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How Nurse Practitioner Authority Varies By State

How Nurse Practitioner Authority Varies By State

The degree to which nurse practitioners (NPs) can utilize the full extent of their education and training varies from state to state and practice to practice. For NPs, there are rules on how they can see patients, whether or not they need a collaborative physician, and what controlled substances they can prescribe with or without the need for co-signatures. Depending on the needs your organization is trying to fill, whether it’s addressing the growing provider shortage or decreasing patient wait time, utilizing a nurse practitioner can help with a wide variety of issues.

According to the AANP, nurse practitioners’ independence varies depending on what state they choose to practice in. The three types of state practice environments are:

  • Full practice (independent)
  • Reduced practice (partially independent)
  • Restricted practice (non-independent)

In restricted practice states like Texas, NPs must be under another health provider’s supervision to practice. Reduced practice states like New York allow NPs to be in a collaborative agreement with another health provider to facilitate patient care. They also have one or more limits on NP practice. Full practice states like Arizona allow NPs to practice independently, evaluate, and provide care to patients without a collaborating physician or agreement.

As of right now, there are 23 full practice states, 16 reduced practice states, and 11 restricted practice states.

Finding the right fit

While NPs are essential to addressing the provider shortage and improving the patient experience, they’re also indispensable when it comes to mental health treatment. The type of NP working in the mental health field is called a psychiatric mental health nurse practitioner or a PMHNP. These providers can be found working in correctional settings, residential treatment centers, inpatient hospitals, health systems, and some private practices. However, the majority of PMHNPs are practicing in underserved and rural areas.

PMHNPs can be a major benefit to your organization, especially if your organization serves patients from vulnerable populations, like Community Mental Health Centers (CMHCs), Certified Community Behavioral Health Clinic (CCBHCs) and Federally Qualified Health Centers (FQHCs). They are skilled at caring for patients, and their quality level is similar or equal to that of a psychiatrist. Not only can they provide a similar quality of care as a psychiatrist, but they are also skilled at facilitating holistic care, which overall contributes to the level of quality care and treatment they can provide.

PMHNPs receive specific training in various types of treatment they provide like:

  • Extensive training in psychotherapy and behavioral health conditions
  • Crisis intervention and directing patient care planning
  • Collaborative care
  • Effective communication with patient families

If your organization is looking to provide these skills and treatments, PMHNPs might be a valuable asset for your organization.

Challenges and opportunities you might face

Across the country, healthcare organizations are experiencing a primary care shortage that is being exacerbated by the COVID-19 pandemic, especially in rural areas. According to USAFacts, as of March 2021, 37% of the U.S. population lived in 5,833 mental health professional shortage areas. Providing cost-effective but high-quality care can be difficult in these regions, but nurse practitioners can serve as a primary care provider in full practice states.

In restricted and reduced practice states, PMHNPs cannot practice without a collaborating physician. During the provider shortage, it is especially challenging to find a collaborating physician. These agreements have to be renewed annually, and they have to meet with the physician they are collaborating with on a monthly basis. This specific agreement can cause issues for rural areas where there may not be a physician locally available, or there may be a shortage of physicians who would be able to work collaboratively with a nurse practitioner. In some extenuating circumstances, if the collaborating physician becomes ill or retires, patients cannot be seen, and you might have to cancel the appointment.

By utilizing telepsychiatry, you can find the best-qualified PMHNP for your organization’s needs, especially during a provider shortage when you cannot find a PMHNP locally. Telehealth can extend healthcare delivery to underserved populations and rural areas. With the help of a PMHNP, it can be easier to meet that need by partnering with telehealth organizations like Iris Telehealth. Telepsychiatry solutions can help healthcare organizations overcome access issues and help alleviate the pressure of finding a qualified provider locally. For example, a PMHNP living in Texas can meet the licensure requirements in Utah, making it possible to extend healthcare delivery through telepsychiatry.

Telepsychiatry that meets you where you are

Regardless of where nurse practitioners practice, they can utilize telehealth to connect their patients with specialty care while working in their scope of practice. Telepsychiatry can open up your search by hiring a PMHNP from across the country instead of searching locally, especially since there is a high saturation of providers on the East Coast and a higher need on the West Coast.

If you decide to hire a PMHNP for your organization, you can ease some of the administrative burdens, like licensing, credentialing, and obtaining a collaborative agreement.

How Iris Telehealth can help

Iris Telehealth serves as a resource for providers who need support and can help your organization source and vet potential PMNHPs. If you’re looking to develop a formal telepsychiatry program to provide high-quality care for your patients, Iris can help you through the process.

If you would like to learn more about how telepsychiatry can help supplement your behavioral health team, contact us today.

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