A Case Study on the Role of PMHNP in Medical Institutions

Psychiatric-Mental Health Nurse Practitioners (PMHNP) are common in behavioral healthcare, dealing with patients exhibiting mental health disorders. From psychiatric diagnosis to the recommendation of therapy programs, PMHNPs provide psychiatric health to patients who may have a drug abuse history while also recommending treatment plans. The number of psychiatric patients increases yearly in the U.S., and the need to train and employ more PMHNPs grows daily as the demand for these professionals grows in healthcare institutions (Fraino & Selix, 2021). Among all psychiatric care institutions, John Hopkins Hospital was named one of the best mental health organizations from 2020-2021. The staff provides high-quality healthcare to admitted patients and those that enroll in their treatment programs. The organization is learning, research, and healthcare center, providing a wide range of services, including gynecology, surgery, and psychiatric care. Located in Maryland, the organization seeks to provide quality healthcare services to its patients through proper diagnosis of diseases and research that prescribes medication to cure medical issues in human beings, providing hope to humanity. Additionally, the organization seeks to provide training to produce the best nurse practitioners, physicians, and doctors. I was pleased to interview Nancy Roberts, a professional PMHNP in John Hopkins, Maryland. In our interview, she portrays a depth of understanding of the role of psychiatric care in society and shares her commitment to the institution's long-term goals and vision. Her responses are an excellent resource for me and any PMHNP in training who hopes to practice professionally.

Interview Questions

1.    Describe your role as a PMHNP at John Hopkins Hospital and other roles that may be allocated to you.

2.    In your view, have psychiatric health policies influenced the quality of healthcare provided in your institution?

3.    As we have seen in other healthcare institutions, does the quality of psychiatric healthcare provided by John Hopkins dependent on the type of insurance cover patients have?

4.    How long have you been a professional PMHNP? Could you share essential experiences in your roles that were pertinent to your current role?

5.    Is the training offered in psychiatric training institutions sufficient in preparing practitioners to work with patients with actual mental health issues? As such, what is the place of research and EBP in practice?

6.    Which inter-professional collaborations have been most significant to your role as a PMHNP? Are there recommendations you would make to your organization or other organizations on improving the efficiency of such collaborations?

7.    Are there professional requirements before a change of role or promotion to leadership status at John Hopkins?

8.    What ethics in healthcare have improved the quality of healthcare in Maryland, especially psychiatric healthcare?

9.    What is your general view of working as a PMHNP? Do you find it fulfilling? What are your future goals?

10.                What recommendations would you make to your organization, the state government, or citizens to improve psychiatric healthcare?

 Interview analysis

Nancy Roberts works as a professional PMHNP at John Hopkins hospital. She has been working in the organization for five years in the same role and psychiatric department, although one year out of the five was spent in practitioner training. During the one-year training, she earned her Post-Masters Psychiatric-Mental Health Nurse Practitioner certificate and qualified to work in the workforce.

“Towards the end of 2021, when I got accepted to study for my master's degree at John Hopkins Hospital, I had just completed my degree program and was looking for a job that could help me pay bills and have a regular source of income. However, I did not know that that was my best decision. My experience here has been great since I have worked with professionals that are well recognized in practice and patients who have been invaluable. In my department, we diagnose mental disorders for individual patients, couples, and families and recommend treatment plans that could improve or completely eradicate these conditions (Roberts, personal communication, September 15, 2022).”

The cost of healthcare continues to increase every year. Nancy Roberts noted some Maryland policies which influence patients' insurance covers and the quality of healthcare available to them. Other policies, however, include amounts set aside for healthcare by treasury departments in various states, immunization specifications for children and the process practitioners go through before they can professionally practice (Healthcare Policy in Maryland, 2022). These policies influence the general well-being of citizens since insurance covers are limited by the payments made by clients, which are also influenced by the cost of healthcare and citizens' income. Nancy mentioned that,

“Specifically for mental health disorders, we have diagnosed serious chronic mental illnesses too late since patients cannot afford regular checkups or subsequent treatments. The continual demand for healthcare is not matched by government funds to finance the same and consider the different social classes. Only a few citizens can afford mental healthcare. Additionally, I believe that policies that increase the awareness of mental health issues influence the willingness among citizens to access professional help. At John Hopkins, like other medical institutions, insurance coverage influences the type of medical care provided by professionals but does not influence the quality of healthcare provided. We treat all patients equally in terms of care and recommend treatment plans that work long-term (Roberts, personal communication, September 15, 2022).”

Nancy spoke fondly of her training process, degree qualification, residency, and experience at John Hopkins Hospital.

“I thought academic qualifications were most important in becoming a PMNHP, but qualifications go beyond academia. The ability to empathize with people is an important skill I developed, essential for my practice. For a person with mental disorders, society's stigmatization influences their relationship with their helpers; therefore, it is important to practice kindness and empathy to understand patients, which may positively influence the treatment plans a medical team may recommend. I believe there is sufficient training depending on the institutions aspiring PMHNPs in the U.S. choose to study. However, research and empirical practice are essential since medical solutions always improve, with different professionals discovering ways to explore treatment options (Golom & Schreck, 2018). Additionally, inter-professional collaboration, a healthcare trend enables healthcare workers to interact with patients and decide the best treatment plans in unison. John Hopkins Hospital applies a PET research model, which enables nurses to have practice questions, research the evidence, and translate it into their practice (Parekh & Swartz, 2021). If the same were applied universally for all healthcare institutions, healthcare quality would improve (Roberts, personal communication, September 15, 2022).”

Since John Hopkins is ranked as the best nursing training and post-graduate institution, Nancy noted that even getting a chance to study or work there is an honor. Academic qualifications are very high, ensuring enrolled students are the best in healthcare. However, she said that experience with patients, consistently good reviews from the psychiatrist in charge, and unique skills in nursing and healthcare could be prerequisites for promotion. Most recent ethical issues include digital psychotherapy, which facilitates the online interconnection between patients and psychiatric helpers (Martinez-Martin & Kreitmair, 2018). Since these sessions are not supervised, ethical issues such as confidentiality, patient consent before engaging other professionals for a pool of treatment help, accountability, and safety are essential in assuring the patients (Martinez-Martin & Kreitmair, 2018). These ethical issues have improved medical practice since it has allowed Nancy to interact with patients without physical meetings and give accounts of sessions to required supervisors, as is the requirement in medical practice. From the interview, it was clear that Nancy Roberts loves her job and is committed to improving the quality of psychiatric healthcare in her community by increasing awareness of mental health issues and providing affordable and high-quality treatment plans.

Conclusion

From this interview, I was intrigued by the vision and mission of John Hopkins Hospital, which Nancy Roberts, my interviewee, shared. I learned of her process before admission as a professional PMHNP at the organization, which is ranked among the best healthcare institutions in the U.S. Health policies in Maryland have contributed to factors such as accessibility to mental healthcare and accessibility to licenses by practitioners. From her experience, I learned the place of research, empirical-based practice, and inter-professional collaboration, which are common concepts at John Hopkins Hospital. Healthcare trends such as digital psychotherapy, if applied well, could be recommended to other psychiatric centers for better healthcare service provision.

 References

Fraino, J., & Selix, N. (2021). Facilitating Well-Rounded Clinical Experience for Psychiatric Nurse Practitioner Students. The Journal for Nurse Practitioners, 17(8), 1004-1009. https://doi.org/10.1016/j.nurpra.2021.05.015.

Golom, F. D., & Schreck, J. S. (2018, February). The Journey to Interprofessional Collaborative Practice. Pediatric Clinics of North America, 65(1), 1–12. https://doi.org/10.1016/j.pcl.2017.08.017.

Healthcare policy in Maryland. (2022). Ballotpedia. https://ballotpedia.org/Healthcare_policy_in_Maryland.

Martinez-Martin, N., & Kreitmair, K. (2018). Ethical issues for direct-to-consumer digital psychotherapy apps: addressing accountability, data protection, and consent. JMIR mental health, 5(2), e9423. https://doi.org/10.2196/mental.9423.

Parekh, V. K., & Swartz, K. L. (2021). Lessons for psychiatrists from the COVID pandemic: the need for expanded roles and additional competencies. International Review of Psychiatry, 33(8), 668-676. https://doi.org/10.1080/09540261.2021.2011709.