of psychiatric-mental health NP and blended role CNS/NP programs, there will be a shift in the APRN educational background and the roles they are expected to fill in providing comprehensive primary care for the mentally ill as patients and payers seek an integrated approach. • Paradigm of scholarship in psychiatric-mental health nursing will continue to evolve in the areas of discovery of knowledge, integration across disciplines, application of knowledge to problem solving, and the dynamics of the faculty-student engagement in the process of learning.4
• Genetics and vulnerability markers will lead to new formulations of all illnesses, including mental illness.
CHALLENGES AND OPPORTUNITIES FOR PSYCHIATRIC-MENTAL HEALTH NURSING
Nancy M. Valentine is special assistant to the Secretary and advisor to the Undersecretary for Health, Department of Veterans Affairs, pastpresident, American Psychiatric Nurses Association, Washington, DC, and former treasurer and Board of Directors member of the American College of Mental Health Administrators, Pittsburgh, Pennsylvania.
• Rejuvenate and retool the current workforce. Develop pathways to new information sources and continuing education opportunities to inform and inspire the current workforce of the trends, changes, and rapidly emerging opportunities in psychiatric-mental health nursing. Transform the skills of nurses currently employed in the field to reflect the needs, trends, and proposed changes in the delivery of mental health care.
Nurs Outlook 2000;48:238-9. Copyright © 2000 by Mosby, Inc. 0029-6554/2000/$12.00 + 0 35/1/110604 doi:10.1067/mno.2000.110604
238
Valentine
• Expand the work settings and roles of both generalist and VOLUME 48 • NUMBER 5
NURSING OUTLOOK
Valentine
Challenges and Opportunities in Psychiatric-Mental Health Nursing
advances practice nurses. Seek opportunities to participate in developing quality and outcome measures and new roles in the emerging field of genetics and enhancing research opportunities in government and industry that afford all psychiatric-mental health nurses new venues. • Enhance recruitment efforts. Develop strategies to make psychiatric-mental health nursing an attractive option to recruit students into the field of nursing. Likewise, develop strategies for nursing students to select psychiatric nursing as a prime area of specialization in greater numbers on the basis of positive role models in practice roles.5 • Develop the business acumen of psychiatric-mental health nurses. Champion nurses to take advantage of small business loans and other vehicles to launch provider organizations, consulting services, and Internet services to clients and consumers. • Develop the role of the advanced practice nurse. Resolve titling and credentialing controversies between the clinical nurse specialists and the nurse practitioners in mental health. Foster the independent practice elements of the advanced practice nurse roles. Increase the number of
O
advanced practice nurses on health maintenance organization provider panels. • Encourage partnership development. Encourage integrating with other service providers through enhancement of a team approach to the delivery of services as well as increased outreach to consumers and consumer advocacy groups. • Develop a public health consciousness. Encourage nurse participation in social policy issues that affect the mental health of the United States. ■ REFERENCES 1. Shea CA, Pelletier LR, Poster EC, et al. Envisioning the future in mental health care. In: Shea CA, Pelletize LR, Poster EC, Stuart GW, Verey MP, editors. Advanced practice nursing in psychiatric and mental health care. St Louis (MO): Mosby; 1999. p 547-8. 2. Herslinger RE. Market driven health care: who wins, who loses in the transformation of America’s largest service industry. Reading (MA): Addison-Wesley; 1997. 3. Jones LD. Building the information infrastructure required for managed care. IMAGE: J Nurs Sch 1997;29:377-82. 4. Boyer EL. Scholarship reconsidered—priorities of the professorate. San Francisco: Jossey-Bass Publishers; 1990. 5. Psychiatric nursing…profiles in compassion [videotape]. Boston (MA): Fanlight Productions; 1999.
N THE MOVE? Send us your new address at least 6 weeks ahead
Don’t miss a single issue of the journal! To ensure prompt service when you change your address, please photocopy and complete the form below. Please send your change of address notification at least 6 weeks before your move to ensure continued service. We regret we cannot guarantee replacement of issues missed due to late notification. JOURNAL TITLE: Fill in the title of the journal here.
OLD ADDRESS:
NEW ADDRESS:
Affix the address label from a recent issue of the journal here.
Clearly print your new address here. Name Address City/State/ZIP
COPY AND MAIL THIS FORM TO:
OR FAX TO:
OR PHONE:
Mosby Subscription Customer Service 6277 Sea Harbor Dr Orlando, FL 32887
407-363-9661
800-654-2452 Outside the US, call 407-345-4000
NURSING OUTLOOK
SEPTEMBER/OCTOBER 2000
239