Enhancing Psychiatric Mental Health Nurse Practitioner Practice: Impact of State Scope of Practice Regulations

Abstract

Introduction Shortages of behavioral health providers, particularly prescribing clinicians, are widespread nationally. Although rapidly increasing numbers of psychiatric mental health nurse practitioners (PMHNPs) could increase access to behavioral health services, state limitations on scope of practice may restrict their ability to do so. Aim The purpose of this comparative case study was to assess how state scope of practice regulations impact PMHNP practice in five states with different levels of nurse practitioner autonomy (full, reduced, and restricted), as categorized by the American Association of Nurse Practitioners. Methods Site visits and interviews were conducted with 94 key informants, including state board of nursing staff, PMHNP practitioners and educators, behavioral health agency directors, and psychiatrists. State scope of practice regulations were reviewed. Thematic analysis was used to analyze qualitative data. Results Findings indicated that scope of practice regulations affected settings and arrangements in which PMHNPs practiced. In states where physician supervision is required, PMHNPs and agency leaders reported costs and administrative burdens related to obtaining and documenting supervision. PMHNP practice was sometimes constrained by institutional restrictions not required by law. Conclusion Mandated physician supervision of PMHNPs adds cost and diminishes accessibility to both psychiatrists and PMHNPs. Full nurse practitioner practice authority allows for more efficient utilization of PMHNPs and may increase access to services. Shortages of behavioral health providers, particularly prescribing clinicians, are widespread nationally. Although rapidly increasing numbers of psychiatric mental health nurse practitioners (PMHNPs) could increase access to behavioral health services, state limitations on scope of practice may restrict their ability to do so. The purpose of this comparative case study was to assess how state scope of practice regulations impact PMHNP practice in five states with different levels of nurse practitioner autonomy (full, reduced, and restricted), as categorized by the American Association of Nurse Practitioners. Site visits and interviews were conducted with 94 key informants, including state board of nursing staff, PMHNP practitioners and educators, behavioral health agency directors, and psychiatrists. State scope of practice regulations were reviewed. Thematic analysis was used to analyze qualitative data. Findings indicated that scope of practice regulations affected settings and arrangements in which PMHNPs practiced. In states where physician supervision is required, PMHNPs and agency leaders reported costs and administrative burdens related to obtaining and documenting supervision. PMHNP practice was sometimes constrained by institutional restrictions not required by law. Mandated physician supervision of PMHNPs adds cost and diminishes accessibility to both psychiatrists and PMHNPs. Full nurse practitioner practice authority allows for more efficient utilization of PMHNPs and may increase access to services.