TNA executive director addresses Texas House Select Committee on Mental Health
Thursday, April 28, 2016
Posted by: Nadia Tamez-Robledo
By Cindy Zolnierek, PhD, RN
Executive Director, Texas Nurses Association
April 28, 2016
As lawmakers prepare for the next Legislative session in January, their attention has turned to the issues faced by patients and health providers in Texas. It is vital that nurses share their wealth of knowledge and experience to inform the state-level decision-making process.
I had such an opportunity today when I addressed the Texas House Select Committee on Mental Health. The Texas Nurses Association appreciates the focus on mental health services by the legislature as well as the platform to provide our perspective of opportunities to improve the system.
As the executive director of the Texas Nurses Association and a former psychiatric mental health clinical nurse specialist, I brought expertise from both roles. There are three key areas I addressed before Texas House Select Committee on Mental Health, and TNA will continue to inform lawmakers on these important topics as we move toward the next legislative session.
- The role of nurses in providing care to persons with mental health and substance use issues;
- The importance of an adequate nursing workforce; and
- Nursing workplace issues that affect nursing recruitment and retention as well as the provision of care.
1. Psychiatric/Mental Health Nurses: Role and Scope
While all registered nurses receive education and clinical training in caring for persons with mental disorders, psychiatric/mental health nurses (PMH) identify this area as their primary population of focus. PMH nursing practice focuses on the promotion of mental health and employs a range of therapeutic approaches to produce positive outcomes.
Additionally, PMH Advanced Practice Registered Nurses (APRNs; including nurse practitioners and clinical nurse specialists) are prepared with graduate degrees (masters and/or doctorate) and advanced education in the diagnosis and treatment of mental disorders, including psychotherapy and the prescribing of therapeutic medication.
PMH nurses practice in virtually all clinical settings: crisis intervention and psychiatric emergency services, acute inpatient care, intermediate and long-term care, partial hospitalization and intensive outpatient treatment, residential services, community-based care, assertive community treatment. Levels and roles of nursing practice are differentiated according to the nurse’s educational preparation and practice setting.
2. Workforce issues
The nursing shortage is not over. According to preliminary projections by the TCNWS, the nursing shortage in Texas is expected to more than triple – from a deficit of 17,000 nurses in 2015, to over 66,000 in 2030.
Why is this important when considering mental health workforce?
- While a small number of nurses specialize in psychiatric/mental health nursing (only 7,500 of 280,000 practicing nurses in Texas identify as PMH, and only 536 of those are APRNs) ALL nurses will care for persons with mental health issues.
- People with mental disorders experience other medical illnesses – heart disease, diabetes, cancer, and others – at a greater rate than the general population. These conditions often require care in community as well as hospital settings where nurses practice (emergency departments, intensive care, medical-surgical units, etc.).
- There are not enough psychiatric beds for people with acute mental conditions requiring hospitalization. These patients are often treated in emergency department and other non-psychiatric settings, where nurses without psychiatric expertise practice.
- Nurses experience mental illness and substance use issues to the same extent as the general population – about 8%. The Texas Peer Assistance Program for Nurses, TPAPN, operates under contract with the Texas Board of Nursing to provide peer assistance to Texas nurses (LVNs, RNs, APRNs) who have mental health and/or substance use issues so that they can safely return to practice. The program is funded by nurse licensure fees.
- When demand exceeds supply, nurses can easily assert preferences for work environments, and factors such as workplace safety become critically important. The workplace violence encountered by PMH nurses is well documented. The unintended consequence of open carry legislation last session left nurses and others employed by state hospitals vulnerable to gun violence in their work setting.
The Texas Nurses Association recommends the follow actions:
- The legislature should continue its commitment to funding the Nursing Shortage Reduction Program to ensure continued production of nurses to address the ongoing shortage.
- The student loan repayment program for certain mental health professionals provided by SB 239 (Schwertner) in 2015 should be extended to include registered nurses who agree to serve persons with mental illness.
- Appropriations to the Texas Board of Nursing should continue to enable full funding of the Texas Peer Assistance Program for Nurses so that nurses can return to safe practice.
- The legislature should consider options to expand access to inpatient care to reduce the housing of persons needing acute mental health treatment in emergency departments, nonpsychiatric hospital beds, and in the jail/prison system.
- The legislature should expand the exception in statue such that state psychiatric hospitals and community mental health centers are able to prohibit open or concealed carry of firearms.