Psychiatric-mental health nurse practitioners (PMHNPs) work with patients with mental or behavioral issues and their families in different settings. They assess their clients’ needs, develop nursing care plans, implement them, and evaluate their effectiveness in improving wellbeing. PMHNPs usually have the responsibility to evaluate and determine their sufferers’ health. They consult and work in conjunction with other wellness professionals on treatment plans. They develop the blueprint for a journey to get the victims back to normal. They also provide psychotherapy medication and are tasked with maintaining medical records for those sick. They provide help and support for the mentally ill and educate them and their families to gain suitable recovery. Many of these roles are similar to those conducted by psychiatrists and include diagnosis and prescription of curative drugs (Ohnishi et al., 2019). They should be open-minded as those people may have those conditions accompanied by other disorders.
Training and Education
PMHNPs begin their career with ordinary nursing education at an associate degree, diploma, or bachelor’s level. The learning is followed by studying pharmacology and behavioral and social sciences. Within three years after becoming registered nurses (RN), PMHNPs must acquire 2,000 hours of experience in the field of mental health or complete 30 hours of such schooling. Alternatively, they can work as full-time RNs for two years. Therefore, PMHNPs have training differing from psychiatrists, social workers, and psychologists, but they work alongside each other (Ring & Lawn, 2019). They cannot make formal diagnoses, advance treatment plans, or prescribe medications unless advanced practice registered nurses have completed master’s or doctoral-level studies in this field.
Scope of Practice and Visibility
PMHNPs have their scope of practice defined by professional bodies, work environments, or countries of operation. Institutional level constraints have been a major concern for psychiatric nurses, affecting their work and causing moral distress (Chapman et al., 2019). When institutions limit the nurses’ choices, they remain helpless, and patients continue to suffer. When the PMHNPs are limited by external power from institutions or laws, their roles become less helpful in the overall care process.
PMHNPs are the majority of staff members in the mental health practice but are also the most limited. Phoenix (2019) found that over 4% of American nurses are directly working with such facilities or indirectly operating in diverse institutions that treat patients in the mental health practice. This is the same case in many parts of the world like in our case study, Australia. Many of these are called staff nurses, while a few have the title of nursing manager, and even fewer are designated as advanced practice nurses.
Most institutions and health regulations require nurses to diagnose or prescribe medications only under the supervision of medical doctors (Chapma et al., 2019). Psychiatric nurses require the supervision of psychiatrists to prescribe medications and release mental health holds. PMHNPs opt to work in more autonomous settings, where they can make most decisions without seeking supervisors or waiting for other medical personnel to authorize. Moral distress occurs when PMHNPs know the right thing but cannot do it because they must adhere to institutional regulations or the law. Therefore, these nurses would optimally perform where they have autonomy in decision-making and patient care.
PMHNPs lack visibility in the relevant literature, which affects educational funding and development, career forecasts, and visibility in the health sector. The career area lacks data to support research or government publications (Phoenix, 2019). Joubert and Bhagwan (2018) found little research on the challenges and roles of psychiatric nurses in inpatient environments. Staff shortage in mental health facilities could be resolved by broadening the mandate of PMHNPs. Chapman et al. (2018) argue that the underutilization of psychiatric nurses, mainly due to institutional barriers, is a major contribution to understaffing because they account for more than half of all professional care providers in these centers. These limitations can only be lifted if researchers focus on the psychiatric nursing field and provide enough evidence for their roles, training, experience, and special skills. Delaney and Vanderhoef (2019) identify reasons for low visibility as incorrect information regarding the psychiatric nurse practice, misrepresentation of the workforce, and faculty shortages in psychiatric mental health programs (PMH). These gaps in visibility and scope of practice must be closed in training schools, literature, and places of work.
PMHNPs Specific Skills
There is insufficient information about psychiatric nurses, including their education and training, work environments, and roles. Nevertheless, certain skills are basic to the practice but may change with an institution or work setting. According to Beks et al. (2018), generalist nurses working in rural mental health facilities experience several challenges when handling patients due to lack of formal training, feelings of being ill-equipped, time wasted in telephone triage, and need for support from psychiatrists on site. These problems indicate that PMHNPs must possess specialized skills, personal qualities, and training.
There are certain elements of caring that contribute to the effectiveness of their job. NPs should be attentive, responsible, competent, and responsive to the patients. Their aim should achieve the preservation of the client’s dignity, which leads to a personal connection with each sufferer. Their dedication should push them to go out of their way to ensure that the needs of the customers are well met. Nursing facilities should establish policies that contain the requirement of hourly rounding and ‘No Pass Zones.’ They should be aware of their roles in regards to the people under their care who need treatments and inform them of the medical options available and suitable to them. Competence should be demonstrated regularly and re-certified by enrolling in programs and seminars to advance their skills and knowledge. Patients’ recovery also depends on how their families manage it. Maintaining a positive outlook should be provided by NP for a quick path to well-being.
Clinical Challenges of the Role They have Chosen To their Workplace
Although psychiatrists’ activities are becoming more well-known, little research has been done on the function and challenges of psychiatric nurses in local mental care facilities. The current study looked at the roles of psychiatric nurses in hospital inpatients and the obstacles and difficulties that come with caring for those who are mentally ill (Posluns & Gall, 2020). Travel limitations make it difficult for the PMHNPs personnel to go to their areas of work (Wu et al., 2020). Psychiatric nurses who work in a dangerous setting are not aware of the dangers they face. They require assistance and support in their work since they are under a great deal of stress from a variety of work-related issues and increased domestic and family responsibilities (Svavarsdottir & Gisladottir, 2019). Due to the Partition Wall and movement restrictions, psychiatric nurses, for example, confront similar obstacles.
One of the most significant concerns confronting psychiatrists is that health services governed by health authorities have been experiencing financial difficulties since their beginnings. Sanctions imposed due to a lack of foreign funding have affected the financial position, and a scarcity of resources is difficult for all psychiatric nurse practitioners. PMHNPs, just like other nurses and midwives, make a living, work long hours, are understaffed, and are responsible for heavy loads. Psychiatric nurses (Joubert & Bhagwan, 2018) work in deplorable conditions and receive little inspiration.
PMHNPs have a medical equipment scarcity as well as a monthly income shortage. This lack of resources can be linked to complete political constraints before and during the Health Authority’s leadership. A factor is the lack of an effective nursing organization for employing more resources. Human resources, learning opportunities, supervision or mentorship, substandard requirements and infrastructure, and financial support have been in short supply. Each district, which may have a population of a quarter of a million people, may have one or no psychiatric nurse in the most covered region (Posluns & Gall, 2020). During retirement or employee leave, adjustments are not uncommon to occur due to under-staffing.
Financial difficulties are especially pressing for mental health services that provide care at one of Australia’s most demanding training institutions. According to the WHO and the Australian Ministry of Health, mental health services have been badly impacted by chronic funding. When faced with overwork and a lack of resources, mental healthcare practitioners were unable to give the kind of care they would have otherwise received, and a distinction was drawn between what they learned and what they were able to perform. Joubert & Bhagwan (2018) discovered that nurses working in the mental health field were earning poor salaries. There were major staff shortages even before the Health Authority took over the people’s welfare system in 1995 (Ameel et al., 2019). Home visits are limited or non-existent, as are further education or professional development opportunities.
Insults connected with mental illness are present in the context of social obstacles. This research uncovered facts that could be linked to findings in previous documents from other countries. Racism, for example, is one of the most pressing issues in low- and middle-income nations. Nurses that handle psychiatric patients cannot continue or join the mental health field due to a lack of funding and resources. In Australian countries, the most consistent challenge in this sector is the fact that they view the outcome very negatively. There is stigmatization and prejudice in persistence despite all the media campaign awareness and celebrity disclosure indicating the amount of work to be done to curb the same. Nurses in this region are exposed to the unpredictable behavior of their patients who may be in a position to cause harm (Ameel et al., 2019). There is a lot of dissatisfaction in their workplaces that is underestimated.
There is a problem with collaboration due to a lack of clarity in work positions. The issues were a lack of clear job descriptions, various tasks, significant positions, and a lack of communication and required technology. There has been a bias against nurses, particularly mental health nurses. As a result, a Credentialed Mental Health Nurse in Autralia is weak, divided across the country, and lacks job ownership and independence (Joubert & Bhagwan, 2018). These issues were intertwined with lack of enough support and resources.
Theoretical Understanding of the Chosen Role
Maintaining a healthy and supportive workplace offers two benefits. Psychiatric Nurse practitioners are more satisfied and provide better care when working in a positive environment. Our findings imply that hospitals and community centers have different psychiatric nursing staffing requirements, which should be considered when planning the provision of mental health services to minimize negative consequences for patients and psychiatric nurses. Collaboration, self-regulation, leadership, and independence were all highlighted as areas of weakness in this study. According to the literature, these factors influence care-givers and patient outcomes, as well as the quality of care offered. As a result, it’s beneficial to understand why this issue happens at work. In addition, the study highlighted critical factors influencing carers’ perceptions of vocational training areas in greater depth (Ameel et al., 2019). Finally, the findings of this study could be used to develop management strategies targeted at enhancing their professionalism.
Low power and certified medical directors (CMDs) are crucial to examine, both in terms of how they affect nurses and staff engagement. Significant correlations with night work, insomnia, junk food, and high levels of common symptoms and isolation were discovered in this study. Low back pain and CMD, both connected to poor health in this study, may come from a lack of nurses and presentation. Because it is easy to recognize and measure, absenteeism is frequently a key concern in organizational and personnel matters (Delaney & Vanderhoef, 2019). However, given the potential for widespread impact on productivity, personal wellbeing, and patient safety while nurses with CMDs are on the job, the presence of demonstrations may be even more concerning.
The Registration Standards in Australia and the Practice Domains
The standards of Registered Nursing Ethics should be examined in light of Australia’s wide cultural and linguistic variety. RNs recognize the historical and cultural significance of health and wellbeing, according to Beks et al. (2018). This approach reveals a unique knowledge of the impact of colonization on Aboriginal and Torres Strait Islander cultural, social, and spiritual lives, which has resulted in severe health disparities in Australia. Psychiatric nurses register as generalist nurses but must have training in mental health. The specific requirement in Australia is a master’s course in mental health nursing. Therefore, every RN can become a PMHNP by pursuing this academic requirement.
To inform the delivery of mental health treatment, they understand and incorporate applicable laws, rules, and standards. In addition to the rules, guidelines, and qualities that every nurse plans to follow internally in terms of mental health care, requires further consideration. Rules and regulations define procedures for mentally ill persons in areas such as information availability, consent, automatic treatment, and decision-making when they do not have the power to do so (Delaney & Vanderhoef, 2019). These issues are frequently linked to the basic operating system where people begin treatment. Furthermore, specialized diagnostic recommendations for several psychological health issues reflect evidence-based care and treatment alternatives.
These criteria emphasize that nurses are frequently exposed to various mental health difficulties, from a debilitating psychological disease that does not meet the diagnostic threshold to severe brain illness. According to Joubert and Bhagwan (2018), it also acknowledges the nurse’s responsibility to promote rational health and wellbeing and decrease the stigma associated with this illness. A nurse can often apply these rules in their work, although judgments on whether a specific aspect of clinical care is under her unique responsibility are made by a single nurse using the NMBA decision-making framework. The following standards are also used to facilitate their working procedures.
Standard 1: Analyzing and critical thinking practice of nursing in making decisions, psychiatric nurses employ a variety of thinking strategies and the most up-to-date evidence to provide a safe, standardized tending practice within human-centered and evidence-based structures. They use the best available exhibit, including the findings of a safe, quality practice study, to access, assess, and apply it. These care-givers develop a habit of reflecting on their experiences, knowledge, actions, feelings, and beliefs. This is done in a bid to see how these formation processes respect all cultures and experiences, including the role of the family and community in supporting Indigenous Australian life and Torres Strait Islander people.
Standard 2: The practice of a registered nurse is founded on active participation in successful and professional medical relationships. This standard entails liberal sharing in mutual trust and respect in professional partnerships. The psychiatrist will build, maintain, and manage connections so that the lines between professional and personal interactions are well defined. Second, they successfully communicate while respecting human dignity, culture, values, beliefs, and rights, and last, they recognize that people are experts in their own lives.
Standard 3: It keeps RNs’ capacity to practice as regulated health professionals responsible for ensuring that they are safe and have the authority to do so. It entails constant self-regulation and response when other health professionals’ ability to adjust is questioned. RNs are in charge of their executive growth and contribute to the development of others. They also have a responsibility to provide information and education to enable people to make health-related decisions and actions.
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