Barriers to Practice and Impact on Care: An Analysis of the Psychiatric Mental Health Nurse Practitioner Role (Report‪)‬

Clinical vignette (2007) An advanced practice psychiatric mental health nurse practitioner (APRN-PMHNP) provides mental health services within a small community based private practice. The New York State Nurse Practice Act mandates that a psychiatric nurse practitioner (NP) maintain a statutory collaborative agreement with a collaborating psychiatrist in order to provide comprehensive mental health services. Although some third-party insurance companies authorize APRN-PMHNPs on panels, a collaborative agreement must be established with a psychiatrist from each insurance panel. This becomes a critical issue when the collaborative psychiatrist decided to close his practice and abruptly discontinued the collaborative agreement. In order to prevent discontinuity in care, the APRN-PMHNP needed to establish a collaborative agreement with another psychiatrist and develop a practice agreement (Form 4NP) based on protocols established by the State of New York. This time-consuming process resulted in a disruption in treatment for several patients. The APRN-PMHNP managing this case reported a major incident by a high-risk patient that occurred as a result of this disruption in continuity of care. This case vignette highlights the potential negative consequences related to statutory collaborative agreements as well as the ability of an APRN-PMHNP to provide effective, safe, and consistent care.