Insight Matters
Spring 2005

APN Preparation is Extensive

Patricia A. Galon, M.S.N., Manager of Community Services, Summit County Alcohol, Drug Addiction and Mental Health Services Board

Introduction: In addressing scope of practice issues, including the major battle we anticipate over psychologists attempts to get prescriptive authority, members of OPA need to be as informed as we can be about the training and current scope of practice of our colleagues in psychiatric nursing. When Pat Galon agreed to present to OPA Council at our spring meeting, it was clear to me that many of us are unclear about the different kinds of Advance Practice Nurses (APN) . Pat explained there are four different names for APNs depending on their specialty. All have the same licensure. The four types of APNs in Ohio are Certified Registered Nurse Anesthetist (CRNA), Certified Nurse Practitioner (CNP), Certified Nurse Midwife (CNM) finally, Clinical Nurse Specialists (CNS). Most advance practice psychiatric nurses in Ohio are Clinical Nurse Specialists. One of the most important points from Pat's talk at Council is that psychiatric nurse clinical specialists who obtain prescriptive authority must collaborate with a psychiatrist. Psychiatric APN's cannot collaborate with non-psychiatric physicians and conversely psychiatrists cannot have a standard care arrangement for collaboration with a nurse practitioner or non-psychiatric nurse. I appreciate Pat's willingness to amplify on the information she presented to Council below. - Mark Munetz, M.D., OPA Past President

I had the opportunity to address the Executive Committee of OPA about a month ago about the educational preparation of Advanced Practice Nurses in Ohio. There appeared to be some common misconceptions among the group regarding both education and practice under current Ohio law. I would like to address a larger audience of psychiatrists with a brief factual presentation on some of those issues dealing with education in this column. For an excellent overview of the law and rules governing Psych APN practice in Ohio from the perspective of a psychiatrist see my colleague Mark Munetz' article entitled __________ in the ( date ) issue of Insight Matters.

It is surprising how little we know about the preparation of the other mental health professionals with whom we closely work. The particular competencies and educational preparation of other disciplines is something not often discussed in everyday practice and it can be awkward to inquire about details with colleagues in the clinical setting. Educational preparation reflects not only the unique knowledge but also the values of a discipline. It must grow and transform as the discipline matures, academic standards evolve, and the needs of the public change.

In Ohio Advanced Practice Nurses must have a masters degree and national certification in their respective clinical specialty in order to obtain a license called a Certificate of Authority (COA). Such degrees must be obtained in accredited colleges or universities, in organized programs of study, and within a specifically accredited college or school of nursing. There are six programs in Ohio offering a Master of Science in Nursing degree (MSN) with a clinical specialty in psychiatric nursing. A quick perusal of these programs via the Internet revealed, as expected, the curricula and length of programs are very similar. They are generally 2 full time academic years with at least part-time summer studies. They combine clinical and didactic experiences including courses in advanced human physiology/pathophysiology, graduate level general pharmacology, psychopharmacology, physical and mental assessment/diagnosis, individual and group psychotherapy as well as health policy and clinical inquiry/research. Many programs require a thesis as well.

It is also important to remember that these are academic credit-hour courses; they are not contact hours as in continuing education. While academic courses do meet for 3-4 hours weekly for about 11 weeks (which averages around 38- 40 hours of class), like any graduate level science course they involve reading to prepare for class, test taking, case studies and papers. Most graduate university courses require 4 hours of preparation time for each academic hour assigned to the course. Clinical courses are taught by doctoral-prepared faculty (yes, you can get a PhD in nursing) within the college or school of nursing, but some didactic courses may be taken in other colleges or programs depending on availability and applicability. Clinical course hours are generally calculated on at least a three clock hour to one credit hour ratio. For example, a 4 credit hour assessment course would require 12 hours of clinical practicum weekly.

Unlike physicians, student APNs often attend school part time while continuing to practice as nurses. They also tend to begin graduate education a bit later in their careers. It often takes up to 5-6 years to complete an MSN part time.

Once the degree is completed the initial certification is obtained by national testing. Currently, in Ohio, the only acceptable certifying body for Psych APNs is the American Nurse Credentialing Center (ANCC). The potential APN submits a fee and an extensive application packet which includes a detailed description of the nurse's academic program, documentation of the required 500 hours of supervised clinical practice, as well as scholarly accomplishments including publications and presentations. The ANCC individually evaluates applications. Within that process the course work completed is evaluated for applicability to the scope of practice of the Psych APN. Academic course content must be within the clinical specialty for which the potential APN is applying for certification. If the academic program does not supply the 500 hours of supervised clinical practice, the potential APN arranges for further supervision following completion of the program before sitting for the exam. The APN must then complete the national test which is offered twice yearly in paper and pencil form in larger cities throughout the country. Completing an on-line version in a national testing center is also an option.

Keep in mind a COA alone does not authorize prescriptive authority in Ohio. A Certificate to Prescribe (CTP) necessitates meeting an additional set of criteria including up to 1800 hours of clinical supervision, possible additional education, and a formal collaborative relationship between the Psych APN and a psychiatrist. Additional and specific continuing education requirements exist for Psych APNs to maintain a CTP.

Should you have additional questions concerning the educational preparation of Psych APNs or their practice there are a number of websites listed below that you may find helpful. You can also email me at galonp@admboard.org and I will try to answer your questions or find someone who can.

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