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APNA 30th Annual Conference Session 4013: October 22, 2016 Delaney 1

Report on the APNA National Psychiatric Mental Health Advanced Practice Registered Nurse Survey

Kathleen R. Delaney, PhD, PMHNP‐BC Barbara L. Drew, PhD, PMHCNS‐BC Amy J. Rushton, MSN, PMHCNS‐BC ‐

Conflict of Interest Statement

• We have no conflicts of interest to report

Objectives for Presentation

• Describe the characteristics of the Psychiatric

Mental Health (PMH) Advanced Practice Registered Nurse (APRN) workforce, its size, characteristics and major activities

• Identify critical differences between the PMH

APRN workforce and other APRN specialty groups

• Explain, based on the data presented, implications

for PMH APRN workforce development; particularly in light of its current capacity and mental health service needs.

APNA 30th Annual Conference Session 4013: October 22, 2016 Delaney 2

Survey Intent, Design and Delivery

• The survey was intended to gather data from all

certified PMH APRNs in the United States.

• It designed in line with the national nursing workforce

minimum data set‐questions that are considered essential to nursing workforce surveys. Additional questions were added relevant to PMH nursing and psychotherapeutic interventions.

• The survey was delivered on‐line during March 2016. A

survey link and invitation to participate were sent to lists of PMH APRNs derived from three sources

Data is Presented Here in 3 Sections‐ Questions Encouraged between Sections

• 1,761 certified PMH APRNS responded to survey
• Respondents: PMH CNSs (867) and PMH NPs (1049)*
• 70 respondents were PMH APRNs who did not hold certification

723 144 480 569 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Psych/mental health adult CNS Psych/mental health child and adolescent CNS Psych/mental health adult NP Psych/mental health family/lifespan NP

Percent holding certifications

*These numbers contain duplicates; individuals holding two certifications

Who are PMH‐APRNs: Demographics

4% 1% 2% 4% 1% 78% 10%

Racial demographics

Hispanic/ Latino American Indian/ Alaska Native Asian Black/ African American Native Hawaiian/ Other Pacific Islander White No response

• We are largely female (90.1%);

male (9.9%)

• Largely white
• Average age of 54
• The CNS group is slightly older

(x=61) versus NP (x= 48.9)

• Preparation at MSN level (82%)

Post masters (25%)

• 32% of respondents completed

their education more than 20 years ago (from 1970‐1994)

APNA 30th Annual Conference Session 4013: October 22, 2016 Delaney 3

Stability of our Work Force

37 105 296 393 702 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% In 2016 1‐2 years 3‐5 years 6‐10 years more than 10 years

When do you plan to retire?

APRNs are Largely Employed in Clinical Practice: Why Important?

86% 8% 1% 2% 4%

Employment Areas for Certified PMH APRNs

APN in Clinical Practice Faculty requiring an APN credential Researcher requiring an APN credential Administrator requiring an APN credential Other (specify)

Majority have Prescriptive Authority – Some Differences in CNSs vs NPs

96.2% 3.8%

NP: Do you have prescriptive authority

Yes No

64% 36%

CNS: Do you have prescriptive authority?

Yes No

APNA 30th Annual Conference Session 4013: October 22, 2016 Delaney 4

PMH APRNs Practice in a Variety of Settings –Including Community Arena

159 230 115 84 44 98 28 129 132 17 36 85 0% 5% 10% 15% 20% 25%

Break‐down of ambulatory and hospital settings

39% of Respondents Report Income Between $95, 000‐ 125,000

0% 2% 4% 6% 8% 10% 12% 14% 16%

2015 pre‐tax earnings from primary position

Section 2: Workforce Roles‐ This is what we do

APNA 30th Annual Conference Session 4013: October 22, 2016 Delaney 5

If you conduct psychotherapy, what type of psychotherapy do you use in your practice? PMH APRNs Provide a Complex Mix of Services

APRNs deliver services to a range of patients in terms of diagnostic categories and age

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

APRN‐reported most treated disorders

Age Most Some Few None 1‐10 44 (4%) 157 (15%) 149 (14%) 721 (67%) 11‐20 112 (10%) 351 (31%) 466 (40%) 220 (19 %) 21‐30 232 (18%) 793 (62%) 166 (13%) 81 (6%) 31‐60 828 (62%) 358 (27%) 65 (5%) 83 (6%) 61+ 161 (13%) 560 (44%) 412 (32%) 133 (11%)

APNA 30th Annual Conference Session 4013: October 22, 2016 Delaney 6

Section 3: Satisfaction and Provider Relationships

54.7% 32.5% 8.4% 2.3% 0% 10% 20% 30% 40% 50% 60% Very Satisfied Satisfied Dissatisfied Very Dissatisfied

Satisfaction: Autonomy

PMH APRNs are Largely Satisfied With Most Aspects of Role Save Two Elements

366 604 327 131 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Very Satisfied Satisfied Dissatisfied Very Dissatisfied

Satisfaction: amount of administrative support

Billing and Use of NPI aligns with National Rates

584 432 55 46 55 162 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Bill under my provider number Bill under my clinic/facility number Bill under a physician’s provider number No billing, cash only No billing, grant supported/free clinic Other (specify)

Current Billing Arrangement

APNA 30th Annual Conference Session 4013: October 22, 2016 Delaney 7

Implications for Practice: Size of the Workforce and Potential for Growth Potential for Growth as Providers: Barriers and Facilitators Addressing issues of Geographic Maldistribution: Use of RN Workforce

0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 1,000 ‐ 9,999 10,000 ‐ 24,999 25,000 ‐ 49,999 50,000 ‐ 99,999 100,000 ‐ 249,999 250,000 ‐ 499,999 500,000 ‐ 999,999 1,000,000 or more

Community size where principal APN practice is located

APNA 30th Annual Conference Session 4013: October 22, 2016 Delaney 8

Conclusions

• PMH APRNs specialty has assumed activities that comprise primary

mental health care for individuals dealing with serious mental illness, e.g., diagnosis and management, prescribing, education.

• Two‐thirds of the respondents are using psychotherapeutic

approaches, it would seem in combination with prescribing since only 15% of APRNs are delivering psychotherapy alone to most patients.

• APRNs prescribing/diagnosis and management activities are

dominating the role. How much of this shift is in response to work place demands? Will PMH nurses continue to move forward with a somewhat narrow definition of their role within mental health services delivery?

• Age and geographic mal‐distribution are workforce issues. The

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