“LEAVING ON A JET PLANE”
Interprofessional Collaboration: One of the underlying tenets of President Obama’s Patient Protection and Affordable Care Act (ACA) is the provision of patient-centered holistic care, provided by interdisciplinary teams of health professionals. Psychology and nursing have a long, if not well appreciated, history of collaborative efforts. Carol Goodheart, APA 2010 President, has a nursing background; as does Linda Richardson, former President of Division 18 (Psychologists in Public Service). Beverly Malone, CEO of the National League for Nursing, and Nursing “Living Legend” Angelia McBride both possess doctoral degrees in psychology. Susan McDaniel, 2016 APA President noted: “The primary care workforce now depends on Nurse Practitioners (NPs) and nurses to provide high quality primary care.”
Accordingly, when on February 4, 2019, New Mexico Governor Michelle Lujan Grisham signed into public law a significant modification of their landmark 2002 Prescriptive Authority legislation, we were very pleased that our ground-breaking colleagues involved professional nursing. The new provisions authorized New Mexico psychiatric nurse practitioners (as well as clinical nurse specialists and other nurse practitioner specialties) to serve as supervisors and collaborative partners during the required practicum supervision and conditional authority process.
“New Mexico’s psychologists, and particularly prescribing psychologists, have always maintained a highly respectful and productive relationship with our nursing colleagues. Our close working relationship with nurses has greatly enhanced quality care to many underserved populations in the state. Academic nurses from New Mexico State University (NMSU) were instrumental in developing the pathophysiology and physical assessment modules of the University’s post-doctoral master’s degree in clinical psychopharmacology. They testified for psychologists on behalf of our RxP bill and have taught in the NMSU post-doctoral program, as well as providing some ongoing continuing education training for our prescribing psychologists. We are pleased to be expanding our collaborative efforts. Nurse practitioners provide a preponderance of care in underserved communities in New Mexico. With our appended law, which will allow nurses to supervise our RxP students in training, we will be able to extend access and quality care across New Mexico” (Renee Wilkins and Elaine Levine). Following New Mexico’s lead, psychology prescribing bills in the Hawaii and Florida legislature this year will also formally recognize nursing’s clinical expertise.
Advancing the RxP Movement: Hawaii’s Judi Steinman, Division 55 President: “We have included Nurse Practitioners and Prescribing Psychologists as practicum supervisors in our Hawaii RxP bills, recognizing the skills and expertise of these specialties as educators as well as practicum preceptors. Some of our islands do not even have physicians, let alone psychiatrists, willing to serve as supervisors. The University of Hawaii at Hilo and now Alliant International University MSCP programs include APRNs-Rx’s as faculty members.” Steve and Anthony Ragusea: “Florida prescribing psychologists would welcome nurse practitioner supervision as one of several options and we hope that the Florida legislature will permit us to follow New Mexico’s visionary lead in this regard.”
The Duke Blue Devils: Two of the former faculty members of the Daniel K. Inouye Graduate School of Nursing at the Uniformed Services University (USU), U. S. Navy Commanders (ret.) Sean Convoy and Pam Wall have been developing the psychiatric mental health nurse practitioner program at Duke University, emphasizing on-line education. Both Sean and Pam served in the Navy for over two decades. Sean: “We are hoping this effort reflects a new entrepreneurial spirit defined by genuine inter-professional collaboration that places patient access and outcomes above provider pedigree and earning potential. Supported by the Institute of Medicine’s Future of Nursing report, the Federal Trade Commission’s report on Competition and the Regulation of Advanced Practice Registered Nurses (APRNs), and the seven states and territories that have passed legislation supporting prescriptive authority for clinical psychologists, we are constructing a strong foundation for a long overdue paradigm change. APRNs providing prescriptive supervision to clinical psychologists represents scaffolding for this new paradigm. We would like to see a more balanced approach where APRNs collaborate with clinical psychologists to translate their psychotropic prescribing knowledge, skills and abilities (KSA) and our clinical psychologist brethren translate their advanced psychotherapeutic KSA back to APRNs. In a new paradigm such as this, all members of the mental health care delivery system would be vital and valued members of an ensemble cast where the diversity of our education and experience are seen as strengths and not wedge issues.
“At Duke University’s School of Nursing we are currently partnering with all willing stakeholders to grow our psychiatric mental health nurse practitioner program. We partner with our physician and clinical psychology colleagues for preceptorship support, standardized patient simulation and most recently a local DukeAhead grant entitled ‘Training and Education to Advance Multicultural Mental Healthcare Delivery (TEAM Mental Healthcare Delivery)’. Much like the larger political discourse we currently live in, the public has grown weary of political infighting. Now is the time for members of the mental health care delivery system to genuinely collaborate, strike grand bargains and reestablish that shared mental health vision which recognizes the patient as the chief outcome of a shared interest.” In appreciation for their collaboration, Susan McDaniel served on the Duke University School of Nursing Board of Advisors for six years.
Telehealth – The Wave of the Future: “As the Program Manager for the Military Health System Virtual Health Program, I can appreciate the importance of psychology and nursing developing an increasing presence in telehealth. The National Defense Authorization Acts of 2017 and 2019 gave us a path to work together as a team of healthcare providers supporting Soldiers, Sailors, Marines, and Airmen to achieve a high level of Readiness while maintaining the health of Military Beneficiaries. For this reason, the legislation centralized the delivery of healthcare within the Military Treatment Facilities around the world that support military health beneficiaries with the intent of making the Quadruple AIM goals (i.e., improving the health of populations, enhancing the experience of receiving care, reducing the per capita cost; and, for the military, enhancing Readiness) a reality. Virtual health, as a modality to deliver healthcare, provides our beneficiaries medical care through mobile technologies, anytime and anywhere, while enhancing the availability of specialty services.
“Three main capabilities are being pursued within the Military Health System which includes Synchronous, Asynchronous and Remote Health Monitoring care. Synchronous capabilities allow beneficiaries to perform live interactions with members of the healthcare team. Asynchronous capabilities provide a direct provider to provider teleconsultation portal that enhances the ability of primary care providers to get near immediate access to specialists in any environment, including areas that have limited or sporadic bandwidth. Finally, remote health monitoring allows for the direct visualization of healthcare status of chronically ill patients, allowing us to inject a dose of healthcare within the patient’s home environment. Virtual health technology will allow us to improve the ‘lethality’ of the Military Health System (from a healthcare perspective) by enabling methods to improve Readiness while enhancing the availability of Military Medical Services around the world, while reducing costs, enhancing access and improving quality” (U. S. Army Col. Francisco Dominicci).
A Recurring Question: Are psychology’s graduate training programs preparing the next generation of clinicians to practice successfully within the health care environment of the future? To date, I have not been able to identify any psychology graduate program that provides its students with telehealth training experiences. In contrast, at USU Jeff Goodie actively collaborates with the Family Medicine department and Nursing programs to have graduate psychology students engage with their medical and nursing colleagues. “We have our advanced clinical psychology students observe Family Medicine clerkship students during an interview with standardized patients and then give structured feedback to those medical students about their communication skills. Psychology students also practice providing behavioral health interventions alongside Psychiatric Mental Health Nurse Practitioner students during a three day deployment exercise.”
APA recognizes the importance of promoting interprofessional training. As APA President Susan, with support from APA staff Catherine Grus, appointed Jeff and Ron Rozensky co-chairs of a work group that created an Interprofessional Seminar on Integrated Primary Care [https://www.apa.org/education/grad/curriculum-seminar] that is a resource for helping healthcare professionals develop competencies for working together. The seminar includes modules that can be adapted as needed to cover a range of topics including elements of interprofessional care, ethics, models of leadership, and health policy and advocacy. “Don’t know when I’ll be back again” (John Denver). Aloha,
Pat DeLeon, former APA President – Hawaii Psychological Association – March, 2019
