Psychiatric Mental Health Advanced Practice Nurses Prepared During Their Academic Careers for Interprofessional Care Collaboration

Saturday, 21 July 2018

Kathy D. Wright, PhD, RN
College of Nursing, Discovery Themes-Traumatic Brain Injury, The Ohio State University, Columbus, OH, USA
Gail E. Bromley, PhD, RN
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA


The dearth of qualified practitioners and educators is currently not able to meet the increased needs of patients with psychiatric diagnoses. According to the World Health Organization (WHO, 2014), there are 7.7 mental health nurses per 100,000 people in the world with or without mental illness. This creates a deficit in the number of potential nurse preceptors that are qualified to provide mental health education and clinical training to advanced practice nursing students. An alternative to the silo approach of clinical education is interprofessional education where students are able to gain knowledge from peers in other healthcare disciplines. Interprofessional collaboration, defined as work with teams of other practitioners and learners to promote trust and shared decision making, can improve the health of patients, families and communities (CIHCPIS, 2010). Interprofessional collaboration in advanced practice nurse mental health creates a more seamless transition from academia to collaborative clinical practice. This transition is further enhanced by didactic and supervisory sessions with other disciplines.

Interprofessional collaborations have been globally successful in the practice setting to bring nurses, community members and providers together to solve mental health challenges. In Norway, nurses developed interprofessional collaborations with psychiatric health care providers to enhance skills within the healthcare team and coordinate care for mental health patients (Andvig, Syse & Severinsson, 2014). Nurse educators in Canada, , in collaboration with the Mental Health Commission of Canada, developed transformational learning experiences for students with other healthcare disciplines to build trust and reduce the feeling of “us against them” in the care environment (Knaak, Karpa, Robinson & Bradley, 2016). Yet, opportunities remain for educators to develop strategies to enhance the clinical experiences of advanced practice nursing mental health students.


In this ongoing Margaret Clark Morgan Foundation funded project, key stakeholders from academia and a large academic health care system partnered to develop a clinically vibrant interprofessional clinical experience for advanced practice mental health nursing students. The primary goal is to enhance the transition from academia to clinical practice which optimally prepares these students for their Advance Practice Nurse (APRN) roles.


Graduate students enrolled in an education and consultation course in the Master’s Advanced Practice program participated in this more robust curriculum and were matched with clinical preceptors aligned with their areas of interest. Mental health preceptors from various disciplines received up to 15% dedicated release time during a semester to clinically supervise students. Students were placed with a psychiatrist, social worker, mental health advanced practice nurse and psychologist in an urban or rural in-patient hospital setting. Students also interfaced with a unit based pharmacist, which increased dialogue relative to psychopharmacology. The clinical areas included child and adolescent psychiatry, emergency department, oncology and general medical surgical consultation liaison team. These interprofessional teams were comprised of a nurse, physician, medical student and/or social worker. Nursing students made rounds with their preceptor and interprofessional teams to provide consultation and treatment recommendations for patients. Follow-up consult rounds were often made by the advanced practice nursing student and medical student. Consultation reports conducted by the nursing and medical student dyad were reviewed by the preceptors.

Students and the faculty met in a videoconference group one hour each week to promote open dialogue. Students engages in self-reflection and self-evaluation about their clinical experiences intended to promote professional development and insight. Faculty provided additional supervision about these clinical experiences. During the 16 week semester, the academic medical center Director of Nursing Research and Clinical Educator met with the faculty and the advanced practice nursing group periodically to discuss leadership and professional development. Verbal feedback from students was elicited by the academic lead, preceptors and the Director of Nursing Research and Clinical Educator to refine programmatic issues and enrich clinical experiences.


A total of 5 (3 women and 2 men) students participated in the first semester of the program and 6 preceptors (4 Psychiatrists, 1 APRN and 1 Social Worker). Each advanced practice nursing student completed at least 10 written mental health consultation reports with interprofessional clinical recommendations for treatment. The nursing students reported an improvement in their confidence to suggest recommendations in an interprofessional setting. Additionally, they reported greater confidence in their role as an APRN in their collaboration with interprofessional teams. Students felt they had an opportunity to provide clinical evidence that contributed to shared decision making with the preceptors and medical students.

Program evaluation feedback provided an important source for information about continuous improvement. The student precepted by the APRN preceptor reported less than optimal role modeling. Students precepted by psychiatrists reported that their learning exceptions were met and there was support for the APRN role. In the program evaluation surveys, clinical preceptors reported that the APRN students benefitted most when they functioned autonomously. Students found the transition from academic to practice roles beneficial.


Partnerships among key stakeholders is an advantageous model to enrich the interprofessional clinical experience of APRN students. Such professional relationships can be implemented by others to develop or enhance existing mental health clinical experiences. Globally, stakeholders from different countries can partner using videoconferencing to gain clinical experience working with interprofessional mental health teams and to discuss cases. Future programs should include community health workers and care partners as members of the interprofessional teams to create a more patient-centered clinical experience (Pelletier & Auclair, 2017). Without the breadth of experiences and dialogue from an interprofessional clinical education, the advanced practice mental health nursing students’ experiences remain compartmentalized. This disadvantages learning and leaves the student unfamiliar with the skills that are necessary to build trust and engage in shared decision making within a team to improve mental health patient outcomes (Chong, Aslani & Chen, 2013).