Seeing a patient smile… is a reminder that while many things can be wrong and recovery is a lifelong journey, small things like a momentary smile symbolize ongoing hope.
Patients with psychiatric problems need special care. That’s why it’s important for nurses to know that they want to pursue this facet of the nursing field before actually doing it.
What follows is our interview, edited for length and clarity.
How did you get interested in being a psychiatric NP, treating trauma and mental health? What drew you to it? How long have you been doing it?
I have been a psychiatric mental health nurse practitioner (PMHNP) since 2010.
Treating trauma and mental health was an accidental merge as I worked as a trauma nurse while completing my clinical rotations for mental health. Over time, I would see my patients recovering from head trauma and would start showing signs of mental health needs that were often untreated by the time of their discharge. I felt a sense of responsibility to my patients, with a conviction that the emergence of mental health symptoms was not coincidental. I thought pursuing research was the best way to help my patients in a strategic way.
Explain to me briefly what you do in general. What types of patients do you serve? What do you provide for them?
I am a board-certified psychiatric nurse practitioner who has worked in trauma and psychiatry. I work as the track coordinator for the Psychiatric Mental Health Nurse Practitioner Certificate program and maintain a clinical practice in Baltimore City serving families recovering from substance use. My research includes identifying biomarkers for PTSD in Veterans with a history of traumatic brain injury (TBI), which includes exploring the factors influencing seeking treatment for PTSD after a TBI.
You’re a Jonas Philanthropies Scholar. What does that mean? What do you do as one?
Jonas Philanthropies and its Jonas Scholars program support nurse scholars across the country who have transitioned into roles as faculty, clinical leaders, and researchers. The goal of the program is to improve health care by investing in doctoral nursing students, such as myself, who are pursuing PhD, EdD or DNP degrees, and whose research and clinical focus addresses the nation’s most pressing healthcare needs. As a Jonas Scholar, I’m given financial assistance, leadership development, and networking support for my work as a psychiatric nurse practitioner and my research on biomarkers for PTSD in Veterans.
What do you like most about your work? Why?
I love working with individuals and their families, and I feel really lucky that I get to explore multiple aspects related to mental health through research, my clinical practice, and teaching.
What are the biggest challenges in your work?
Waiting for science to catch up with reality. Research is often very slow and tedious to find supportive evidence to enact change. It is necessary, but so many people are in need of it, and it is often difficult to be patient with the process.
What are your greatest rewards?
Seeing a patient smile. It is a reminder that while many things can be wrong and recovery is a lifelong journey, small things like a momentary smile symbolize ongoing hope.
If you could fix/cure one thing in your line of work (could be with patients or whatever), what would it be and why?
Take away the stigma related to mental health – it hinders so much, and so many people who deserve help are often unwilling to seek it because they do not want to be labeled negatively.
Is there anything I haven’t asked you that is important for our readers to know?
Research for TBI and mental health has made incredible exposure and progress in the last few years, yet so much needs to be done to help individuals who desperately need it. It makes the difference between just existing and having an opportunity to live a fulfilling meaningful life, and that’s what we all deserve regardless of a diagnosis or injury.
Jane Gunter, a nurse practitioner in Tuolumne County, California, has long wanted to specialize in mental health so she can treat patients who have anxiety, depression and more complicated mental illnesses.
Her county, a rural outpost in the Sierra Nevada foothills with a population of about 54,000, has only five psychiatrists — “a huge shortage,” she said.
But Gunter, 56, wasn’t about to quit her job at the Me-Wuk Indian Health Center in Tuolumne and relocate to some distant campus for two years to get certified as a psychiatric nurse practitioner.
Then, in February, she learned that the University of California was launching a new program to provide that certification online in just one year. She fired off her application, and last month she received an acceptance letter.
“Sometimes I think, ‘What are you doing?’” Gunter said, referring to the online classes that will take over her nights and weekends once the program starts. “But I care about the community.”
The online certification program, conducted jointly by the nursing schools at the University of California-San Francisco, UCLA and UC-Davis, was scheduled to start in the fall, but it has been postponed until January because the on-site clinical hours required as part of the training are not possible during the COVID-19 shutdown.
Despite the delay, the potential expansion of psychiatric care is opportune given the expected increase in mental health problems due to the social isolation and financial stress stemming from the pandemic.
The need for more mental health nurses is about to be bigger than ever, said E. Alison Holman, a health psychologist at UC-Irvine who studies emotional responses to collective trauma.
“We now have 30 million Americans who have lost their jobs, who have no income — and how are they going to pay rent? How are they going to buy food?” Holman said. “And then you have to stay home. This event is rolling out like a long, chronic stressor.”
Even before the current crisis, California faced a serious shortage of mental health professionals, especially in rural areas. California’s psychiatrists and psychologists are approaching retirement age in large numbers, and fewer medical students are choosing psychiatry.
A UCSF study projected that the state would have 41% fewer psychiatrists than needed by 2028. More than half of Californians with mental illness receive no treatment, according to a February 2019 report by the California Future Health Workforce Commission.
UC’s online mental health nurse practitioner program is one of the solutions recommended by the commission, a statewide, multisector panel that created a master plan to address the Golden State’s shortage of health care workers.
The program is expected to put 300 more mental health NPs into California communities, particularly rural ones, over the next five years. Applicants such as Gunter, who live in underserved rural areas, will be given priority in the hope that they will stay in their communities upon completion of the training, said Deborah Johnson, a UCSF nursing professor who is co-director of the program.
Forty spots are available for the class that begins in January, and not all have been filled yet, Johnson said. Applications are being accepted until June 1, and 65 additional spots will open in fall 2021 and each fall thereafter for three more years, she said.
The UC system received a $1.5 million grant from the California Health Care Foundation to develop, design and launch it. But tuition is expected to make it self-sustaining. (Kaiser Health News, which produces California Healthline, is an editorially independent publication of the foundation.)
Applicants for the new program must already be advanced practice nurses, which means they hold either a master’s degree or doctorate in nursing. More than 27,000 NPs now practice in California, but only 1,200 are certified to treat psychiatric patients.
Three hundred more psychiatric NPs won’t completely fill the growing mental health care need, but they are expected to treat nearly 400,000 patients over a five-year period.
Though the online program means working nurses won’t have to leave their jobs and their lives to relocate, they will still face challenges.
For one thing, their certification will require 500 hours of supervised clinical training with patients in hospitals, jails or schools. And some applicants live in communities where such opportunities may not be available, which could require them to commute long distances to meet the requirement.
Another challenge is that, even after nurse practitioners are certified, state law requires they find a medical doctor to supervise them. Havilyn Kern, a school nurse in Nevada City, California, quit her job two years ago so she could spend three days a week at UCSF — 155 miles away — to train as a psychiatric nurse practitioner.
She graduates in June, so the new online program is too late for her. Kern, who plans to work in her own community, hopes she will find a psychiatrist in the Bay Area willing to tele-supervise her.
“It shouldn’t have to be this way,” said program co-director Johnson. “California is so archaic. It’s the most restrictive state in the western portion of the country.”
Twenty-eight states plus Washington, D.C., allow nurse practitioners to work autonomously. Santa Rosa Assembly member Jim Wood, a Democrat, has introduced a bill, AB-890, that would allow California NPs to practice without doctor supervision. It passed the Assembly in January and is pending in the Senate.
“If AB 890 passes, it will certainly help fill the loss of specialty physicians such as psychiatrists everywhere, including in underserved areas,” Wood said.
But that’s a big “if.”
California’s powerful doctors’ lobby, which has repeatedly scuttled similar legislation, is aggressively fighting it again. They argue that letting NPs order tests and prescribe medications independently would “dilute care.”
Doctors also have a financial incentive to keep things the way they are. It restricts competition, and they bill NPs between $5,000 and $15,000 a year to review their charts and prescriptions every few months, according to a report by the California Health Care Foundation and UCSF.
Johnson suggested it is time for a change.
“We are the workhorses,” she said. “Oh, my God, there is so much need. This new program could not come at a more important time.”
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
Virtual Reality (VR), once a province of science fiction, is becoming an everyday fact of life – and health care practitioners have been quick to recognize its potential.
Although physically in a classroom at the Vanderbilt University School of Nursing (VUSN), a group of students was far, far away, virtually experiencing campfires, galaxies, snowfall, and other relaxing settings.
The Psychiatric-Mental Health Nurse Practitioner students were exploring how virtual reality can be used in health care and education, taking part in an innovative VUSN pilot program called SparkleVille, which uses technology to enhance kinesthetic learning. The program also offers learning opportunities for nursing informatics students as part of their practicum.
“Students read research papers about virtual reality and are entrenched in didactic learning, but we wanted to provide an opportunity to experience the technology firsthand,” explained Assistant Professor and Skills and Simulation Lab Director Jo Ellen Holt, DNP. “The trial run gave students the opportunity to use VR and even consider prescribing it to clients in the future.”
The idea and VR class stemmed from a startup called Very Real Help, Inc. founded by Vanderbilt Psychological Sciences PhD candidate Noah Robinson, who studies clinical psychology and cognitive behavioral therapy in the College of Arts and Science. Kelly Aldrich, DNP, FHIMSS, VUSN Associate Professor and Director of Informatics Innovation, was introduced to Robinson through her projects at the Wond’ry, Vanderbilt’s Center for Innovation and Design. Very Real Help was spun out of the Wond’ry and has raised over $2MM to build its virtual reality clinical research platform. Robinson’s startup created a free VR app, Help Club (app.helpclubvr.com), to allow people to join peer-led mental health groups and experience calming situations. Aldrich thought it would provide a great opportunity to enhance nursing education.
Leaders of VUSN’s highly ranked Psychiatric-Mental Health Nurse Practitioner program agreed, always seeking ways to bring new experiences to their students.
After donning VR headsets, the students experienced the app’s areas of relaxation for themselves. When asked about the experience, most found it relaxing. They could see it being used for therapy, chronic pain management, working through fears and to offer unique experiences to people in nursing homes or hospice care.
“Initially the students were excited to try something new other than lecture,” Holt explained. “Some were skeptical or just had never considered VR environments. They had the courage to try and found it to be beneficial.”
Students shared their thoughts on Post-it notes mounted on a wall under different categories, including future applications/benefits, lingering questions, etc.
“Immersive virtual reality is the most interpersonal and anonymous technology—it simultaneously allows people to feel as if they are with others while also becoming an anonymous avatar with a username,” Robinson said.
Aldrich and Holt plan to set up research projects to see how VR can play a role in nurse support, stress reduction and retention, starting with a dedicated space for School of Nursing students, faculty and staff to try out VR technology for stress reduction later this spring. Some nurses leave the profession after a few years, citing stressful situations, Aldrich said. An app like Robinson’s could offer peace to those working this important, yet emotionally taxing job.
Under the SparkleVille program umbrella, Holt and Aldrich also work to advance innovation in nursing and health sciences through use of 3D printers, a maker’s space and smaller pilot programs.
“The program is a unique opportunity—a spark or magical area—where the two worlds of technology and informatics combine,” Holt said, adding that Sparkle stands for Simulation Projects Advancing Research and Kinesthetic Learning Experiences. “We want to see how we can advance these ideas and disseminate them.”
Aldrich believes VR nurse training will be a fruitful research avenue going forward. Vanderbilt may one day use VR to help students experience everything from empathy training to the positions of internal organs and disease processes.
“We’ve been exploring and pushing innovation in our curriculum,” Aldrich said. “As virtual reality gets better and better, we hope to find ways to advance the simulation environment through immersion experiences.”
Simulation pairs nicely with a virtual environment, offering numerous opportunities for educational experiences and learning critical techniques in a safe space.
“It’s fun to see how faculty are continuously trying to improve the experience for their students through our simulation lab,” Holt said. She said that the school’s simulation team is continually working with informatics faculty to help apply technology in smart ways.
“We were really excited to collaborate with Jo Ellen Holt and Kelly Aldrich to create a rich simulation experience for the PMHNP students in the Neuroscience for Mental Health Practitioners course,” said Assistant Professor Megan Simmons, DNP, PMHNP-BC. “The VR experience was a wonderful way for the students to explore an innovative form of self-care, which is especially important for mental health providers. After the simulation, many students commented that this was their first time using VR and they were surprised how much their mood was improved by the experience.”
“This interesting approach to education can scale beyond the traditional simulation environment,” Aldrich explained. “It will help as we watch pandemic protocols and want to continue helping students with this advanced learning experience.”
SparkleVille’s VR project, which is poised to support nurse well-being and retention, is being developed through a collaboration between VUSN’s nursing informatics program faculty and its simulation team.
During her last rotation as a nursing student at an outpatient program for severely mentally ill patients, Dawn Bounds found her calling as a psychiatric nurse.
“I loved it – to sit and talk with my patients and try to understand the context of their lives and how to support them,” recalls the Chicago native. “It was such an enjoyable experience that I knew specialize in psychiatry from that moment on.”
Pivoting to Psychiatry
Bounds, who planned to go into medical-surgical nursing, took a position in an inpatient child and adolescent psychiatry unit right after graduation.
Being in such a challenging environment came naturally to her – so much so that she used to joke she’d return after she retired. Bounds worked there while earning a master’s degree to become a family psychiatric-mental health nurse practitioner and a Ph.D. in nursing science at Rush University.
As a nurse practitioner, Bounds served in high schools and the county juvenile detention center on Chicago’s West Side. There, she helped at-risk female youths caught in a cycle of running away and getting locked up.
“I had two questions: Who are you running away from – what’s happening in the household that keeps you running? And who are you running to?” she recalls.
“Years ago, I attended a forensic nursing conference. They were talking about sex trafficking and sexual exploitation and all the red flags. I couldn’t help but think, ‘These are the girls I’m already taking care of,’” Bounds says.
“But nobody’s calling it sex trafficking or sexual exploitation. They’re just criminalizing these girls’ behaviors. They had these histories of being traumatized, and then on the other end, I was seeing them in juvenile detention, and I thought, ‘Something needs to change.’”
Supporting the Family Unit
Her research and day-to-day treatment took a fresh focus. Child welfare services often remove youngsters from abusive homes. But teens are more likely to remain in tenuous situations until they flee on their own.
Supporting young people, Bounds realized, meant supporting their entire families, especially those with minimal resources.
“These amazing kids were still going to school despite living in neighborhoods with shootings, violence, and substance use,” she says.
“I was just looking for ways to be of assistance and help them solidify some support networks so that they could not just survive but thrive amid many things beyond our control.”
Psychiatric DNP program
At UCI, where she joined the faculty this summer, Bounds will help establish a psychiatric-mental health nurse practitioner specialization in the Doctor of Nursing Practice program.
But the campus is not the only community that will benefit from her expertise and compassion. She plans to partner with primary care providers across Orange County to create an intervention that supports at-risk youths and their caregivers.
She wants to offer support beyond identifying trauma and suggesting emotional regulation techniques like exercise, yoga, and mindfulness.
“I feel like there’s this healthcare gap in how to make that happen. I think nurses and other health workers can become health coaches in the community,” Bounds says.
“Supporting teens chronically exposed to adversity could also mean connecting them to positive environments.”
This includes school-, faith- or sports-based youth programming, mental health care, housing, and support groups.
Technology’s Role in Helping Vulnerable
Her courses in the Sue & Bill Gross School of Nursing are delivered through Zoom, a tool she thinks could also serve a purpose in treating vulnerable patients. Still, Bounds misses the human connection and hopes her students can feel her warmth and sincerity through the screen.
“Being a psychiatric nurse practitioner, I know that those relationships you build are so important,” she says. “Even when they’re not my patients, students, and colleagues, I want that connection to be there.”
When asked about her proudest accomplishment, Bounds cites her mentoring ability.
“I come from a community that could be considered under-resourced, so I’m proud to be a role model for those I work with. A single mom raised me. I’m a first-gen college student. And now I have a Ph.D. and am working at the University of California,” she says.
“To me, I’m an example of that young person who might have limited resources and support right now. Examples like mine that demonstrate possibilities for young people are so important.”
The Executive Committee of the Fellows of the American Association of Nurse Practitioners (FAANP) has announced the recipients of this year’s Loretta C. Ford Award and Legacy Awards. The FAANP program was established in 2000 to recognize nurse practitioner (NP) leaders who exemplify the values of their profession through research, practice and advocacy.
“The recipients of the 2022 FAANP Awards,” said April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of AANP, “are trailblazers and innovators who truly exemplify the excellence for which NPs are known. Each awardee has made admirable contributions to health care — and to the NP role — inspiring NPs of the future.”
2022 Loretta C. Ford Award for Advancement of the Nurse Practitioner Role in Health Care
Named for co-founder of the NP role, Loretta C. Ford, EdD, RN, PNP, NP-C, CRNP, FAAN, FAANP, this award is presented annually to an NP who demonstrates participation in health care policy development at an international, national or local level; sustained and specific contribution to clarification of the role and scope of practice of NPs; or creative and effective action that turns a challenge to the NP role into an effective opportunity to advance practice and improve patient outcomes.
The recipient of the 2022 Loretta C. Ford Award is
William E. Rosa, PhD, MBE, AGPCNP-BC, FAANP, FAAN.
Rosa, an NP, is an assistant attending behavior scientist in the department of psychiatry and behavior sciences at Memorial Sloan Kettering Cancer Center. Rosa’s work focuses on cancer pain disparities, global palliative care inequities, LGBTQ+ inclusive palliative care communication and psychedelic-assisted therapy in the context of cancer-related distress. He is the editor of four books and has contributed more than 150 academic publications in journals and texts. He was the lead researcher for the 2021 Nurses for Health Equity: Guidelines for Tackling the Social Determinants of Health policy report endorsed by the World Health Organization.
2022 FAANP Legacy Award
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Established in 2020, the FAANP Legacy Award honors, recognizes and memorializes a member of FAANP whose lifelong career has had a profound and enduring impact on the profession and the NP role, articulating a dream that others share and follow. The vision, innovation, courage, persistence and inspiration of the honoree are essential components of the legacy.
Recipients of the 2022 FAANP Legacy Awards are as follows:
Ruth Kleinpell, PhD, RN, FAAN, FAANP, FCCM, is well known for her research related to outcomes after critical illness, patient- and family-centered care, the role of the advanced practice registered nurse (APRN) and APRN outcomes. Most recently, she served as the co-principal investigator on a national survey of more than 7,000 APRNs assessing barriers to practice and the impact of the COVID-19 pandemic on APRN practice.
Lori Martin-Plank, PhD, FNP-C, GNP-BC, PMHNP, FNAP, FAANP, began teaching NPs in 1995 and has continued to balance practice with teaching, often serving as a preceptor for her students. Martin-Plank has a passion for advocacy and health policy and has been active in her home state of Pennsylvania, as well as in New Jersey. She is a strong believer in networking, mentoring and sharing knowledge among practitioners, students and educators for the benefit of the profession.
Henry Silver, MD, FAANP(H), was co-founder of the NP role at the University of Colorado. FAANP honors his pioneer spirit, courage and dedication. Thanks to his collaboration with Ford, a new health care role was created with the goal of improving access to care for underserved pediatric populations. Despite many barriers and fierce opposition to the implementation of the NP role, Silver and Ford remained a tenacious and unstoppable team who put patients’ needs first and forever changed health care in a profoundly positive way. Today, patients make more than 1 billion visits to NPs annually.
Forty new AANP Fellows will be inducted at the 2022 AANP National Conference in Orlando, Florida, on June 23. Learn more about the FAANP program and the invaluable contributions these NP leaders have made to patient health.
I have been a psychiatric mental health nurse practitioner (PMHNP) since 2010.
Named for co-founder of the NP role, Loretta C. Ford, EdD, RN, PNP, NP-C, CRNP, FAAN, FAANP, this award is presented annually to an NP who demonstrates participation in health care policy development at an international, national or local level; sustained and specific contribution to clarification of the role and scope of practice of NPs; or creative and effective action that turns a challenge to the NP role into an effective opportunity to advance practice and improve patient outcomes.