Psychiatric mental health nurses at both the generalist and advanced practice level are uniquely qualified to serve in both indirect and direct care roles within managed caresystems. Nurses alone among the various mental health disciplines combine the biopsychosocial knowledge, psychopharmacological competency, physical and psychiatric assessment skills with an intrinsic perspective of patient advocacy and 24-hour accountability. Psychiatric nurses are expert at evaluating complex psychiatric, substance abuse and physical health needs and problems of patients over the life span. Nurses assess and treat psychosocial consequences of physical illness (APNA, 1997). Further, the American Nurses Association "…endorses the utilization of psychiatric-mental health nurses as highly qualified professional participants in both indirect and direct care roles within psychiatric-mental health managed care systems. As the managed care industry evolves, we believe that it will be important for the professional to monitor the operationalization of the managed care concept to assure that its original objectives are fulfilled" (ANA, 1998). While there is great variability of nursing activity based on service setting and geographic location, the advanced practice nurse and generalist nurse may assume a number of roles in managed care systems. These include (Stuart, 1997) :
Psychiatric-Mental Health Nurse – Nurses with various levels of preparation serve as direct care providers in contracted facilities and practices. These roles includestaff nurses, managers and administrators, practitioners in psychiatric home health and community mental health settings, primary care providers and independent providers of psychotherapy to individuals, groups and families across the life span. While the advanced practice registered nurse, psychiatric-mental health (APRN-PMH) has prescriptive authority in most states, all registered nurses administer and monitor pharmacologic agents and monitor their effects.
Care Manager
Nurses in this role assess patients and develop treatment plans, coordinate resources and care provided by others. The Care Manager also manages patient needs and resources episodically and is skilled in managing psychiatric rehabilitation as well as relapse prevention.
Assessment, Evaluation, Triage and Referral Nurse
In this role, the nurse evaluates patients in direct encounters or by telephone in order to triage the patient to the most appropriate level of care, including referrals to credentialed providers, contracted facilities and community resources.
Utilization Review Nurse
Many managed care companies employ psychiatric nurses to function as utilization reviewers in which they review aspects of the patient’s care and influence decisions about treatment assignment. In this role they serve as "gatekeepers" to mental health services.
Patient Educator
Some settings hire nurses with responsibility assigned to them for patient and family education. This role has grown with the growing emphasis that is being placed on patient compliance and disease management programs. In public sector programs, this role could include prevention, education and outreach.
Risk Manager
Nurses who work as risk managers are charged with the task of decreasing the probability of adverse outcomes related to patient care. They engage in identifying risk factors, individual and system-wide problems, corrective actions and the implementation of strategies to reduce risk and prevent loss.
Chief Quality Officer
Nurses have assumed primary responsibility for formulating and implementing comprehensive quality management and improvement programs for managed care companies. They engage in training other staff on-site and synthesize data related to performance improvement, outcomes management and other health services research activities.
Marketing and Development Specialist
Some psychiatric nurses work in the managed care growth areas of sales (proposal writing), marketing and program development. In these roles, they interface with consumers, employers, providers and regulators and they make recommendations for furthering the mission and goals of the managed care organization.
Corporate Managers and Executives
Psychiatric nurses are also present in middle management positions, as well as senior management positions where they participate in the development of corporate policy and strategic planning. Nurses hold positions in various departments including: Provider Relations, Quality Management, Care Management/Clinical Operations, Service Operations and Clinical/Medical Affairs.
The role of mental health nurses According to Weiss (1947), quoted by Stuart Sundeen in Principles and Practice of Psychiatric of Nursing Care (1995), the role of the nurse is as Attitude Therapy, namely:
• observe the changes, whether minor or permanent changes that occur on the client.
• Demonstrates acceptance.
• Respect.
• Understand the client.
• Promote interest and participation in client interaction.
Whereas according to Peplau, the nurse's role includes:
• As educators
• As a leader in the situation of local, national, and international.
• As a "surrogate parent "
• As a counselor.
And in addition to the additional role of nurses is :
• Working with mental health agencies,.
• Consultation with the welfare foundations.
• Providing services to clients outside the clinic.
• On doing some research.
• To help public education.
References
Fountaine Karen Lee.1943.Mental Health Nursing.4th ed
Yosep,Iyus.2009.Keperawatan Jiwa.PT. Refika Adinata : Bandung.
Gail Wiscarz Stuart, Sandra J.SundeenmPrinciples and Practise of Psychiatric Nursing.5th ed.
American Psychiatric Nurses Association (http://www.apna.org)
http:// Psychiatric_and_mental_health_nursing- wikipedia..htm
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