Practicum Journal Entry: Certification Plan

Describe the PMHNP practice environment for Texas, highlighting restrictions or limitations for practice.

Compare the PMHNP practice environment in Texas with a neighboring state.

Describe a professional and/or clinical practice issue a new PMHNP will need to consider and address with the certification, licensure, credentialing, or relocation process.

Develop a checklist for passing the national certification exam, including a detailed timeline that includes academic preparation (study plan), registration, financial preparation, etc.

Psychiatric-Mental Health Nurse Practitioner (PMHNP) Practice Environment in Texas: Certification Plan and Comparison with the Neighbouring State of Louisiana

Scope of practice for advanced practice registered nurses (APRNs) such as the psychiatric-mental health nurse practitioner or PMHNP is regulated by individual states. According to the American Association of Nurse Practitioners (AANP, 2020), the practice environment can be restrictive, reduced, or autonomous with full practice authority (FPA). On one extreme, restrictive states for APRN practice limit NPs from doing at least one element of practice. On the other extreme, FPA states have practice and licensure laws that allow the NP to practice to the fullest extent of their education and training without supervision. With restricted practice, there must be a written collaborative agreement with a practicing physician in the state. This physician will then offer career-long supervision to the APRN and delegate them tasks to perform. In other words, the NP has absolutely no autonomy in these states with a restrictive practice environment (AANP, 2020; Peterson, 2017). Twelve states still had APRN restricted practice laws by 2017. Texas happens to be one of the restrictive states that still have archaic practice and licensure laws. This paper looks at the practice environment in Texas, certification plan for the PMHNP, and then compares Texas with the neighboring state of Louisiana.Practicum Journal Entry: Certification Plan

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PMHNP Practice Environment in the State of Texas 

In Texas, the NP does not have autonomy of practice. The state still has restricted practice for NPs. This means that they must have a written collaborative agreement between them and a practicing physician who will supervise and delegate duties to them for the rest of their career (Blore, 2019; Scope of Practice Policy, 2019a; Peterson, 2017). The limitations include that the NP cannot see a patient on their own and prescribe medications without referring to the physician who has ultimate authority. Restrictions include prohibition of prescribing scheduled medications. This can only be done with the approval and concurrence of the supervising physician. Regulation of NP practice in Texas is done by both the Texas State Board of Nursing and the Texas Board of Medicine (Blore, 2019). In 2017, one NP working with the Department of Veteran Affairs was granted FPA. However, this was not state-wide and all NPs still cannot practice autonomously in Texas (Jimenez, 2017). It is still a restricted practice state.

Comparison Between Texas and Louisiana

Texas is a restricted practice state for NPs (the worst practice environment) while Louisiana is a reduced practice state (AANP, 2020; Scope of Practice Policy, 2019b). Reduced practice in this context means that the NP’s ability to practice at least one element of practice is reduced. A written collaborative agreement is required and the NP practices under lifelong regulation by the collaborating physician (AANP, 2020; Peterson, 2017). Unlike in Texas, however, the NP in Louisiana has some level of autonomy and can even prescribe schedule II –V substances (Scope of Practice Policy, 2019b). In all, the state of Louisiana is less restrictive for NPs than Texas.

A Clinical Practice Issue and the National Certification Examination

There is a clinical practice issue that a new PMHNP will need to consider and address with the licensure, certification, credentialing, and relocation. This is the issue of state scope of practice for NPs. The new PMHNP must know whether the state in which they are seeking licensure to practice has a restricted practice environment, reduced practice, or FPA. This will spare them disappointment once they begin practice in the state of preference.

National Board Certification from the American Nurses Credentialing Center (ANCC) is needed before one can get licensure to practice in both states. Getting this board certification requires that the PMHNP prepares and sits for a special competency examination (ANCC, n.d.). Application for the examination is done online and a payment fee of $395 made. Members of a professional nursing organization pay slightly less at $270. The timeline involves (i) booking the examination online (application) (ii) revision of three months for the examination (iii) sitting for the examination, and (iv) award of the PMHNP-BC.        Practicum Journal Entry: Certification Plan

References

American Association of Nurse Practitioners [AANP] (October 20, 2020). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

ANCC [American Nurses Credentialing Centre] (n.d.). Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC). https://www.nursingworld.org/our-certifications/psychiatric-mental-health-nurse-practitioner/

Blore, J. (Ed.) (2019). Texas nurse practitioners: The fight for full practice authority. https://www.nursepractitionerschools.com/blog/texas-np-practice-authority/

Jimenez, S. (26 July 2017). Texas grants first nurse practitioner full practice authority. https://www.nurse.com/blog/2017/07/26/texas-grants-first-nurse-practitioner-full-practice-authority/

Peterson, M.E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 74-81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/

Scope of Practice Policy (2019a). Texas scope of practice policy: State profile. http://scopeofpracticepolicy.org/states/tx/

Scope of Practice Policy (2019b). Louisiana Scope of Practice Policy: State Profile. http://scopeofpracticepolicy.org/states/la/

2U, Inc. (2018). Psychiatric and Mental Health Nurse Practitioner (PMHNP). Nursing License Map. https://nursinglicensemap.com/advanced-practice-nursing/nurse-practitioner/psychiatric-and-mental-health-nurse-practitioner-pmhnp/

Practicum Journal Entry: Certification Plan