1. Wheeler, Kathleen PhD, APRN-BC, PMHCNS, PMHNP, FAAN

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Dear Drs Jones and Minarik,


I thought your guest editorial "The Plight of the Psychiatric Clinical Nurse Specialist" (26[3]:121-125) raised many important issues surrounding the extinction of our specialty. I agree that if we do not claim our role as psychotherapists we are in danger of extinction particularly with the move toward integrated care and family nurse practitioners and other nurse practitioners being pushed to prescribe psychotropics as never before.


As a clinical nurse specialist (CNS), I was the cochair of the National Organization of Nurse Practitioner Faculties panel that developed the first Psychiatric-Mental Health Nurse Practitioner (PMHNP) Competencies with another CNS, Judi Haber. We were very careful to include as a competency that PMHNPs need to know how to conduct individual, group, and family psychotherapy. If PMHNP programs now do not include this content, they will not be accredited as the Commission on Collegiate Nursing Education bases its accreditation standards on National Organization of Nurse Practitioner Faculties competencies. At the time those competencies were established, 2003, there were many programs that did not include this expectation and now must do so. Of course, PMHNPs who prescribe must know how to embed psychopharmacology within the framework of the therapeutic relationship and psychotherapy. I wrote a book in 2008, Psychotherapy for the Advanced Practice Psychiatric Nurse, which has been adopted by many graduate programs in psychiatric nursing, and I am currently revising this book so I know that this content is being included in many programs. I think the doctor of nursing practice includes much of the "old" CNS content (systems perspective, research, QI, etc), so I see this as the emerging PMHNP + CNS. So I don't think the CNS is extinct, but morphing into a different name.


Also, I am remaining hopeful that there is a resurgence in interest in psychotherapy recently as American Psychiatric Nurses Association is having its first psychotherapy preconference this year, and they asked me to get people to speak, which I did. The hope is that it will evolve as a stand-alone conference like their annual psychopharmacology conference if enough people are interested. There would definitely be enough interest if a specified number of psychotherapy continuing education units (CEUs) were required for American Nurses Credentialing Center (ANCC) recertification much like the current mandate for a specified number of pharmacology CEUs. This would also ensure ongoing lifelong learning and supervision for PMHNPs, which is needed in order to become a skilled psychotherapist. In addition, it would encourage more PMHNP graduate programs to emphasize psychotherapy content. If psychotherapy CEUs became a requirement for recertification, a specified percentage of items on the ANCC examinations would be on psychotherapy. From conversations with an ANCC board member, I was told that this type of recertification requirement needs to be proposed to ANCC by our professional associations. So American Psychiatric Nurses Association and International Society of Psychiatric-Mental Health Nurses, how about it? Can we work together to make this happen? It is important and crucial for the growth, credibility, and viability of our profession. Thanks again for a thoughtful, insightful editorial.


Kathleen Wheeler, PhD, APRN-BC, PMHCNS, PMHNP, FAAN




School of Nursing


Fairfield University


Fairfield, Connecticut