Constraints to advanced psychiatric-mental health nursing practice

Constraints and barriers to advanced practice psychiatric nursing were reported by respondents of the Primary Mental Health and Advanced Practice Psychiatric Nursing survey of certified psychiatric clinical nurse specialists. Primary data (N = 507) were the qualitative responses to a survey item about constraints and secondary data were the literature and theoretical memos. Methodology was based on principles of qualitative data analysis and procedures for manifest and latent content analysis. Findings resulted in eight themes that explained both constraints and barriers to advanced practice: (1) reimbursement, (2) prescriptive authority, (3) admitting privileges, (4) bureaucracy, (5) practice environment, (6) colleagues, (7) image, and (8) personal. Themes were interpreted within the context of regulatory, market-based, and inter/intraprofessional constraints and barriers that led to suggestions for organizational and individual strategies for action. The survey was funded by the Society for Education and Research in Psychiatric-Mental Health Nursing with technical support from the Center for Mental Health Services.