Member Groups

Mental Health Matters
The newsletter of the ISBA’s Mental Health Law Section

June 2018, vol. 4, no. 4

Presentation provides insights into work of psychiatric advanced practice nurses

Advanced practice registered nurses Leah Shaffer and Evelyn Norton from Holy Cross and Mt. Sinai hospitals, respectively, provided information to Mental Health Section Council members about psychiatric mental health nurse practitioners (PMH-APRNs). The presentation included an overview of education and licensing requirements, scope of practice, and their day-to-day work. Joseph T. Monahan arranged the presentation to aid council members as they consider possible changes to the Mental Health and Developmental Disabilities Code to reflect the services PMH-APRNs provide.

APRNs are registered nurses who receive additional education, either a master’s or doctoral degree, in one of four areas: certified nurse practitioners, certified nurse anesthetists, certified nurse midwives, and certified nurse specialists.

Psychiatric mental health nurse practitioners (PMH- APRNs) are certified nurse practitioners or certified nurse specialists. In addition to the required extra academic requirements, PMH-APRNs must also satisfy clinical requirements and pass a national exam. An APRN who is certified by one of the certifying organizations, such as the American Nurses Credentialing Center, is then Board Certified. The state licenses advance practice nurses under the Nursing Practice Act, 225 ILCS 65-5. PMH-APRNs are also federally licensed to prescribe medications.

PMH-APRNs often work with physicians and other professionals. In the past, a formal relationship with a physician was required. A recent change in the Nursing Practice Act will enable APRNs, including PMH-APRNs, to work independently once additional clinical requirements are met.

PMH-APRNs have a wide scope of practice. They often serve as a patient’s primary mental health care provider. In a clinic setting, they most likely diagnose, treat, and monitor a patient’s condition. Most clinic appointments are relatively short, as the PMH-APRN focuses primarily on medication management. Other providers, such as social workers, provide counseling, information, and referral services.

In the inpatient behavioral health setting, the role of the PMH-APRN is that of the primary provider. The PMH-APRN enters the admitting orders, assesses the patient, orders and monitors medications, and sees the patient every day. If a patient is on a medical unit and a psych consult is needed, it is often the PMH-APRN who provides the consult.

Against this backdrop, council members questioned the two about their experience in completing certificates, testifying in commitment cases and ordering emergency interventions.

Norton noted one case where a PMH-APRN was the primary provider for a patient yet the PMH-APRN was not permitted to testify. Instead, a psychiatrist, who did not know the patient, had to testify. Providing testimony, ordering emergency interventions such as restraints, and completing the “second certificate” are among possible legislative changes the council is considering. The presentation provided helpful information and insights about these issues.

Patti Werner is an attorney in private practice. She can be reached at pattiawerner@gmail.com.