Preparing for Prescriptive Privileges: A Standard for the Psychiatric‐Mental Health Preceptorship

TOPIC. Establishing a standard for preparation for prescriptive authority for advanced practice psychiatric nurses. PURPOSE. To outline a best practice standard for the clinical and prescriptive authority preceptorship. SOURCES. NACNS and NONPF competencies and practice guidelines. CONCLUSIONS. The authors recommend a clinical preceptorship with planned faculty monitoring, clinical logs, case studies, and group supervision to prepare the psychiatric-mental health advanced practice nurse to serve within the expanded prescribing role. Search terms: Curricula development, psychiatric advanced practice nurses, prescriptive authority ********** Major shifts in today's healthcare system have resulted in a clear demonstration that advanced practice nurses (APNs) are able to provide cost-effective, high-quality care to patients and their families (Cooper, 2001; Gabay & Wolfe, 1997; Mundinger et al., 1999; Pinkerton & Bush, 2000). Although much of the focus has been on nurse practitioners (NPs) in the primary care setting, APNs in specialty areas are receiving growing attention. Specifically, psychiatric-mental health APNs (both clinical nurse specialists and psychiatric nurse practitioners) have become significantly more visible in providing care to the mentally ill population (Baradell & Bordeaux, 2001; Puskar & Bernado, 2002; Society, 1997). And, just as primary care NPs have altered and positively affected the primary care environment (Pearson, 2002; Simpson et al., 2001), psychiatric-mental health APNs have become key players in building a mental healthcare environment and infrastructure that increases patients' access to quality care, while reducing overall costs. As the need for psychiatric-mental health APNs increases and the barriers restricting expanded practice diminish, nursing educational programs are challenged with the issues of developing and modifying curricula (Lenburg, 1999a). To ensure that the psychiatric-mental health APN in the 21st century has the skills and competencies required for an expanded independent practice, it is essential that a standard be established for both academia and clinical practice (Lenburg, 1999b). The purpose of this paper is to outline a best practice standard for the clinical and prescriptive authority preceptorship for the psychiatric-mental health APN. This focused clinical preceptorship is designed to come at the conclusion of the student's graduate studies and is based on an expectation that the student has achieved basic competency in the traditional domains of psychiatric-mental health advanced practice nursing. The graduate student also has completed core course studies and been supervised in the traditional domains of psychiatric-mental health advanced practice nursing--clinical experiences of individual, group, and family therapy. In addition, the student must have successfully completed the required advanced physical assessment, pathophysiology, pharmacology, and psychopharmacology courses prior to the prescriptive authority preceptorship experience. Standards for Academia and APN Clinical Practice Background The task of setting standards of practice has been a significant focus for educators of primary care advanced practice nurses (Redman, Lenburg, & Hinton-Walker, 1999). The National Organization of Nurse Practitioner Faculties (NONPF) spearheaded the project by releasing the first set of core competencies for all nurse practitioner graduates in 1990, with updates in 1995 and 2000 (NONPF, 1995; 2000). In 2002, the U.S. Department of Health and Human Services Division of Nursing commissioned NONPF and the American Association of Colleges of Nursing (AACN) to undertake a national process to identify consensus-based competencies for the nurse practitioner specialties (NONPF, 2002). For the first time, comprehensive competencies became available for the five primary care specialties (adult, family, gerontological, pediatric, and women's health). …