Commentary on "Blueprint for developing the advanced practice psychiatric nurse workforce".

The authors provide a blueprint for developing the Advanced Practice Psychiatric Nurse (APRN-PMH) workforce that it is incumbent on all of us to take seriously, even if we are not in that specialty, because behavioral health is one of the most all-encompassing areas of health care. The need for a professional workforce skilled in addressing behavioral health is enormousdnearly 96% of U.S. counties have an unmet need for prescribersdand there simply are not enough providers prepared to meet demand for such services. Current efforts to reform health care by creating accountable care organizations provide us with an exceptional opportunity for insinuating APRN-PMHs more forcefully than ever before into mainstream health care services, because the emphasis will increasingly be on prevention, rehabilitation, and management of chronic conditions. The work of The Annapolis Coalition on Behavioral Health Workforce is creatively used to frame a vibrant nursing agenda in this area: eliminate state-by-state inconsistencies regulating licensure, accreditation, and certification; ensure that our educational programs reflect what is now known about the brain and the recovery principles espoused by the Substance Abuse and Mental Health Services Administration (SAMHSA); develop a research agenda that evaluates our effectiveness; and strengthen nurse engagement in community boards and other interprofessional policy forums. This article should be required reading for everyone interested in advanced nursing practice because substance abuse and mental health problems affect every other nursing specialty, and this blueprint is a clarion call to needed action. Ironically, my biggest criticism of the paper is that it is too balanced when we need to be more agitated about this matter. Although the authors admit that we are few in number (n 1⁄4 8751) compared with the other core mental health professionalsdthere are almost 5 times as many psychiatrists, 10 times as many psychologists, 12 times as many social workers, and 17 times as many counselorsdthey are so judicious in calling for action that the enormity of what is at stake may be lost in their restraint. After having taken the lead in originally developing advanced nursing practice, APRN-PMNs are now comparatively so few in numberdonly 377 graduates in 2010dthat they may soon no longer be regarded as core mental health professionals (they are not currently represented on either SAMHSA’s or the National Institute of Mental Health’s advisory council). What needs to be done? To the authors’ list of very important considerations, I would add 2 more recommendations. First, we have to confront more forcefully than we have to date the persistent and damaging belief that you cannot specialize in psychiatric nursing if you do not have some postlicensure medical-surgical nursing experience. Even though we are developing accelerated programs of all sorts to meet the demand for nursing occasioned by the graying of America, many of us continue to show a lack of respect for those who take advantage of these programs and do not “pay their dues” by working a set amount of time as generalists before specializing. Going right into advanced practice psychiatric nursing must become a valued and encouraged career pathway. We need to give up any residual notions that there is one right way to launch a nursing career. No matter where you start, the real issue is do you know what you know and what you don’t know? If you know your strengths and limitations and are supported in your journey from novice to expert, you can grow wherever you are planted. The second thing we need to do, and it is closely related tomy first point, is to create a practice-research agenda that is very clear about what our special contribution to behavioral health is. APRN-PMHs share with psychiatrists a view of behavioral health that is based on an understanding of overall health and