NRNP 6675 WEEK 1 – PMHNP Across the Lifespan II

NRNP 6675 Week 1 Discussion: Nurse Practitioner Professional Issues

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Among Nurse Practitioner Professional Issues in addition to the specialized clinical knowledge that you have gained, there are additional important and practical ways to prepare yourself for your future career. Module 1 is designed to help increase your familiarity with licensing requirements, coding and billing as a provider, and your current progress toward preparation for your certification exam. 

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What’s Happening This Module?

This course is composed of three modules covered over the course of 11 weeks. Each module consists of an overarching topic, and each week within the module includes specific subtopics for learning. As you work through each module, you will have an opportunity to draw upon the knowledge you gain in various assignments that are due throughout each of the modules.

Module 1, Professional Practice Issues,  is a 2-week module that focuses on issues that will help you prepare to practice as a PMHNP. You will begin this module by exploring the certification and licensure requirements for PMHNPs in the state in which you plan to practice. As practice agreements, collaboration requirements, and prescription authority vary between states, it is important to prepare for the standards you will need to meet in order to practice. You will then move to understanding billing and coding. Here you will identify and explain what information is needed to support the coding of services you provide to your patients. Finally, you will review the study plan that you created in NRNP 6665 to evaluate the progress you made and determine what revisions are necessary to prepare for the PMHNP certification exam. 

What do I have to do?	When do I have to do it?
Review your Learning Resources.	Days 1–7, Weeks 1–2
Discussion: Certification and Licensure Plan	Post by Day 3 of Week 1 and respond to your colleagues by Day 6 of Week 1.
Assignment: Evaluation and Management (E/M)	Complete by Day 7 of Week 2.
Assignment: Study Plan	Complete by Day 7 of Week 2.

Discussion: Nurse Practitioner Professional Issues

Psychiatric-mental health nurse practitioners are committed to the assessment, diagnosis, and treatment of psychiatric disorders in individuals and groups through psychotherapy and medication. Since the role of the PMHNP carries such responsibility, it is no surprise that there is a rigorous path to obtain and maintain your PMHNP certification and licensure.

PMHNPs currently have only one choice for certification, which is through the American Nurses Credentialing Center (ANCC). The ANCC offers the “psychiatric/mental-health nurse practitioner (across the lifespan)” board certification (PMHNP-BC). In many states, board certification is a necessary prerequisite to receiving an NP license. Even if board certification is not a requirement for state licensure, it may be a requirement to receive privileges in various hospitals and other health care facilities. Malpractice insurance providers may also require board certification prior to issuing coverage to NPs. 

This week, you will review your state specific PMHNP certification and licensure requirements and scope of practice, as well as prescriptive authority issues.

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LEARNING OBJECTIVES

Students will:

• Summarize nurse practitioner certification and licensure processes
• Explain state-specific scope of practice for psychiatric-mental health nurse practitioners
• Explain state-specific restrictions or limitations for practice
• Explain nurse practitioner prescriptive authority and DEA registration processes

Topic for Week 1 Discussion: Nurse Practitioner Professional Issues

Now that you are in the final course in your program, it is time to turn in earnest to preparing for certification and licensure. You will need to take and pass the national PMHNP certification exam. Once certified, you will then be eligible to apply for licensure as an advanced practice registered nurse (APRN) in the state desired. It will be up to you to ensure you are knowledgeable about the practice agreements, scope of practice, and prescriptive authority in your state.

Although a movement called the APRN Consensus Model is attempting to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish an independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement.

Another important area to consider and plan for is prescriptive authority. The appropriate board, which may be the medical board, state board of pharmacy, or nursing board, grants prescriptive authority under state law for the appropriate state licensure. The federal government grants the authority to write for a controlled substance, and the Drug Enforcement Administration (DEA) verifies this action through by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.
In this Discussion, you will locate and review the practice agreements in the state in which you plan to practice, identify potential collaboration requirements in your state, and understand the certification and licensing process that you will need to follow.

Resources for Nurse Practitioner Professional Issues

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

To Prepare:

• Review practice agreements in your state.
• Identify whether your state requires physician collaboration or supervision for nurse practitioners, and if so, what those requirements are.
• Research the following:
  • How do you get certified and licensed as an Advanced Practice Registered Nurse (APRN) in your state?
  • What is the application process for certification in your state?
  • What is your state’s board of nursing website?
  • How does your state define the scope of practice of a nurse practitioner?
  • What is included in your state practice agreement?
  • How do you get a DEA license?
  • Does your state have a prescription monitoring program (PMP)?
  • How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

By Day 3 of Week 1

Post a summary of your findings on your state based on the questions listed above. Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state. Be specific. Also, describe what surprised you from your research.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days in one or more of the ways listed below.

• Share an insight from having viewed your colleagues’ posts.
• Suggest additional actions or perspectives.
• Share insights after comparing state processes, roles, and limitations.
• Suggest a way to advocate for the profession.
• Share resources with those who are in your state.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply! 

Required Readings for Nurse Practitioner Professional Issues

• American Association of Nurse Practitioners. (2020). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment
• On the map on the webpage, click on your state and review. After you complete the PMHNP Program, pass the certification exam, and get a job, you will need to revisit this website to apply for the privilege to practice as an APRN with your state Board of Nursing.
  
• American Psychiatric Association. (2020). Telepsychiatry. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry

• Buppert, C. (2021). Nurse practitioner’s business practice and legal guide  (7th ed.). Jones & Bartlett Learning.
  • Chapter 1, “What Is a Nurse Practitioner?”
  • Chapter 2, “Nurse Practitioner Scope of Practice”
  • Chapter 3, “State Regulation of the Nurse Practitioner Practice”
  • Chapter 4, “Federal Regulation of the Nurse Practitioner Profession”
  • Chapter 5, “Prescribing”
    
• Centers for Disease Control and Prevention. (2020). Using telehealth to expand access to essential health services during the COVID-19 pandemic . https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html
• Centers for Medicare & Medicaid Services. (2019). National provider identifier standard (NPI) . https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand
• The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.
  
• Drug Enforcement Administration Diversion Control Division. (2020). Registration . https://www.deadiversion.usdoj.gov/drugreg/index.html
  • This site contains information about applying for your DEA registration number. This number is required for writing prescriptions.
  • After completing PMHNP Program and passing the PMHNP certification exam, complete the DEA application to request prescriptive privileges. Your DEA number will be renewable every five years.
    
• National Panel for Psychiatric Mental Health NP Competencies. (2003). Psychiatric-mental health nurse practitioner competencies.
• National Organization of Nurse Practitioner Faculties (NONPF).  https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/imported/PMHNPcomps03.pdf
  
• DeNisco, S. M. (2023). Role development for the nurse practitioner (3rd ed.). Jones & Bartlett Learning.
  • Chapter 1, “Historical Perspectives: The Art and Science of Nurse Practitionering” (pp. 6-16)
    • “Nurse Practitioner Core Competencies”
    • “Nurse Practitioners’ Unique Role” (pp. 21-27)
    • Chapter 2, “Evidence-Based Practice and Dissemination Strategies” (pp. 33-62)
    • Chapter 8, “Quality, Safety, and Prescriptive Authority” (pp. 215-233)
• Substance Abuse and Mental Health Services Administration. (2020). Become a buprenorphine waivered practitioner https://www.samhsa.gov/medication-assisted-treatment/buprenorphine-waiver-management/apply-for-practitioner-waiver
  • This site contains information about applying for a practitioner waiver to prescribe or dispense buprenorphine under the Drug Addiction Treatment Act of 2000 (DATA 2000).
  • After youobtain a Drug Enforcement Agency (DEA) number and completed 24-hour medication-assisted treatment (MAT) waiver training, you may apply to Substance Abuse and Mental Health Services Administration (SAMSHA) for MAT waiver to be able to prescribe Schedule III, IV, or V opioid drugs for the maintenance and detoxification treatment of opioid use disorders relapse prevention.
    
• Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual . Springer Publishing Company.
  • Chapter 2, “The Role of the Psychiatric-Mental Health Nurse Practitioner: Regulations and Scope of Practice”
  • Chapter 3, “Theoretical Foundations of Care and Nonpharmacological Therapies”

Recommended Resources

Consult these professional organization websites as needed. 

• American Psychiatric Nurse Association (APNA)   https://www.apna.org
• International Society of Psychiatric-Mental Health Nurses (ISPN)  www.ispn-psych.org
• National Alliance on Mental Illness (NAMI)   https://www.nami.org
• National Council for Behavioral Health Links to an external site.(NCBH) www.thenationalcouncil.org
• National Institute of Mental Health (NIMH)  https://www.nimh.nih.gov/index.shtml
• Substance Abuse and Mental Health Services Administration (SAMHSA)  www.samhsa.gov

Telehealth

Telehealth provides a method to increase timeliness of care and access to care for individuals in a variety of different circumstances Of all the disciplines, psychiatric-mental health care lends itself most easily to this format. For example, a patient who lives far away from medical services can still receive psychotherapy via videoconference. A nurse may be in a remote office coordinating that individual’s treatment plan, managing their medication regimen, or ordering diagnostics or follow-ups. This type of care is evolving in nature and growing in popularity. The role of the PMHNP will continue to emerge in this setting.

Review this week’s resources on telehealth, and consider possible avenues for professional development in this area. 

What’s Coming Up in Week 2?

In Week 2, you will explore the relationships among documentation, coding, and billing in advanced practice nursing as you understand how diagnostic codes and criteria relate to patient service documentation. Additionally, you will revisit the study plan that you created in NRNP 6665 in order to evaluate the progress you have made in your program and develop additional goals to help you prepare for your national certification examination.