In the press of caring for patients, family nurse practitioners (FNPs) must tend to a patient’s physical well-being and mental health. Caring for a patient’s mental status can be vital to meeting healthcare needs.
As primary care providers, FNPS play a significant role in tending to mental health concerns. The American Association of Nurse Practitioners (AANP) reflected that 88% of the nation’s NP workforce are certified in an area of primary care, with over 70% delivering primary care services, notes LaMicha M. Hogan, PhD, APRN, FNP-BC, associate dean/department chair for APRN Programs for the Texas Tech University Health Sciences Center School of Nursing-Graduate Program.
In this article, we’ll offer ways to ensure you’re attending to your patient’s mental health needs and touch on how FNP programs should educate students about mental health.
Great Impact
Though stigmatizing societal attitudes regarding mental healthcare have improved, a patient’s initial encounter with a healthcare provider will likely have the most significant impact on self-perception of a mental health complaint as well as willingness to seek continued treatment, notesHogan.
Early detection and intervention lead to the best outcomes, in conjunction with a trusting, collaborative rapport between the patient and FNP to reduce stigma present with having a mental health condition, according to Hogan. FNPs must be aware that a patient’s mental health status has a greater impact on chronic physical health conditions if undiagnosed or left untreated, she notes.
It’s imperative for FNPs, especially those in primary care settings, to prioritize the screening of conditions such as depression and anxiety, notes Amanda Ringold, DNP, FNP-BC, CRNP, SANE-A, assistant professor at the University of Pittsburgh School of Nursing. “To ensure effective mental health assessments, FNPs must address and overcome organizational barriers, including time constraints, a lack of a universal screening policy, and providers’ feelings of inadequacy in conducting mental health screenings. FNPs are poised to take on leadership roles within clinical settings to address and mitigate these challenges,” she explains.
Screening Strategies
Various strategies exist for dealing with mental health during patient care visits. For instance,
Ringold notes that not every screening needs to be done face-to-face with the FNP. Instead, screenings can be conducted with pen and paper in the waiting room or via an app before the appointment. She notes that other team members, including nurses or medical assistants, can be trained in administering the screenings.
Lisa Johnson, DrNP, CRNP, ACNP-BC, associate professor and DNP/NP Program Coordinator at Gwynedd Mercy University, agrees that patients can complete questionnaires in the waiting room or before the visit. However, “we have to be cautious not to fatigue patients with questionnaires and to ascertain their reading level and primary language prior to requesting a mental health assessment be completed by the patient,” she warns.
In an interview, Irene W. Bean, DNP, FNP/PMHNP-BC, FAAN, FAANP, FNAP, CEO of Serenity Health Care, P.C., and Tennessee State Rep for AANP, says to pay attention to a patient’s body language once in a patient encounter. Watch for poor eye contact or note whether a patient has been crying.
She says to pay attention to slurred speech and be aware of signs such as a patient who typically speaks loudly suddenly speaking in a whisper or a normally talkative patient now being reserved.
FNP Programs
Johnson says NP educational standards emphasize assessing mental health in varied patient populations. Healthcare providers and institutions of higher education need to focus on the cultural considerations of mental health disorders and further emphasize collaborative communication between primary care and mental health providers, she notes.
Hogan says clinical competencies are best attained via a competency-based educational model throughout the FNP curricula. Specialized courses on mental health, simulation training, interprofessional education, and clinical rotations in primary care settings can develop competence. She says that after graduation, FNPs should maintain continuing education specific to FNP’s scope of practice and evidence-based care for mental health concerns.
Ringold notes a growing trend of students at the University of Pittsburgh School of Nursing opting for dual FNP-PMHNP degrees.
Scope of Practice
While FNPs can treat mental health conditions such as basic anxiety and depression, they need to be mindful of their state’s scope of practice, says Bean. For patients with conditions such as bipolar disorder or schizophrenia, you may be stepping outside your practice scope and may need to refer the patient to a specialist, Bean says
“One thing that I would stress, and I stress to my students, is that you want to protect your license. You want to ensure the patient is safe while protecting your license,” Bean says.
Calling on Compassion
When you realize your patient is anxious, depressed, or dealing with a mental health issue, “What you don’t want to do is rush that patient from that conversation,” says Bean. “You’re going to miss a lot of things when you rush patients who have a mental health crisis through your clinic,” Bean says.
“You have to have compassion for patients dealing with a crisis. Their crisis may not be something you feel is a crisis, but to them, it’s everything. You can’t discount their feelings, and you can’t discount what you’re seeing in that patient.”
Stacey Garnett, MSN, RN, PMH-BC, NEA-BC, FACHE, is the vice president and chief nursing officer at Sheppard Pratt, the nation’s largest private, nonprofit provider of mental health services. In the fast-paced and ever-evolving behavioral healthcare field, nursing leaders are crucial in ensuring efficient operations, a supportive work environment for nurses, and providing quality patient care.
Among these dedicated professionals, Garnett stands out as an exceptional leader whose unwavering commitment to serving people in crisis has made a significant impact on the nursing community. As the demand for behavioral healthcare services increases and burnout and staffing shortages weigh on nurses, she serves as a staunch advocate for patients and nurses alike—she recently received the Maryland Hospital Association’s Advocacy Champion Award for her role in helping to pass SB 960/HB 611, a bill that ensures adequate hospital staffing in Maryland.
As a minority leader with more than 30 years of experience in nursing and nursing administration, Garnett continues to lead and inspire future generations of gifted nurses. Her commitments to nurturing talent and diversifying her industry have not only enhanced the capabilities of individual nurses but have also contributed to the overall strength and competence of behavioral health nurse practitioners throughout the state of Maryland and beyond.
The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Stacey Garnett, vice president and chief nursing officer at Sheppard Pratt.
Empowering Growth
Garnett recognizes the importance of continuous professional growth and exhibits this in her commitment to teaching and mentoring the next generation of skilled nurses. In addition to leading Sheppard Pratt’s nursing team, she also serves as an educator and mentor. Garnett consistently enables her staff, students, and mentees to use educational and professional development opportunities to foster their growth and advancement.
As a leader who has overcome challenges, Garnett recalls being the only African-American student in her undergraduate nursing program. She now serves as a fierce proponent for diversity in the nursing field, creating opportunities for Sheppard Pratt to partner with historically black colleges and universities (HBCUs). She hopes that others will see representation in the field and continue to seek advancement opportunities.
Garnett’s success and dedication to excellence inspire her staff, students, and mentees. She understands that high-quality care begins with a personal commitment to perseverance in adversity. In 2019, she mentored a student struggling to pass her exam to become an LPN. After working with Garnett to master the material and conquer her testing anxiety, she passed the test and currently works as an LPN in hospice. Garnett’s tenacity and zeal energize her followers to achieve incredible feats.
Championing Patient-Centered Care
At the core of Garnett’s success throughout her 30-year career is a deeply rooted dedication to patient-centered care. As a motivated and passionate leader, she challenges and inspires her staff to prioritize each patient’s care, dignity, and progress during some of the most vulnerable times in their lives. She emphasizes the importance of building meaningful connections with patients, their families, and their communities. By actively listening to feedback, encouraging interdisciplinary collaboration, and prioritizing patient satisfaction initiatives, she establishes and maintains a patient-first mindset within Sheppard Pratt’s nursing staff. This holistic approach to patient care makes Sheppard Pratt a distinguished leader in behavioral healthcare and a place where patients can expect to be treated with the utmost care and respect.
Driving Excellence
As a transformational leader with a proven track record of generating and building relationships, managing nursing hospital operations, engaging and collaborating with physicians, and maintaining successful regulatory reviews, Garnett maintains a strong focus on delivering exceptional care. By setting these high standards, she has cultivated an environment encouraging continuous improvement and professional development among Sheppard Pratt’s nursing staff.
Garnett played a fundamental role in the launch of Sheppard Pratt’s new Baltimore/Washington Campus hospital in June 2021. Her colleagues have heralded her ability to think strategically as she responded to issues immediately and directly to open the new hospital to the public in June 2021. Her tenacity and innovation during the inception of the new campus, which offers five inpatient units, day hospital programs, and a Psychiatric Urgent Care, both set and maintained a precedent for a high standard of care across the hospital’s operations.
Collaboration and Communication
Effective communication and collaboration are vital in any healthcare setting, but these factors are critical in behavioral healthcare. Garnett truly has a heart for the patient, frequently interacting with them directly on units. She understands and appreciates that everyone has a journey and a story—by actively listening to the people she serves, she gains insight and perspective into the lives of others to help them overcome life’s most difficult challenges. When patients feel their voices are heard, they feel empowered to share their stories—these stories can reveal crucial information about a patient’s diagnosis, treatment, and recovery.
Garnett fosters a culture of open dialogue and teamwork, where patients, their families, and staff value her as someone with whom they can discuss difficult issues openly, honestly, and without judgment. She actively encourages nurses to voice their ideas, concerns, and suggestions, ensuring that all perspectives are valued and considered. By promoting transparency and maintaining strong lines of communication, Garnett has facilitated a collaborative environment that empowers nurses to work together, resulting in streamlined processes and improved patient care.
Garnett is a beacon of hope for a nation desperately needing passionate and skilled behavioral health nurse practitioners. Her leadership inspires current and future nurses to provide patients with the high-quality care they need and deserve.
The Office of Minority Health, a division of the U.S. Department of Health and Human Services, designates each July as Minority Mental Health Awareness Month. By calling attention to the specifics of mental health in minority communities, the awareness campaign helps spread information about the importance of good mental health practices, shares resources for finding help, and removes some of the stigma around seeking treatment for conditions including depression or anxiety.
As the COVID pandemic has retreated, many folks are left with lingering feelings of trauma, particularly in minority communities that were impacted more than others. Many people lost loved ones during the past few years and others are coping with the lingering health impacts of having had COVID or caring for those who did. The pandemic exposed glaring health disparities in which racial and ethnic minority patients had less access to high-quality health care, more severe illness, and higher numbers of severe COVID.
Beyond healthcare and within a society that has structural racism, the pandemic caused far-reaching impacts from a disease that upended employment, income, insurance coverage, childcare, transportation, and family structure. The long-term impacts of the trauma people experienced, and are still experiencing, is something that will influence minority mental health for years to come.
During Minority Mental Health Awareness Month, nurses can help spread information about the importance of good mental health by discussing it with patients. They can offer resources, talk about how mental health changes physical health, and normalize discussions around emotions and trauma.
Because nurses educate patients, they can call attention to symptoms that patients might associate with mental health struggles including
new or marked sadness or crying
changes in eating (too little or too much)
changes in sleep patterns (difficulty falling asleep or getting out of bed)
lack of interest in hobbies, relationships, work
thoughts of suicide
They can also verbalize symptoms that aren’t always recognized as symptoms of something like depression or anxiety including
anger and rage
increased substance use and abuse
new or increased compulsive actions (checking locks, food patterns)
Talking about minority mental health with nurses encourages patients to recognize their feelings, be attentive to changes, and understand that they aren’t alone. These efforts might not always seem significant, but nurses can keep in mind that their conversation about mental health might be the only time a patient discusses their concerns. Some minority communities have such a barrier to openly discussing mental health that it is a subject that is just never brought up.
When nurses identify symptoms, highlight resources, make connections for therapy or medication providers, and show support, patients feel seen and heard. Emphasizing that mental health is a physical condition and that effective treatment is available is a beacon of hope for people who are feeling like they aren’t sure what to do. Nurses can make a meaningful difference to patients with a caring conversation about minority mental health and some resources to get started.
No matter where you live, the depths of winter tend to bring out the armchair traveler in all of us. As new year’s resolutions to “do more” or “be better” begin to lose their luster and work or school responsibilities grind on, the idea of going somewhere–anywhere– becomes particularly appealing.
Even if you can’t get away right now, it’s never a bad time to begin planning where you might want to head to when the opportunity arises. Studies have shown that taking a vacation is good for your mental health, butplanning a vacation also has its own benefits. When your brain switches to planning ode–or armchair travel mode–anticipating where you’ll go, what you’ll do, and even just thinking of being in a different setting can all flip a switch in your brain and get you out of the rut you might be in.
Why take the time to plan a vacation that’s far off or that you might never actually go on? Planning travel helps your brain imagine new places and motivates you to learn about other areas, other cultures, or other foods. It gives you an opportunity to see how others live and what’s important to them–all of which can inspire change in or gratitude for your own life.
Have you always wanted to spend a week exploring a mega city like New York, London, or Paris? What about a new place like Dubai? Would you rather dive deep into the history of Athens or Beijing? Or does something like the big sky of Montana or Canada hold an appeal? Any of those places can get you out of your typical pattern and learning about a place different from where you are.
During the COVID-19 pandemic, there was a noticeableuptick in Twitter searches that included the words coastal, beaches, and escape. From the New England shipping ports like Portsmouth where you can take aharbor cruise to learn about the area’s maritime history to days spent exploring theNewport mansions and envisioning the lives of America’s barons, the possibilities for learning rich history focused on what interests you feeds the escapist need. Looking into staying in sunny Hawaiian islands or envisioning the blue Caribbean waters can actually serve to bring your stress levels down. Frequent studies show that getting out in nature is good for your health and you might notice your heart rate slows down a bit just thinking about it.
If you’re thinking of a place but don’t think you’ll get there soon, armchair travel helps you create the adventure at home in ways that are fun and let you feel a little escapism. Involve all your sense to heighten your experience. Try out local foods from the place you want to visit. You can try your hand at a new recipe or, if you’re lucky enough, you might have different restaurants nearby that offer different cuisine choices. Watch movies or shows based in the location you have in mind. Listen to music from the area or in a different language. Check out the endless choices of travel blogs, tourism websites, and books to find out about the cultures, traditions, and history.
When you’re ready to hit the road on your next adventure, you’ll be well prepared with information and excited to embark on something that’s new but not completely unfamiliar. In the meantime, all your armchair travel will have managed to give your mind a break and your mental health a boost.
Despite the increased focus on mental health over the pandemic, it’s not always easy to diagnose or recognize depression. When it’s something you are experiencing, it can be even tougher to see the bigger picture.
October 6 is National Depression Screening Day and offers an excellent opportunity to assess your own mental health by taking an online depression screening and learning more about depression. Depression can happen at any time and to any person regardless of their race, ethnicity, social status, income, lifestyle, location, family history, or previous mental health status. Sometimes depression is triggered by an event–a death, a divorce, a diagnosis, a job loss, a trauma. Sometimes depressive symptoms coincide with the changing seasons. Depression can also be brought on by genetics or by hormonal changes in pregnancy, menopause, or puberty. It can be fleeting, lasting less than a year, or it can be something a person manages throughout their lifespan.
Why do people need a depression screening? Because depression can look like a lot of other things. This condition can appear as individual bothersome symptoms that are easy to overlook or brush off. When seen collectively, it becomes more obvious that there’s something more serious going on. A depression screening gives that broader scope and opens the path for treatment options.
Many people recognize some of the more obvious symptoms of depression including feeling sad, having crying spells, or a lack of interest in many things they once loved. But other symptoms of depression are more difficult for people to recognize.
Less obvious symptoms of depression include
irritability and anger
generalized, persistent feelings of fatigue or being tired that are unrelated to amount of sleep
lack of focus
feelings of being unwell like stomach pains, muscle aches, headaches
trouble sleeping or sleeping too much
changes in eating–eating too much or not enough
What do these look like in real life? It can be as simple as noticing you are raising your voice at your kids or your partner. You might find yourself getting unusually frustrated at work when a colleague is late or a patient is challenging. It could be that the daily walks that used to give you energy and a sense of calm, have dropped off your activity list because you just can’t get motivated. Or you seem to have a pounding headache by the time your day ends–on most days. Taken individually, these might not seem to be anything but an unusual blip in life. But when any of these happen repeatedly or happen collectively, it’s a signal that something else is going on.
A depression screening is an excellent tool for nurses to apply to themselves or to patients or loved ones. Nurses can look more into depression assessments to see what kind of assessment is used in particular circumstances in the industry too. But simple depression screenings can help you recognize when you might need help to manage your symptoms.
Depression treatment can include talk therapy and medications for milder cases and more intensive treatments for moderate to severe depression. If you notice that you’re experiencing symptoms of depression or that someone you love or someone you care for is, seeking additional help should be the next step.
