Practice Agreements for Psychiatric Nurse Practitioners

A psychiatric Nurse Practitioner is licensed to provide mental healthcare as specified by the ANA scope of practice to adult, geriatric, and pediatric populations. The Psychiatric Mental Health Nurse Practitioners (PMHNP) perform a variety of roles including performing mental health evaluations to determine psychiatric conditions, interpreting lab and other diagnostic procedures, and prescribing of drugs among other functions. The paper comprehensively discusses various components associated with PMHNP including the practice agreements in California, physician collaboration issues, and barriers for PMHNP practicing independently in California.

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Practice Agreements for PMHNPs
The PMHNP performs duties under the scope of Registered Nurses (RN) relying on standardized procedures for authorization to execute overlapping medical functions. They operate under the Nursing Practice Act (NPA) to perform a variety of roles including mental and physical assessments, prevention of diseases, conducting of immunization and skin tests among others. The Californian PMHNPs are mandated to provide mental health services in collaboration with a consulting physician (Coffman et al., 2018). The other practice agreement is that NPs in California are not permitted to sign death certificates. Only qualified Medical Doctor (MD) is allowed to sign a death certificate (Xue et al., 2016). The PMHNPs are only authorized to approve handicap parking permits and thus cannot declare someone dead.
Physician Collaboration Issuess
No regulations specify the proximity distance between the consulting physician and the NPs. As a result, some physicians opt to provide remote supervision which adversely affects the service delivery process (Spetz & Muench, 2018). In California, the NPs are required to collaborate with the consulting physicians for a minimum period of two years before they are allowed to prescribe medications independently. As a consequence, many NPs have relocated to other states which grant the autonomy leading to the inadequacy of PMHNP personnel in California.

Barriers to Mental Health Nurses Practicing Independentlys
California State has strict laws and regulations concerning the scope of practice of the NPs and other healthcare professionals significantly hindering the independence of PMHNPs in the profession. One area of concern is the prescription of buprenorphine which is used in the treatment of opioid abuse disorder. In 2002, a regulation was passed that required buprenorphine prescription to be only done by the healthcare professionals who have obtained the waiver from the Drug Treatment Act of 2000 (Kraus & DuBois, 2017). This regulation limited buprenorphine prescription to physicians until the enactment of the Comprehensive Addiction and Recovery Act (CARA) of 2016 which permitted NPs and physician assistants (PAs) to obtain the waivers (Johnson, 2016). These strict regulations adversely affect the performance of PMHNPs especially in the treatment of opioid use disorder (Rinaldo & Rinaldo, 2013).

The PMHNP-physician collaboration is associated with various challenges such as remote supervision. To address this problem, I would write a letter to the California Board of Nursing to limit the monitoring to only healthcare professionals in the same facility to improve the quality of healthcare service. Second, I would also request a limitation in the number of NPs a consulting physician is allowed to supervise. Third, I would also ask the board to amend the law to reduce the collaboration time to six months to avoid the challenge of brain drain.

The practice agreements for California requires PMHNPs to provide psychiatric healthcare services in collaboration with the consulting physician. The NPs are allowed to work under a consulting physician for a minimum of two years before they are allowed to prescribe drugs. This is linked to various challenges such as NP migration to other states which guarantee prescription autonomy. The law also inhibits NPs to sign a death certificate and thus they cannot declare someone dead. Therefore, the California Board of Nursing needs to amend specific statutes and regulations to address the problems facing PMHNPs in drug prescription and collaboration issues.


1. Coffman, J., Bates, T., Geyn, I., and Spetz, J. (2018). California’s current and future behavioral health workforce. Healthforce Center: University of California, San Francisco.
2. Johnson, C. A. (2016). CARA: policy designed to prevent and effectively treat heroin addiction through multidimensional strategies. Cleveland: Cleveland State University School of Social Work.
3. Kraus, E., and DuBois, J. M. (2017). Knowing Your Limits: A Qualitative Study of Physician and Nurse Practitioner Perspectives on NP Independence in Primary Care. Journal of general internal medicine, 32(3), 284-290.
4. Rinaldo, S. G., and Rinaldo, D. W. (2013). Availability without accessibility? State Medicaid coverage and authorization requirements for opioid dependence medications. Advancing access to addiction medications: Implications for opioid addiction treatment, 9-71.
5. Spetz, J., and Muench, U. (2018). California Nurse Practitioners Are Positioned To Fill The Primary Care Gap, But They Face Barriers To Practice. Health Affairs, 37(9), 1466-1474.
6. Xue, Y., Ye, Z., Brewer, C., and Spetz, J. (2016). Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review. Nursing outlook, 64(1), 71-85.

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