Even though Psychiatric Advanced Practice Nurses are thoroughly educated and intensely trained, many are understandably apprehensive upon landing a job, being handed a prescription pad, and told to start diagnosing patients on their own.
In a field where critical thinking is crucial to making accurate assessments, APNs lack opportunities to gain confidence because there is no residency program for the position. Unless, that is, those APNs are employed by Center For Family Guidance, PC.
“It is unrealistic to expect nurse practitioners to be adequately prepared to successfully perform their duties at the moment they are hired,” said Martha Pearson, an APN Clinical Educator who oversees CFG’s residency program for psychiatric nurse practitioners. “Our program concentrates on going beyond what was learned in school, and providing the experience necessary to allow them to be critical thinkers and problem solvers, with the end result being exceptional care for our patients.”
The residency program created by CFG, which is a psychiatrist-owned behavioral healthcare organization, allows APNs the opportunity to learn to practice and prescribe under the direct supervision of professionals in the field. But unlike any other program that exists nationwide in the for-profit sector, they are paid a full salary and provided with benefits while participating in the program, and hired prior to obtaining the necessary licensures. There is no other similar program in the country.
“I have heard horror stories about nurse practitioners getting jobs where they receive no guidance on how to perform their duties,” said Anna Marks, one of two initial residents in CFG’s APN residency program. “But everyone involved with this initiative is so supportive and knowledgeable. I am really excited to come to work every day. I feel as though there was a lucky star hanging above my head when I was accepted into CFG’s residency program.”
Marks is joined in the program by fellow University of Pennsylvania graduate Janan McCormick, who said she appreciates the collaborative nature of the process.
“The collaborative approach is not only the most efficient method, but also produces the best outcomes for the patient,” McCormick said. “It has allowed me to observe how experienced professionals practice, and provides the opportunity to ask questions. The pressure of having to make decisions on my own is removed. Determinations are made with the guidance of experienced professionals in the field of psychiatry.”
The year-long program, which kicked off in September, began with Marks and McCormick studying the history of psychiatry with Pearson. This included a review of the shortcomings of the Diagnostic and Statistical Manual of Mental Disorders.
“The structure of this program is to teach evidence-based practice that is founded in science,” Pearson said. “This is critical when learning to properly diagnose patients.”
Above all else, Pearson is most excited about the opportunity to teach APNs how to make certain that the best treatment is being provided to those under their watch.
“Making a diagnosis is complex, and you cannot simplify the process,” Pearson said. “There are so many confounding factors to take into consideration when making decisions. You have to ask the right questions, and you have to understand what is troubling the patient. When you only symptom prescribe in this profession, you fail.”
In addition to running its own clinics, CFG provides hospital-based programs including inpatient psychiatric services, ED evaluations, psychiatric crisis center intervention, medical/surgical floor consults, school-based programs, partial hospitalization programs, substance abuse treatment, residential treatment services and healthcare services for correctional facilities, among other services.
Participants in the residency program receive exposure to treatment across a broad spectrum over a several-month period before choosing an area in which to concentrate for the remainder of their residency, once licensure is received.
“Medical school is followed with years of residency and supervision, yet that experience historically has not been made available to APNs, and it really makes no sense,” Pearson said. “CFG had the wisdom and vision to invest in this venture, and it demonstrates our commitment to the quality of care we want our employees to be able to provide to our patients.”
McCormick is assigned to an acute inpatient adult psychiatric hospital, where she is in charge of a 25-patient unit. Marks is practicing at an adult behavioral healthcare unit at a separate location.
Both emphasized their appreciation for the supportive, collaborative and educational atmosphere of the program, while also expressing gratitude for being fully salaried as part of the process.
“I feel very fortunate that I was accepted into this program,” Marks said. “I have learned so much. It has been a tremendous opportunity for me.”
As the program expands, it will be able to accommodate up to six residents, Pearson said.
“We are extremely excited about the opportunities that we are able to provide through these residencies,” she said. “The APNs are very well educated, but they have not yet been given the opportunity to put their knowledge into action. This program allows them to gain experience and learn how to make the right decisions under supervision, which removes the fear of feeling that they are on their own.”
CFG President and Medical Director Dr. James Varrell said the program was created after realizing that many APNs were graduating without the comfort level necessary to deal with the complex problems that confronted them and the experience needed to make the best decisions about the health care being provided to patients.
“We recognized the need for early-career APNs to have additional hands-on psychiatric experience in multiple and diverse settings,” Dr. Varrell said. “They need mentoring to grow into solid, confident practitioners who can appropriately prescribe. We view this a way to attract, train and then keep the very best from this field. We are confident that this program will enable us to achieve that goal.”