Licensure at levels of role and population foci APRN Regulatory Model APRN Specialties Focus of Practice beyond role and population focus Linked to health care needs Examples include but are not limited to: Oncology, Older Adults, Orthopedics, Nephrology, Palliative care POPULATION FOCI Adult- gerontology Gender Specific Neonatal Pediatrics Psych/Mental Health Family/individual Across lifespan Licensure at levels of role and population foci APRN ROLES Nurse Anesthetist Nurse midwife Clinical Nurse Specialist Nurse Practitioner New Role Primary care Acute care

Options for Advanced Practice Psychiatric Nursing A new role As a Specialty As a Role and Population

A New Role Would require vetting of new role among all national and state regulatory organizations. Would require vetting of new role among all third party reimbursers. Would require creating a new title, identity and recognition by the public, clients, other health and mental health professionals. Would require creation of competencies, perhaps new affiliations or creations of new organizations. Would require creation of new certification exams.

As a Specialty Would first be educated, certified and licensed in a role (CNS or NP) and a population (Family/Lifespan, Gender, Adult/Gerontology, Pediatrics, Neonatal). Then one could chose the specialty of PMH (Adult, child etc.) More focused area of practice than role and population foci In addition to role and population focus preparation—cannot replace preparation for role and population foci Definition built on ANA (2004) Criteria for Recognition as a Nursing Specialty Cannot expand scope of practice beyond the role or population focus Addresses a subset of the population focus Title may not be used in lieu of licensing title Is developed, recognized and monitored by the profession

As a Role and Population Would create a foundation for practice as an advanced practice psychiatric nurse with a role as CNS or NP and a population focus of psychiatric-mental health. Is consistent with the trends in education and certification. Would increase workforce for psychiatric-mental health services in underserved areas where the APRN-PMH is the only mental health person in the area. Would support life span continuity and movement among age groups with mental health needs. Ex. Someone who sees adolescents could follow them into young adulthood. Someone who sees the nineteen- year-old brother could see the younger sister. As a population-focus, the profession would determine needed specialties and what would constitute acquisition of that knowledge and skill. Maintains existing identities, titles, competencies, and supports.

ANCC Certification/Exam Trends 2003 to 2006 %   n Change CNS-Adult Psych 7356 6,699 -8.9% CNS-Adolescent Psych 825 964 16.8% Adult Psych NP 454 1,587 249.6% Family Psych NP 118 540 357.6% 8753 9,790 11.8%

Parallel Processes Adult Psychiatric Nurse Practitioner Certification Exam—2002 Family Psychiatric Nurse Practitioner Certification Exam--2003 Psychiatric-Mental Health Nurse Practitioner Competencies--2003 Logical Job Analysis—2005 Psychiatric Mental Health Nursing Scope and Standards--2007 Revision of certification exam--2007 Joint APNA-ISPN Child and Adolescent Taskforce--2007