Introduction
Psychiatric-mental health nursing is an area of nursing that has developed as the understanding of mental illness has evolved and as society’s views of those living with mental illness have changed. From its beginnings, psychiatric nursing practices have evolved from largely custodial and medical model-based systems to practices that are now predominantly based on various forms of psychotherapy and pharmacotherapy. As part of the general nursing workforce, many registered nurse clinicians provide nursing care to individuals with mental health disorders. However, the specialty area to care for mentally ill children, adolescents, adults, families, or older adults has expanded nursing practice so that psychiatric-mental health care has a distinct focus, body of knowledge, and scope of practice. Those who pursue the education to become a psychiatric-mental health nurse practitioner demonstrate mastery of these nursing specializations at an advanced level.
Psychiatric-mental health care is important to overall health, yet millions of persons with mental health issues do not receive appropriate care. Nearly one in five employs a mental health diagnosis. While not everyone receives treatment, data estimates there are only psychiatric nurse practitioners in the U.S., the vast majority of whom are certified as family nurse practitioners and are not experts in mental healthcare. Certified practitioners and those who treat individuals with mental health disorders have a significant impact on patient outcomes. Suicidal experiences have a lower suicide rate when they involve psychiatric nurse practitioner care. Drug costs for individuals with mental illness are reduced when psychiatric nurse practitioners are employed with or without the supervision of a physician. For a nurse practitioner in psychiatric mental health, two pathways are available to individuals with nursing licenses. The first is a focused or doctoral degree at the master's or doctoral level.
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Roles and Responsibilities
When civil society faces an increase in violence and natural disasters, but investment in public health is scarce or inadequate, large teams of health workers internationally are trained in MHCP to cover the unmet need in primary and secondary care. When the focus shifts to primary care, PMHNPs can develop partnerships with MHCPs for advance care planning to optimize nursing interventions related to cutting-edge scientific advances. Part of what makes PMHNPs unique is advocacy for patient-centered care. A PMHNP is a licensed NP who independently conducts comprehensive assessments, diagnosing mental health and substance use disorders in the clinical interview. If an individual already has such diagnoses, the PMHNP determines and manages the emotional and physical responses to routine changes in their condition. A PMHNP is fully responsible for determining the differential diagnoses, as well as normal and problematic responses to nursing interventions. Medication management requires diagnostic reasoning. An NP does not delegate their decision-making role to initiate, change, or discontinue one or more medications. An NP's scope of practice is based on their national education and certification as an advanced practice nurse. In some states in the USA, PMHNPs can practice at the RN level with an MSN in Psychiatric Mental Health Nursing.
Personal Motivations
Much more closely related to the findings in the general field of nursing is the idea of self-actualization. This would include fulfilling careers as a prerequisite for overall life satisfaction. The PMHNP role offers multiple – perhaps unknown – rewards that are satisfying to a person personally and reinforce "giving back" to society through employment. In the next phase, our empirical investigation of basic determinant variables of career choice will translate both tables meaningfully into human life space. At this juncture, we confront more personal variables potentially predicting the PMHNP career.
Some students may look back and realize that they may have been nominally depressed due to increasing stress from juggling a full-time college schedule with part-time work, but saw a therapist and/or temporarily used medication themselves to get through it. They realize that, as a spiritual person or just a good corporate citizen, they want to be at least some part of the solution. Exploratory, perhaps they shared a personal story of a close friend or relative that they saw struggle with mental illness and did or did not receive proper treatment. They saw the pain and want to help those deep down. The recognition of potential students’ extraordinary range of in-depth motivations to join the PMHNP student population grows exponentially when public stakeholders consider their personal payoff through realizing the societal rewards. Thus, the deep motivations for PMHNP practice reported here could be read to exemplify a powerful feature of the role itself, attracting a decidedly unique and interested elite. Societal involvement in coming to grips with the influencers is worthy of empirical inquiry. Interview and focus group projects could usefully further illuminate these preliminary interpretations.
Challenges and Rewards
Working in psychiatric-mental health nursing is described as both "heaven" and "hell" depending on the day and the situation. It is a specialty where managing challenging and complex patient interactions and behaviors is common and can be tiring, frustrating, and leave the nurse feeling hopeless. This issue is compounded by the fact that mental illness remains stigmatized and patients still struggle to access care. In the psychiatric-mental health nurse practitioner (PMHNP) role, it can be challenging to manage clients' high emotional needs, and in some cases, psychiatric diagnostic complexity is compounded by concomitant serious or life-threatening medical illnesses. Provider burnout in the PMHNP role is also a concern, with loss of idealism and high levels of moral distress being reported within the first 10 years of practice.
While the PMHNPs have some of the highest intention-to-leave rates in nursing, those who enter psychiatric nursing fields and stay also report the highest job satisfaction in nursing. This dichotomy is important as it speaks to the resilience and to the anti-fragility of the human spirit. When asked about what were the most rewarding aspects of their work, several participants pointed to the same issue – "reducing the stigma associated with mental health by helping people accept themselves and others as worthwhile individuals." This ability to touch clients at their core and assist them through recovery – no matter how short or long that recovery can be – is deeply rewarding. Engaging clients and truly changing lives for the better is a theme that runs through discussions about satisfaction with the PMHNP role. Due to the complexity of the practice environment and the emotional tax associated with working with mental illness on a daily basis, warding off burnout is a common concern. In response to this, many participants engage in meaningful professional development activities, such as taking psychotherapy supervision, workshops, reading, or mentorship; all in an attempt to re-energize their practice in meaningful ways.
Conclusion
After exploring the motivations of PMHNPs, obtaining an understanding of the external and internal factors influencing career decision-making is crucial. Today, more emphasis and tools are given to medical residents to ensure that the practice of medicine remains gratifying by studying factors related to job satisfaction, work-life balance, and the declaration of nursing in advance. Implementing similar programs and tools readily available before completing a degree for both undergraduate nursing students and APRNs should be a priority to enhance the long-term replenishment of PMHNPs, but it is also necessary to address any stress or dissatisfaction with the role before or after graduation. Furthermore, PMHNP faculty and preceptors both need to recognize value and enhance both personal and professional motives to work with patients and increase people's access to pharmacological and non-pharmacological treatments. It was noted nearly 20 years ago that students enrolling in PMHNP programs had the major goal of accepting medical roles instead of becoming a PMHNP for the right reasons. Future research may include obtaining input from other stakeholder groups to form a unique picture of why individuals choose a career as a PMHNP, including the use of interpretive phenomenological analysis of interview data. Finally, there is still so little known about advanced psychiatric nursing work motivation, which would benefit from more research using various work motivation models.
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