Letter to the Editor on Advanced Practice Nursing (in the Psychiatric Arena)

Advanced Practice Nursing

May 11, 2005
in response to: "Advanced Practice Nursing"

Dear Editor:

I write in follow-up to the Advanced Practice Nursing (APN) topic. It has been seven years since I, as a student in a Psychiatric-Mental Health Nursing Clinical Nurse Specialist Program, wrote an article in OJIN entitled "Parity and Clarity; the Role of the Advanced Practice Psychiatric Nurse." Since I have received my Master's Degree, I have worked as a psychotherapist having prescriptive privileges in both community mental health and federal systems. In reviewing these past seven years as an APN, I am disheartened by the Psychiatric APN's ability both to gain the respect of other health care providers and to advance the practice of professional nursing.

The lack of parity with other health care providers, and the lack of professional respect for Psychiatric APNs remains appalling. Although I am a nurse who prescribes, I do not share collaborative equality with physicians or sense respect for the proficiency of my work from other mental health professionals. State law, agency policy, physician attitude, and professional fear have limited the role of the Psychiatric APN. Although I believe that prescribing can be one of the valuable roles of the nurse, far too often prescribing has become the single focus of much of the work of the Psychiatric APN's work. The real strengths of professional nursing are being lost as a result of this dominant focus on prescribing medications.

Hence I also no longer share general inclusiveness as a nurse in my own profession. As I and other APNs around me have increasingly focused our role on prescribing, we have lost the art of holistic nursing. As we spend more time on physical assessment and patient management, we are losing sight of the patient as a unique person. We have become nothing short of Advanced Practice Handmaidens. We have become both the perpetrators and victims of our own identity theft. As we have added prescribing to our list of practice activities, we have lost our distinctiveness as nurses in the delivery of health care systems.

This is a pivotal time in nursing when we have the opportunity to add clarity to our professional role and educate others so that they comprehend and appreciate our significant role as nurses in the health care system. The holistic quality of nursing must not be lost. We must limit our time spent prescribing to that which is really necessary, or we will become prescribing stepchildren of medicine. We are not nurses because we couldn't become doctors, and we are not prescribing to enjoy the function of physician extenders. We prescribe, as well as practice, because we engage in a unique relationship with patients in order to holistically assess, plan, engage in intervention, and evaluate treatment of the whole person so as to optimize health status and quality of life for our clients. This is our profession's knowledge, skill, art, and unmatched contribution to health care and society. Let's not forget. Spread the word!

Laura Paisley Mullen, APRN, BC
Kent, OH