Psychiatric Mental Health Nurse Practitioners (PMHNPs) are board-certified advanced practice nurses who diagnose and treat mental health and substance abuse issues. PMHNPs work in outpatient and inpatient settings, providing assessment, therapy, and medications. PMHNPs are critical in any disaster, providing emergent mental health care and psychosocial support to new patients and continuing outreach and support to established patients. Most recently, the COVID-19 pandemic has initiated a global mental health crisis.
The pandemic mental health crisis is unique in its influence on millions impacted by isolation, job loss, financial strain, and grief. Approximately half of Americans feel that the pandemic harmed their mental health. In addition, millions of healthcare workers that cared for COVID patients are expected to suffer mental health issues for up to a year after the pandemic ends. This increase in mental health issues post-COVID will create an additional cyclical mental health strain on the healthcare system.
To meet the increasing and expected mental health and substance abuse issues, the practice landscape for PMHNPs has changed. Recognition of emergent and forecasted needs combined with a national shortage of psychiatrists has led to dramatic changes in the PMHNP role.
1. Expanded scope of practice
Many states aligned with the Centers for Medicare and Medicaid Services (CMS) to expand Advanced Practice Registered Nurse (APRN) practice flexibility, including relaxing physician supervision mandates. These changes allow the PMHNP to practice to the full extent of their certification—independently counsel patients, prescribe medications, and consult —without physician oversight.
2. Further defined patient populations
In addition to the traditional patient groups, COVID-19 defined the patient population into focused groups to monitor pandemic effects and needs. In the beginning, the elderly population were quickly identified as an at-risk group. Then, the pandemic revealed the health disparities among underserved populations, shedding light on this chronic problem in health care.
Throughout the pandemic, additional patient populations were identified and assessed for risk of increased mental health needs or substance abuse. These groups included: health care workers, school-aged children and teens, university students, the homeless population, and the institutionalized. The expansion of these societal groups provides a detailed assessment of physical, emotional, and support needs.
3. Lowered access barriers
Pre-pandemic barriers to psychiatric care included:
Limited access to care
Stigma associated with mental health care services
Cost of seeking treatment
Although telehealth was available, this service was limited due to insurance reimbursement and the cost of HIPAA-protected technology. During the pandemic, CMS expanded approval for telehealth services. Also, the Department of Health and Human Services (HHS) waived penalties for HIPAA violations associated with the use of technologies such as FaceTime, Skype, or WhatsApp.
Some mental health practices delivered care through drive-up clinics. These clinics continued pre-pandemic care to psychiatric patients by administering long-acting injectable medications, and safely participating in socially distant face-to-face appointments if telehealth was not an option. These drive-up clinics improved treatment and follow-up compliance throughout the pandemic.
Telehealth allowed better access to mental health services, and also allowed patients to be seen in their homes. This view into the patient’s home life provided valuable information about their surroundings, lifestyle, and support systems.
4. Innovative practice opportunities
COVID-19 created a need for PMHNPs to consult with school administrations. Children and teens transitioning from the traditional school day to a virtual day struggle with isolation, depression, and anxiety. A school-aged child with a pre-existing diagnosis (such as ADHD or other behavioral and learning disabilities) may struggle with changes in routine and environment. PMHNPs can offer consulting services to the school and to parents to help children through these challenging times. PMHNPs are also needed for the post-pandemic period for readjustment back to daily in-person school.
Many patients initially reported depression and anxiety to primary care providers (PCP). The PMHNP is a valued consultant for the PCP to initiate holistic therapies, medications, and follow-up for these patients.
During the peak of the COVID-19 assault on New York City, a pair of Yale DNP graduates quickly identified that the city was in crisis. They responded by offering Lavender, an online psychiatry office employing 14 PMHNPs to provide counseling services. (Also an ANA 2021 Innovation Winner). Lavender offers same-day inquiry response, and transparent pricing that is approximately 30% less than existing psychiatric practices.
The pandemic revealed gaps in the current healthcare system and created a mental health emergency. However, PMHNPs are prepared to provide needed services through an expanded scope of practice, telehealth services for patient counseling, and consulting services to schools and medical practices.
Andrew Penn, RN, MS, NP, CNS, APRN-BC, an adult and psychiatric nurse practitioner, is exploring how COVID-19 has changed humanity. Society transitioned from overscheduled bustling lives in society, to adapting to the isolation of working from home, home-schooling children, and a nonexistent social life. These unexpected changes have left us exhausted and wary of the future. He cautions us to slowly emerge from our isolation, give attention to self-care, and look forward to a promising, and transformed future.
When it comes to caring for patients suffering from COVID-19, nurse practitioners (NPs), as you might expect, are making a major contribution.
Some 61% of NPs are treating patients who have been diagnosed with COVID-19, according to a recent survey from the American Association of Nurse Practitioners (AANP). Almost as many (58%) are offering COVID-19 testing at their practices.
“It was somewhat surprising to see how many nurse practitioners are literally on the frontlines of this pandemic,” said Stephen Ferrara, DNP, FNP, of ColumbiaDoctors Nurse Practitioner Group and Associate Dean of Clinical Affairs at Columbia University School of Nursing. He is also Executive Director of the Nurse Practitioner Association of New York State and the Editor-in-Chief of theJournal of Doctoral Nursing Practice.
Barriers to Treatment
Caring for COVID-19 patients does not come without obstacles, however. NPs identified lack of testing (47%) and lack of personal protective equipment (PPE) (24%) as the top barriers to treating patients with COVID-19, according to an executive summary of the survey. The survey was conducted from May 8 to May 17, 2020 and garnered over 4,800 responses from across the country. In many locations, COVID-19 testing is limited to patients who meet a narrow set of criteria (69%).
Of note, over three-quarters of the survey respondents (79%) said they reused PPE. And more than one out of two (53%) were exposed to SARS-CoV-2 in their practice or elsewhere.
At ColumbiaDoctors, Ferrara notes that he has had to reuse PPE. Specifically, he has reused an N95 mask and changed an outer surgical mask.
The use of PPE is “probably forever changed,” said Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, president of AANP in an interview with DailyNurse. She notes that the CDC has provided guidance on safely reusing PPE, and that a variety of mask shapes and sizes have been approved.
Long-Term Changes
As in many areas of health care, COVID-19 may lead to significant structural changes. For one thing, notes Thomas, “the expansion of the use of telehealth is going to change the landscape in which we provide health care in this country and will definitely improve access to care for all patients.” NPs, she noted, “are big utilizers of telehealth because we feel it’s important to provide access to patients wherever they are.”
Ferrara’s Manhattan-based primary care practice rapidly adopted telehealth/virtual visits for non-COVID patients, he said. The practice restricted in-person visits only to those patients with COVID-19 symptoms.
Another change involves lowering regulatory obstacles. The AANP and the general NP community, Thomas said, “call on the nation’s governors to suspend all legislative and regulatory barriers that prevent NPs from providing patients with full and direct access to all the health care services that NPs are educated and prepared to provide.”
Five governors, she said, have issued executive orders to allow NPs to practice at the top of their education and training. She hopes that these five governors “will make those executive orders permanent to change that regulatory language, and I hope that we modernize health care delivery in all the other states and allow nurse practitioners to practice at the top of their education and training.”
“Beacon of Light”
As the pandemic continues, NPs need to educate patients, said Thomas, on the importance of wearing masks to prevent the spread of COVID-19. In a July 14 statement, the AANP called on the American public to wear masks, socially distance, and wash hands. NPs, said Thomas, need to be the “beacon of light to their patients.”
In a significant development for mental health services in the military, U.S. Navy Lieutenant j.g. Lindsay Bender demonstrated strong leadership and empathy in her contributions throughout her military career, particularly at Walter Reed National Military Medical Center. This resulted in her being chosen to fill the critical leadership billet of Assistant Service Chief.
U.S. Army Col. Wendy Woodall, Walter Reed’s director of nursing, emphasized that “This role is typically for an O-3 or higher and GS-12,” acknowledging the significance of Bender’s assignment.
Additionally, in March 2024, Bender was accepted into the Uniformed Services University (USU) Psychiatric Mental Health Nurse Practitioner, Doctor of Nursing Practice Program. This achievement and progress involved Bender’s leadership ability, empathy, and collaborative mentality.
Daily Nurse named U.S. Navy Lieutenant j.g. Lindsay Bender the Nurse of the Week for her outstanding contributions as a Navy nurse, including her caring nature, innovative mindset, clinical expertise, commitment to nursing excellence, and military mental health services.
While at Walter Reed, Bender took on multiple roles, notably serving as the Assistant Service Chief of a 20-bed medical-surgical unit and efficiently leading more than 60 military and civilian personnel. The George Mason University graduate understood the gravity of occupying a role usually reserved for higher-ranking individuals, crediting her success to the guidance received and her experience in nursing leadership.
“I feel very fortunate to have been selected to fill this role,” Bender remarked. “I owe a lot of gratitude to the mentors and leaders I’ve worked with throughout my career, who have helped shape me into who I am today.”
Recognizing her work as Assistant Service Chief as a continuation of her recent experience as a floor nurse, which influenced leadership decisions, Bender added, “Nursing is a team effort, and I approach each day as a unique opportunity to improve upon the previous day, with the awareness that influence can be felt throughout every level of the leadership structure.”
She also acknowledged her “floor experience” for providing a distinctive perspective when discussing unit operations and management with other nursing leaders, underlining the significance of a supportive and collaborative environment.
Additionally, Bender was a Patient Safety Advisor and ‘Super User’ for MHS GENESIS, the DOD’s new electronic health records system.
As a Patient Safety Advisor, Bender played a significant role in enhancing patient safety and quality improvement, fostering an environment of understanding and compassion essential for patient care.
Adapting to change, Bender led efforts during the MHS GENESIS implementation as a ‘Super-User,’ contributing to staff proficiency by linking traditional practices with new technology.
Committed to innovation and process improvement, Bender used her ‘why’ approach to revamp the nursing workflow for lab specimen handling across the directorate, improving policies and resulting in increased scanning compliance rates among nursing staff.
Bender’s dedication to military mental health services was further fueled by her personal experiences, leading to her pursuit of a degree in Psychiatric Mental Health from USU. This degree program begins this month.
“Throughout my career, I have encountered various stigmas and barriers toward seeking mental health care, which has fueled my passion for advocacy for change,” Bender explained. “This is why the opportunity to complete the Psychiatric Mental Health Nurse Practitioner, Doctor of Nursing Practice degree through USUHS is so exciting!”
Her advocacy was driven by recognizing the need among service members, including the challenges of military life and seeking mental health treatment.
“I hope to be an advocate for change and another person in the fight to increase mental health services for service members,” shared Bender. “The opportunity to attend USUHS and receive a top-quality education is life-changing, and I’m extremely grateful.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
Kate Veenstra, DNP, MSN, RN, CNL, CMSRN, ACM, NEA-BC, was recently appointed as the new chief nursing officer at the University of Michigan Health-West. Her more than 18 years of experience also tells quite a story.
Veenstra started as a bedside nurse at the hospital in 2006 and has held many roles, from associate chief nursing officer to the most recent interim chief nursing officer. Throughout her career, Veenstra has been a champion for her team and patients, leading initiatives that have significantly improved care and productivity.
One of her most notable accomplishments is co-leading a clinical nurse program, which helped to reduce cardiac readmissions and hospital stays. She also participated in a clinical care team during the COVID-19 pandemic.
Daily Nurse named Kate Veenstra the Nurse of the Week for her outstanding contributions. According to Dr. Ronald Grifka, president of UM Health-West, “Kate’s caring nature, innovative mindset, clinical expertise, and commitment to nursing excellence make her the ideal leader for this role.”
Veenstra is passionate about the success of nurses in West Michigan and has been involved in developing the Amy Van Andel Nursing Scholars program, which aims to remove cost barriers for those looking to start their careers in nursing. She has also played a significant role in creating a talent partnership with talent partnership with Grand Rapids Community College and the UM Health-West Foundation.
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
Have you ever wondered if you could have a side gig as a skincare blogger? Could you make money at it? Would you like it?
Christina Diferdinando, DNP, RN-BC, has done just that. While she’s had an amazing career from everything as an ER nurse to a nurse providing project management, digital strategy, and quality improvement, her full-time job now is as the director of product operations at the Digital Innovation Group within a large healthcare organization. She currently partners with leaders to uncover and understand their most significant pain points and opportunities to inform what digital solutions they build and to inform new features for their current solutions.
But her side gig, which is eponymously named, is Christina DiFerdinando. While blogging as a skincare specialist, she used her name as her brand if she chose to expand or pivot her niche.
She took time to answer our questions. What follows is our interview, edited for length and clarity.
Why did you decide to start blogging about skincare? When did you start it, and how did you go about it?
Blogging Interest
I’ve always been interested in owning my own business, but I was looking for a digital way to earn passive income. I wanted to avoid the overhead of investing and testing in a physical product business. I also enjoyed the flexibility to travel—one that didn’t require me to be at home fulfilling orders, managing inventory, etc.
I Googled different ways to earn passive income and found that blogging could be very profitable within a few years if done correctly.
I started to learn more about the blogging business and how to generate passive income via affiliate marketing and ad revenue.
This began with selecting a niche that wasn’t too competitive—e.g., focusing on a sub-niche within a broader niche to get more traffic and prove authority/expertise to Google–by doing some keyword research and analysis, determining what topic I could write at least 100+ articles and a niche that I wanted to grow/establish myself in.
I took a few courses to help me learn how to start a blogging business, develop my blogging strategy, and view this as a business rather than a side hobby.
These courses taught me about SEO, how to create a topical mapping (e.g., a plan to support your transactional posts—for example, money-making posts) with informational posts (which build authority and traffic), and which keywords to go after.
Right now, I’m learning more about writing sales copy and getting backlinks to help improve my domain authority to increase my post rankings by Google—to rank as one of the top three search listings on Google when searching for a specific keyword.
I love learning, testing to see what works, looking at my data to see how I can improve my posts, finding keywords to drive more traffic to my site, and seeing my business grow.
My future goal is to have the option to do this full-time, as well as generate enough revenue to feed back into my business to hire 1 or 2 writers to help my business grow.
Skincare
I’ve always been passionate and interested in learning about skincare products. What works and why? Is there any evidence to support marketing claims? Which ones will work best for my skin?
I’ve always struggled with acne and hyperpigmentation. While I was growing up, my family did not have the monetary means to see a dermatologist. So, I was reliant on trying various drugstore products to try to have clean skin. When I tried one product, it destroyed my skin, and I had to do a lot of research and testing to repair my skin barrier.
On another note, I was born in South Korea but was adopted when I was one year old. I grew up in a very small town in Pennsylvania in a predominately white neighborhood where few, if any, people looked like me.
Growing up, I hated being different and struggled with my ethnic identity. Even though I had a group of friends, I often felt alone, like an outsider who never really fit in.
I largely ignored my Korean heritage until I stumbled on Korean skin care. Learning more about their beauty philosophies, routines, and products was a gateway to exploring my Korean culture further and starting to accept/be proud of my Korean heritage.
I am now studying Korean. I have a tutor and took my first trip to Korea this year. I now have plans to visit every year moving forward.
So, my passion for skin care and helping others, my Korean heritage, and my drive to start a passive digital business all aligned with creating a skincare blogging business.
What kinds of topics do you cover? Why do you think it’s important to cover this kind of care? Do you interact with your readers?
My blog content helps you to create a simple skincare routine that targets your unique skin.
Within my posts, I’ll share skincare routines for different skin types and concerns such as acne, hyperpigmentation, aging, sensitive skin, dehydrated skin, etc. I then infuse evidence/research to support my recommendations.
I’ll also provide product recommendations based on my experience and review the ingredient labels. I will also analyze customer feedback to give readers non-biased information to help them determine what products are worth trying and how to incorporate them into their routine.
Sharing this information with individuals is important since cutting through all the marketing hype makes it hard to determine if products are worth purchasing.
Also, with social media like TikTok, it can take time to find trustworthy information.
Since I’ve struggled with my skin, I’ve learned a lot over the years through my own experiences, including staying up-to-date with the latest trends, as well as always diving into the literature to debunk or validate claims.
If I were looking for this information, others would find it helpful.
The caring aspect of nursing still sticks with me. I love helping others and enabling individuals to make the best decisions based on the right information.
Did you have previous entrepreneurial experience? Or did you learn on the go? Did it take a lot of time or money to establish your business? How do you make money from this business?
I’ve tried side hustles like Amazon FBA, and my husband and I started our own fitness company providing home workouts during COVID, but I’ve been learning on the go.
I spend a lot of time learning, testing, and figuring out which strategy will bring me the most value.
In each of my businesses, I’ve been able to earn a profit, which has been enough to cover the courses and the money I invested into each one—leaving a few thousand more to either invest in something new or pay for a few international trips.
Even though I’m no longer running my FBA and fitness business, I found the experience and knowledge invaluable.
I started my blogging business in October 2022, and I’ve had a little affiliate revenue come in, but I’m still early in my journey. It usually takes a few years to see all your work pay off, which is hard to do when you dedicate so much time and effort to your business.
What did you enjoy most about your side gig?
What I enjoy most is learning how to create and implement the best business strategy to see if it works. It’s so rewarding to see positive results and gain knowledge/skillsets you never thought you’d have.
For me, it’s proving that I’m smart and capable enough that if I put my mind to it and constantly learn, grow, and tweak it, I can one day be my own boss and validate that my decisions and work were successful. It’s helping me be more confident and prove my value/self-worth to myself.
What are some of the challenges?
Blogging is a long-term play. It takes several years to see the fruits of your labor. Also, you question yourself if you’re making the right decisions. Unlike working with a team that can help validate or address any questions you have, it’s up to you to research and make those decisions on your own. So, you always have this little voice asking, “Did I choose the right niche? Am I focusing on the right content to write? Is this bringing value to my readers? etc.”
It also takes a lot of dedication and time. Since I work full-time, I work on my blog after work, early in the mornings, and on the weekends. Balancing my life, work, and business can be challenging.
What are the most significant rewards of having your side gig?
I’m learning and growing, and I hope it results in my ability to have more work-life balance, manage my schedule, and be my own boss one day. That possibility is exciting, and I am opening myself up to other professional opportunities that might come my way.
I hope that one day, I’ll collaborate with a few Korean skincare brands and use my business to help connect me more to my Korean culture and heritage.
What would you say to someone considering blogging about skincare or another topic?
It’s not for the faint of heart, but if you’re willing to work, are open to learning, and want a passive business/income, go for it. It doesn’t mean it was a waste if it doesn’t work out.
You can apply what you’ve learned to your next venture. There is no such thing as failing because you always learn something valuable from that experience that you can leverage and apply in the future.
I recommend researching courses and learning about blogging as a business, SEO, and affiliate marketing as much as possible.
Be sure to avoid the “get rich quick schemes” like the ones that read, “I made $60,000 per month within my first three months of blogging.” They never work and are a waste of your time.”
