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

APNA 30th Annual Conference Session 4013: October 22, 2016 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 Percent holding certifications 45% 723 40% 569 35% 480 30% 25% 20% 15% 144 10% 5% 0% Psych/mental health adult CNS Psych/mental health child and Psych/mental health adult NP Psych/mental health family/lifespan adolescent CNS NP *These numbers contain duplicates; individuals holding two certifications Who are PMH ‐ APRNs: Demographics • We are largely female (90.1%); Racial demographics male (9.9%) Hispanic/ Latino • Largely white American Indian/ • Average age of 54 4% Alaska Native 1% 2% 1% 4% 10% Asian • The CNS group is slightly older (x=61) versus NP (x= 48.9) Black/ African American • Preparation at MSN level (82%) Native Hawaiian/ Other Pacific Post masters (25%) 78% Islander White • 32% of respondents completed No response their education more than 20 years ago (from 1970 ‐ 1994) Delaney 2

APNA 30th Annual Conference Session 4013: October 22, 2016 Stability of our Work Force When do you plan to retire? 50% 702 45% 40% 35% 30% 393 25% 296 20% 15% 10% 105 5% 37 0% In 2016 1 ‐ 2 years 3 ‐ 5 years 6 ‐ 10 years more than 10 years APRNs are Largely Employed in Clinical Practice: Why Important? Employment Areas for Certified PMH APRNs 2% 1% 4% 8% APN in Clinical Practice Faculty requiring an APN credential Researcher requiring an APN credential Administrator requiring an APN credential Other (specify) 86% Majority have Prescriptive Authority – Some Differences in CNSs vs NPs NP: Do you have CNS: Do you have prescriptive authority prescriptive authority? 3.8% Yes Yes No 36% 64% No 96.2% Delaney 3

APNA 30th Annual Conference Session 4013: October 22, 2016 PMH APRNs Practice in a Variety of Settings –Including Community Arena Break ‐ down of ambulatory and hospital settings 25% 230 20% 159 15% 132 129 115 10% 84 98 85 44 5% 36 28 17 0% 39% of Respondents Report Income Between $95, 000 ‐ 125,000 2015 pre ‐ tax earnings from primary position 16% 14% 12% 10% 8% 6% 4% 2% 0% Section 2: Workforce Roles ‐ This is what we do Delaney 4

APNA 30th Annual Conference Session 4013: October 22, 2016 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 APRN ‐ reported most treated disorders 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 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%) Delaney 5

APNA 30th Annual Conference Session 4013: October 22, 2016 Section 3: Satisfaction and Provider Relationships Satisfaction: Autonomy 60% 54.7% 50% 40% 32.5% 30% 20% 8.4% 10% 2.3% 0% Very Satisfied Satisfied Dissatisfied Very Dissatisfied PMH APRNs are Largely Satisfied With Most Aspects of Role Save Two Elements Satisfaction: amount of administrative support 45% 604 40% 35% 30% 366 25% 327 20% 15% 131 10% 5% 0% Very Satisfied Satisfied Dissatisfied Very Dissatisfied Billing and Use of NPI aligns with National Rates Current Billing Arrangement 50% 584 45% 40% 35% 432 30% 25% 20% 15% 162 10% 55 55 46 5% 0% Bill under my provider Bill under my Bill under a physician’s No billing, cash only No billing, grant Other (specify) number clinic/facility number provider number supported/free clinic Delaney 6

APNA 30th Annual Conference Session 4013: October 22, 2016 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 Community size where principal APN practice is located 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 1,000 ‐ 9,999 10,000 ‐ 24,999 25,000 ‐ 49,999 50,000 ‐ 99,999 100,000 ‐ 250,000 ‐ 500,000 ‐ 1,000,000 or 249,999 499,999 999,999 more Delaney 7

APNA 30th Annual Conference Session 4013: October 22, 2016 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 specialty must actively devise and implement solutions to provide access for a wider span of individuals, some of these solutions may be utilization of service models such as tele ‐ psychiatry References • American Health Insurance Plans (2016). New Data Brief Finds Physician Shortages Lead to Network Adequacy Challenges. Retrieved from https://ahip.org/new ‐ data ‐ brief ‐ finds ‐ physician ‐ shortages ‐ lead ‐ to ‐ network ‐ adequacy ‐ challenges/ • Burke, B. T., Miller, B. F., Proser, M., Petterson, S. M., Bazemore,… & Phillips, R. L. (2013). A needs ‐ based method for estimating the behavioral health staff needs of community health centers. BMC Health Services Research, 13 , 245. • Delaney, K. R. (2016). Psychiatric Mental Health Nursing Workforce Agenda Optimizing Capabilities and Capacity to Address Workforce Demands. Journal of the American Psychiatric Nurses Association , 22 , 122 ‐ 131. • de Nesnera, A., & Allen, D. E. (2016). Expanding the Role of Psychiatric Mental Health Nurse Practitioners in a State Psychiatric System: The New Hampshire Experience. Psychiatric Services , 67 , 5, 482 ‐ 484 • Durbin, A., Durbin, J., Hensel, J. M., & Deber, R. (2016). Barriers and enablers to integrating mental health into primary care: a policy analysis. The Journal of Behavioral Health Services & Research , 43 (1), 127 ‐ 139. • Fang, D., Li, Y., Arietti, R., & Trautman, D.E. (2015) 2014 ‐ 2015 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Washington DC: AACN. • Graves, J. A., Mishra, P., Dittus, R. S., Parikh, R., Perloff, J., & Buerhaus, P. I. (2016). Role of Geography and Nurse Practitioner Scope ‐ of ‐ Practice in Efforts to Expand Primary Care System Capacity: Health Reform and the Primary Care Workforce. Medical care , 54(1 ), 81 ‐ 89. • Health Resources and Services Administration (2015) Projecting the Supply of Non ‐ Primary Care Specialty and Subspecialty Clinicians: 2010 ‐ 2025. Retrieved from http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/clinicalspecialties/index • Health Resources and Services Administration (January, 2016) HPSAs by State and County. Retrieved from http://www.hrsa.gov/shortage/find.html 25 US Census Bureau . • Staff Care (2015). Behavioral health: The silent shortage. Retrieved from http://www.staffcare.com/uploadedFiles/StaffCare/Content/Resources/Blogs/white ‐ paper ‐ behavioral ‐ health ‐ silent ‐ shortage.pdf • Ying Xue Y & Intrator, O. (2016) Cultivating the Role of Nurse Practitioners in Providing Primary Care to Vulnerable Populations in an Era of Health ‐ Care Reform. Policy Politics Nursing Practice 1527154416645539, first published on May 9, 2016 Thanks for Having Us Today QUESTIONS??? COMMENTS??? Delaney 8