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Discussion

Psychiatric Nurses-- Scope of Practice?

Hi! (waves to all)

I'm seriously thinking about going into psychiatric nursing-- probably not now, but in a couple of years. I would need to get some prerequisites out of the way first anyway, and I also don't want to jump right into it! My question concerns the psychiatric nurse's scope of practice. Exactly what can it entail? For instance, under which circumstances may a psych nurse lead therapy groups? Psychosocial groups? Would this be something that only an NP could or would do? That really is something I've been wondering about, because I would be switching over from social work, and it would be very important to me to be able to keep that piece of practice. All advice appreciated!

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When I first started working as a psych nurse, I worked the evening shift. I ran all sorts of groups. The only one that was specified was medication education. Otherwise, they were up to me. You pick a topic, I probably did a group on it, including some with therapy involved. I wasn't an advanced practice nurse then.

  • Experts

The "official" scope of practice, according to the professional organizations and ethics standards within nursing, is that generalist RNs (undergrad-prepared, basic licensure) are not prepared/qualified to do psychotherapy -- RNs can do psychoeducational groups (coping skills, anger management, med education, etc., etc.) but not process groups or individual psychotherapy. Individual and group psychotherapy is within the scope of practice for psych CNSs and NPs, who are educated in this (at least minimally) as part of their graduate education (before prescriptive authority became such a big trend, psych CNS education consisted almost entirely of training as a psychotherapist. Now, most programs are focused on physical assessment, pharmacology, and medication management, with a little psychotherapy thrown in on the side).

  • Author

I really appreciate the advice. :) I would definitely be looking at psych NP anyway, and I definitely do have a certain amount of psychotherapy training and experience as an MSW. (MSW's can do different types of therapy under the supervision of LCSW's, and then they can provide any type of therapy as LCSW's-- but they have to do 2-3 years of supervised work under an LCSW before they can become licensed, and the real catch is it has to be a very specific kind of job which is just about impossible to get right now.) Mostly, I was wondering if the jobs available for a psych NP would include being able to provide therapy, particularly for groups.

Psych NPs are more likely to do physicals while psych CNSs are more likely to do therapy--at least that's what I've seen.

I've never heard of a Psych NP doing physicals. My NP program is focused on diagnosing mental illness, therapeutic technique, and prescribing...we rarely ever touch our patients. As for leading groups as a psych nurse I have done a variety of different types, but none that were specifically labeled as "psychotherapy," rather you might lead an unstructured interpersonal group that has a similar emphasis on the process, but is not so specific...it really is a fine line to walk. I was actually trained to lead groups as a Mental Health Specialist, not even a nurse, and it was encouraged that we lead a variety of groups once we received this training. The main difference in scope of practice for Psych NP's is the ability to diagnose and treat including prescriptive authority as well as individual/group/family psychotherapy.

It must depend on where you got your degree and where you work.

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