2009 Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner

Transcription

1 2009 Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results NOVEMBER 2010

2 About this Report This report pertaining to the practice of adult psychiatric and mental health nurse practitioners is based on the results of American Nurses Credentialing Center s Role Delineation Study of Adult Psychiatric and Mental Health Nursing for Nurse Practitioners and Clinical Nurse Specialists conducted in Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 2

3 Table of Contents ABOUT THIS REPORT... 2 ACKNOWLEDGEMENTS... 4 BACKGROUND... 6 Role Delineation Study Overview... 6 Updated Test Content Outline for Adult Psychiatric and Mental Health Nurse Practitioner... 6 Role of the Content Expert Panels... 7 SURVEY METHODOLOGY... 8 Survey Chronology... 8 Survey elopment and Measures... 8 Data Analysis SURVEY RESULTS Demographic Information Practice Descriptions APPENDICIES WORK ACTITIVIES STATEMENTS... APPENDIX A DEMOGRAPHIC DATA SUMMARY... APPENDIX B WORK ACTIVITIES DESCRIPTIVE STATISTICS... APPENDIX C WORK ACTIVITIES OVERALL CRITICALITY -- RANK ORDER... APPENDIX D 2009 Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 3

4 Acknowledgements The American Nurses Credentialing Center (ANCC) wishes to thank a number of content experts who served on the 2009 ANCC Role Delineation Study of Adult Psychiatric and Mental Health Nursing for Nurse Practitioners and Clinical Nurse Specialists panels for sustaining this effort and producing a role delineation study of such high caliber. Without their numerous hours of input and feedback, the study would not be possible. Clinical Nurse Specialist in Adult Psychiatric and Mental Health Nursing Germaine M. Edinger, DNP, MS, APRN,BC Marlene Nadler-Moodie, MSN, APRN,BC, CNS Pamela A. Terreri, MSN, PMH, CNS, BC Robin L. Davitt, EdD, ARNP, BC Eugenia H. Zelanko, RN, MS, CNS-BC, PhD Patricia D. McArthur-Dotson, BS, MS, APRN, BC Francis J. O'Sullivan, MS, PMHCNS-BC Anne L. Bateman, EdD, PMH, APRN, BC Adult Psychiatric and Mental Health Nurse Practitioners Mary Jane Allen, MSN, PMHNP-BC John Boisseau, MSB, PHMP-BC Thelma Boyd, MSN, PHMP-BC Rebecca Christophersen, BSN, MSN, PMHNP-BC Ann Murphy Harris, MSN, PMHNP-BC Eileen L. Poupore, MN, PMHNP-BC Sherryl D. Pavlick, RN,C, MSN, CRNP, APMHNP Mary Ann G. Wilkinson, EdD, APRN/PMH, CRNP-PMH Teresa C. Keane, RN, MSN, PMHNP-BC April Rumage, MSN, PMHNP-BC Advanced Practice Adult Psychiatric and Mental Health Nursing Naomi Brown, MSN, APRN-BC, PMHNP Sattaria S. Dilks, DNP, APRN-BC Kathleen A. Emrich, EdD, APRN-BC Lori A. Firestone, MSN, APRN-BC Kathryn Johnson, RN, NP, APRN-BC Dana Olive, MSN, CRNP, DNSc Carol R. Selby, MSN, NP, APRN-BC Barbara Warren, PhD, APRN-BC Nasrintaj Falsafi, PhD, RN, PMHCNS-BC Karen A. Taylor, PMHNP-BC, ARNP 2009 Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 4

5 We also would like to thank the ANCC staff who also spent numerous hours working to make this study possible: Christine DePascale, MS (Project Manager) David Paulson, PhD, CAE Chie Ohba, PhD Cheray Jones Finally, we would like to thank the ANCC-certified advanced practice adult psychiatric and mental health nurses who supported this study by donating their time to complete the survey questionnaire. The contributions that all of these people made to the study were essential to its success Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 5

6 Background The American Nurses Credentialing Center (ANCC), which was incorporated in 1991 as a subsidiary of the American Nurses Association, is the largest nursing credentialing organization in the United States. Its vision is to be a galvanizing force for quality healthcare through credentialing excellence. Currently, ANCC offers 25 examinations at various levels including diploma and associate degree, baccalaureate, and advanced practice for nurse practitioners, clinical nurse specialists, and other disciplines. Approximately 10,000 12,000 candidates take an ANCC certification examination each year. In addition to certification, ANCC provides services such as the Magnet and Pathways to Excellence recognition programs for hospitals and other facilities that demonstrate excellence in nursing services, accreditation of continuing education programs, education and consultation services, and outreach to nursing organizations around the globe. Role Delineation Study Overview Role delineation or job analysis studies are typically carried out at the national level with the goal of describing current practice within a particular role or specialty. ANCC has a current goal for each of its examinations to conduct approximately every three years a role delineation study of the specialty to capture changes in work activities and the knowledge and skill areas required to perform those activities. The findings from each study are used to update the content of its respective certification examinations. The American Nurses Credentialing Center conducted a 2009 role delineation study of adult psychiatric and mental health nursing for nurse practitioners and clinical nurse specialists. This study involved two sets of processes or activities that ran more or less concurrently: a national web-based survey and a linking activity. The national survey was designed to collect information on the work activities adult psychiatric and mental health nurse practitioner or clinical nurse specialists actually perform in practice, while the linking activity identifies the major knowledge and skill areas required for performance of the work activities listed in the survey. The results of both of these processes were used in the updating of the test content outlines for each examination contained within the study. Updated Test Content Outline for Adult Psychiatric and Mental Health Nurse Practitioner The test content outline for the Adult Psychiatric and Mental Health Nurse Practitioner examination was updated using the results of this role delineation study. Examination forms produced based on this updated test content outline are scheduled to go into effect April 5, A copy of the test content outline is available on the American Nurses Credentialing Center website Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 6

7 Role of the Content Expert Panels Throughout the study, ANCC invited professionals in practice and educators who teach courses relevant to either adult psychiatric and mental health nurse practitioners or clinical nurse specialists to serve on content expert panels for this study. They developed the work activities and demographic items for the survey, linked knowledge and skill areas to the work activities list, and finalized the test content outlines for the respective certification examinations. All of the content experts serving on the panels were certified by ANCC as either an adult psychiatric and mental health nurse practitioner or clinical nurse specialist and were invited to serve on the panels based upon expertise in their specialties Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 7

8 Survey Methodology The purpose of the development and administration of the national survey was to collect information on the work activities adult psychiatric and mental health nurse practitioners and clinical nurse specialists actually perform in practice. Since the survey instrument that was used for the purposes of this study would be used for both adult psychiatric and mental health nurses working as a nurse practitioner or a clinical nurse specialist, representatives from both of these roles were asked to serve as members of a nine (9) member initial study workgroup that acted as a sort of steering committee. This workgroup met for three days April 22-24, 2009 to draft a single pilot version of the survey and to construct the initial map of knowledge and skill areas relevant to the work activities included in the survey. Five members of the panel had certification as Adult Psychiatric and Mental Health Nurse Practitioner. Survey Chronology The survey development and administration timeline was as follows: April - June 2009 The initial study workgroup along with staff from ANCC drafted the survey. The survey was pilot tested and revised. July-August 2009 The final survey was administered to the national sample on the web. September - October 2009 The survey activity results were analyzed, and activity weights were determined. Each panel met to review the survey results and activity weights. Survey elopment and Measures The panel members at the April meeting reviewed the work activities which had been used in a logical job analysis for advanced practice psychiatric and mental health nursing conducted in 2005 by the American Nurses Credentialing Center and the American Psychiatric Nurses Association. During the meeting, they discussed any additions, deletions, and changes they would make to update the work activity list to reflect current practice. In reviewing and updating the task list for the current study, the panel referred to the Nursing: Scope and Standards of Practice; Psychiatric and Mental Health Nursing: Scope and Standards of Practice, the NACNS Statement of Clinical Nurse Specialist Practice, and the Clinical Nurse Specialist Core Competencies developed by the National CNS competency task force, and the NONPF Psychiatric and Mental Health Nurse Practitioner core competencies. These deliberations resulted in a new list of 128 work activities to be used in the 2009 survey. The complete text of the work activities list is presented in Appendix A. The workgroup also identified and finalized a set of 17 demographic items for inclusion in the survey (See Appendix B). During the same meeting, the workgroup reviewed and approved three scales that respondents would use to rate the work activities listed in the survey Performance Expectation (how soon on the job the performance of an activity is expected), Consequence (the consequence of performing an activity incorrectly), and Frequency (the frequency with which a work activity is performed), The performance expectation scale was specifically designed to 2009 Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 8

9 distinguish entry-level skills. These three questions and the instructions for answering them are presented in Table 2. Table 2. Survey Questions for Rating Work Activity Statements Please respond to each activity with three separate responses, one response in each category. When considering a response for one category, do not consider the other categories. For example: When considering the consequences of incorrect performance of an activity, do not worry about whether you perform or are expected to perform the activity; the possibility exists that an activity has severe consequences, even if you never perform it. Performance Expectation: When is a newly certified advanced practice adult psychiatric and mental health nurse functioning within your current role first expected to perform this activity? -- Within the first 6 months of working within the role -- After the first 6 months of working within the role -- Never expected to perform this activity within the role Frequency: How often does a newly certified advanced practice adult psychiatric and mental health nurse functioning within your current role perform this activity (consider within a one year period)? -- Frequently -- Often -- Occasionally -- Seldom -- Never Consequences: Does incorrect performance of this activity cause: -- Little or no harm -- Moderate harm -- Severe harm The study design included combining each respondent s responses to each of the three rating scales in a hierarchical manner into one overall ranking of criticality. To select a procedure for combining the three scales, the initial study workgroup discussed the importance of each scale to the performance of the work activity. The workgroup determined that the performance expectation scale should be regarded as more critical than the other two scales for representing entry-level practice. The consequence scale was then regarded as more critical than the frequency scale. Therefore the panel agreed to combine the scales so that a particular value on the performance expectation scale would outweigh or outrank all values on the consequence and frequency scales. This hierarchical scheme emphasized the work activities that are required immediately on the job and have the greatest impact on public health or safety. Thus this scheme was selected as the organizing mechanism for combining the responses from the three survey scales into an overall measure of criticality. Sample Selection On May 7, 2009, there were a total 2,255 actively certified ANCC Adult Psychiatric and Mental Health Nurse Practitioner with a valid address within the United States or its territories. A random sample of 1,500 Adult Psychiatric and Mental Health Nurse Practitioner stratified by region was selected from the ANCC certification database. Table 1 presents the numbers of ANCC certified Adult Psychiatric and Mental Health Nurse Practitioner that were selected from each region Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 9

10 Table 1. Number of Surveys Mailed Out per Geographic Region Adult Psychiatric and Mental Health Nurse Practitioner Geographic Region Number certified (percent Number selected of total pop.) (percent of total pop.) Northeast NY, CT, MA, NJ, ME, PA, NH, VT, RI 777 (34%) 520 (35%) South TN, MS, TX, FL, LA, AL, GA, AR, OK, VA, MD, SC, DC, NC, WV, DE, KY 697 (31%) 456 (30%) Midwest IA, NE, KS, OH, MO, MN, SD, ND, MI, IL, IN, WI 282 (13%) 180 (12%) West WA, AZ, CA, OR, CO, AK, ID, NM, UT, HI, NV, WY, MT 495 (22%) 340 (23%) Other AE, AP 4 (<1%) 4 (<1%) Total 2,255 (100%) 1,500 (100%). Data Collection Pilot Testing. Using the same procedures intended for administering the national data collection, the survey was piloted in May Fifty (50) ANCC certified adult psychiatric and mental health nurse practitioners randomly selected from across the nation were included in the sample of 100 ANCC advanced practice adult psychiatric and mental health nurses invited to take the pilot survey. Overall, 46 (46 percent) of the 100 advanced practice psychiatric and mental health nurses invited to take the pilot survey responded; 26 (52%) respondents were from the adult psychiatric and mental health nurse practitioner pool. The respondents of the pilot test in general indicated that the work activities were appropriate and reflective of the jobs of adult psychiatric and mental health nurse practitioners and clinical nurse specialists. National Survey. Beginning in July 2009, the 1,500 adult psychiatric and mental health nurse practitioner selected to take the national web-based survey were sent two notifications via the United States Postal Service: an alert letter, and a follow-up reminder. The alert letter explained the purpose and importance of the study, the eligibility criteria of the study, and stated how to access the survey via the internet. The letter indicated that the participant s responses would be kept confidential. The letter also notified that respondents completing the survey receive a 5 hour reduction of their continuing education requirement for their recertification. The follow-up reminder letter was sent approximately two-weeks after the alert letter. It thanked recipients if they had already submitted their completed survey and encouraged them to do so if they had not already. Data Analysis The three rating scales were combined into a single measure of overall criticality using a hierarchical method. As agreed by the initials study workgroup, the three rating scales were combined into a single measure in such a manner that a particular value on the performance expectation scale would outweigh or outrank all values on the consequence and frequency scales, and that a particular value on the consequence scale would outweigh or outrank all values on the frequency scale. Table 3 displays how the values of the overall criticality rating were constructed according to all the possible survey response patterns that might be given to rate an individual work activity by its performance expectation, consequence, and frequency. For example, if a respondent indicated that a particular work activity was expected to be performed within the first six months of 2009 Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 10

11 assuming the role of an adult psychiatric and mental health nurse practitioner, could cause severe harm to the patient if it was performed incorrectly, and is performed occasionally, the overall criticality rating for that response pattern would be 29. A score of 22 suggests that a work activity is generally expected to be performed within the first six months of assuming the role and have moderate consequences if incorrectly performed. Therefore, work activities with scores of 22 or higher on the overall criticality variable may be considered as highly critical. When a work activity was rated as never expected on the performance expectation scale, it would receive an overall criticality score of 1 as the bottom row in Table 3 indicates. Table 3. Construction of the Overall Criticality Variable Survey Response Options Overall Performance Expectation Consequence Frequency Criticality Score Within first 6 months Severe Frequently 31 Often 30 Occasionally 29 Seldom 28 Never 27 Moderate Frequently 26 Often 25 Occasionally 24 Seldom 23 Never 22 Little or no Frequently 21 Often 20 Occasionally 19 Seldom 18 Never 17 After first 6 months Severe Frequently 16 Often 15 Occasionally 14 Seldom 13 Never 12 Moderate Frequently 11 Often 10 Occasionally 9 Seldom 8 Never 7 Little or no Frequently 6 Often 5 Occasionally 4 Seldom 3 Never 2 Never expected All options All options Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 11

12 Survey Results The total sample size of the national survey included 1,500 ANCC certified Adult Psychiatric and Mental Health Nurse Practitioners. A total of 515 valid adult psychiatric and mental health nurse practitioner surveys were returned for an overall response rate of 34 percent. Four hundred fourteen (414) of these respondents indicated that they worked solely within the nurse practitioner role while 94 respondents indicated working in a dual or blended role. Table 4 shows the percent of surveys returned in each geographic region compared to the total number of ANCC certified adult psychiatric and mental health nurse practitioners selected to participate in the survey within each region. Table 4. Number of Surveys Returned per Geographic Region for Adult Psychiatric and Mental Health Nurse Practitioner Adult Psychiatric and Mental Health Nurse Practitioner Geographic Region Northeast NY, CT, MA, NJ, ME, PA, NH, VT, RI South TN, MS, TX, FL, LA, AL, GA, AR, OK, VA, MD, SC, DC, NC, WV, DE, KY Midwest IA, NE, KS, OH, MO, MN, SD, ND, MI, IL, IN, WI Number Selected (percent of total pop.) Total Number Return (percent of total pop.) Number Return Indicating NP Role Only (percent of total pop.) 520 (35%) 187 (36%) 140 (34%) 456 (30%) 148 (29%) 122 (29%) 180 (12%) 67 (13%) 54 (13%) West WA, AZ, CA, OR, CO, AK, ID, MN, UT, 340 (23%) 110 (21%) 96 (23%) HI, NV, WY, MT Other AE, AP, APO 4 (<1%) 3 (<1%) 2 (<1%) Total 1,500 (100%) 515 (100%) 414 (100%) Demographic Information Appendix B details the responses to the survey s demographic questions which included inquiry on the nurse practitioner s background and practice setting. The demographic data is reported for two groups: 1) all ANCC-certified adult psychiatric and mental health nurse practitioners and 2) those respondents who reported practicing solely in a nurse practitioner role. Only responses from those who indicated practicing solely in a NP role was used in the data analysis of the tasks statements for the adult psychiatric and mental health nurse practitioner group. Demographic Background Approximately 88 percent of the respondents were female and approximately the same percent reported to be white. In addition, 71 percent of the overall sample fell into the age group of years of age. Eighty-four percent of the adult psychiatric and mental health nurse practitioner respondents indicated that they held a Masters in Nursing as one of their highest degrees Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 12

13 Approximately three percent of the respondents held a Doctorate of Nursing Research (Ph.D.) and one percent indicated they held a Doctorate of Nursing Practice (DNP). The average number years of experience the adult psychiatric and mental health nurse practitioner respondents had an RN was 23 years. The respondents also reported on average seven years of experience as an advanced practice adult psychiatric and mental health nurse either as a nurse practitioner or a clinical nurse specialist. Practice Settings Approximately 38 percent of the adult psychiatric and mental health nurse practitioner respondents indicated that they practiced in cities with populations between 50,000 and 249,999. Towns with a population between 2,500 and 49,999 had the second highest percent of respondents (30 percent). Almost five percent of the respondents indicated working in a rural (population less than 2,500) practice location. In terms of practice setting, the highest percentage of adult psychiatric and mental health nurse practitioner respondents indicated they practiced in an outpatient setting (33 percent); Community/Public Health setting had the second highest percentage at 19 percent and Inpatient hospital had the third highest percentage at approximately 15 percent. When analyzing the data for all adult psychiatric and mental health nurse practitioner respondents, on average they reported 14 percent of their time was spent providing psychotherapy and 64 percent of their time performing psychopharmacologic management. When looking at the data for those adult psychiatric and mental health nurses who reported performing only the nurse practitioner role, 13 percent of the time on average was spent performing psychotherapy while 67 percent of time was spent performing psychopharmacologic management. In terms of the percent of time spent with different age groups, on average approximately 77 percent of their time was spent in caring for adults (ages 18 to 65 years), 16 percent with aging adults (ages over 65 years), and six percent of time spent caring for adolescent patients (13 to 17 years of age). Finally, overall more than 98 percent of the all adult psychiatric and mental health nurse practitioner respondents indicated that they have privileges to prescribe medication in their current practice. Seventy nine (79) percent of the respondents indicated that they are required to have a physician collaborator or supervisor in their practice setting. Practice Descriptions Descriptive statistics (means, standard deviations, and medians) for the three ratings of all 128 work activities performance expectation, consequence, and frequency and mean overall criticality are listed in Appendix C. Since the focus of this data analysis was to evaluate the criticality of work activities adult psychiatric and mental health nurse practitioners performed, only the data from the 414 respondents who reported currently practicing in a nurse practitioner only role were used for this analysis. The scales were highly reliable. Cronbach s coefficient alpha estimates for the performance expectation, consequence, and frequency scales when applied to all the data were , , and , respectively. (Cronbach's coefficient alpha, a measure of internal stability, ranges in value between 0 and 1.) In Appendix D, the overall criticality statistics are presented in rank order of criticality. As indicated in Table 5, 61 work activity statements were rated by the adult psychiatric and mental health nurse practitioner respondents as highly critical (with a mean overall criticality rank of 22 or above) Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 13

14 Table 5. Number of Work Activities falling within Each Mean Overall Criticality Range Category as Rated by Adult Psychiatric and Mental Health Nurse Practitioner Between 22 and 27 Between 17 and 22 Mean Overall Criticality Score Between 12 and 17 Between 7 and 12 Below 7 Total number above 22 Above 27 Number of Work Activities Table 6 and 7 displays the 20 highest-ranking and the 20 lowest-ranking work activities by median overall criticality respectively. Table 6. Top 20 Work Activities Ranked by Median Overall Criticality for Adult Psychiatric and Mental Health Nurse Practitioner Work Activity Number and Name Median Overall Criticality 11 Perform a risk assessment including suicidal, homicidal, substance use behaviors and life threatening physical conditions Maintain professional boundaries Prescribe appropriate pharmacologic agents for clients Establish a therapeutic nurse-client relationship Identify need for diagnostic and laboratory tests elop plans of care for the management of psychiatric emergencies Document client information in accordance with regulatory requirements Manage adverse responses to medications and other psychiatric emergencies Perform a mental status examination appropriate to the client, presentation, and setting Interpret diagnostic medical lab tests Analyze the impact of complications of medical conditions on mental health status Differentiate presentations of psychiatric symptomatology from physical health problems Monitor general health indicators, pertinent lab findings and client response to treatment interventions Refer/consult client whose complex client issues are beyond the scope of individual's clinical expertise Coordinate involuntary commitments in collaboration with other health care providers Prioritize interventions based on the severity and complexity of physical and mental health issues Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 14

15 Work Activity Number and Name Median Overall Criticality 71 Evaluate risk for relapse Initiate appropriate diagnostic and lab tests based on client risks, costs, benefits and clinical guidelines Incorporate appropriate treatment modalities into the plan of care, including recovery processes, medical interventions, drug regimens, psychotherapies, and other evidence based practices Formulate differential diagnosis based on current DSM criteria 26 Table 7. Bottom 20 Work Activities Ranked by Median Overall Criticality for Adult Psychiatric and Mental Health Nurse Practitioner Work Activity Number and Name Median Overall Criticality 108 Facilitate integrated programs across the continuum of care Disseminate knowledge through publications/presentations Provide leadership in organizational change and development Contributes to the development of interdisciplinary standards of practice and guidelines for care 8 98 elops educational programs that target the needs of staff to improve nursing practice and/or client outcomes Implement educational programs for nurses and others Oversee client case management systems Evaluate educational programs tht target the needs of staff to improve nursing practice and/or client outcomes Provide consultation for program development Participate in community crisis response initiatives Analyze the impact of different types of health care delivery systems (e.g., managed care, telemedicine) on the plan of care and treatment options Evaluate the impact of the practice environment on nurses, systems, treatment outcomes and policy development elop innovative programs, methods, strategies and models of practice elop systems that promote compliance with regulatory (local, state, federal), accrediting, and professional standards Provide leadership in disaster preparedness coordination activities Engage in collaborative research Participate in nursing research related to role and practice (e.g., CNS, NP) Provides leadership for legislative and regulatory initiatives elop nursing programs related to orientation, internships, mentorships and preceptorship elop community based mental health programs Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results 15

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17 Appendix A Work Activities Statements 2009 Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner -- National Survey Results

18 Work Activity No. and Statement 1 Performs a comprehensive biopsychosocial assessment 2 Obtain a problem-focused or interval history for the client 3 Identify the client and family health risk based on comprehensive assessment 4 Perform biopsychosocial developmental screenings 5 Perform a pain assessment 6 Perform a focused physical assessment as appropriate 7 Conduct a review of systems 8 Identify normal and abnormal findings in client history and physical examination 9 Corroborate collected information using multiple sources 10 Perform a mental status examination appropriate to the client, presentation, and setting 11 Perform a risk assessment including suicidal, homicidal, substance use behaviors and life threatening physical conditions 12 Assess for trauma risk - current and past 13 Conduct a risk assessment related to sexual activities 14 Perform a nutritional screening 15 Assess client support systems, including interpersonal relationships and community supports 16 Assess client's and family's perception of health and vulnerability to disease 17 Assess client's and family's knowledge/use of alternative or complementary therapies 18 Assess family's communication patterns including who makes health care decisions 19 Perform a cultural assessment including mind, body, spiritual and genomics factors 20 Assess client's health care risks based on environmental exposure 21 Identify, in collaboration with the client, factors that facilitate or inhibit the recovery process 22 Conduct assessments using evidence based techniques, including appropriate screening tools 23 Identify need for diagnostic and laboratory tests 24 Document client information in accordance with regulatory requirements 25 Differentiate between typical and atypical presentations of psychiatric disorders 26 Analyze the impact of complications of medical conditions on mental health status 27 Differentiate presentations of psychiatric symptomology from physical health problems 28 Analyze client presentation using a holistic approach, including cultural, epidemiological, community, environmental and developmental characteristics 29 Integrate comprehensive assessment data 30 Interpret diagnostic medical lab tests 31 Formulate differential diagnosis based on current DSM criteria 32 Prioritize biopsychosocial diagnoses in collaboration with the client 33 Identify expected outcomes of care consistent with the diagnoses Appendix A Work Activities Statements A Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner -- National Survey Results

19 Work Activity No. and Statement 34 Discuss laboratory and diagnostic results and the impact on the plan of care with the client and family 35 Collaborate with the client in establishing desired outcomes 36 Incorporate appropriate treatment modalities into the plan of care, including recovery processes, medical interventions, drug regimens, psychotherapies, and other evidence based practices 37 elop a plan of care based on accepted biopsychosocial theories and evidence based practices 38 Prioritize interventions based on the severity and complexity of physical and mental health issues 39 Facilitate integrated multidisciplinary care for the client to promote recovery processes across the continuum of care 40 Incorporate the client s cultural needs and support system into the treatment plan 41 elop plans of care for the management of psychiatric emergencies 42 elop comprehensive client/family treatment plans that are culturally and linguistically appropriate 43 elop/design risk management protocols 44 Manage psychiatric conditions using the least restrictive alternatives 45 Collaborate on clinical issues with the interdisciplinary team 46 elop activities to improve systems impacting the knowledge of client/family and significant others 47 Provide education to promote the client's knowledge and understanding of pertinent health issues 48 Prescribe appropriate pharmacologic agents for clients 49 Prescribe appropriate nonpharmacologic biopsychosocial interventions including, psychotherapies and other evidence based modalities 50 Coordinate involuntary commitments in collaboration with other health care providers 51 Admit and discharge clients to and from the hospital in collaboration with physician 52 Conduct psychotherapy with individuals, families, and group 53 Treat disorders using psychosocial rehabilitation model 54 Facilitate client health and wellness promotion and disease prevention 55 Manage conditions related to nutritional issues including, restricted diets, metabolic disorders, food/drug interactions and eating disorders 56 Monitor general health indicators, pertinent lab findings and client response to treatment interventions 57 Educate the client regarding the influence of cultural and genetic factors on treatment outcomes 58 elop programs for reintegration 59 Facilitate improved communication utilizing culturally and linguistically appropriate techniques 60 Recommend measures to minimize caregiver stress 61 Initiate appropriate diagnostic and lab tests based on client risks, costs, benefits and clinical guidelines 62 Manage adverse responses to medications and other psychiatric emergencies Appendix A Work Activities Statements A Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner -- National Survey Results

20 Work Activity No. and Statement 63 Provide client education using teaching - learning theories and principles 64 Educate clients and families about diagnostic tests and treatment plans 65 Evaluate impact of interventions in light of cultural, ethnic and spiritual diversity 66 Evaluate client and family's specific, evidence-based outcomes to assess the effectiveness of treatment and modify plan as appropriate 67 Determine appropriate follow-up based on outcomes evaluation 68 Evaluate client s progress in health promotion/disease prevention activities 69 Evaluate caregiver's willingness and ability to provide care 70 Evaluate impact of multiple life stressors on the client's current biopsychosocial status 71 Evaluate risk for relapse 72 Evaluate comprehensive findings and modify treatment plans accordingly 73 Perform risk-factor analysis 74 Assess client population for emerging trends in health care problems 75 elop a culturally and linguistically appropriate plan for health maintenance/health promotion with clients, families, and groups 76 Provide anticipatory guidance for expected, potential, and situational system changes 77 Participate in community crisis response initiatives 78 Provide leadership in disaster preparedness coordination activities 79 Support clients, families, and groups through death, dying, and the grieving process 80 Document health promotion/disease prevention activities 81 Provide official/legal documentation supporting client's needs for services and/or accommodations 82 Maintain professional boundaries 83 Establish a therapeutic nurse-client relationship 84 elop guidelines/strategies that incorporate ethical/legal principles into nursing practice 85 Design quality improvement initiatives 86 Evaluate the effectiveness of quality improvement initiatives 87 Advocate for the protection of client rights (e.g., client self determination, access to care) 88 Advocate for psychiatric mental health advanced practice nursing 89 Advocate for health policy issues related to mental health 90 Articulate the role and scope of practice (e.g., CNS, NP) 91 elop systems that promote environments that uphold client's rights 92 elop systems and mechanisms that address ethical dilemmas 93 elop systems and mechanisms that facilitate the usage of evidence-based practice/research 94 Provide client centered consultation 95 Provide consultation for program development Appendix A Work Activities Statements A Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner -- National Survey Results

21 Work Activity No. and Statement 96 Provide consultation regarding psychiatric mental health issues to health care providers and others 97 Engage in clinical supervision for self 98 elops educational programs that target the needs of staff to improve nursing practice and/or client outcomes 99 Implement educational programs for nurses and others 100 Evaluate educational programs that target the needs of staff to improve nursing practice and/or client outcomes 101 Evaluate the impact of the practice environment on nurses, systems, treatment outcomes and policy development 102 elop nursing programs related to orientation, internships, mentorships and preceptorship 103 Serve as a mentor/preceptor/role model to colleagues and others 104 Provide clinical supervision to others 105 Oversee client case management systems 106 elop systems that promote compliance with regulatory (local, state, federal), accrediting, and professional standards 107 elop innovative programs, methods, strategies and models of practice 108 Facilitate integrated programs across the continuum of care 109 Engage in collaborative research 110 Discuss/critique research findings 111 Participate in nursing research related to role and practice (e.g., CNS, NP) 112 Utilize evidenced based practice and research to shape nursing practice (e.g. policies and procedures, standards, guideline) 113 elop community based mental health programs 114 Contributes to the development of interdisciplinary standards of practice and guidelines for care 115 Analyze the impact of different types of health care delivery systems (e.g., managed care, telemedicine) on the plan of care and treatment options 116 Disseminate knowledge through publications/presentations 117 Provide leadership in organizational change and development 118 Provides leadership for legislative and regulatory initiatives 119 Provide leadership in promoting collaboration among interdisciplinary groups (e.g., conflict resolution, team development) 120 Manage resources including human, financial, and information 121 Facilitate access of information through use of computer-based/web-based systems (e.g., nursing informatics) 122 Provide official/legal documentation supporting client's needs for services and/or accommodations 123 Identify client problems beyond the scope of individual's clinical expertise 124 Refer/consult client whose complex client issues are beyond the scope of individual's clinical expertise 125 Practice autonomously to manage complex client problems 126 Evaluate your clinical practice in relation to professional practice standards and relevant statutes and regulations Appendix A Work Activities Statements A Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner -- National Survey Results

22 Work Activity No. and Statement 127 Participate in peer review 128 Evaluate the impact of regulations and legislation on advanced nursing practice and advocate for changes when appropriate Appendix A Work Activities Statements A Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner -- National Survey Results

23 Appendix B Demographic Data Summary Appendix B Demographic Data Summary B Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results

24 This appendix details the responses to the survey s demographic questions which included inquiry on the nurse practitioner s background and practice setting. The demographic data is reported for two groups: 1) all ANCC-certified adult psychiatric and mental health nurse practitioners and 2) those respondents who reported practicing solely in a nurse practitioner role. Only responses from those who indicated practicing solely in a NP role was used in the data analysis of the tasks statements for the adult psychiatric and mental health nurse practitioner group. 1. Primary place of work Recruitment Pool All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent Count Percent Northeast % % % South % % % Midwest % % % West % % % Other % % % Total % % % 2. What is your gender? All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent Male % % Female % % Total % % Not Answered What is your racial/ethnic background? Optional All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent White/Caucasian % % American Indian/Alaska Native % % Asian/Pacific Islander % % Black/African-American % % Appendix B Demographic Data Summary B Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results

25 Hispanic % % Native Hawaiian % % Other % % Total % % Not Answered Appendix B Demographic Data Summary B Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results

26 4. What is your age? All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent years old % % years old % % years old % % years old % % 65 and older % % Total % % Not Answered Indicate the highest educational level you have completed. All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent Master's in Nursing % % Master's in field other than nursing % % Doctorate in Nursing Practice (DNP) % % Doctorate in Nursing Research (PhD) % % Doctorate in Nursing Science (DNS) % % Doctorate in field other than nursing % % Other % % Not Answered * Respondents may choose all that apply. The percentage is computed using Total = 515 for All, and Total = 414 for NP Role Only. Appendix B Demographic Data Summary B Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results

27 6a. Which certification do you hold? All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Certification Count Percent Count Percent Adult Psychiatric and Mental Health NP % % Both Adult Psychiatric and Mental Health NP and CNS % % % % 6b. How many years have you been certified as a NP in Adult Psychiatric and Mental Health? All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent 0 year % % 1 to 3 years % % 4 to 6 years % % 7 to 9 years % % 10 to 19 years* % % Total % % Invalid 4 3 All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Mean Median Appendix B Demographic Data Summary B Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results

28 7. Are you certified in another advanced practice specialty? All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent Yes % % No % % Total % % 8a. Which advanced practice adult psychiatric and mental health nursing role do you function as within your current practice? All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent NP % % CNS % % Dual/blended % % Total % % Appendix B Demographic Data Summary B Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results

29 9a. How many years have you been a registered nurse in the United States? All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent 0 to 9 years % % 10 to 19 years % % 20 to 29 years % % 30 to 39 years % % 40 to 49 years % % 50 to 59 years % % Total % % Invalid 1 1 Not Answered All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Mean Median Appendix B Demographic Data Summary B Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results

30 9b. How many years have you been practicing as an advanced practice nurse in Adult Psychiatric and Mental Health (either as an NP or CNS)? All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent 0 to 9 years % % 10 to 19 years % % 20 to 29 years % % 30 to 39 years % % Total % % Invalid 1 1 Not Answered All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Mean Median What is the population size of your primary practice setting? (Mark only one) All Respondents ANCCcertified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent Rural (population less than 2,500) % % Town (population between 2,500-49,999) % % City (population between 50, ,999) % % Metropolitan (population between 250, ,999) % % Greater Metropolitan (population greater than 999,999) % % National % % Total % % Not Answered Appendix B Demographic Data Summary B Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results

31 11. Which of the following best describes your current primary employment setting? (You may mark more than one) All Respondents ANCC-certified as APMH-NP Respondents Practicing NP Role Only Count Percent Count Percent Community/Public Health % % Home Health Care % % Hospice/Palliative Care % % Hospital, inpatient % % Outpatient % % Managed care (HMO, PPO, IPA) % % Medical school % % Not-for-Profit clinic % % Skilled Nurse/Subacute/Long-term care % % Owned practice (group) % % Owned practice (solo) % % Occupational health % % Private medical practice % % Rural health clinic % % School or college health % % VA/Armed forces % % Other % % Not Answered * Respondents may choose all that apply. The percentage is computed using Total = 515 for All, and Total = 414 for NPS Role Only. 13. Estimate the percentage of time that you provide healthcare for patient/client in each of the age groups listed below. Appendix B Demographic Data Summary B Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results

32 All Respondents ANCC-certified as APMH-NP Adolescent Adult Older Adult (13 to 17 years) (18 to 65 years) (Over 65 years) Count Percent Count Percent Count Percent 0% % % % 1% to 20% % % % 21% to 40% % % % 41% to 60% % % % 61% to 80% % % % 81% to 100% % % % Valid Responses % % % Invalid 1 Not Answered Adolescent Adult Older Adult (13 to 17 years) (18 to 65 years) (Over 65 years) Mean percent spent with each 5.64% 77.03% 15.68% age group Respondents Practicing NP Role Only Adolescent Adult Older Adult (13 to 17 years) (18 to 65 years) (Over 65 years) Count Percent Count Percent Count Percent 0% % % % 1% to 20% % % % 21% to 40% % % % 41% to 60% % % % 61% to 80% % % % 81% to 100% % % % Valid Responses % % % Invalid 1 Not Answered Adolescent Adult Older Adult (13 to 17 years) (18 to 65 years) (Over 65 years) Mean percent spent with each age group Appendix B Demographic Data Summary B Role Delineation Study: Adult Psychiatric and Mental Health Nurse Practitioner National Survey Results