Nurse educators are charged with ensuring that graduates are well prepared to function in the context of an ever-evolving and increasingly complex health care environment. Professional consultation and collaboration skills have been identified as necessary for the advanced practice nurse, yet teaching such skills can be a challenge. In 1995, the American Association of Colleges of Nursing (AACN) first identified communication, collaboration, and consultation as essential content in the advanced practice nursing curriculum.
The new Essentials of Master’s Education in Nursing (AACN, 2011) has similarly identified Interprofessional Collaboration for Improving Patient and Population Health Outcomes as one of the nine essentials stressing collaboration, consultation, and communication skills in interprofessional teams.
Core competencies outlined by the National Organization of Nurse Practitioner Faculties (2011) also include the nurse practitioner’s ability to make appropriate and timely referrals and consultations and to effectively collaborate in providing care. Competencies specific to psychiatric and mental health nurse practitioners include building collaborative, interdisciplinary relationships to provide optimal care to the patient, collaborating as a member of the interdisciplinary mental health and other health care teams, and providing consultation to health care providers and others to enhance quality and cost-effective care (National Panel for Psychiatric Mental Health NP Competencies, 2003).
Finally, the landmark Future of Nursing report (Institute of Medicine, 2011) likewise underscores the importance of preparing nurses for team-based and interprofessional patient care as a vital nursing education transformation needed to meet current practice challenges and goals.
Given these educational and practice mandates, a team of adult and family primary care nurse practitioner faculty and psychiatric and mental health advanced practice nurse faculty at MGH Institute of Health Professions School of Nursing developed an innovative learning experience for students to practice consultation and collaboration skills in a safe, supportive environment.
We focused specifically on consultation and collaboration between primary care and psychiatric and mental health advanced practice nursing students because approximately 70% of all primary care visits have a psychosocial basis (Fries, Koop, & Beadle, 1993) and because the majority of Americans receive treatment for behavioral health conditions from a primary care provider (Kessler & Stafford, 2008; Quirk et al., 2000). Collaborating to address behavioral health issues in the context of primary health care can substantially reduce the health care burden, while also improving care and quality of life for affected patients at the same time. Models of integrated primary and behavioral health care include onsite mental health and primary care clinicians working in the same office, collaborative coordination of care with community-based mental health clinicians, and collaborative care such as proposed in medical home models.
For the past 3 years, students from the family, adult, and psychiatric mental health specialties have met for a clinical seminar during their final semester of graduate nursing education. Students were informed that the purpose of the seminar was to provide an opportunity for collaboration and consultation. Primary care advanced practice nurse students are asked to present a case they encountered during clinical practice for which they felt consultation with a psychiatric and mental health advanced practice nurse would have been beneficial.
Preparation entailed learning content regarding consultation and collaboration skills. At the consultation seminar, students were divided into small groups composed of a mix of primary care and psychiatric and mental health students. The format for the small group interaction entailed the presentation of a case and a specific request for consultation by a primary care student, followed by a psychiatric and mental health student’s response, and then a small group dialogue/collaboration about the case.
Typically, there was much back and forth in the groups, with questions, sharing information, and engaged discussion of “what to do.” Cases thus far have included how to treat patients who are borderline, somatizing, or suicidal; collaborating to provide care to patients with bipolar disorder; and coordinating pharmacological treatment in the case of patients being treated for pain, anxiety, and depression. Faculty members observed the consultation and collaboration experiences but did not participate, allowing students to work things out together. The seminars concluded back in the full group, with students and faculty processing the learning experience together.
The consultation/collaboration experience provided an opportunity to evaluate students’ case presentation skills, discuss the scope of practice, share specialty nursing knowledge, more fully consider differential diagnoses, and discuss how to negotiate (simulated) shared care. The experience also provided teaching opportunities regarding when and how to make referrals, diagnostic formulations, and providing holistic care to complex patients.
Verbal and written feedback from students has been positive and included student consultants’ reports of the unanticipated benefit of an increase in self-confidence and recognition of knowledge attainment in their specialty area. The experiences validated for students how much they already knew and what they could offer each other. Expansion of the learning experience could include partnering with other health disciplines for simulated interprofessional consultation, and practicing telephone and written consultation exercises.
Janice H. Goodman, PhD, RN, PMHCNS-BC
Patricia Reidy, DNP, FNP-BC
Jeanne Cartier, PhD, PMHCNS-BC
MGH Institute of Health Professions
- American Association of Colleges of Nursing. (1995). The essentials of master’s education for advanced practice nursing. Retrieved from http://www.aacn.nche.edu/Education/pdf/MasEssentials96.pdf
- American Association of Colleges of Nursing. (2011). The essentials of master’s education in nursing. Retrieved from http://www.aacn.nche.edu/Education/pdf/Master%27sEssentials11.pdf
- Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.
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- Kessler, R. & Stafford, D. (2008). Primary care is the defacto mental health system. In Kessler, R. & Stafford, D. (Eds.), Collaborative medicine case studies: Evidence in practice (pp. 9–24). New York, NY: Springer. doi:10.1007/978-0-387-76894-6_2 [CrossRef]
- National Organization of Nurse Practitioner Faculties. (2011). Nurse practitioner core competencies. Retrieved from http://www.nonpf.com/associations/10789/files/IntegratedNPCoreCompsFINALApril2011.pdf
- National Panel for Psychiatric Mental Health NP Competencies. (2003). Psychiatric-mental health nurse practitioner competencies. Washington, DC: National Organization of Nurse Practitioner Faculties.
- Quirk, M.P., Simon, G., Todd, J., Horst, T., Crosier, M. & Ekorenrud, B. et al. (2000). A look to the past, directions for the future. Psychiatric Quarterly, 71, 9–95. doi:10.1023/A:1004618918550 [CrossRef]