How Nurse Practitioner Authority Varies By State

Nurse practitioner practice authority varies by state. This variation defines whether or not nurse practitioners (NPs) can utilize the full extent of their education. For NPs, they follow guidelines around how they can see patients, whether or not they need a collaborative physician, and what controlled substances they can prescribe with or without the need for co-signatures. Whether your organization needs help addressing the provider shortage or decreasing wait times, an NP can help.

According to the AANP, nurse practitioners’ practice authority varies depending on what state they choose to practice in. The three types of state practice environments are:

  • Full practice (independent)
  • Reduced practice (partially independent)
  • Restricted practice (non-independent)

In restricted practice states like Texas, NPs must work under another health provider’s supervision to practice. Reduced practice states like New York allow NPs to be in a collaborative agreement with another health provider to facilitate patient care. They also have one or more limits on NP practice. Full practice states like Arizona allow NPs to practice independently, evaluate, and provide care to patients without a collaborating physician or agreement.

As of right now, there are 29 NP full practice authority states, 16 reduced practice states, and 11 restricted practice states.

Finding the right fit

While NPs are essential to addressing the provider shortage and improving patient experience, they’re also indispensable when it comes to mental health treatment. The type of NP working in the mental health field is called a psychiatric mental health nurse practitioner or a PMHNP. These providers work in correctional settings, residential treatment centers, inpatient hospitals, health systems, and private practices. However, the majority of PMHNPs are practicing in underserved and rural areas.

PMHNPs can be a major benefit to your organization, especially if your organization serves patients from vulnerable populations, like Community Mental Health Centers (CMHCs), Certified Community Behavioral Health Clinic (CCBHCs) and Federally Qualified Health Centers (FQHCs). PMHNPs are skilled at caring for patients, and their quality level is similar or equal to a psychiatrists. Not only can they provide a similar quality of care as a psychiatrist, but they are also skilled at facilitating holistic care, which overall contributes to the level of quality care and treatment they can provide.

PMHNPs receive specific training in various types of treatment they provide like:

  • Extensive training in psychotherapy and behavioral health conditions
  • Crisis intervention and directing patient care planning
  • Collaborative care
  • Effective communication with patient families

If your organization is looking to provide these skills and treatments, PMHNPs might be a valuable asset for your organization.

Challenges and opportunities you might face

Across the country, healthcare organizations are facing a provider shortage. According to USAFacts, as of March 2021, 37% of the U.S. population lived in 5,833 mental health professional shortage areas. Providing cost-effective but high-quality care can be difficult in these regions, but in full authority NP states, the providers can serve as a primary care provider.

In restricted and reduced practice states, PMHNPs cannot practice without a collaborating physician. During the provider shortage, it is especially challenging to find a collaborating physician. These agreements have to be renewed annually, and they have to meet with the physician they are collaborating with on a monthly basis. This specific agreement can cause issues for rural areas where there may not be a physician locally available, or there may be a shortage of physicians who would be able to work collaboratively with a nurse practitioner. In some extenuating circumstances, if the collaborating physician becomes ill or retires, patients cannot be seen, and you might have to cancel the appointment.

By utilizing telepsychiatry, you can find the best-qualified PMHNP for your organization’s needs, especially during a provider shortage when you cannot find a PMHNP locally. Telehealth can extend healthcare delivery to underserved populations and rural areas. With the help of a PMHNP, it can be easier to meet that need by partnering with telehealth organizations like Iris Telehealth. Telepsychiatry solutions can help healthcare organizations overcome access issues and help alleviate the pressure of finding a qualified provider locally. For example, a PMHNP living in Texas can meet the licensure requirements in Utah, making it possible to extend healthcare delivery through telepsychiatry.

Telepsychiatry that meets you where you are

Regardless of where nurse practitioners practice, they can utilize telehealth to connect their patients with specialty care while working in their scope of practice. Telepsychiatry can open up your search by hiring a PMHNP from across the country instead of searching locally, especially since there is a high saturation of providers on the East Coast and a higher need on the West Coast.

If you decide to hire a PMHNP for your organization, you can ease some of the administrative burdens, like licensing, credentialing, and obtaining a collaborative agreement.

How Iris Telehealth can help

Iris Telehealth serves as a resource for providers who need support and can help your organization source and vet potential PMNHPs. If you’re looking to develop a formal telepsychiatry program to provide high-quality care for your patients, Iris can help you through the process.

If you would like to learn more about how telepsychiatry can help supplement your behavioral health team, contact us today.

The Long-Term Effects of COVID-19 on Mental Health

The COVID-19 pandemic has left a seismic impact on the hearts and minds of people across the world — whether through job loss, the grief of losing a loved one, difficulty paying bills, or trouble finding quality healthcare.

In tandem with these experiences, the state of mental health has plummeted. According to data published by The Lancet, 76 million people have reported pandemic-related anxiety, a number that increased by 26 percent between 2019 and 2020.

As the pandemic continues, we’re pausing to look back at the unique experiences of different populations across the country, the long-term effects on mental health, and how to help decrease the impact of COVID-19.

Long-term effects on families, rural Americans, and underserved populations

The COVID-19 pandemic has affected everyone differently and has been particularly challenging for families, Americans in rural parts of the country, and underserved populations.

Families and children

For families, the pandemic transformed daily life. Social determinants of health have been exacerbated, and paying bills has gotten harder. In fact, The Commonwealth Fund reported that 7.7 million workers lost their employer-sponsored health insurance (ESI) jobs due to the pandemic-induced recession. This loss also affected 6.9 million dependents across the country.

Additionally, nearly 93% of school-aged children were engaged in distance learning, creating changes and new dynamics in the home. Today, as kids transition from a more controlled, virtual environment to one that’s in-person with more people, noise, and different expectations, it may trigger separation anxiety or underlying fears that could potentially impact their development.

The compounding stress has been so significant that the American Academy of Pediatrics, alongside the Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association, recently declared a national state of emergency in children’s mental health.

Rural America

During the pandemic, 30% of rural Americans reported suffering from anxiety or depression. While finding care can prove challenging, many rural Americans turned to telehealth. In fact, 43% say they have used telehealth for mental health and/or substance use treatment services once a month or more over the past year.

Telepsychiatry works to reach people to get them the right care when and where they need it. For healthcare organizations located in rural areas looking to impact their communities and improve their services in the wake of COVID-19, telepsychiatry can make a real difference in the short and long term.

Underserved Populations

The impact COVID-19 had on underserved populations was especially hard. A survey by The Commonwealth Fund found that Latino and Black people, women, and people with low income are most at risk of mental health concerns because of the pandemic.

The COVID-19 pandemic has underscored the need for health equity. By making mental healthcare more accessible and equipping communities with the right mental health resources, these populations will have the care they need throughout and after the pandemic.

Provider shortages and increased need

Healthcare organizations were hit hard throughout the pandemic, further exacerbating the pre-existing psychiatrist shortage and causing people to delay mental and medical care. At the height of the pandemic, 1 in 5 adults in the U.S. reported they could not get care or delayed care for serious problems, and 57% reported negative consequences. Additionally, a report by the Kaiser Family Foundation (KFF) found that the pandemic and the economic recession created new barriers for those experiencing mental health conditions. In a July 2020 poll, KFF reported specific negative impacts on adults:

  • 36% had difficulty sleeping
  • 32% had difficulty eating
  • 12% experienced an increase in alcohol consumption or substance use
  • 12% experienced worsening chronic conditions due to worry and stress

While there’s mounting pressure on healthcare organizations, there are steps they can take to help relieve shortages and empower patients and providers.

Solutions for healthcare organizations

This lack of access to care for both mental and physical health throughout the pandemic decreased overall wellness. So, what can healthcare organizations and providers do to help set their patients up for success? There are three solutions every organization should consider.

1. Incorporate an integrated care program

Conditions like generalized anxiety disorder, social anxiety, agoraphobia, and more have been exacerbated. When mental health goes untreated, certain medical conditions can worsen over time. The Centers for Disease Control and Prevention (CDC) calls mental and physical health equal components of overall health.

That’s where integrated care programs come in. These programs can play a significant role in helping hospitals, health systems, Federally Qualified Health Centers, and Community Health Centers recover from the pandemic. This convergence of medical and behavioral health facilitates true collaboration between providers, offers patients the best possible care, and mitigates downstream medical costs.

2. Invest in telepsychiatry

As the demand for care increases due to unmet needs, staffing up healthcare organizations with telepsychiatry solutions can help hospitals keep up with demand, support providers, and provide high-quality care to patients. This solution is beneficial for patients in need of specialty care who may not have time to sit on a waiting list or in an emergency room.

By incorporating this solution, hospitals will have a specialist on call 24/7 in the emergency department to consult with inpatient services or support outpatient services to drive better outcomes. Telepsychiatry makes it possible for people to get the care they need when they need it.

3. Ask questions

When providers take the time to ask people how they are and how COVID has affected their lives, it can open up critical communication channels that can ultimately help your organization better serve your patients. For example, if a patient is experiencing food insecurity, providers can point them toward a food bank. Or, if they need to get tested for COVID but don’t know where to go, your organization can help them find a testing location. Asking the right questions can reveal core issues, reduce stress, and encourage connection.

Healing long-term effects through self-care and awareness

Stress can take a toll on us all. For providers who are already dealing with high rates of burnout, it’s imperative to set aside time for self-care. Incorporating lifestyle medicine principles into your life can help heal long-term physical and mental effects. The pillars of this solution include staying hydrated, eating nutritious foods, exercising, getting adequate sleep, limiting substance use, and emphasizing social connectedness.

Taking care of your mental health and turning your awareness towards self-care can make a big difference in helping heal the long-term effects of the COVID-19 pandemic.

Where Iris Telehealth fits in

If you’re looking to incorporate telepsychiatry into your organization but don’t know where to start, Iris Telehealth is here to help. Together, we can help your organization combat the long-term effects of the COVID-19 pandemic. Contact us today!

How Telepsychiatry Can Serve as a Long-Term Solution for Shortage Areas

In many rural areas across the U.S., and even in a lot of urban areas, there’s a huge lack of access to psychiatry or behavioral health services in general. Partially due to the ongoing (and worsening) psychiatry shortage, many healthcare organizations find it difficult to locate high-quality, local behavioral health providers to serve their communities.

And, those challenges compound when an organization needs more specialized care — like bilingual providers or providers who specialize in working with children or older populations. Fortunately, telepsychiatry can go a long way toward filling those care gaps.

In this piece, we’ll break down how telepsychiatry can specifically benefit shortage areas across the country, what challenges your healthcare organization might face in implementing a telepsychiatry program, and best practices that will set you up for success.

What is a shortage area?

Health Professional Shortage Area (HPSA) is a federal designation that identifies an area as having a geographic shortage, which means there’s a shortage of providers for everyone in a defined geographic area. There are also population-based shortages areas — Medically Underserved Areas (MUAs) or Medically Underserved Populations (MUPs), which signify a shortage of providers for a specific group of people — for example, migrant farmworkers or low-income patients. Organizations that qualify as facility HPSAs include public hospitals or nonprofit outpatient centers, correctional facilities, state mental health hospitals, and FQHCs.

Telepsychiatry can provide critical behavioral health support to shortage areas

Shortage areas or HPSAs may be a particularly good fit for telepsychiatry programs because they are disproportionately affected by the national psychiatrist shortage. Healthcare organizations in HSPAs are often unable to have an in-person provider on staff for their care setting, , but through telepsychiatry, they can access quality providers from across the country. Without utilizing telepsychiatry services, organizations will often find themselves with long wait times — or without care entirely.

Having access to providers all over the country who can provide excellent care quickly and conveniently is a huge benefit for these organizations.

Telepsychiatry can also open up access to providers with specific specialties that would otherwise be nearly impossible for healthcare organizations in HPSAs to staff. For example, in communities where the prominent language spoken isn’t English, having access to a telepsychiatry provider who speaks that language is a huge benefit to patients as it enables them to see someone who they feel they can connect with. Additionally, some providers specialize in mental healthcare for LGBTQ patients or other specific patient populations. It can be hugely beneficial to have access to someone who is an expert in that area.

Through telepsychiatry, your organization can access those specialties and fill gaps you can’t fill through your local provider network.

Challenges and considerations for implementing telepsychiatry programs in HPSAs

Whenever your organization begins the process of searching for a telepsychiatry provider, it might be difficult to find the right fit for your community. It’s important to make sure any potential providers understand the culture of your area and can work effectively with your specific patient populations. Working with a telepsychiatry vendor, like Iris Telehealth, can be beneficial through that process as they have in-depth knowledge and experience with identifying, interviewing, and matching providers who would be a good fit for your community and your organization.

Initially, your organization may also face challenges in locating adequate funding for your telepsychiatry program. However, there is no shortage of federal grants available to help bring any necessary resources or technology to your community — you just need to make sure you consider the time it could take to apply for and receive that grant funding.

Some good grant resources to keep an eye on include:

  • Rural Health Information Hub: RHIhub keeps an active list of all funding opportunities for all U.S. states and territories. If your organization is located in a rural area, this will be a great resource for current and future grants.
  • SAMHSA: SAMHSA keeps a comprehensive list of grants for the improvement of quality and availability of substance use and mental health treatment services.
  • Grants.gov: Grants.gov is the largest repository of federal grants for healthcare organizations across the country.

Setting your telepsychiatry program up for success

Regardless of where your organization is located, there are certain steps you can take to help ensure the long-term success of your telepsychiatry program:

  1. Train and educate your staff: Training your staff on specific systems or processes you may need to implement for your telepsych program can seem daunting at first, but it’s an important step to ensure you have the buy-in from your team to launch a successful program. As you walk them through any changes that might come with your new program, remember there are many resources available to help train your staff on how to work with specific technologies. Start by reaching out to your local telehealth resource center to learn more.
  2. Work with a dedicated telepsychiatry partner: If the prospect of launching your program and staffing it with telepsychiatry providers seems overwhelming, it may be a good idea for your organization to reach out to a company like Iris, who can help you set up your program from the ground up.
  3. Educate yourself and your staff on how federal and state policies apply to you: It’s important to make sure your organization is aware of how billing and reimbursement policies affect your telepsychiatry program. And remember, there’s no shortage of evidence that patients like having access to telepsychiatry and telemental health services.

No matter what stage you’re in with your telepsych program, support is out there to help you build a program that provides life-saving access to behavioral health services for your community. If you’re looking for highly qualified, compassionate psychiatrists and psychiatric mental health nurse practitioners with experience working in shortage areas, Iris Telehealth can help. Contact us for more information about building an effective telepsychiatry program.

A Psychiatrist’s Guide to Job Hunting

Job hunting can be a stressful process, and there’s a lot to consider when navigating your next career move. As a psychiatrist, finding a job that prioritizes your well-being is essential. After all, being a mental health professional is tough, and provider burnout is a serious issue affecting 78% of psychiatrists. While the psychiatry field is full of opportunities, it’s crucial to pick the right one to ensure you avoid burnout and love your work.

So, how can you find a fulfilling, flexible job that gives you ample time with family and friends? Read on to learn how you can find that perfect fit.

Know what you want

Psychiatrists spend an average of 48 hours at work per week, and 60% of that time is spent with patients. Additionally, psychiatrists report above-average stress related to their work environment and the complexities of their jobs. That means ensuring your work environment encompasses what you want is essential whether you’re onsite seeing patients or conducting telepsychiatry appointments from home.

As you search for the right fit, consider the following:

  • Time zone difference (telepsychiatry)
  • Patient population
  • Patient volume
  • Work/life balance
  • Amount of paperwork
  • Flexibility

Most importantly, be honest with yourself and realistic about what you want. Whether that’s your desired schedule, patient volume, or team culture — you shouldn’t have to settle. Creating a list can help identify what you need from a position and help you stay true to what’s negotiable and non-negotiable for you. These boundaries can help create longevity and happiness over time.

Questions for a potential employer

The job market for psychiatrists is rife with opportunity, and it’s projected to grow by 13% in the next decade, significantly outpacing other healthcare professions like pediatricians, surgeons, and anesthesiologists. Simultaneously, the U.S. is also experiencing a provider shortage, and the need for psychiatrists is great. That surplus of opportunity makes it all the more important to find the perfect fit that will help you thrive.

The following questions can help you narrow in on the right position.

Compensation

  • What’s their pay structure?
  • What’s their no-show rate?
  • Will you be paid fee-for-service?
  • Who is responsible for taxes?

Administrative

  • What type of electronic medical record do they use?
  • Who is responsible for their licensing? Credentialing? Malpractice insurance?

Growth

  • How many partners do they work with?
  • How long has the company been in business? How have they grown?

Culture

  • What does their company value?
  • Is the organization mission-driven?

At Iris Telehealth, we make our values clear from the beginning. From creating a culture that promotes a positive work-life balance to ensuring less administrative paperwork and excellent benefits — we prioritize people over all else.

Telepsychiatry companies and the importance of job matching

If you’ve ever worked for a medical group, telepsychiatry company, or staffing agency, you’ve probably witnessed good and bad job matching. How an organization approaches job matching can make a big difference in quality.

For telepsychiatry companies, a provider might be matched at random — or they might be matched thoughtfully based on experience and need. If you’ve only worked for healthcare organizations directly, you’ve most likely not dealt with job matching, but if you’re considering working with a telepsychiatry company to expand your options, it’s something you should be aware of.

Acknowledging red flags

As a mental health professional, chances are there have been times when you’ve felt undervalued. Or, maybe you’ve worked in a healthcare system that didn’t prioritize quality care. Whether you’ve dealt with long commutes, troublesome work politics, or disorganization, you know a job can quickly turn stressful.

Being able to identify and acknowledge red flags is an integral part of the job search. Below are three common red flags you should take note of during your job hunt.

  1. They’re not getting to know you: The company you’re talking to should try to get to know you as a person, understand what you like about a job, and understand your personality. When companies take this extra step, it shows they care about making sure their providers are placed somewhere that aligns with the work they want to do and the values they hold.
  2. They’re not giving you information about your placement: If the company isn’t giving you information about your placement, chances are they might take a “plug and play” approach. This approach makes matches based on age and licenses, without regard to a provider’s preference towards things like desired schedule or population. That said, it’s also important to make sure you have the specialization to serve the population they’re asking you to see. All of this can make a big difference in whether or not the company can provide longevity.
  3. They have a high turnover rate: Does the company have a swinging door or providers coming and going? If so, this can be indicative that the telehealth company or staffing agency isn’t making suitable matches. If you suspect their retention is low, it could be helpful to ask how often their clinicians switch jobs or change sites. Additionally, it’s always best practice to check out a company’s Glassdoor page. Company review websites like Glassdoor can provide insights into turnover rates, culture, and whether they live up to their mission and values.

Transparency is key. That’s why at Iris, we get to know our providers first to ensure we can find the right job or clinic placement for them. We pride ourselves on being upfront with all of the necessary details that will affect your day-to-day and job satisfaction. From the clinical setting to the scheduling details to our prescribing philosophy, we are committed to ensuring the role is the right match for you.

Finding the perfect fit

The perfect fit means that you’ll be able to do great, meaningful work and have time for the important stuff. The right job should also include excellent benefits, have a great culture, and allow you to enjoy the work-life balance you’ve always dreamed of. At Iris, we surveyed our providers to determine why they saw Iris as the perfect fit, and four reasons stood out among the rest.

  1. Communication and organization
  2. Staff connection
  3. Iris’ match commitment
  4. Unparalleled clinical support

The benefits of working somewhere that aligns with your goals and values is indispensable. Where you spend your time matters, and for providers at the frontlines of the country’s behavioral health challenges, making sure you have the work/life balance you need to make time for yourself and your family and friends is of the utmost importance. As a mental health professional, you should be respected, valued, and applauded for your work, and finding an employer who aligns with that mission is essential.

Love your work and save the world

At Iris Telehealth, we prioritize the wellbeing of our providers over everything else. Work-life balance is a top priority, and we create a flexible, fulfilling culture that helps you spend more time caring for patients and less time on paperwork — we take care of that for you.

Through our telepsychiatry services, Iris providers deliver care to the patient populations who need it most and help healthcare organizations achieve their goals through clinically sound and financially sustainable psychiatry programs. If you want to learn more about working for us, contact us today.