Abstract
We are shouting it out! Can you hear us? Just look at the APNA 36th Annual Conference Program.
We are demonstrating who we are, we are teaching about what we do, and we are talking about what we need. And wait—there’s more! We have a new Psychiatric-Mental Health Nursing: Scope and Standards of Practice (American Nurses Association, American Psychiatric Nurses Association, and International Society of Nurses [ANA, APNA, ISPN], 2022) to guide us! To top it off, we have the newly released comprehensive results of the APNA Workforce Survey: the APNA Psychiatric-Mental Health Nursing Workforce Report (2022a), initiated by the APNA Board of Directors and completed by the APNA Workforce Task Force.
My theme this year has been “Psychiatric-Mental Health Nurses Activating Our Voices: Who we are, what we do, what we need.” In looking at the work you are doing and the work APNA is doing, I realized once again that we are stewards, guardians, and transformers of a dynamic profession. Just as we learn a challenging new therapy for our patients, we discover or initiate another new intervention that may have a better outcome for that individual. We continuously learn psychopharmacological treatments and consider each person’s genetics and lifestyle when we recommend medications as a part of that person’s treatment plan. We constantly must “think on our feet,” using the best evidence we have and weighing it with the individual needs of the people we serve.
That is the crux of the matter: serving. We didn’t choose psychiatric-mental health (PMH) nursing to be bystanders. We chose it to be active in the health and wellness of a population of people who often cannot speak for themselves. We are nurses first; we may have known that we wanted to work in PMH right away, or maybe that realization came later. Regardless, at some point in our careers, we chose to serve people who have mental health and substance use concerns. Simply put, it is what we do as PMH nurses.
We are all contributing, all adding to the definition of “who we are and what we do”; this allows for a fuller view of what PMH nursing involves. Through APNA Position Papers such as “Psychiatric-Mental Health Nurses’ Role in Primary Care” (American Psychiatric Nurses Association [APNA], 2022b), “The Use of Seclusion and Restraint” (APNA, 2022c), “Psychotherapy and the Psychiatric-Mental Health Advanced Practice Registered Nurse Role” (APNA, 2021), and “Psychiatric-Mental Health Nursing’s Role in Tobacco Treatment (APNA, 2020), we articulate some of the unique aspects and issues within our roles on a national level. We each work with unique individuals with unique needs in a range of communities and settings. We are all PMH nurses, but we are each also one-of-a-kind. The depth and breadth that will be shared at the APNA Annual Conference this October 19–22 in Long Beach is one example of how PMH nurses are activating their voices to articulate how each of us are stewarding, innovating, and transforming PMH care. We each bring nuances and specialized expertise to the already solid foundation of PMH nursing to share with our patients, students, and colleagues. These nuances allow a greater range of services to be available to all.
Our specialized expertise and the important subtleties of what we offer need to be stressed not only to our colleagues, but also to those outside our profession, to policymakers, and to funders. The new Psychiatric-Mental Health Nursing: Scope and Standards of Practice (ANA, APNA, ISPN, 2022) notes that, when discussing population health needs and workforce requirements, we are the providers who are best positioned to bridge gaps in care between mental health and other areas of health care, such as primary or acute care. It further observes that, for Psychiatric-Mental Health Advanced Practice Nurses (PMH-APRNs), barriers and restrictive reimbursement policies need to be removed to allow consumers better access to care. Who can we inform of these crucial facts to shape PMH care moving forward?
Through involvement in important interdisciplinary efforts in nursing and in mental health, we share our knowledge and demonstrate our expertise as administrators, clinicians, researchers, and educators to those outside our field. For example, by hosting the APNA Annual Clinical Psychopharmacology Institute (CPI) for the past 20 years, we have taught colleagues in medicine, psychology, social work, public health, national mental health and substance use policy, and nurses in multiple specialty areas that we are on the cutting edge of PMH care and treatment. We demonstrate who we are and what we do.
Historically, our roles and contributions have not been fully understood, not only by other disciplines in health care, but also by decision-makers in policy, funding, and systems. For example, as a part of their scenario projections for future workforce needs, the Human Resources and Services Administration (HRSA) did not take into consideration that PMH-APRNs are also needed, in addition to psychiatrists, to help cover Health Provider Shortage Area (HPSA) designations (U.S. Department of Health and Human Services, 2021). Clearly, our roles in meeting our nation’s mental health care needs are not fully appreciated, and this lack of understanding contributes to our invisibility in the eyes of the government, non-nursing colleagues, and funding agents. We are always working to educate the public about our influence on pressing mental health issues at the community, state, and national level. Our patients cannot obtain quality mental health care without funding; they cannot seek quality PMH nursing care without access to nurses.
However, we are on the right track. APNA’s national efforts to address pressing mental health issues can be seen through many avenues. For example, we participate in several national coalitions which prioritize policy efforts in nursing and mental health. Mostly notably, APNA has collaborated with these coalitions and organizations to develop and endorse communications which go to national agencies that influence mental health and nursing policy. There is a wealth of activity over the past 4 years listed on the APNA website at: https://www.apna.org/advocacy/
We also now have a great source for baseline data when it comes to educating others about the nuances of who we are, what we do, and what we might need: the results of the APNA (2022a) Psychiatric-Mental Health Nursing Workforce Survey. This survey, administered 2021–2022 and informed by workforce surveys of other professions, was created specifically to “understand the demographic, education, employment characteristics, and earnings of PMH nurses working in the United States” (APNA, 2022a, p. 6). What makes it unique is that the questions and responses were developed and analyzed by those who understand the nuances of who PMH nurses are and what they do best: PMH nurses themselves. Now is the time to make stakeholders in your community aware of this vital information to guide decisions about addressing the Mental Health State of Emergency (The White House, 2022). We have been steadily gaining momentum in raising awareness of PMH nursing, but now is not the time to stop using our voices! It’s time to amplify them and provide the evidence stakeholders need to make the best possible decisions for those in need of access to safe, effective, person-centered PMH care.
As we further understand and articulate who we are, we also gain an understanding of who we need to become—how we need to grow and be more inclusive. The APNA Diversity, Equity, and Inclusion (DEI) Advisory Committee actively supports the APNA Board in fostering a welcoming environment for all PMH nurses. By collecting demographic information of survey respondents and comparing it with data on the overall nursing workforce, the APNA (2022a) Workforce Report adds more information to the picture of who we are and the direction we need to go for a more inclusive workforce. The data show areas that we can build on, as well as areas to which we need to give further attention. We are moving in the right direction by exploring where we need to go. But there is always more progress to be made in fostering diversity, equity, and inclusion within the organization, as well as for the profession, to help address health disparities and create positive and sustainable change for those to whom we provide care.
As an association organized for science and education, as well as devoted to supporting who we are, what we do, and what we need, APNA offers quality conferences and online education to provide the latest best practices and evidence-based tools and resources, keeping us up to date and on the cutting edge. APNA councils, committees, task forces, and chapters encourage members with the same vision for PMH nurses and for people with mental health and substance use disorders to work together, with the support of their association of professionals. Resources are provided to advance all areas of PMH nursing, to support each of us to continually improve our scientific understanding of our practice and our patients’ needs, and to guide us as individuals in our efforts to communicate with local, state, and national leadership about important issues in nursing and mental health.
Stay curious; be positive; know that you, too, can make this profession even better to serve our chosen population. Keep looking for ways to do useful research, better educate our students, lead interprofessional teams, and provide better care to people with mental health and substance use issues. Your contribution is unique, and your professional outlook cannot be accurately duplicated in another profession. Tell policy stakeholders, colleagues, friends, and family how your vision of health care is unique and valuable to all people!
Boldly use your voice to spread the word about your unique skills in your profession of Psychiatric-Mental Health Nursing!