Rapid Response Request

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SUBSTANCE USE DISORDER CURRICULA IN MEDICAL, NURSING, AND 

PHYSICIAN ASSISTANT SCHOOLS

Authors: Maria Gaiser, Brooke Lombardi, Lisa de Saxe Zerden, Brianna Lombardi 

Publica�on Date: July 2023

Table of Contents 

SUBSTANCE USE DISORDER CURRICULA IN MEDICAL, NURSING, AND PHYSICIAN ASSISTANT 

SCHOOLS......................................................................................................................................... 1

Purpose ....................................................................................................................................... 3

Introduc�on and Need................................................................................................................ 3

Inclusion of SUD Curriculum Integrated into Exis�ng Content in Medical, Nursing, and 

Physician Assistant Schools......................................................................................................... 3

Curriculum Requirements....................................................................................................... 3

SUD Curricula in Medical Schools........................................................................................... 4

SUD Curricula in Graduate-Nursing Schools ........................................................................... 5

SUD Curricula in Physician Assistant Schools.......................................................................... 7

Peer-Reviewed Substance Use Related Trainings and Studies.................................................... 8

Medical school training:.......................................................................................................... 8

Nursing school training: .......................................................................................................... 8

PA school training:................................................................................................................... 9

Interprofessional SUD Training Studies:.................................................................................. 9

Summary of SUD Training Studies:.......................................................................................... 9

Barriers to Incorpora�ng SUD Curriculum into Exis�ng Content.............................................. 21

Barriers in Exis�ng Medical School Curriculum.................................................................... 21

Barriers in Exis�ng Graduate Nursing School Curriculum..................................................... 23

Barriers in Exis�ng Graduate Physician Assistant School Curriculum................................... 24

Summary of Barriers............................................................................................................. 24

Facilitators to Incorpora�ng SUD Curriculum into Exis�ng Content......................................... 25
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Facilitators in Exis�ng Medical School Curriculum................................................................ 25

Facilitators in Exis�ng Nursing School Curriculum................................................................ 26

Facilitators in Exis�ng Physician Assistant Program Curriculum........................................... 26

Summary of Facilitators........................................................................................................ 26

Summary................................................................................................................................... 27

References................................................................................................................................. 28

Appendix I ..................................................................................................................................... 35

Appendix II .................................................................................................................................... 36

Medical School Curricula........................................................................................................... 36

Alpert Medical School, Brown University Substance Misuse Curriculum Outline................ 36

Core Competencies for the Preven�on and Management of Prescrip�on Drug Misuse ..... 37

Pennsylvania State Core Competencies for Educa�on on Opioids and Addic�on................ 38

Symposium on Curriculum Development in Opioid Management....................................... 40

University of California Pain and Substance Use Disorder Competencies............................ 42

Nursing Curricula....................................................................................................................... 44

American Psychiatric Nurses Associa�on Scope and Standard of Prac�ce: Psychiatric Mental 

Health Nursing, 2nd Edi�on. ................................................................................................. 44

The Addic�ons Nursing Scope and Standards of Prac�ce .................................................... 65

Physician Assistant Curricula..................................................................................................... 66

Massachusets Physician Assistant Educa�on Core Competencies for the Preven�on and 

Management of Prescrip�on Drug Misuse........................................................................... 66

Mul�disciplinary Curricula........................................................................................................ 67

AMERSA: Select SUD Core Competencies Shared by Two or More Disciplines.................... 67

SAMHSA: Recommenda�ons for Curricular Elements in Substance Use Disorders Training 67

Appendix II References.............................................................................................................. 69
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Purpose

The Na�onal Center for Health Workforce Analysis (NCHWA) and the Substance Abuse and 

Mental Health Services Administra�on (SAMHSA) requested the Behavioral Health Workforce 

Research Center (BHWRC) respond to a rapid request to beter understand substance use 

disorder (SUD) curriculum in medical, nursing, and physician assistant (PA) schools. The BHWRC 

responded to the following ques�ons:

1. How is SUD curriculum integrated into exis�ng content in medical, nursing, and PA 

schools? Please include course format (e.g., hybrid, in-person) and educa�on hours.

2. What are the barriers to incorpora�ng SUD curriculum into exis�ng content?

3. What are the facilitators to incorpora�ng SUD curriculum into exis�ng content?

A literature review was conducted and included peer reviewed literature, gray literature, and 

educa�onal accredi�ng bodies and curricula for medical, graduate-level nursing, and PA schools. 

The search strategy is presented in Appendix I.

Introduc�on and Need

The rate of SUDs con�nues to rise across the U.S., currently matching the prevalence of diabetes 

and heart disease at 8% to 12% percent of the general popula�on (Lowe et al., 2022). While the 

prevalence of SUDs increases, less than 10% of those who experience SUD receive treatment 

(Substance Abuse and Mental Health Services Administra�on, 2021). Lack of SUD treatment is 

connected to a shortage of specialty behavioral health clinicians. Given the shortage in the 

addic�on specialist workforce, enhanced training is needed across medical, nursing, and PA 

professions to detect and treat pa�ents with SUDs. As such, the medical (Muzyk et al., 2019), 

nursing (Smothers et al., 2018), and PA (Ma�ngly, 2019) professions have called for increased 

efforts to prepare and train current and future health care professionals to respond to SUDs 

(Finnell et al., 2022).

Inclusion of SUD Curriculum Integrated into Exis�ng Content in Medical, Nursing, 

and Physician Assistant Schools

Curriculum Requirements

Educa�onal accredi�ng bodies specify the educa�on requirements and learning outcomes 

required for each profession. These requirements provide educa�on programs with a 

framework for developing their curriculum standards and learning competencies. Though the 

standards and competencies are not synonymous terms, they are interrelated in what students 

learn within required curricula content and courses. In conduc�ng a literature review of the SUD 
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curriculum in medical, graduate nursing, and PA programs, we examined each profession’s 

curriculum requirements and learning competencies based on the following defini�ons:

Curriculum requirements: There are specific statements and learning outcomes describing the 

content that must be included in didac�c and/or clinical training.

Learning competencies: These are general statements that describe the knowledge, skills, and 

behaviors that students must demonstrate in didac�c and clinical se�ngs.

Among the three professions, only the Accredita�on Review Commission on Educa�on for the 

Physician Assistant (ARC-PA) requires the inclusion of SUD in their curriculum. ARC-PA 

introduced required SUD content into their didac�c curriculums star�ng in 2020 (ARC-PA, 2023). 

However, clinical curriculum requirements are s�ll not required across the three professions.

Due to the Medica�ons Access and Training Expansion Act (MATE) as part of the Consolidated 

Appropria�ons Act of 2023 there is no longer the Drug Enforcement (DEA) waiver training. Yet, 

in order to gain new or renew DEA registra�on to deliver buprenorphine and other medica�ons 

for SUDs, providers will con�nue to need training. As of June 27, 2023, eight hours of training is 

the minimum requirement on the topics of opioid or other SUDs. SAMHSA, in collabora�on with 

accredi�ng bodies and key stakeholders, developed a set of recommended core curricular 

training elements (Substance Abuse and Mental Health Services Administra�on, 2023). These 

elements are included in Appendix II.

Given the lack of SUD curriculum requirements, this rapid response is largely informed by peerreviewed studies that examined SUD-related trainings for medical, graduate nursing, and PA 

students, as well as organiza�ons and state-based working groups that have recommended SUD 

curriculum guides and learning competencies for students in these professions.

SUD Curricula in Medical Schools

Despite expecta�ons for the next genera�on of medical providers to provide treatment for 

individuals with SUDs, there are currently no required curriculum standards within medical 

schools for SUD/addic�on (Ayu et al., 2017; Servis et al., 2021; Welsh et al., 2020). The Liaison 

Commitee on Medical Educa�on (LCME), which accredits all U.S. medical schools, currently 

only requires that each school include “behavioral subjects” in its medical curricula, but there is 

no specific men�on of requirements for SUD training (Ram & Chisolm, 2016). Further, key words 

in SUD training such as “addic�on,” “substance,” and “drug,” are absent from the 2023- 2024 

LCME standards (Liaison Commitee on Medical Educa�on, 2022).

Although there are no specific SUD curriculum requirements in medical school training, the 

majority of medical school programs are including SUD training content in their curricula. For 
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example, the Associa�on of American Medical Colleges (AAMC) surveyed medical schools and 

colleges in the U.S. in 2022 and reported 148 schools out of 157 cover opioid addic�on and pain 

management during required pre-clerkship course experiences, 143 during required clerkships, 

85 during required didac�c sec�ons in Years 3 and 4 of the curriculum, and 46 during clinical 

experiences in the pre-clerkship period (Associa�on of American Medical Colleges, 2021, 2022). 

Notably, training methods used to deliver this SUD curricula varies across medical programs. As 

such, SUD content is not consistently taught, nor is it delivered at the same �me of one’s 

training (e.g., first-year course versus a fourth-year clinical rota�on) (Singh & Pushkin, 2019; Sun 

et al., 2022). SUD curricula o�en include didac�c components which include small group 

learning and case-based learning (Cooper et al., 2020). In an older study conducted in 2000, a 

survey of n=1183 directors of a variety of medical residency programs found that approximately 

56% of programs offered training in SUDs, with a median number of seven hours of training

devoted to the curriculum throughout the length of residency (Isaacson et al., 2000). Further, a 

2019 study indicated that only 15 of 180 medical schools had a formal addic�on teaching 

curriculum (Hoffman, 2018).

To increase medical school graduates’ competence in SUDs and addic�on, several states have 

enacted state legisla�on and established work groups to ensure medical student trainees 

receive SUD educa�on. For example, in 2014 the Pennsylvania Physician General created a task 

force in response to increasing drug overdose deaths from 2013-2015 to develop learning 

competencies on educa�on in addic�on and opioids for all Pennsylvania medical schools 

(Ashburn & Levine, 2017). Addi�onally, the six medical schools of the University of California 

(UC) System appointed an opioid crisis workgroup to develop educa�onal strategies and 

competencies for adop�on across all UC medical schools that address pain, SUDs, and public 

health issues stemming from the opioid crisis (Servis et al., 2021). In another example, the 

Warren Alpert Medical School of Brown University hosted a na�onal, mul�disciplinary, 

interprofessional symposium on curriculum development in opioid management in medical 

schools atended by geographically diverse health professional experts in pain, addic�on, and 

medical educa�on (Wallace et al., 2020). The symposium iden�fied a need for learning 

competencies to include a focus on pain management, opioid use disorder (OUD), and pa�entcenteredness (Wallace et al., 2020). The resul�ng curriculum guides can serve as a framework 

or blueprint for integra�on of SUD content into medical training curricula. More details on these 

curriculum guides are described in Appendix II.

SUD Curricula in Graduate-Nursing Schools

The Accredita�on Commission for Educa�on in Nursing (ACEN) and the Commission on 

Collegiate Nursing Educa�on (CCNE) are the two professional organiza�ons that establish

quality standards for nursing educa�on, assist schools in implemen�ng educa�onal standards, 

influence the nursing profession to improve health care, and promote public support for 

professional nursing educa�on, research, and prac�ce (Accredita�on Commission for Educa�on 
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in Nursing, 2023a; American Associa�on of Colleges of Nursing, 2023b). The ACEN provides 

specialized accredita�ons for all levels of nursing educa�on and transi�on-to-prac�ce programs 

in the U.S., including clinical doctorate/DNP specialist cer�ficate, master’s/post-master’s 

cer�ficate, baccalaureate, associate, diploma, and prac�cal nursing programs (Accredita�on 

Commission for Educa�on in Nursing, 2023b). The CCNE is an autonomous arm of the American 

Associa�on of Colleges of Nursing (AACN), the later of which represents more than 865 

member schools of nursing housed at public and private universi�es across the U.S. and 

maintains eight Leadership Networks for nursing school faculty and staff involved in research, 

instruc�onal development, faculty prac�ce, organiza�onal leadership, business opera�ons, 

graduate student recruitment, and development and communica�ons (American Associa�on of 

Colleges of Nursing, 2023a).

The degree to which SUD curriculum is embedded within graduate nursing programs remains 

unknown given a dearth of research on how many nursing programs in the U.S. include SUDs in 

their curricula. The AACN led the na�onal consensus-based development of the Core 

Competencies for Professional Nursing Educa�on which outline competency expecta�ons for 

graduates of baccalaureate, master’s, and Doctor of Nursing Prac�ce (DNP) training programs 

(American Associa�on of Colleges of Nursing, 2023); however, these competencies do not 

men�on the terms “substance use”, “SUD”, “OUD”, or “addic�on” specifically (American 

Associa�on of Colleges of Nursing, 2023). In 2002, the addi�on of SUD educa�on in graduate 

nursing educa�on programs was accelerated in response to emerging specified competencies, 

ini�ally published by the Associa�on for Mul�disciplinary Educa�on and Research in Substance 

Use and Addic�on (Rutkowski, 2019; Tierney et al., 2020). These competencies, later updated 

and expanded in 2018, con�nue to define minimal standards of SUD care at the graduate level 

and promote the infusion of nursing knowledge and skills into all clinical prac�ce se�ngs 

(Tierney et al., 2020). Yet, these are voluntary competencies and not uniformly included in 

graduate nursing educa�on.

Although there are no SUD requirements in graduate level nursing educa�on, there are exis�ng 

SUD-related competencies that align with na�onal nursing specialty cer�fica�ons at and include 

the Psychiatric-Mental Health Nursing Scope and Standards of Prac�ce (American Psychiatric 

Nurses Associa�on, 2014), and the Addic�ons Nursing Scope and Standards of Prac�ce 

(American Nurses Associa�on, 2013), which align respec�vely with the American Nurses 

Creden�aling Center's cer�fica�ons of Psychiatric Mental Health Nurse Prac��oner (PMHNP) 

and Psychiatric Mental Health Registered Nurse (PMHRN), and with the Addic�ons Nursing 

Cer�fica�on Board's designa�ons of Cer�fied Addic�ons Registered Nurse (CARN) and Cer�fied 

Addic�ons Registered Nurse, Advanced Prac�ce (CARN-AP) (Tierney et al., 2020). Increased 

endorsement and implementa�on of these competencies during graduate nursing educa�on 

programs could be used to guide future development of SUD content and immersion into 

training curricula (Tierney et al., 2020).
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SUD Curricula in Physician Assistant Schools

The American Academy of Physician Assistants (AAPA) is the professional society for PAs which 

advocates and educates on behalf of the PA profession and the pa�ents PAs serve (AAPA, 2023). 

In 2019, the AAPA surveyed PAs to understand their level of competency in diagnosing, trea�ng, 

and managing SUDs. Results of this na�onal survey (N=532) indicated that PAs skills and abili�es 

to competently treat SUDs were lower than what they desired and felt necessary for clinical 

prac�ce (AAPA, 2020). As such, the Accredita�on Review Commission on Educa�on for the 

Physician Assistant (ARC-PA, 2023) included SUDs within the standard requirements of didac�c 

educa�on. The SUD educa�on requirement is a subcategory of the social and behavioral 

sciences didac�c requirements (e.g., death, dying, and loss, human sexuality, and violence 

iden�fica�on and preven�on) (ARC-PA, 2023). While the PA profession has made SUD educa�on 

a requirement, the decision of how this is incorporated into the schools’ curricula is le� at the 

discre�on of each training program. Specifically, the ARC-PA (2019) accredita�on standards 

state: “The Standards allow programs to remain creative and innovative in program design and 

the methods of curriculum delivery and evaluation that are used to enable students to achieve 

program goals and student competencies. Mastery of program defined competencies is key to 

preparing students for entry into clinical practice” (p.4).

As it relates to the PAs educa�on, curriculum requirements are connected to didac�c learning 

outcomes, whereas program competencies are connected to the clinical educa�on outcomes. 

While there are curriculum requirements related to SUDs, the PA profession has yet to create 

adapted learning competencies related to SUD educa�on and training. The extent to which SUD 

curriculum is embedded within PA programs is unknown, as to date, no current study has 

examined how many PA programs include SUDs in their curricula. However, a study by Yealy and 

colleagues (2019) found that 180 out of 209 PA programs included pain educa�on into their 

curriculum, which typically involves content related to reducing prescrip�on pain medica�on 

use/misuse, preven�on of overdose, and recognizing signs of SUDs. In searching publicly 

available curriculums among PA schools across the U.S., three schools described the 

components of their required SUD educa�on on their program websites (see Table 1). Further, 

the Massachusets Academy of PAs came together with all nine PA programs in the state to 

develop learning competencies (White et al., 2019) and a web-based Screening Brief 

Interven�on Referral to Treatment (SBIRT) training module has been created throughout five PA 

programs in the midwestern US (Tenkku Lepper et al., 2019) (See Appendix 1; addi�onally, a MA 

specific model was created to adopt and implement the educa�on learning competencies for 

the preven�on of prescrip�on drug misuse (see Figure 1) (White et al., 2019).
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Figure 1. Workflow for adoption and implementation of education learning competencies for the 

prevention and management of prescription drug misuse (White et al., 2019).

Peer-Reviewed Substance Use Related Trainings and Studies

In atempt to further educa�onal opportuni�es for medical, graduate nursing, and PA students 

related to SUDs, various studies across the fields have been conducted to educate and train 

students in SUD diagnosis and treatment modali�es. A summary of the studies’ findings is 

presented in Table 2, including the topical area, method, dura�on, and descrip�on of training.

Medical school training: Eighty-nine peer-reviewed publica�ons inves�ga�ng the presence of 

SUD training in medical school program curricula, including clerkships, were iden�fied through a 

literature search between the years 2008 and 2023. Of these publica�ons, 34 focused 

specifically on SUD educa�on during residency, 15 on curriculum and competency development, 

14 on training program content, 13 on barriers and facilitators to SUD educa�on in four-year 

medical school curricula, 7 on supplemental SUD training curricula, 4 on SBIRT training, and 3 on 

Drug Addic�on Treatment Act of 2000 (DATA 2000) Waiver training. Given the wealth of studies 

assessing SUD training in medical school curricula, 11 examples are outlined in Table 2.

Nursing school training: In the last 11 years (2012 - 2023), twenty-nine peer-reviewed studies 

inves�ga�ng the presence of SUD educa�on in nursing program curricula were located during a 

review of relevant literature. Of these, 10 focused on facilitators and barriers to integra�ng SUD 

content into training program curricula, 7 on competency and curriculum development, 7 on 

SUD content broadly, and 5 on SBIRT training. Five exemplary studies examining SUD educa�on 
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in nursing programs are highlighted in Table 2: three on SBIRT training, one on MOUD, one on 

mo�va�onal interviewing.

PA school training: Seven peer-reviewed publica�ons were found (2013-2022) that examined 

the results of substance related training for PAs. Two of the PA studies looked at Medica�on for 

Opioid Use Disorders (MOUD), one of the studies addressed SBIRT, one study focused on waiver 

training, one study looked specifically at OUD, one looked at pain management, and one study 

looked broadly at SUDs. All seven studies are described in Table 2.

Interprofessional SUD Training Studies: Some of the literature discussing trainee exposure to 

specialized SUD-focused content is primarily focused on interprofessional courses in clerkships 

and fellowships, such as lectures and team-based learning courses. One example of an 

interdisciplinary course is a 2021-2022 pre-clerkship course offered through the Duke University 

School of Medicine (Muzyk et al., 2023). This pre-clerkship course was embedded within a 21-

week Founda�ons of Pa�ent Care class intended to bridge biomedical sciences and clinical 

educa�on to prepare students for the clinical learning environment (Muzyk et al., 2023). 

Enrolled students engaged in learning through a mixture of synchronous and asynchronous 

ac�vi�es including live lectures (approximately 50 minutes in length), lecture recordings (50 

minutes), person-centered workshops, team case-based learning (2.5 hours), mo�va�onal 

interviewing of a standardized pa�ent (20 minutes per session), and an opioid overdose 

simula�on exercise (15 minutes). The design of the course involved community advocates, 

interdisciplinary faculty, and persons with an SUD. A 2020 scoping review of n=14 studies of 

interprofessional SUD educa�on in health professions educa�on programs found that

educa�onal interven�ons improved students’ SUD-related educa�onal outcomes, with nine of 

those studies repor�ng on educa�onal outcomes related to SUDs and three exploring 

educa�onal outcomes beyond sa�sfac�on and a�tudes (Muzyk et al., 2020). Educa�onal 

interven�ons discussed in the reviewed studies included faculty and pa�ent panels, small- and 

large-group discussions, simula�on and standardized pa�ent exercises, case-based exercises, 

web-based modules, didac�c lectures, mentoring, and reflec�on paper assignments (Muzyk et 

al., 2020).

Summary of SUD Training Studies: Across the three professions there was a priority of the 

delivery of MOUD and SBIRT-focused trainings. It appears that the many studies related to 

MOUD were focused on preparing students for the previous DATA buprenorphine waiver 

programs and mechanisms to increase the likelihood that the providers would deliver MOUD 

post-gradua�on. Further, many training programs were rooted in addressing the ramifica�ons of 

pain management that may include addic�on. It appears that the integra�on of SUD curriculum

varies significantly in dura�on, with some trainings las�ng a few hours while others several 

weeks. Similarly, the method also varied across studies, inclusive of didac�c lecture based, as 

well as integra�on of clinical training via clerkships and medical residency rota�ons.
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Table 1. Studies examining SUD trainings.

Training Topical area Modality of training; hours of training; 

type of training

Descrip�on of training

Medical Training

SBIRT (Kidd et al., 2020) 1st year of medical school, 2nd semester:

• Addic�on-focused mo�va�onal

interviewing small group and roleplay (60 minutes)

• Mo�va�onal interviewing and

brief interven�on didac�c (60

minutes)

• SBIRT standardized pa�ent small

group (90 minutes)

• SUDs course (120 minutes)

• General medical mo�va�onal

interviewing role-plays (120

minutes)

2nd year, 1st semester:

• 12-step/self-help class (60

minutes)

• 12-step group visits

• Alcoholics Anonymous Small

Group Discussion (120 minutes)

• SUD screening class (60 minutes)

• SBIRT Objec�ve Structured Clinical

Exam (OSCE) (i.e., a method to

Enhanced Pre-Clinical SBIRT Curriculum 

designed to reduce s�gma, help medical 

students empathize with the experiences 

of people using alcohol and drugs, 

understand substance use in-context, and 

feel more op�mis�c about efforts to 

prevent and treat SUDs. This study 

evaluated the substance-related a�tudes 

of medical students who par�cipated in 

the curriculum.
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Training Topical area Modality of training; hours of training; 

type of training

Descrip�on of training

assess clinical competence in 

medical school)

• Two SUD small group case 

discussions (180 minutes)

• Neurobiology of addic�on class 

(60 minutes)

• SUDs course (100 minutes)

SBIRT (Tetrault et al., 2012) Didac�c/prac�ce por�on: 1-1.5 hours of 

instruc�on.

Standardized pa�ent por�on: 1-1.5 hours 

(15-minute �me slots)

Internal medicine (3rd or 4th year 

residents in tradi�onal medicine, primary 

care, and medicine/pediatrics): Two 1.5-

hour sessions separated by 1 week OR 

two 1.5-hour sessions offered in a daylong “addic�on curriculum” day.

Psychiatry (2nd year residents): two 1.5-

hour sessions separated by 1 week.

Obstetrics and Gynecology (4th year 

residents): One 3- hour session. 

Evalua�on of the feasibility and 

acceptability of ini�a�ng a SBIRT for 

alcohol and other drug use curriculum 

across mul�ple medical residency 

programs. SBIRT project faculty in the 

internal medicine, psychiatry, obstetrics 

and gynecology, emergency medicine, 

and pediatrics programs were trained in 

performing and teaching SBIRT.

The SBIRT project faculty trained the 

residents in their respec�ve disciplines, 

accommoda�ng discipline-specific 

implementa�on issues and developed a 

SBIRT training Web site. Post-training, 

residents were observed performing 

SBIRT with a standardized pa�ent. 

Measurements included number of 

residents trained, performance of SBIRT 

in clinical prac�ce, and training 

sa�sfac�on.
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Training Topical area Modality of training; hours of training; 

type of training

Descrip�on of training

Emergency medicine: One 2-hour session 

during an alloted weekly 5-hour resident 

educa�on block.

Pediatrics (2nd year and 3rd year 

residents): One 2.5- hour session during 

required adolescent medicine rota�on.

SBIRT (Neufeld et al., 2012) 3 days, 15-hour course focused on SUDs 

and SBIRT. The course included 5 hours of 

direct pa�ent interac�on during clinical 

demonstra�ons and in small-group skills 

development.

Course for 2nd year medical students that 

used SBIRT as the course founda�on. The 

course arose from collabora�on between 

faculty in the Departments of Medicine 

and Psychiatry. This course was also 1 of 7 

preclinical intersessions featured in a 

“Genes to Society” curriculum (i.e., a 

model of health a disease based on how 

individuals adapt to their environment).

SBIRT (Wamsley et al., 2018) Hours and modali�es not defined in the 

study; training emphases for physicians 

and nursing were:

• Physician: Diagnosis and 

treatment of acute and chronic 

illness; Evidence-based prac�ce; 

Variable inclusion of curricular 

content on alcohol and drugs in 

post-graduate training depending 

on specialty.

• Nursing: Physical assessment; 

Caring prac�ces; Evidence- based 

Review of current literature regarding 

SBIRT effec�veness, training, and 

implementa�on by MDs, nurses, 

psychologists, and social workers. An 

SBIRT expert and representa�ve from 

each health profession synthesized 

literature and training experiences to 

inform the development of 

interprofessional training and 

collabora�ve implementa�on strategies.
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Training Topical area Modality of training; hours of training; 

type of training

Descrip�on of training

prac�ce; Diagnosis and 

management of acute and chronic 

disease by Advanced Prac�ce 

Registered Nurses.

DATA 2000 Waiver (McCance-Katz et al., 

2017)

24-hour Substance Misuse Curriculum for 

pre-clerkship (MS I and II), clerkship, and 

clinical years (MS III and IV): spans all four 

years of medical school with 3 hours of 

classroom didac�cs.

Proposed model at the Brown University 

Alpert Medical School in which

medical students complete the necessary 

training to be eligible for the waiver to 

prescribe opioid medica�ons to treat 

these disorders by the �me of medical 

school gradua�on.

DATA 2000 Waiver (Zerbo et al., 2020) Hybrid online (3.5 hours) and in-person 

(4.5 hours) waiver training. The online 

por�on had to be completed within 30 

days of the mandatory in-person training.

Training as part of a longitudinal opioid 

curriculum requirement for all rising Year 

4 medical students.

DATA 2000 Waiver (Lien et al., 2021) Two op�ons to complete the online 8-

hour MAT waiver training over eight 

weeks: 

• 4.25-hour webinar, 3.75-hour selfpaced module. 

• Self-paced 8-hour modules. 

Zero cost MAT waiver training integrated 

into Wayne State University’s School of 

Medicine’s 8-week Internal Medicine 

clerkship (3rd year medical students).

SUD focus in clerkships (Oldfield et al., 

2020)

Workshop delivered at the midpoint of 

the 12-week combined psychiatryMandatory workshop on harm reduc�on for clerkship medical students with a 

curriculum informed by the Department 

of Veterans Affairs’ Overdose Educa�on 
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Training Topical area Modality of training; hours of training; 

type of training

Descrip�on of training

primary care clerkship at the Yale 

University School of Medicine.

Didac�c and discussion-based content, 

including two video clips and an ac�ve 

demonstra�on of naloxone 

administra�on.

and Naloxone Distribu�on (OEND) 

program.

SUD focus in clerkships (Tookes et al., 

2022)

In-person, didac�c training:

• 60-minute OUD small group case 

study followed by discussion. 

• 60-minute pa�ent panel with a 

large group, with focus on OUD 

recovery and experiences of 

s�gma. 

Small-group, case-based ac�vity delivered 

via videoconference to facilitate analy�cal 

student thinking about OUD, harm 

reduc�on, and the impact of s�gma on 

providing care to pa�ents with OUD. 

Pa�ent panel with three pa�ents with 

OUD, with modera�on by physician with 

exper�se in trea�ng pa�ents with OUD. 

The panel focused on pa�ent recovery 

experiences and s�gma and was intended 

to assist with student documenta�on 

skills during a medicine clerkship.

SUD focus in clerkships (Feeley et al.,

2018)

Didac�c and clinical components:

• 7 one-hour lectures. 

• Independent pa�ent evalua�on 

and treatment plan development. 

Mandatory psychiatry curriculum at 3rd 

and 4th year medical school clerkship 

sites.

Innova�ons in SUD training (Monday et 

al., 2020)

Content delivered in 26 sessions (22 

mandatory and 4 op�onal) during didac�c 

PowerPoint lectures, case- based role 

playing; procedures on cadavers; a 

Residency prepara�on “boot camp” 

nonprocedural elec�ve course for 4th 

year medical students. Content divided 

into six interrelated domains: pa�ent 
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Training Topical area Modality of training; hours of training; 

type of training

Descrip�on of training

session on teaching and giving feedback.

12 symptom-based modules covering 

common clinical scenarios.

The curriculum was adapted for remote 

synchronous delivery due to the 

pandemic in 2020 using a combina�on of 

didac�c lectures and case-based role play 

responses using a chat box.

care; medical knowledge; prac�ce-based 

learning and improvement; interpersonal 

communica�on skills; professionalism; 

and systems-based prac�ce.

Nursing Training

SBIRT (Knopf- Amelung et al., 2018) SBIRT training was taught in 

approximately 6 hours of coursework. 

Didac�c instruc�on (SBIRT overview), 

either in- classroom, using asynchronous 

narrated slides, or 4- hour asynchronous 

interac�ve online course.

Role-playing with peers, prac�cing with 2 

SPs, and implementa�on of SBIRT in 

clinical rota�ons.

3-year study of n=256 BSN students 

trained in SBIRT during a Management of 

Mental Health course during their junior 

year: n=95 in- person, n=99 via narrated 

slides; n=62 via online course.

SBIRT (Fioravan� et al., 2018) Didac�c learning (module on sensi�vity 

learning): dura�on and format not 

described.

Simula�on in small groups via a 

simula�on center: dura�on not 

described.

Study inves�ga�ng a curriculum 

integra�on project (Addic�on Training for 

nursing trainees using SBIRT, or ATNSBIRT) combining cultural competency 

educa�on, simula�on, and educa�ng 

students to use SBIRT for alcohol and 

other drug use in one course. Students 

were within their junior year of an 
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Training Topical area Modality of training; hours of training; 

type of training

Descrip�on of training

undergraduate psychiatric-mental health 

nursing course at the University of 

Pitsburg School of Nursing.

SBIRT (Lukowitsky et al., 2022) 7-hour SBIRT training program:

Online module on risky substance use, 

SUDs, validated screening tools, MI, brief 

interven�ons, and sample SBIRT 

interven�ons (3-4 hours).

In-person didac�cs involving review of 

online module, sample pa�ent screening, 

and video SBIRT demonstra�ons (1.5 

hours). 

Role-playing in SBIRT simula�on (1.5 

hours).

Study evalua�ng the beliefs and a�tudes 

of graduate health care trainees toward 

individuals with SUDs and to assess the 

effect of SBIRT on those a�tudes and 

beliefs. Par�cipants were N=461 students 

from a variety of healthcare-related 

disciplines: PA (n=53), nurse prac��oner 

(n=66), pharmacy (n=136), psychiatry and 

psychology (n=38), and medical students 

(n=168).

MOUD (Barcelona et al., 2022) 24 total hours of training:

• First 8 hours of training offered as 

fully online or as hybrid (virtual 

didac�c and online) op�ons.

• Remaining 16 hours of training 

completed via self-paced training.

Innova�ve approach incorpora�ng DEA Xwaiver training in a required community 

health APRN course in partnership with 

addic�on medicine clinicians.

Mo�va�onal Interviewing (McMorrow & 

Chang, 2021)

3-day curriculum of brief didac�c 

lectures, student role-playing, and a 

standardized pa�ent (SP) simula�on.

This study aimed to determine whether 

mo�va�onal interviewing training with a 

standardized pa�ent simula�on improved 
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Training Topical area Modality of training; hours of training; 

type of training

Descrip�on of training

Two hours of didac�c lectures that 

reviewed mental health and SUDs, 

mo�va�onal interviewing (MI), and an 

overview of the SP simula�on process.

35-minute SP simula�on using MI.

APRN students’ knowledge, confidence, 

and skills in MI.

PA Training

Pain management (Doorenbos et al., 

2013)

In-person; didac�c and clinical educa�on 1) Case-based learning: Use of real or 

simulated stories that include pa�ent 

problems/symptoms. 2) Didac�c: A Power 

Point presenta�on or lecture that may 

include brief ques�on-and-answer 

sessions. 3) Problem- based learning: 

Focused, experien�al learning that is 

organized around the inves�ga�on of 

clinical problems. Learner groups are 

presented with a case and set their own 

learning objec�ves. 4) Simula�on-based 

learning: Simula�ons (low tech or high 

tech) duplicate clinical scenarios and 

allow learners to engage in ac�vi�es that 

approximate realis�c situa�ons. 5) Teambased learning: Teacher-directed method 

for incorpora�ng small- group ac�ve 

par�cipa�on in large-group educa�onal 

se�ng. Learners must ac�vely par�cipate 

in and out of class (prepara�on and 

discussion).
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Training Topical area Modality of training; hours of training; 

type of training

Descrip�on of training

MOUD (Ma et al., 2022) Online; 24 hours; didac�c training This study was conducted to assess 

perceived quality and value of MOUD 

waiver training and to determine if 

training improved student self- reported 

knowledge, confidence, interest in, 

comfort with, and likelihood of caring for 

future pa�ents with SUD and OUD.

MOUD (Phelps et al., 2021) Online; 24 hours; didac�c training

The online 24-hour �med training 

consisted of 11 objec�ves spread 

between one 8-hour and one 16- hour 

module. The 8-hour module has 29 

components with a pretest, Eight 45- to 

60-minute video presenta�ons with 

cases, and one postest of 20 ques�ons. 

The 16-hour module comprises 32 

components with 16 PowerPoint slide 

sets involving cases and 16 postests with 

4 to 6 ques�ons each.

The course content was comprised of the 

waiver materials available through the 

American Academy of PAs and the 

American Society of Addic�on Medicine. 

The free online course includes 2 

modules: the first 8- hour module was 

developed from the original online 

training for physicians and modified to fit 

PAs and NPs; a second module included 

16 hours of addi�onal training.

SBIRT (Scudder et al., 2021) In-person; 4-6 hours; didac�c educa�on.

The training was conducted by the 

classroom instructor for each course and 

took place over a 6- week period of a 15-

week semester.

The training consisted of five modules: (1) 

Introduc�on to SBIRT and Screening, (2) 

Brief Interven�on, (3) Referral to 

Treatment, (4) Medical and Psychiatric 

Complica�ons of Substance Use, and (5) 

Pharmacologic Treatments. Of note, 

students in professions with prescribing 

privileges (e.g., PAs, Psychiatric NPs) 
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Training Topical area Modality of training; hours of training; 

type of training

Descrip�on of training

underwent expanded pharmaceu�cal 

complica�ons and interven�on modules.

Waiver (Robbins et al., 2022) Hybrid; 8 hours; didac�c educa�on.

The 4 hours of live instruc�on included 

didac�c sec�ons on the pharmacology of 

MOUD, diagnosis of SUDs, instruc�on on 

how to conduct a buprenorphine 

induc�on, and 3 interac�ve cases studies 

in which par�cipants could apply their 

knowledge; the four hours of online 

instruc�on focused on medica�on 

assisted treatment.

1) 4 hours of live instruc�on included 

didac�c sec�ons on the pharmacology of 

MOUD, diagnosis of SUD, instruc�on on 

how to conduct MOUD induc�on, and 3 

interac�ve cases studies in which 

par�cipants could apply their knowledge. 

2) 4 addi�onal hours of online content is 

sponsored by Providers’ Clinical Support 

System for Medica�on Assisted Treatment 

(PCSS).

OUD (Brown & Solh, 2021) In-Person; 7 hours; didac�c.

First, a 4-hour lecture series on OUD; 

Next, a 3-hour opiate prescribing 

educa�on lecture series was given.

This study compared the didac�c and 

clinical phase PA cohorts to determine the 

best �me to integrate the OUD training in 

the curriculum. 

Curriculum overview:

Overall, OUD treatment knowledge; 

history taking skills; discussing urine drug 

screen results; pa�ent educa�on and 

counseling skills; ability to formulate a 

treatment plan for pa�ents with chronic 

pain complaints.

SUD (Finnell et al., 2022) Online; 6 modules. (Interprofessional, 

nursing, PA, pharmacy, and social work)

The purpose of this study was to have 

mul�ple professionals take the same

online course and determine which 
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Training Topical area Modality of training; hours of training; 

type of training

Descrip�on of training

This course was mapped alongside 

AMERSA competencies.

modules match the current curriculum.

Content of the 6 modules included:

1. How can I show compassion 

toward pa�ents with SUDs?

2. How do I know if my pa�ent has a 

SUD?

3. How do I recommend treatment 

op�ons? 

4. What medica�ons help pa�ents 

manage their SUDs?

5. What psychosocial or behavioral 

therapies are available for pa�ents 

with SUDs?

6. What societal factors impact 

successful recovery?
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Barriers to Incorpora�ng SUD Curriculum into Exis�ng Content

Barriers in Existing Medical School Curriculum

Prior studies to iden�fy major obstacles to incorpora�ng SUD content into exis�ng medical school curricula 

iden�fied three main barriers: 1) insufficient �me for new content, 2) limita�ons in the availability of staff and 

clinical sites to provide lectures and supervision for SUD content learning, and 3) incen�vizing medical 

residents to spend an addi�onal year or more applying to and comple�ng an SUD-focused fellowship (Schwartz 

et al., 2018). Consequen�ally, survey studies of medical school graduates indicate feelings of unpreparedness 

toward caring for pa�ents with SUDs, including knowledge and prescribing of medica�ons (Morreale et al., 

2020). Correc�on of current failings in medical SUD curricula coverage, including under- and misdiagnosis, 

s�gma toward individuals with SUDs, and feelings of inadequacy or helplessness in trea�ng SUDs, is cri�cal 

content needed in medical training programs. A review of literature suggests that insufficient and 

underdeveloped SUD educa�on curricula are atributable to a variety of factors, including: a lack of 

standardized addic�on medicine competencies; a dearth of educators with the exper�se and availability to 

provide SUD training and supervision; limited space in curricula for new SUD content addi�ons; persistent 

s�gma in educators and trainees; and difficulty atrac�ng trainees due to a lack of financial incen�ves for 

comple�ng addi�onal training.

A Lack of Standardized Competencies in Addiction Medicine

Deficiencies in SUD training exists in both the pre-clinical and clinical medical school curricula. While the 

literature on SUD training in medical schools is limited, available studies demonstrate there is insufficient 

exposure to SUD content in pre-clinical medical school curricula, including classroom didac�cs, lectures, and 

small group learning (Ram & Chisolm, 2016). No na�onal data on the number of medical school hours 

dedicated to addic�on medicine exists and only minimal addic�on medicine competencies are present in the 

Na�onal Board of Medical Examiners blueprints, making it challenging for schools to priori�ze it as a topic 

(Smith, 2022). Prior studies indicate that medical schools in the U.S. devote an average of 12 hours of 

curricular �me to substance use, with most formal training conducted via psychiatric didac�cs and clerkships 

(Rasyidi et al., 2012; Smith, 2022). One survey conducted by the Liaison Commitee for Medical Educa�on 

(LCME) found that 119 of the 125 U.S. accredited medical schools reported providing SUD educa�on as part of 

a larger, required course at the �me of the study, yet only 12 schools offered a separate required course and 

only 45 offered a separate elec�ve course on SUD (Yoast, 2008).

Curriculum Space Limitations and the Dearth of Educators

Inadequate training in addic�on medicine during medical school is par�ally atributable to an undersupply of 

educators with the qualifica�ons and availability to provide supervision and instruc�on on SUD training. This 

shortage, in combina�on with difficulty in acquiring space for curricular addi�ons, poses a challenge for 

integra�ng more SUD content into medical educa�on. Despite every specialty in medicine involving treatment 

of pa�ents with SUDs, departments may interpret the inclusion of addic�on content as taking �me away from 
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other important didac�c and clinic teaching �me (Lembke & Humphreys, 2018). Given the difficulty of securing 

“teaching blocks,” or a period set aside for exclusive teaching of a single subject, educators wishing to 

incorporate more SUD training are likely to encounter the obstacle of not being granted enough �me to cover 

the necessary content (Lembke & Humphreys, 2018). Program curriculum developers may consider addressing 

these limita�ons by infusing SUD curricula into exis�ng course topics, content, case studies, vignetes, and 

simula�ons (Poon et al., 2016; Ram & Chisolm, 2016).

Trainee and Educator Stigma

Insufficient exposure to persons with SUDs, in combina�on with limited faculty specializing in addic�on 

medicine, leads to inadequate SUD training that allows s�gma toward persons with addic�ons to con�nue 

(Rasyidi et al., 2012). A study of general psychiatry residents found trainees had generally poor percep�ons of 

careers in addic�on medicine due to concerns with their addic�on medicine training experience (Renner et al., 

2009). Cited concerns from study par�cipants included a lack of competent faculty, not enough exposure to 

addic�on pa�ents, the challenges of working with “difficult” pa�ents, and overemphasis during training on 

detoxifica�on with limited exposure to long-term care methods (Renner et al., 2009). Other studies indicate 

that s�gma increases when clinical content lacks relevant educa�on, supervision, and reflec�on (Lundin & Hill, 

2022). Studies assessing the root causes of s�gma are minimal, crea�ng challenges in targe�ng whether clinical 

experiences or a�tudes passed on from senior staff members are more instrumental in affec�ng trainee 

a�tudes (Lundin & Hill, 2022). Numerous studies indicate the a�tudes of medical trainees toward pa�ents 

with SUDs as trending toward more nega�ve with increased clinical training, sugges�ng internaliza�on of their 

supervisors’ nega�ve a�tudes toward addic�on (Kidd et al., 2020). Addi�onal studies of medical students 

suggest that posi�ve a�tudes toward pa�ents with SUDs are associated with improved self-efficacy in 

delivering SUD treatment and increased recogni�on of the role of SUD treatment in clinical care (Kidd et al., 

2020).

Challenges in Recruiting Addiction Medicine Fellows

Despite growing awareness of the opioid crisis and reported commitment to social jus�ce among 

contemporary medical students, recruitment for addic�on medicine and addic�on psychiatry remains a 

challenge. Although one study noted the number of Accredita�on Council for Graduate Medical Educa�on 

(ACGME) accredited fellowship posi�ons in addic�on psychiatry is at an all-�me high of 132, only 64% of 

available spots were filled (Morreale et al., 2020). Residents may be reluctant to invest in an addi�onal year of 

training at a lower salary than would be possible if they entered independent prac�ce (Lembke & Humphreys, 

2018). Lackluster fellowship recruitment may also be due to poor coverage of SUD care by insurance plans, 

limi�ng the quan�ty of atrac�ve employment opportuni�es available to gradua�ng fellows (Lembke & 

Humphreys, 2018). While encouraging psychiatry residents to pursue subspecialty training in addic�on 

medicine may be a poten�al method of increasing the number of SUD educators, addi�onal training for nonpsychiatric physician trainees is also necessary (Morreale et al., 2020). Though the shortage of qualified 

physicians knowledgeable in addic�on medicine may lessen in the coming decades as this workforce is 
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expanded through addic�on medicine fellowship training, the need for qualified providers outpaces current 

workforce growth.

Barriers in Existing Graduate Nursing School Curriculum

Gaps in graduate nursing educa�on, par�cularly inadequate instructor knowledge of SUDs and insufficient 

classroom and clinical hours devoted to SUD training, are well- documented in the literature (Farrell, 2020; 

Mitchell et al., 2013). Since the Affordable Care Act’s introduc�on in 2010, the capacity of health systems to 

serve a larger pa�ent popula�on has grown and with this, more nurse prac��oners and PAs have been called 

upon to address increased demand for services (Kim et al., 2023). In par�cular, the role of advanced prac�ce 

registered nurses (APRNs) in trea�ng pa�ents with SUDs has expanded in primary care. For example, data from 

a 2013 study indicated that nurse prac��oners ranked third for opioid- related insurance claims for Medicare 

Part D that year, covering nearly 70% of the 50 million individuals insured through Medicare (Chen et al., 

2016). However, one mul�disciplinary study of nursing trainees found that 77% of surveyed physicians and 

nurse prac��oners named fear of causing harm as a primary concern and 35% iden�fied insufficient pain 

management educa�on as barriers to safe and effec�ve opioid prescribing (Spitz et al., 2011). One study posits 

the limited number of SUD content hours in nursing curricula contributes to a cycle in which nurses who lack 

the skills and knowledge to provide adequate care inadvertently contribu�ng to the low propor�on of those 

seeking and receiving care due to lack of educa�on (Mitchell et al., 2013).

Stigma and Lack of Readiness to Treat

Studies inves�ga�ng the prevalence of SUD content in nursing educa�on programs indicate a lack of content 

on communica�ng about SUDs and addressing biases in SUD care. There is limited examina�on of nursing 

students’ a�tudes toward pa�ents with SUDs, with some documenta�on of nursing students as having the 

least tolerant a�tude toward persons with SUDs compared with students in social work, psychology, and 

health and social care fields (Harling, 2017). Without interven�on and educa�on, bias and s�gma against 

pa�ents with SUDs by nursing professionals may persist as they transi�on into professional healthcare prac�ce 

(Lanzillota-Rangeley et al., 2020). Prior studies indicate that delivery of care services can be nega�vely 

impacted by biases such as expec�ng persons with SUDs will be challenging to care for and distrust of persons 

with SUDs (Selby & Trinkoff, 2023). One survey study of nursing students (n= 567) suggested that trainees 

generally feel knowledgeable about screening and recognizing signs and symptoms of SUDs but lack 

experience in applying these skills, with trainees repor�ng they need more informa�on on the effects of 

different substances and available treatments (Selby & Trinkoff, 2023).

Limited Time Availability in Current Curricula for New SUD Content

Similar to the barriers iden�fied in medical curricula, a lack of adequate �me and content in nursing educa�on 

curricula to sufficiently teach SUD training has been long documented in the literature (Farrell, 2020). Results 

from a study of nursing program directors indicate �me constraints and limited curricular flexibility as the 

largest barriers for including OUD content in graduate nurse prac��oner programs, with respondents repor�ng 
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that addi�ons to the curricula would overwhelm students (Kameg et al., 2021); other respondents indicated 

faculty resistance to adding to students’ workload as a product of opioid coverage as not any more important 

than other topics (Kameg et al., 2021). Addi�ons of SUD content to current nursing curricula remains a 

challenge given limited openings in educa�onal programs for added informa�on.

Barriers in Existing Graduate Physician Assistant School Curriculum

PA educa�on is o�en adopted from medical educa�on and therefore has similar barriers to standardizing the 

inclusion of SUD among PA programs curricula (Judd et al., 2002). PAs are well posi�oned to provide care for 

pa�ents experiencing SUD, however, common barriers have been cited that prohibit comprehensive SUD 

educa�on.

1) Limited availability of clinical rota�ons in psychiatry/behavioral health care. Fi�y percent of PA program 

directors stated they have a very difficult �me securing clinical placements in psychiatry/behavioral 

health care se�ngs (Ma�ngly, 2019).

2) Without competencies for PAs regarding SUDs there is significant varia�on in both the didac�c and 

clinical instruc�onal methods. Further, this has created difficulty in promo�ng and recrui�ng PAs to 

prac�ce in addic�on medicine (Ma�ngly, 2019).

3) State level barriers in prescribing buprenorphine, such as restric�ons on prescribing at all (i.e., in Illinois 

and Missouri) or requirements for physician supervision (Andraka-Christou et al., 2022). These barriers 

have been raised by PA programs as it is difficult to recruit students to study SUD when certain states 

will not allow PAs to prescribe buprenorphine (Ma et al., 2022).

4) Disagreement among PA programs in how SUD training should be included in the curriculum has led to 

lack of consensus and resul�ng curricula ac�on (White et al., 2019).

Summary of Barriers

Barriers to integra�on of SUD content into medical, nursing, and PA educa�on programs share commonali�es. 

Insufficiency of �me in curricula for content addi�ons, a shortage of qualified and interested educators, a lack 

of standardized competencies, inconsistency in how SUD content is presented, internalized student and/or 

educator s�gma toward persons with SUDs, and state-level barriers all contribute to under-presenta�on of 

SUD training across all three program types.

There are well-documented barriers to incorpora�ng SUD content into the curriculums across medical, nursing, 

and PA educa�on. While these barriers are slightly nuanced among each profession, they share commonali�es. 

Figure 2 shows the common barriers that exist across the three professions at the educa�on, policy, and 

accredita�on levels. Further, the sec�ons below detail more of the specific barriers across each profession.
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Figure 2. Barriers across medical, graduate nursing, and PA professions

Facilitators to Incorpora�ng SUD Curriculum into Exis�ng Content

Facilitators to incorpora�ng SUD content into the curricula of medical, graduate nursing, and PA educa�on and 

training programs are similar across all three professions. The following sec�ons provide an overview of 

common facilitators at the individual and ins�tu�onal levels and offer examples demonstra�ng how exposure 

to SUD content can be improved both in and out of the classroom.

Facilitators in Existing Medical School Curriculum

Recent literature indicates an up�ck in the number of health professionals pursuing cer�fica�on in addic�on 

medicine, and there is evidence of increased collabora�on between the addic�on psychiatry and addic�on 

medicine subspecial�es (Zisman-Ilani et al., 2023). Studies inves�ga�ng the feasibility of adding SUD content to 

training programs suggest that availability of educa�onal resources on addic�on, such as faculty development 

workshops, individual mentorship, and didac�c curricula, are a necessary component of suppor�ng the 

curricular addi�ons (Schwartz et al., 2018). Current medical school content modeling the SBIRT modality, 

including through video content, offers an introduc�on to SUD assessments and can improve student empathy 

in standard pa�ent encounters (Frances, 2018). Supplemental educa�onal opportuni�es, such as con�nuing 

• State level

restric�ons in

prescribing

buprenorphine,such

as restric�ons to

prescribing at all or

requirements for

physician

supervision.

Policy Level

• Lack of providersto

precept and train

students in clinical

settings.

• Lack of �me to

educate studentsin

the didac�c

se�ngs.

• Difficulty recrui�ng

students to spend

more �me

specializing in

SUDs.

Educa�on Level

• Lack of learning

competencies across

all three professions

to train and educate

on SUD.

•Lack ofrequirements

for SUD in didac�c

educa�on in medical

and graduate

nursing educa�on

and clinical

educa�on in

medical, graduate

nursing, and PA

professions.

Accreditation Level
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educa�on courses and clerkships focused on SUD/OUD training, offer addi�onal pathways to increasing 

exposure to SUD content in medical training programs (Schwartz et al., 2018).

Facilitators in Existing Nursing School Curriculum

Nursing student interest and faculty investment in SUD curricular addi�ons are the primary drivers of 

increased SUD content in training programs. Virtually all nursing students (N=567, with n=282 BSN students, 

n=152 MS/MSN, n=99 DNP, and n=14 PhD) at a large mid- Atlan�c school of nursing responding to a 2019 

study inves�ga�ng their perceived knowledge, a�tudes, and interest in addic�ons educa�on agreed on the 

importance being educated about SUD and that having an addic�ons nurse specialist as a resource would be 

helpful for their prac�ce (Selby & Trinkoff, 2023); the majority were also interested in enrolling in an addic�ons 

course, and some students also reported viewing nurses as poten�al leaders in addic�ons care (Selby & 

Trinkoff, 2023). Studies assessing the feasibility of integra�ng OUD content into graduate nursing curricula 

point to the importance of faculty and stakeholder buy-in to successful curricular modifica�ons (Kameg et al., 

2018). Faculty members who iden�fy as champions of OUD training and who enthusias�cally engage in the 

curriculum are more likely to elicit posi�ve student responses with high par�cipa�on levels (Kameg et al., 

2018; Kameg et al., 2021). Further, ensuring the availability of resources such as Centers for Disease Control 

and Preven�on (CDC) guidelines and modules and state-level board of nursing training for trainees increases 

the likelihood of successful student educa�on in SUDs (Kameg et al., 2021).

Facilitators in Existing Physician Assistant Program Curriculum

Over one-fourth of all PAs work in primary care se�ngs and will interface will pa�ents experiencing a SUD 

while receiving rou�ne care. To address the SUD epidemic, all PA students are required to learn about SUDs as 

part of their didac�c curriculum (ARC-PA, 2023; Saitz & Daaleman, 2017). In a 2021 qualita�ve study examining 

the readiness of university-based PAs (and other health professionals) to treat SUDs, N=15 interviewed 

par�cipants comprising current/experienced (n=10) and future/new (n=5) preceptors recognized a need for 

further educa�on and treatment recommenda�ons for pa�ents experiencing a SUD. Moreover, respondents 

felt providers in primary care se�ngs should be required to receive SUD training and precep�ng (Lowe et al., 

2022). In addi�on to training PAs to respond to SUD in primary care se�ngs, the PA profession has also called 

for increased knowledge of SUDs when trea�ng and managing pain. This call has facilitated training for PAs in 

pharmacology and SUDs (White et al., 2019). While PAs are now required to learn about SUDs as a part of their 

didac�c curriculum, there are addi�onal training opportuni�es available to meet the demand of recognizing 

and responding to SUDs in clinical se�ngs.

Summary of Facilitators

Similar facilitators to SUD content integra�on exist across medical, graduate nursing, and PA educa�onal 

programs. Increases in interprofessional collabora�on across disciplines, an up�ck in student interest in 

learning how to treat SUDs and OUD, and the importance of faculty and stakeholder advocacy for SUD content 

in educa�on programs all help enable future expansion of training in this area. Greater availability of 
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supplemental educa�onal opportuni�es, such as workshops and con�nuing educa�on courses, offers a 

pathway for expanding the emerging workforce capable of providing SUD diagnoses and treatment services.

Summary

Curriculum standards and SUD treatment competencies are inconsistent across medical, nursing, and PA 

educa�on programs. Mul�ple barriers associated with content integra�on, the supply of educators, and 

variability in content coverage pose challenges to ensuring sufficient workforce training in SUD diagnoses and 

treatments. Con�nued and expanded availability of educa�onal opportuni�es in and beyond the classroom, 

including con�nuing educa�on courses, addic�on-focused medical clerkships, and readily accessible training 

guides and resources, offer trainees greater opportuni�es to broaden their knowledge and exper�se in SUD 

treatment. Future research efforts may consider developing uniform competencies for addic�on treatment 

and standardiza�on of educa�on and curricular requirements needed for licensure.
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28

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htps://doi.org/10.1097/JPA.0000000000000237

82. Yoast, R. (2008). Teaching about substance abuse. AMA Journal of Ethics, 10(1), 21–29. 

htps://doi.org/10.1001/virtualmentor.2008.10.1.medu1-0801

83. Zerbo, E., Traba, C., Mathew, P., Chen, S., Holland, B. K., Levounis, P., Nelson, L. S., & Lamba, S. (2020). 

Data 2000 waiver training for medical students: Lessons learned from a medical school experience. 

Substance Abuse, 41(4), 463–467. htps://doi.org/10.1080/08897077.2019.1692323

84. Zisman-Ilani, Y., Smith, W. R., & Morris, N. P. (2023). Addressing substance use in psychiatric care: An 

old problem with renewed urgency. Psychiatric Services, 74(2), 201–203. 

htps://doi.org/10.1176/appi.ps.202100724
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Appendix I

Peer reviewed and gray literature included:

• PubMed

• PsycINFO

• Cumulated Index to Nursing and Allied Health Literature (CINAHL)

• Google Scholar

• Na�onal Ins�tutes of Health (NIH) gray literature search

Educa�onal accredi�ng bodies included:

• Medicine (including Doctor of Medicine and Doctor of Osteopathic Medicine)

o Liaison Commitee on Medical Educa�on (LCME)

o Accredita�on Council for Con�nuing Medical Educa�on (ACCME)

o American Medical Associa�on (AMA)

o Accredita�on Council for Graduate Medical Educa�on (ACGME)

o Commission on Osteopathic College Accredita�on (COCA)

• Nursing (including undergraduate and graduate degrees in nursing)

o Accredita�on Commission for Educa�on in Nursing (ACEN)

o Commission on Collegiate Nursing Educa�on (CCNE)

o Consor�um for Advanced Prac�ce Providers

o Na�onal League for Nursing, Commission for Nurse Educa�on Accredita�on (NLN CNEA)

o American Associa�on of Colleges of Nursing

• Physician Assistants

o Accredita�on Review Commission on Educa�on for the Physician Assistant (ARC-PA)

o Na�onal Commission on Cer�fica�on of Physician Assistants (NCCPA)

o American Academy of Physician Associates (AAPA)

o PA Educa�on Associa�on (PAEA)
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Appendix II

Examples of SUD Curricula

Medical School Curricula

Alpert Medical School, Brown University Substance Misuse Curriculum Outline

McCance-Katz, E. F., George, P., Scot, N. A., Dollase, R., Tunkel, A. R., & McDonald, J. (2017). Access to 

treatment for opioid use disorders: Medical student prepara�on. The American journal on addic�ons, 26(4), 

316–318. htps://doi.org/10.1111/ajad.12550
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Core Competencies for the Prevention and Management of Prescription Drug Misuse

Antman, K. H., Berman, H. A., Flote, T. R., Flier, J., Dimitri, D. M., & Bharel, M. (2016). Developing Core 

Competencies for the Preven�on and Management of Prescrip�on Drug Misuse: A Medical Educa�on 

Collabora�on in Massachusets. Academic medicine : journal of the Associa�on of American Medical Colleges, 

91(10), 1348–1351. htps://doi.org/10.1097/ACM.0000000000001347 
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Pennsylvania State Core Competencies for Education on Opioids and Addiction

Ashburn, M. A., & Levine, R. L. (2017). Pennsylvania State Core Competencies for Educa�on on Opioids and 

Addic�on. Pain medicine (Malden, Mass.), 18(10), 1890–1894. htps://doi.org/10.1093/pm/pnw348 
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Symposium on Curriculum Development in Opioid Management

Wallace, P. M., Warrier, S., Kahn, M. J., Welsh, C., & Fischer, M. (2020). Developing an opioid curriculum for 

medical students: A consensus report from a na�onal symposium. Substance abuse, 41(4), 425–431. 

htps://doi.org/10.1080/08897077.2019.1635971 
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University of California Pain and Substance Use Disorder Competencies

Servis, M., Fishman, S. M., Wallace, M. S., Henry, S. G., Ziedonis, D., Ciccarone, D., Knight, K. R., Shoptaw, S., 

Dowling, P., Suchard, J. R., Shah, S., Singh, N., Cedarquist, L. C., Alem, N., Copenhaver, D. J., Westervelt, M., & 

Willis, B. C. (2021). Responding to the Opioid Epidemic: Educa�onal Competencies for Pain and Substance Use 

Disorder from the Medical Schools of the University of California. Pain medicine (Malden, Mass.), 22(1), 60–66. 

htps://doi.org/10.1093/pm/pnaa399 
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Nursing Curricula

American Psychiatric Nurses Association Scope and Standard of Practice: Psychiatric Mental Health Nursing, 

2nd Edition.

American Psychiatric Nurses Associa�on (APNA). (2014). Psychiatric-Mental Health Nursing: Scope and 

Standards of Prac�ce, 2nd Edi�on. htps://repository.poltekkes- kal�m.ac.id/601/1/PsychiatricMental%20Health%20Nursing%20(%20PDFDrive.com%20).pdf. Accessed July 13, 2023.

Standard 1. Assessment

The psychiatric-mental health registered nurse collects and synthesizes comprehensive health data that are

per�nent to the healthcare consumer’s health and/or situa�on.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Collects comprehensive data including but not limited to psychiatric, substance, physical, func�onal, 

psychosocial, emo�onal, cogni�ve, sexual, cultural, age-related, environmental, spiritual/transpersonal, 

and economic assessments in a systema�c and ongoing process while focusing on the uniqueness of 

the person.

• Elicits the healthcare consumer’s values, preferences, knowledge of the healthcare situa�on, expressed 

needs, and recovery goals.

• Involves the healthcare consumer, family, other healthcare providers, and other consumer-iden�fied 

support systems (as appropriate) in holis�c data collec�on.

• Demonstrates effec�ve clinical interviewing skills that facilitate development of a therapeu�c 

rela�onship.

• Priori�zes data collec�on ac�vi�es based on the healthcare consumer’s immediate condi�on and the 

an�cipated needs of the consumer or situa�on.

• Uses appropriate evidence-based assessment techniques and instruments in collec�ng per�nent data.

• Uses analy�cal models and problem-solving techniques.

• Ensures that appropriate consents, as determined by regula�ons and policies, are obtained to protect 

confiden�ality and support the healthcare consumer’s rights in the process of data gathering.

• Synthesizes available data, informa�on, and knowledge relevant to the situa�on to iden�fy paterns 

and variances.

• Uses therapeu�c principles to understand and make inferences about the healthcare consumer’s 

emo�ons, thoughts, behaviors, and condi�on.

• Documents relevant data in a retrievable format.
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ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Performs a comprehensive psychiatric and mental health diagnos�c evalua�on.

• Ini�ates and interprets diagnos�c tests and procedures relevant to the healthcare consumer’s current 

status.

• Employs evidence-based clinical prac�ce guidelines to guide screening and diagnos�c ac�vi�es as 

available and appropriate.

• Conducts a mul�genera�onal family assessment, including medical, psychiatric, and substance use 

history.

• Assesses interac�ons among the individual, family, community, and social systems and their 

rela�onship to mental health func�oning.

Standard 2. Diagnosis

The psychiatric-mental health registered nurse analyzes the assessment data to determine diagnoses, 

problems, and areas of focus for care and treatment, including level of risk.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Iden�fies actual or poten�al risks to the healthcare consumer’s health and safety or barriers to mental 

and physical health which may include but are not limited to interpersonal, systema�c, or 

environmental circumstances.

• Derives the diagnoses, problems, or areas in need of care and treatment from the assessment data.

• Develops the diagnosis or problems with the healthcare consumer, significant others, and other 

healthcare clinicians to the greatest extent possible in concert with person-centered, recoveryoriented prac�ce.

• Develops diagnoses or problems that, to the greatest extent possible, are in the healthcare consumer’s 

words and congruent with available and accepted classifica�on systems.

• Documents diagnoses or problems in a manner that facilitates the determina�on of the expected 

outcomes and plan.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):
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• Develops standard psychiatric and substance use diagnoses (e.g., DSM, IDC-10).

• Systema�cally compares and contrasts clinical findings with normal and abnormal varia�ons and 

developmental events in formula�ng a differen�al diagnosis.

• U�lizes complex data and informa�on obtained during interview, examina�on, and diagnos�c 

procedures in iden�fying diagnoses.

• Iden�fies long-term effects of psychiatric disorders on mental, physical, and social health.

• Evaluates the health impact of life stressors, trauma�c events, and situa�onal crises within the context 

of the family cycle.

• Evaluates the impact of the course of psychiatric disorders and mental health problems on the path of 

recovery, including quality of life and func�onal status.

• Assists staff in developing and maintaining competency in the diagnos�c process.

Standard 3. Outcomes Iden�fica�on

The psychiatric-mental health registered nurse iden�fies expected outcomes and the healthcare consumer’s

goals for a plan individualized to the healthcare consumer or to the situa�on.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Involves the healthcare consumer to the greatest extent possible in formula�ng mutually agreed upon 

outcomes and individualized healthcare consumer goals.

• Involves the healthcare consumer’s family, healthcare providers, and other significant supports in 

formula�ng expected outcomes when possible and as appropriate.

• Derives culturally appropriate expected outcomes from the iden�fied diagnoses and problems.

• Considers associated risks, benefits, costs, current scien�fic evidence, and clinical exper�se when 

formula�ng expected outcomes.

• Iden�fies expected outcomes that incorporate scien�fic evidence and are achievable through 

implementa�on of evidence-based prac�ces.

• Defines expected outcomes in terms of the healthcare consumer, the healthcare consumer’s values, 

ethical considera�ons, environment or situa�on, with considera�on of associated risks, benefits, costs, 

current scien�fic evidence, and personal recovery goals.

• Develops expected outcomes that provide direc�on for con�nuity of care.

• Documents expected outcomes as healthcare consumer-focused measurable goals in language either 

developed by the healthcare consumer or understandable to the healthcare consumer.

• Includes a �me es�mate for atainment of expected outcomes.

• In partnership with the healthcare consumer, modifies expected outcomes based on changes in the 

status of the healthcare consumer or evalua�on of the situa�on.
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ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Assists the PMH-RN in iden�fying expected outcomes that incorporate scien�fic evidence and are 

achievable through implementa�on of evidence-based prac�ces.

• Iden�fies expected outcomes that incorporate cost and clinical effec�veness, sa�sfac�on, and 

con�nuity and consistency among providers.

• Develops, implements, and supports and uses clinical guidelines linked to posi�ve clinical outcomes.

Standard 4. Planning

The psychiatric-mental health registered nurse develops a plan that prescribes strategies and alterna�ves to 

assist the healthcare consumer in atainment of expected outcomes.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Develops an individualized plan in partnership with the healthcare consumer, family, and others 

considering the healthcare consumer’s characteris�cs or situa�on; this plan can include, but is not 

limited to, values, beliefs, spiritual and health prac�ces, preferences, choices, developmental level, 

coping style, culture and environment, available technology, and individual recovery goals.

• Establishes the plan priori�es with the healthcare consumer, family, and others as appropriate.

• Priori�zes elements of the plan based on the assessment of the healthcare consumer’s level of risk for 

poten�al harm to self or others and safety needs.

• Includes strategies in the plan that address each of the iden�fied problems or issues, including 

strategies for the promo�on of recovery, restora�on of health, and preven�on of illness, injury, and 

disease.

• Considers the economic impact of the plan.

• Assists healthcare consumers in securing treatment or services in the least restric�ve environment.

• Includes an implementa�on pathway or �meline in the plan.

• Provides for con�nuity in the plan.

• U�lizes the plan to provide direc�on to other members of the healthcare team.

• Documents the plan using person-centered, non-jargon terminology.

• Defines the plan to reflect current statutes, rules and regula�ons, and standards.

• Integrates current scien�fic evidence, trends, and research.

• Modifies the plan (goals/outcomes and interven�ons) based on ongoing assessment of the healthcare

consumer’s achievement of goals and responses to interven�ons.
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ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Iden�fies assessment and diagnos�c strategies and therapeu�c interven�ons that reflect current 

evidence, including data, research, literature, and expert clinical knowledge.

• Plans care to minimize complica�ons and promote individualized recovery and op�mal quality of life 

using treatment modali�es including but not limited to psychodynamic, cogni�ve behavioral, 

suppor�ve interpersonal therapies, and psychopharmacology.

• Selects or designs strategies to meet the mul�faceted needs of complex healthcare consumers.

• Includes synthesis of healthcare consumers’ values and beliefs regarding nursing and medical therapies 

in the plan.

• Ac�vely par�cipates in the development and con�nuous improvement of systems that support the 

planning process.

Standard 5. Implementa�on

The psychiatric-mental health registered nurse implements the iden�fied plan.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Partners with the healthcare consumer, family, significant others, and caregivers as appropriate to 

implement the plan in a safe, realis�c, and �mely manner.

• U�lizes the therapeu�c rela�onship and employs principles of mental health recovery.

• U�lizes evidence-based interven�ons and treatments specific to the problem or issue.

• U�lizes technology to measure, record, and retrieve healthcare consumer data, implement the nursing 

process, and enhance nursing prac�ce.

• U�lizes community resources and systems to implement the plan.

• Provides age-appropriate care in a culturally and ethnically sensi�ve manner.

• Provides care and treatment related to psychiatric, substance, and medical problems.

• Provides holis�c care that focuses on the person with the disease or disorder, not just the disease or 

disorder itself.

• Advocates for the healthcare consumer.

• Addresses the needs of diverse popula�ons across the lifespan.

• Collaborates with nursing colleagues and others to implement the plan.

• Supervises ancillary staff in carrying out care interven�ons.

• Integrates tradi�onal and complementary healthcare prac�ces as appropriate.
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• Documents implementa�on and any modifica�ons, including changes or omissions, of the iden�fied 

plan.

• Incorporates new knowledge and strategies to ini�ate change in nursing care prac�ces if desired 

outcomes are not achieved.

• Manages psychiatric emergencies by determining the level of risk and ini�a�ng and coordina�ng 

effec�ve emergency care.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Facilitates u�liza�on of systems and community resources to implement the plan.

• Supports collabora�on with nursing colleagues and other disciplines to implement the plan.

• Uses principles and concepts of project management and systems management when implemen�ng 

the plan.

• Fosters organiza�onal systems that support implementa�on of the plan.

• Provides clinical supervision to the PMH-RN in the implementa�on of the plan.

• Ac�vely par�cipates in the development and con�nuous improvement of systems that support the 

implementa�on of the plan.

Standard 5A. Coordina�on of Care

The psychiatric-mental health registered nurse coordinates care delivery.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Coordinates implementa�on of the plan.

• Manages the healthcare consumer’s care in order to maximize individual recovery, independence, and 

quality of life.

• Assists the healthcare consumer to iden�fy op�ons for alterna�ve care.

• Communicates with the healthcare consumer, family, and system during transi�ons in care.

• Advocates for the delivery of dignified and humane care by the interprofessional team.

• Documents the coordina�on of care.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):
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• Provides leadership in the coordina�on of interprofessional health care for integrated delivery of care 

and treatment services.

• Func�ons as the single point of accountability for all medical and psychiatric services.

• Synthesizes data and informa�on to prescribe necessary system and community support measures, 

including environmental modifica�ons.

• Coordinates system and community resources that enhance delivery of care across con�nuums.

Standard 5B. Health Teaching and Health Promo�on

The psychiatric-mental health registered nurse employs strategies to promote health and a safe environment.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Provides health teaching (in individual or group se�ngs) related to the healthcare consumer’s needs, 

recovery goals, and situa�on that may include but is not limited to mental health problems, psychiatric 

and substance use disorders, treatment regimens and self-management of those regimens, coping 

skills, relapse preven�on, self-care ac�vi�es, resources, conflict management, problem-solving skills, 

stress management and relaxa�on techniques, and crisis management.

• Uses health promo�on and health teaching methods appropriate to the situa�on and the healthcare 

consumer’s values, beliefs, health prac�ces, developmental level, learning needs, readiness and ability 

to learn, language preference, spirituality, culture, and socioeconomic status.

• Integrates current knowledge, evidence-based prac�ces, and research regarding psychotherapeu�c 

educa�onal strategies and content.

• Engages healthcare consumer alliances, such as peer specialists, and advocacy groups as appropriate in 

health teaching and health promo�on ac�vi�es.

• Iden�fies community resources to assist and support healthcare consumers in using preven�on and 

mental healthcare services.

• Seeks opportuni�es from the individual healthcare consumer for feedback and evalua�on of the 

effec�veness of strategies u�lized.

• Provides an�cipatory guidance to individuals and families to promote mental health and to prevent or 

reduce the risk of psychiatric disorders.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):
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• Synthesizes empirical evidence on risk behaviors, learning theories, behavioral change theories, 

mo�va�onal theories, epidemiology, and other related theories and frameworks when designing health 

informa�on and healthcare consumer educa�on.

• Educates healthcare consumers and significant others about intended effects and poten�al adverse 

effects of treatment op�ons and regimes.

• Provides educa�on to individuals, families, and groups to promote knowledge, understanding, and 

effec�ve management of overall health maintenance, mental health problems, and psychiatric and 

substance disorders.

• Uses knowledge of health beliefs, prac�ces, evidence-based findings, and epidemiological principles, 

along with the social, cultural, and poli�cal issues that affect mental health in the community to 

develop health promo�on strategies.

• Designs health informa�on and healthcare consumer educa�on appropriate to the healthcare 

consumer’s developmental level, learning needs, readiness to learn, and cultural values and beliefs.

• Evaluates health informa�on resources, such as the Internet, in the area of prac�ce for accuracy, 

readability, and comprehensibility to help healthcare consumers access quality health informa�on.

• Assists the PMH-RN in curriculum and program development in the areas of health teaching and health 

promo�on.

Standard 5C. Consulta�on

The psychiatric-mental health advanced prac�ce registered nurse provides consulta�on to influence the 

iden�fied plan, enhance the abili�es of other clinicians to provide services for healthcare consumers, and 

effect change. 

COMPETENCIES

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Ini�ates consulta�on at the request of the consultee.

• Establishes a working alliance with the healthcare consumer or consultee based on mutual respect and 

role responsibili�es.

• Facilitates the effec�veness of a consulta�on by involving the stakeholders in the decision-making 

process.

• Synthesizes clinical data, theore�cal frameworks, and evidence when providing consulta�on.

• Communicates consulta�on recommenda�ons that influence the iden�fied plan, facilitate 

understanding by involved stakeholders, enhance the work of others, and effect change.

• Clarifies that implementa�on of system changes or changes to the plan of care remains the 

responsibility of consultee.

• Assists the PMH-RN and other members of the interprofessional team in resolving complex clinical and 

other situa�ons.
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Standard 5D. Prescrip�ve Authority and Treatment

The psychiatric-mental health advanced prac�ce registered nurse uses prescrip�ve authority, procedures, 

referrals, treatments, and therapies in accordance with state and federal laws and regula�ons.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Conducts a thorough assessment of past medica�on trials, side effects, efficacy, and healthcare 

consumer preference.

• Educates and assists the healthcare consumer in selec�ng the appropriate use of complementary and 

alterna�ve therapies.

• Provides healthcare consumers with informa�on about intended effects and poten�al adverse effects 

of proposed prescrip�ve therapies.

• Provides informa�on about pharmacologic agents, costs, and alterna�ve treatments and procedures as 

appropriate.

• Prescribes evidence-based treatments, therapies, and procedures considering the healthcare 

consumer’s comprehensive healthcare needs.

• Prescribes pharmacologic agents based on a current knowledge of pharmacology and physiology.

• Prescribes specific pharmacological agents and treatments in collabora�on with the healthcare 

consumer and based on clinical indicators, the healthcare consumer’s status, needs, and preferences, 

and the results of diagnos�c and laboratory tests.

• Evaluates therapeu�c and poten�al adverse effects of pharmacological and non-pharmacological 

treatments.

• Evaluates pharmacological outcomes by u�lizing standard symptom measurements and healthcare 

consumer’s reports to determine effec�veness.

Standard 5E. Pharmacological, Biological, and Integra�ve Therapies

The psychiatric-mental health registered nurse incorporates knowledge of pharmacological, biological, and 

complementary interven�ons with applied clinical skills to restore the healthcare consumer’s health and 

prevent further disability.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Applies current research findings to guide nursing ac�ons related to pharmacology, other biological 

therapies, and integra�ve therapies.
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• Assesses the healthcare consumer’s response to biological interven�ons based on current knowledge 

of pharmacological agents’ intended ac�ons, interac�ve effects, poten�al untoward effects, and 

therapeu�c doses.

• Includes health teaching for medica�on management to support healthcare consumers in managing 

their own medica�ons and adhering to a prescribed regimen.

• Provides health teaching about mechanism of ac�on, intended effects, poten�al adverse effects of the 

proposed prescrip�on, ways to cope with transi�onal side effects, and other treatment op�ons, 

including the selec�on of a no-treatment op�on.

• Directs interven�ons toward allevia�ng untoward effects of biological interven�ons.

• Communicates observa�ons about the healthcare consumer’s response to biological interven�ons to 

other health clinicians.

Standard 5F. Milieu Therapy

The psychiatric-mental health registered nurse provides, structures, and maintains a safe, therapeu�c, 

recovery-oriented environment in collabora�on with healthcare consumers, families, and other healthcare 

clinicians.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Orients the healthcare consumer and family to the care environment, including the physical 

environment, the roles of different healthcare providers, how to be involved in the treatment and care 

delivery processes, schedules of events per�nent to their care and treatment, and expecta�ons 

regarding safe and therapeu�c behaviors. Orients healthcare consumers to their rights and 

responsibili�es par�cular to the treatment or care environment.

• Establishes a welcoming, trauma-sensi�ve environment using therapeu�c interven�ons including, but 

not limited to, sensory or relaxa�on rooms.

• Conducts ongoing assessments of the healthcare consumer in rela�on to the environment to guide 

nursing interven�ons in maintaining a safe environment.

• Selects specific ac�vi�es (both individual and group) that meet the healthcare consumer’s physical and 

mental health needs for meaningful par�cipa�on in the milieu and promo�on of personal growth.

• Advocates that the healthcare consumer is treated in the least restric�ve environment necessary to 

maintain the safety of the individual and others.

• Informs the healthcare consumer in a culturally sensi�ve manner about the need for limits related to 

safety and the condi�ons necessary to remove the restric�ons.

• Provides support and valida�on to healthcare consumers when discussing their illness experience, and 

seeks to prevent complica�ons of illness.

Standard 5G. Therapeu�c Rela�onship and Counseling
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The psychiatric-mental health registered nurse (PHM-RN) uses the therapeu�c rela�onship and counseling 

interven�ons to assist healthcare consumers in their individual recovery journeys by improving and regaining 

their previous coping abili�es, fostering mental health, and preven�ng mental disorder and disability.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Uses the therapeu�c rela�onship and counseling techniques to promote the healthcare consumer’s 

stabiliza�on of symptoms and personal recovery goals.

• Uses the therapeu�c rela�onship and counseling techniques, both in the individual and group se�ng, 

to reinforce healthy behaviors and interac�on paterns and help the healthcare consumer discover 

individualized health care behaviors to replace unhealthy ones.

• Documents counseling interven�ons including but not limited to communica�on and interviewing 

techniques, problem-solving ac�vi�es, crisis interven�on, stress management, suppor�ve skill building 

and educa�onal groups, relaxa�on techniques, asser�veness training, and conflict resolu�on.

Standard 5H. Psychotherapy

The psychiatric-mental health advanced prac�ce registered nurse conducts individual, couples, group, and 

family psychotherapy using evidence-based psychotherapeu�c frameworks and the nurse–client therapeu�c 

rela�onship.

COMPETENCIES

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Uses knowledge of relevant biological, psychosocial, and developmental theories, as well as best 

available research evidence, to select therapeu�c methods based on healthcare consumer needs.

• U�lizes interven�ons that promote mutual trust to build a therapeu�c treatment alliance.

• Empowers healthcare consumers to be ac�ve par�cipants in treatment.

• Applies therapeu�c communica�on strategies based on theories and research evidence to reduce 

emo�onal distress, facilitate cogni�ve and behavioral change, and foster personal growth.

• Uses awareness of own emo�onal reac�ons and behavioral responses to others to enhance the 

therapeu�c alliance.

• Analyzes the impact of duty to report and execute other advocacy ac�ons on the therapeu�c alliance.

• Arranges for the provision of care in the therapist’s absence.

• Applies ethical and legal principles to the treatment of healthcare consumers with mental health 

problems and psychiatric disorders.

• Makes referrals when it is determined that the healthcare consumer will benefit from a transi�on of 

care or consulta�on due to change in clinical condi�on.
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• Evaluates effec�veness of interven�ons in rela�on to outcomes using standardized methods as 

appropriate.

• Monitors outcomes of therapy and adjusts the care plan when indicated.

• Therapeu�cally concludes the nurse–client rela�onship and transi�ons the healthcare consumer to 

other levels of care when appropriate.

• Manages professional boundaries in order to preserve the integrity of the therapeu�c process.

Standard 6. Evalua�on

The psychiatric-mental health registered nurse evaluates progress toward atainment of expected outcomes.

COMPETENCIES

The psychiatric-mental health registered nurse (RN-PMH):

• Conducts a systema�c, ongoing, and criterion-based evalua�on of the outcomes and goals in rela�on to 

the prescribed interven�ons by the plan and indicated �meline.

• Collaborates with the healthcare consumer, family or significant others, and other healthcare clinicians 

in the evalua�on process.

• Documents results of the evalua�on.

• Evaluates the effec�veness of the planned strategies in rela�on to healthcare consumer responses and 

the atainment of the expected outcomes.

• Uses ongoing assessment data to revise the diagnoses and problems, outcomes, and interven�ons, as 

needed.

• Adapts the plan of care for the trajectory of treatment according to evalua�on of response.

• Disseminates the results to the healthcare consumer and others involved in the care or situa�on, as 

appropriate, in accordance with state and federal laws and regula�ons.

• Par�cipates in assessing and assuring the responsible and appropriate use of interven�ons in order to 

minimize unwarranted or unwanted treatment and healthcare consumer suffering.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Evaluates the accuracy of the diagnosis and effec�veness of the interven�ons in rela�onship to the 

healthcare consumer’s atainment of expected outcomes.

• Synthesizes the results of the evalua�on analyses to determine the impact of the plan on the affected 

healthcare consumers, families, groups, communi�es, and ins�tu�ons.

• Uses the results of the evalua�on analyses to make or recommend process or structural changes, 

including policy, procedure, or protocol documenta�on, as appropriate.
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• Assists the PMH-RN in the evalua�on and re-formula�on of the plan in complex situa�ons.

Standard 7. Ethics

The psychiatric-mental health registered nurse integrates ethical provisions in all areas of prac�ce.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Uses Code of Ethics for Nurses with Interpre�ve Statements (ANA, 2001) to guide prac�ce.

• Delivers care in a manner that preserves and protects healthcare consumer autonomy, dignity, and 

rights.

• Recognizes and avoids using the power inherent in the therapeu�c rela�onship to influence the 

healthcare consumer in ways not related to the treatment goals.

• Maintains healthcare consumer confiden�ality within legal and regulatory parameters.

• Serves as a healthcare consumer advocate protec�ng healthcare consumer rights and assis�ng 

healthcare consumer in developing skills for self-advocacy.

• Maintains therapeu�c and professional interpersonal rela�onships with appropriate professional role 

boundaries.

• Demonstrates a commitment to prac�cing self-care, managing stress, and connec�ng with self and 

others.

• Contributes to resolving ethical issues of healthcare consumers, colleagues, or systems as evidenced in 

such ac�vi�es as recommending ethics clinical consulta�ons for specific healthcare consumer situa�ons 

and par�cipa�ng on ethics commitees.

• Reports illegal, incompetent, or impaired prac�ces.

• Promotes advance care planning related to behavioral health issues which may include behavioral 

health advance direc�ves.

• Assists healthcare consumers, par�cularly those who may be facing life threatening medical illnesses, 

to plan for and gain access to appropriate pallia�ve and hospice care.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Informs the healthcare consumer of the risks, benefits, and outcomes of healthcare regimens.

• Par�cipates in interprofessional teams that address ethical risks, benefits, and outcomes.

• Promotes and maintains a system and climate that is conducive to providing ethical care.

• U�lizes ethical principles to advocate for access and parity of services for mental health problems, 

psychiatric disorders, and addic�on services.
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Standard 8. Educa�on

The psychiatric-mental health registered nurse atains knowledge and competence that reflect current nursing 

prac�ce.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Par�cipates in ongoing educa�onal ac�vi�es related to appropriate knowledge bases and professional 

issues.

• Par�cipates in interprofessional educa�onal opportuni�es to promote con�nuing skill-building in team 

collabora�on.

• Demonstrates a commitment to lifelong learning through self-reflec�on and inquiry to iden�fy learning 

needs.

• Seeks experiences that reflect current prac�ce in order to maintain skills and competence in clinical 

prac�ce or role performance.

• Acquires knowledge and skills appropriate to the specialty area, prac�ce se�ng, role, or situa�on.

• Maintains professional records that provide evidence of competency and lifelong learning.

• Seeks experiences and formal and independent learning ac�vi�es, to maintain and develop clinical and 

professional skills and knowledge.

• Seeks experiences and formal and independent learning ac�vi�es to maintain and develop skills in and 

knowledge of electronic healthcare media.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Uses current healthcare research findings and other evidence to expand clinical knowledge, enhance 

role performance, and increase knowledge of professional issues.

• Contributes to an environment that promotes interprofessional educa�on.

• Models expert prac�ce to interprofessional team members and healthcare consumers.

• Mentors registered nurses and colleagues as appropriate.

• Par�cipates in interprofessional teams contribu�ng to role development and advanced nursing prac�ce 

and health care.

Standard 9 Evidence-Based Prac�ce and Research

The psychiatric-mental health registered nurse integrates evidence and research findings into prac�ce.
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COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• U�lizes evidence-based nursing knowledge, including research findings, to guide prac�ce decisions.

• Ac�vely par�cipates in research ac�vi�es at various levels appropriate to the nurse’s level of educa�on 

and posi�on. Such ac�vi�es may include:

o Iden�fying clinical problems specific to psychiatric-mental health nursing research.

o Par�cipa�ng in data collec�on (surveys, pilot projects, and formal studies).

o Assis�ng with informed consent process.

o Par�cipa�ng in a formal commitee or program.

o Sharing research ac�vi�es and findings with peers and others.

o Conduc�ng evidence-based prac�ce projects and research.

o Cri�cally analyzing and interpre�ng research for applica�on to prac�ce.

o Using research findings in the development of policies, procedures, and standards of prac�ce in 

nursing care.

o Incorpora�ng research as a basis for learning.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Contributes to nursing knowledge by conduc�ng, cri�cally appraising, or synthesizing research that 

discovers, examines, and evaluates knowledge, theories, criteria, and crea�ve approaches to improve 

healthcare prac�ce. 

• Promotes a climate of research and clinical inquiry.

• Formally disseminates research findings through ac�vi�es such as presenta�ons, publica�ons, 

consulta�on, and journal clubs.

• Promotes a culture that consistently integrates the best available research evidence into prac�ce.

Standard 10. Quality of Prac�ce

The psychiatric-mental health registered nurse systema�cally enhances the quality and effec�veness of nursing 

prac�ce.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):
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• Demonstrates quality by documen�ng the applica�on of the nursing process in a responsible, 

accountable, and ethical manner.

• Uses the results of quality improvement ac�vi�es to ini�ate changes in nursing prac�ce and in the 

healthcare delivery system.

• Uses crea�vity and innova�on in nursing prac�ce to improve care delivery.

• Incorporates new knowledge to ini�ate changes in nursing prac�ce if desired outcomes are not 

achieved.

• Par�cipates in quality improvement ac�vi�es. Such ac�vi�es may include:

o Iden�fying aspects of prac�ce that are important for quality monitoring.

o Using indicators developed to monitor quality and effec�veness of nursing prac�ce.

o Collec�ng data to monitor quality and effec�veness of nursing prac�ce.

o Analyzing quality data to iden�fy opportuni�es for improving nursing prac�ce.

o Formula�ng recommenda�ons to improve nursing prac�ce or outcomes.

o Implemen�ng ac�vi�es to enhance the quality of nursing prac�ce.

o Developing, implemen�ng, and evalua�ng policies, procedures, and guidelines to improve the 

quality of prac�ce.

o Par�cipa�ng on interprofessional teams to evaluate clinical care or health services.

o Par�cipa�ng in efforts to minimize costs and unnecessary duplica�on.

o Analyzing factors related to safety, sa�sfac�on, effec�veness, and cost–benefit op�ons.

o Analyzing organiza�onal systems for barriers.

o Implemen�ng processes to remove or decrease barriers within organiza�onal systems.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Obtains and maintains professional cer�fica�on at the advanced level in psychiatric-mental health 

nursing.

• Designs quality improvement ini�a�ves to improve prac�ce and health outcomes.

• Iden�fies opportuni�es for the genera�on and use of research and evidence.

• Evaluates the prac�ce environment and quality of nursing care rendered in rela�on to exis�ng 

evidence.

Standard 11. Communica�on

The psychiatric-mental health registered nurse communicates effec�vely in a variety of formats in all areas of 

prac�ce.

COMPETENCIES
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The psychiatric-mental health registered nurse (PMH-RN):

• Assesses communica�on format preferences of healthcare consumers, families, and colleagues.*

• Assesses her or his own communica�on skills in encounters with healthcare consumers, families, and 

colleagues.*

• Seeks con�nuous improvement of her or his own communica�on and conflict resolu�on skills.*

• Conveys informa�on to healthcare consumers, families, the interprofessional team, and others in 

communica�on formats that promote accuracy.

• Ques�ons the ra�onale suppor�ng care processes and decisions when they do not appear to be in the 

best interest of the healthcare consumer.*

• Discloses observa�ons or concerns related to hazards and errors in care or the prac�ce environment to 

the appropriate level.

• Maintains communica�on with other members of the interprofessional team to minimize risks 

associated with transfers and transi�on in care delivery.

• Documents referrals, including provisions for con�nuity of care.

• Contributes her or his own professional perspec�ve in discussions with the interprofessional team.

• Documents plan of care communica�ons, ra�onales for changes, and collabora�ve discussions to 

improve nursing care. *(BHE.MONE, 2006)

Standard 12. Leadership

The psychiatric-mental health registered nurse provides leadership in the professional prac�ce se�ng and the 

profession.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Oversees the nursing care given by others while retaining accountability for the quality of care given to 

the healthcare consumer.

• Abides by the vision, the associated goals, and the plan to implement and measure progress of an 

individual healthcare consumer or progress within the context of the healthcare organiza�on.

• Demonstrates a commitment to con�nuous lifelong learning and educa�on for self and others.

• Mentors colleagues for the advancement of nursing prac�ce, the profession, and quality health care.

• Treats colleagues with respect, trust, and dignity.*

• Develops communica�on and conflict resolu�on skills.

• Par�cipates in professional organiza�ons.

• Communicates effec�vely with the healthcare consumer and colleagues.

• Seeks ways to advance nursing autonomy and accountability.*

• Par�cipates in efforts to influence healthcare policy involving healthcare consumers and the profession.
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ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Influences decision-making bodies to improve the professional prac�ce environment and healthcare 

consumer outcomes.

• Influences health policy to promote person-centered, recovery–oriented services for preven�on and 

treatment of mental health problems and psychiatric disorders.

• Provides direc�on to enhance the effec�veness of the interprofessional team.

• Designs innova�ons to effect change in prac�ce and improve health outcomes.

• Promotes advanced prac�ce nursing and role development by interpre�ng its role for healthcare 

consumers, families, and others.

• Models expert prac�ce to interprofessional team members and healthcare consumers.

• Mentors colleagues in the acquisi�on of clinical knowledge, skills, abili�es, and judgment. 

(*BHE.MONE, 2006)

Standard 13. Collabora�on

The psychiatric-mental health registered nurse collaborates with the healthcare consumer, family, 

interprofessional health team, and others in the conduct of nursing prac�ce.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Shares knowledge and skills with peers and colleagues as evidenced by such ac�vi�es as healthcare 

conferences or presenta�ons at formal or informal mee�ngs.

• Provides peers with feedback regarding their prac�ce and role performance.

• Interacts with peers and colleagues to enhance one’s own professional nursing prac�ce and role 

performance.

• Maintains compassionate and caring rela�onships with peers and colleagues.

• Contributes to an environment that is conducive to the educa�on of healthcare professionals.

• Contributes to a suppor�ve and healthy work environment.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Models expert prac�ce to interprofessional team members and healthcare consumers.
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• Mentors other registered nurses and colleagues as appropriate.

• Par�cipates in interprofessional teams that contribute to role development and advanced nursing 

prac�ce and health care.

• Partners with other disciplines to enhance health care through interprofessional ac�vi�es such as 

educa�on, consulta�on, management, technological development, or research opportuni�es.

• Facilitates an interprofessional process with other members of the healthcare team.

Standard 14. Professional Prac�ce Evalua�on

The psychiatric-mental health registered nurse evaluates one’s own prac�ce in rela�on to the professional

prac�ce standards and guidelines, relevant statutes, rules, and regula�ons.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Applies knowledge of current prac�ce standards, guidelines, statutes, rules, and regula�ons.

• Engages in self-evalua�on of prac�ce on a regular basis, iden�fying areas of strength as well as areas in 

which professional development would be beneficial.

• Obtains informal feedback regarding prac�ce from healthcare consumers, peers, professional 

colleagues, and others.

• Par�cipates in systema�c peer review as appropriate.

• Takes ac�on to achieve goals iden�fied during the evalua�on process.

• Provides ra�onale for prac�ce beliefs, decisions, and ac�ons as part of the informal and formal 

evalua�on processes.

• Seeks formal and informal construc�ve feedback from peers and colleagues to enhance psychiatricmental health nursing prac�ce or role performance.

• Provides peers with formal and informal construc�ve feedback to enhance psychiatric-mental health 

nursing prac�ce or role performance.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Engages in a formal process seeking feedback regarding one’s own prac�ce from healthcare consumers, 

peers, professional colleagues, and others.

• Models self-improvement by reflec�ng on and evalua�ng one’s own prac�ce and role performance, 

and sharing insights with peers and professional colleagues.

Standard 15. Resource U�liza�on
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The psychiatric-mental health registered nurse considers factors related to safety, effec�veness, cost, and 

impact on prac�ce in the planning and delivery of nursing services. 

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):

• Evaluates factors such as safety, effec�veness, availability, cost–benefit, efficiencies, and impact on 

prac�ce when choosing prac�ce op�ons that would result in the same expected outcome.

• Assists the healthcare consumer and family in iden�fying and securing appropriate and available 

services to address health-related needs.

• Assists the healthcare consumer and family in factoring in costs, risks, and benefits in decisions about 

treatment and care.

• Assigns or delegates elements of care to appropriate healthcare workers, based on the needs and 

condi�on of the healthcare consumer, poten�al for harm, stability of the healthcare consumer’s 

condi�on, complexity of the task, and predictability of the outcome.

• Assists the healthcare consumer and family in becoming informed about the op�ons, costs, risks, and 

benefits of treatment and care.

• Advocates for resources that promote quality care, including technologies.

• Iden�fies the evidence when evalua�ng resources.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• U�lizes organiza�onal and community resources to formulate interprofessional plans of care.

• Formulates innova�ve solu�ons for healthcare consumer problems that address effec�ve resource 

u�liza�on and maintenance of quality.

• Designs evalua�on strategies to demonstrate quality, cost effec�veness, cost–benefit, and efficiency 

factors associated with nursing prac�ce.

• Builds construc�ve rela�onships with hospital and community providers, organiza�ons, and systems to 

promote collabora�ve decision making and planning to iden�fy and meet resource needs.

Standard 16. Environmental Health

The psychiatric-mental health registered nurse prac�ces in an environmentally safe and healthy manner.

COMPETENCIES

The psychiatric-mental health registered nurse (PMH-RN):
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• Atains knowledge of environmental health concepts, such as implementa�on of environmental health 

strategies.

• Promotes a prac�ce environment that reduces environmental health risks for workers and healthcare 

consumers.

• Assesses the prac�ce environment for factors such as sounds, odors, noises, and lights that threaten 

health.

• Advocates for the judicious and appropriate use of products in health care.

• Communicates environmental health risks and exposure reduc�on strategies to healthcare consumers, 

families, colleagues, and communi�es.

• U�lizes scien�fic evidence to determine if a product or treatment is an environmental threat.

• Par�cipates in strategies to promote healthy communi�es.

ADDITIONAL COMPETENCIES FOR THE PSYCHIATRIC-MENTAL HEALTH ADVANCED PRACTICE REGISTERED 

NURSE

The psychiatric-mental health advanced prac�ce registered nurse (PMH-APRN):

• Creates partnerships that promote sustainable environmental health policies and condi�ons.

• Analyzes the impact of social, poli�cal, and economic influences on the environment and human health 

exposures. Cri�cally evaluates the manner in which environmental health issues are presented by the 

popular media.

• Advocates for implementa�on of environmental principles for nursing prac�ce.

• Supports nurses in implemen�ng environmental principles in nursing prac�ce.
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The Addictions Nursing Scope and Standards of Practice

American Nurses Associa�on. (2013). Addic�ons nursing: Scope and standards of prac�ce. American Nurses 

Associa�on.
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Physician Assistant Curricula

Massachusetts Physician Assistant Education Core Competencies for the Prevention and Management of 

Prescription Drug Misuse

Servis, M., Fishman, S. M., Wallace, M. S., Henry, S. G., Ziedonis, D., Ciccarone, D., Knight, K. R., Shoptaw, S., 

Dowling, P., Suchard, J. R., Shah, S., Singh, N., Cedarquist, L. C., Alem, N., Copenhaver, D. J., Westervelt, M., & 

Willis, B. C. (2021). Responding to the Opioid Epidemic: Educa�onal Competencies for Pain and Substance Use 

Disorder from the Medical Schools of the University of California. Pain medicine (Malden, Mass.), 22(1), 60–66. 

htps://doi.org/10.1093/pm/pnaa399
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Mul�disciplinary Curricula

AMERSA: Select SUD Core Competencies Shared by Two or More Disciplines

Rutkowski B. A. (2019). Specific disciplines addressing substance use: AMERSA in the 21st century. Substance 

abuse, 40(4), 392–395. htps://doi.org/10.1080/08897077.2019.1686726

• Recognize the signs and symptoms of SUD Specific Disciplines Addressing Substance Use: AMERSA in 

the 21st Century.

• U�lize evidence-based measures to perform age, gender, and culturally appropriate substance use 

screening and assessment.

• Intervene with pa�ents whose health is at-risk due to alcohol or drug use and reinforce healthy 

behaviors for those who are at low risk.

• U�lize established protocols to ensure safe care (CIWA-Alcohol, COWS, CIWA-Benzodiazepines).

• Prescribe medica�ons, treatment, and therapies in accordance with the healthcare consumer’s values,

preferences, and needs and according to state- and federally mandated scope of prac�ce.

• Iden�fy and address the legal and ethical issues involved in the care of pa�ents with SUD (e.g., 42 CFR 

Part 2, confiden�ality, minor consent, etc.)

• Use pa�ent-centered language to mi�gate the s�gma associated with substance use.

• Iden�fy referral sources and ensure linkage to treatment for those in need.

• Promote the use of statewide peer assistance programs/groups and the use of alterna�ve to discipline 

programs for health professionals whose prac�ce is impaired because of substance use.

SAMHSA: Recommendations for Curricular Elements in Substance Use Disorders Training

1. Substance Use Disorders

a. Use of validated screening tools for SUD and risk factors for substance use, including mental 

disorders.

b. Diagnosis and assessment of individuals who screen posi�ve for SUDs.

c. The ini�a�on and management of FDA approved medica�ons for SUDs (opioids, alcohol and 

tobacco), including the impact of unique, individual physiology and metabolism on medica�on 

pharmacodynamics.

d. Considera�on of polysubstance use and co-occurring mental disorders.

e. Pa�ent and family educa�on on safety and overdose preven�on (diversion control; safe storage; 

use of naloxone).

2. Effec�ve Treatment Planning

a. Use of pa�ent-centered decision making and paradigms of care, and use of evidence-based 

communica�on strategies such as shared decision making and mo�va�onal interviewing.

b. The impact of s�gma, trauma and the social determinants of health on substance use and 

recovery.
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c. Collabora�ng with other disciplines to facilitate access to medica�ons and referrals to services 

such as case management.

d. Legal and ethical issues involved in the care of pa�ents with SUD.

3. Pain management and substance misuse

a. The assessment of pa�ents with acute, subacute, or chronic pain.

b. Components of developing an effec�ve treatment plan, including general principles underlying 

nonpharmacologic and pharmacologic analgesic therapy, as well as the importance of 

mul�disciplinary treatment interven�ons.

c. Managing pa�ents on opioid analgesics, including tapering off the medica�on when the 

benefits of opioids no longer outweigh the risks.

d. Recognizing signs of OUD in the se�ng of prescribed opioids.
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Appendix II References

Medical Schools

1. Alpert Medical School, Brown University Substance Misuse Curriculum Outline

a. McCance-Katz, E. F., George, P., Scot, N. A., Dollase, R., Tunkel, A. R., & McDonald, J. (2017). 

Access to treatment for opioid use disorders: Medical student prepara�on. The American 

journal on addictions, 26(4), 316–318. htps://doi.org/10.1111/ajad.12550

2. Core Competencies for the Preven�on and Management of Prescrip�on Drug Misuse

a. Antman, K. H., Berman, H. A., Flote, T. R., Flier, J., Dimitri, D. M., & Bharel, M. (2016). 

Developing core competencies for the preven�on and management of prescrip�on drug 

misuse: A medical educa�on collabora�on in Massachusets. Academic medicine: Journal of the 

Association of American Medical Colleges, 91(10), 1348–1351. 

htps://doi.org/10.1097/ACM.0000000000001347

3. Pennsylvania State Core Competencies for Educa�on on Opioids and Addic�on

a. Ashburn, M. A., & Levine, R. L. (2017). Pennsylvania state core competencies for educa�on on 

opioids and addic�on. Pain medicine (Malden, Mass.), 18(10), 1890–1894. 

htps://doi.org/10.1093/pm/pnw348

4. Symposium on Curriculum Development in Opioid Management

a. Wallace, P. M., Warrier, S., Kahn, M. J., Welsh, C., & Fischer, M. (2020). Developing an opioid 

curriculum for medical students: A consensus report from a na�onal symposium. Substance 

abuse, 41(4), 425–431. htps://doi.org/10.1080/08897077.2019.1635971

5. University of California Pain and Substance Use Disorder Competencies

a. Servis, M., Fishman, S. M., Wallace, M. S., Henry, S. G., Ziedonis, D., Ciccarone, D., Knight, K. R., 

Shoptaw, S., Dowling, P., Suchard, J. R., Shah, S., Singh, N., Cedarquist, L. C., Alem, N., 

Copenhaver, D. J., Westervelt, M., & Willis, B. C. (2021). Responding to the opioid epidemic: 

Educa�onal competencies for pain and substance use disorder from the medical schools of the 

University of California. Pain medicine (Malden, Mass.), 22(1), 60–66. 

htps://doi.org/10.1093/pm/pnaa399 

Nursing

1. American Psychiatric Nurses Associa�on Scope and Standard of Prac�ce: Psychiatric Mental Health 

Nursing, 2nd Edi�on.

a. American Psychiatric Nurses Associa�on (APNA). (2014). Psychiatric-mental health nursing: 

Scope and standards of practice (2nd Edi�on). Silver Spring, MD: Nursesbooks.org. 

2. Addic�ons Nursing: Scope and Standards of Prac�ce.

a. American Nurses Associa�on. (2013). Addic�ons nursing: Scope and standards of prac�ce. 

American Nurses Associa�on. Washington, D.C.: Nursesbooks.org. 

Physician Assistant
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1. The Massachusets Physician Assistant Educa�on Core Competencies for the Preven�on and 

Management of Prescrip�on Drug Misuse

a. Servis, M., Fishman, S. M., Wallace, M. S., Henry, S. G., Ziedonis, D., Ciccarone, D., Knight, K. R., 

Shoptaw, S., Dowling, P., Suchard, J. R., Shah, S., Singh, N., Cedarquist, L. C., Alem, N., 

Copenhaver, D. J., Westervelt, M., & Willis, B. C. (2021). Responding to the opioid epidemic: 

educa�onal competencies for pain and substance use disorder from the medical schools of the 

University of California. Pain medicine (Malden, Mass.), 22(1), 60–66. 

htps://doi.org/10.1093/pm/pnaa399 

Mul�-disciplinary

1. AMERSA: Select SUD Core Competencies Shared by Two or More Disciplines

a. Rutkowski B. A. (2019). Specific disciplines addressing substance use: AMERSA in the 21st 

century. Substance abuse, 40(4), 392–395. htps://doi.org/10.1080/08897077.2019.1686726

2. SAMHSA: Recommenda�ons for Curricular Elements in Substance Use Disorders Training

a. Substance Abuse and Mental Health Services Administra�on (2022). Recommendations for 

Curricular Elements in Substance Use Disorders Training. SAMHSA.gov. 

htps://www.samhsa.gov/medica�ons-substance-use-disorders/provider-supportservices/recommenda�ons-curricular-elements-substance-use-disorders-training#_edn7