Competencies for third-year PMHNPs in an outpatient clinic
| Recognize clinical presentations of complex psychiatric disorders, variants, and comorbidities |
| Firm knowledge of diagnostic criteria, and skills for independent comprehensive assessment and diagnosis |
| Firm knowledge of evidence-based outpatient treatments for disorders, with mastery of ≥1 nonpharmacologic modality in addition to prescribing and managing medications |
| Use and provide feedback in comprehensive case formulations and treatment plans |
| Assist in clinical education of trainees in psychiatric nursing, social work, psychiatric residency, and psychology |
| Participate and collaborate in educational events and initiatives |
| Knowledge of internal and external health system and resources, and facilitating patient access to these networks |
| Incorporate mental health and behavioral and psychiatric nursing research into patient care |
| PMHNP: psychiatric-mental health nurse practitioner |
Competencies for third-year PMHNPs on an inpatient psychiatric unit
| Refinement of assessment section in evaluations, progress notes, and discharge summaries |
| Understanding indications for neuropsychological testing, and integrating findings into the treatment plan |
| Assessment of readiness for discharge in patients with a history of suicidality or violence |
| Developing a sophisticated and detailed discharge or follow-up plan |
| Understanding treatment resistance in mood and psychotic disorders, and implementing treatment |
| More detailed knowledge of types of illness treated on an inpatient unit |
| Ability to orient and train PMHNPs and other inpatient unit trainees |
| Ability to gather and use articles and other literature pertaining to inpatient care |
| Increasing competence in short-term, crisis-based therapeutic techniques, including familiarity with DBT, CBT, and IPT |
| Understanding family systems and impact on patient care |
| CBT: cognitive-behavioral therapy; DBT: dialectical behavior therapy; IPT: interpersonal therapy; PMHNP: psychiatric-mental health nurse practitioner |
Principles of practice
Studies have demonstrated the importance of understanding how to effectively implement collaborative care across medical disciplines.12 See the Box12 for a discussion of 3 key determinants for successful clinical collaborations.
Successful clinical collaborations: 3 determinants
San Martín-Rodríguez et al12 recognized 3 key factors that may help develop successful collaborative clinical relationships.
Interactional factors include a mutual willingness to collaborate, a commitment to collaborate, a belief in the benefits of collaborating, and sharing common objectives. Trust in the partnering clinician’s competency contributes to a successful collaboration. Strong communication skills—including the ability to convey what each clinician can contribute to achieving goals—also strengthens collaboration. Learning and understanding skills in conflict management and dialogue are key. Mutual respect also is essential.
Organizational factors include a shift from a traditional hierarchical structure to a more horizontal structure, and a work climate that supports openness, risk taking—ie, a willingness to disagree with a colleague if it is in a patient’s best interest or to develop a new and innovative method of providing care—integrity, and trust. Administrative structures and supports that convey the importance of collaboration also are key components of a strong collaborative environment. Teamwork and shared decision-making are important elements; teamwork should include time to discuss patient issues and develop strong interpersonal relationships. A commitment to professional development is another key factor.
Systemic factors include a social system that supports collegial relationships and professionalism that respects and accepts other professions. This includes decreased focus on protecting professional territory and increased recognition of overlaps among professions.
Enhancing collaboration
Psychiatrists who work with PMHNPs develop trust based on observing each PMHNP’s work, including their relationship with patients, ability to conceptualize a case and develop a treatment plan, and the skill with which they function within a team. The psychiatrist’s comfort level also is related to his or her awareness of the comprehensiveness of the PMHNP’s training and the competencies gained from clinical experience. Respect for the PMHNP’s educational and professional background is the foundation for what is often—at least in the collaborative relationship’s initial stages—a combined cooperative and supervisory relationship with the PMHNP. As such, the PMHNP gradually will absorb certain “intangibles” to supplement the training and work experiences that preceded his or her position. This may include assimilating the psychiatrist’s or clinic’s philosophy and treatment practice, including expertise in dealing with specialized psychiatric populations (eg, developmental disabilities, acute psychosis, or treatment-resistant depression).