DiversityNursing Blog

A Career In Psychiatric Mental Health Nursing

Posted by Erica Bettencourt

Wed, Jul 13, 2022 @ 10:47 AM

GettyImages-1317092006While physical health is undoubtedly important, so is Mental Health. Millions of Americans are affected by mental illness each year. Psychiatric Nurses have the specialized knowledge and skills needed to treat these illnesses. 

According to the American Psychiatric Nurses Association (APNA), Psychiatric Nurses make up the second largest group of behavioral health professionals in the U.S.

In the United States, suicide is a leading cause of death and in 2020, about:

  • 1 in 5 American adults experienced a Mental Health issue
  • 1 in 6 young people experienced a major depressive episode
  • 1 in 20 Americans lived with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression

The pandemic has increased the need for Mental Health care. According to a report from the Centers for Disease Control (CDC), the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased from 36.4% to 41.5% from August 2020 to February 2021.  

There is a dire need for more Psychiatric Mental Health Nurses (PMHNs).

More than 75% of all U.S. counties have a shortage of Mental Health professionals and almost all counties have an unmet need for Psychiatrists.

Mental Health Nurses work in a wide variety of inpatient and outpatient work settings, either as a specialty position or in primary care. Some job opportunities include military care, forensics, private practices, clinics, community health centers, public health facilities, schools, substance abuse centers, senior centers, hospice, rehabilitation services, telehealth and case management.

The day to day duties of PMHNs include:

  • Conducting an assessment of a patient’s status
  • Conducting intake screenings, initial evaluation, and triage
  • Providing nursing care following a treatment plan
  • Administering medication and/or other treatment regimens
  • Teaching patients self-care activities
  • Engaging in crisis intervention and situation stabilization (when necessary)
  • Educating patients on how to manage their condition
  • Providing education to patients’ families and communities
  • Working efficiently alongside other members of an interdisciplinary team

“It’s a very rewarding field. As a Psychiatric health care provider, you may be the first person to talk to someone about why they are in crisis, and that can be a humbling experience," said Emma Mangano, DNP, PMHNP at Johns Hopkins Hospital

Some essential traits of a Mental Health Nurse include:

  • Critical Thinking
  • Good Communication
  • Empathy
  • Reliability 
  • Confidence
  • Compassion

The salary of a PMHN depends on their level of experience and the amount of specialized training they have undergone. According to Indeed, the average Mental Health Nurse's salary in the U.S. is $87,156.

A career in Mental Health Nursing can be demanding, but it is extremely rewarding.

Psychiatric/Mental Health Nurse Practitioner (PMHNP) Windi Woods, says that the best part of the job is “knowing that this team is the end of the road for most of these patients and we give them hope." 

Topics: mental health, nursing career, mental health nursing, psychiatric mental health nurse, behavioral health, Psychiatric Nurses, mental health nurse

Hospitals Healing With Art Therapy Programs

Posted by Erica Bettencourt

Tue, Jul 05, 2022 @ 02:28 PM

GettyImages-1215146649Art therapy is a growing trend throughout hospitals in the United States. Art therapy is an evidenced-based practice that supports the emotional, physical, social and spiritual well-being of patients of all ages through the therapeutic use of art-making. 

These programs use a wide range of outlets such as drawing, painting, sculpting, collage, and photography as tools to:

  • Process feelings about a new diagnosis 
  • Provide a sense of control through normalizing activities to help them adjust to hospitalization and/or illness
  • Cause relaxation and reduction of anxiety
  • Rebuild self-esteem
  • Help manage pain
  • Support groups of patients with similar diagnosis
  • Support siblings and family members in caring for their loved one in the hospital
  • And more!

Childrens National Hospital uses trained art therapists who offer resources like nature art therapy in the Healing Garden and gallery displays to give children the opportunity to express themselves through creative activities. They are also a Beads of Courage member hospital.

The University of Florida Shands Hospital arts in medicine program started small back in 1990. Jill Sonke, an artist at the hospital said, "No one is suggesting in arts and health that the arts can replace medicine or health care or other therapies or interventions. But the arts have a place in the sphere of whole person care. There's so many ways in which the arts can address things like loneliness and social isolation."

Not every hospital has an in-house art program, many bring in outside help from organizations such as, the Museum of Fine Arts (MFA) or the Caring Arts Foundation Program.

MFA Artful Healing offers art-making activities for children, teens, young adults, and their families in Boston-area hospitals and healthcare centers. The MFA currently provides off-site workshops at Boston Children's Hospital, Massachusetts General Hospital, and Dana-Farber Cancer Institute.

A Parent at Boston Children's Hospital said, "We’ve been here more than ten times in the last two weeks . . . but this is the first time I’ve seen my son smiling. Thank you for that!”

The Caring Arts Foundation Program uses professional photographers to take portraits of patients and their families at Lurie Children’s Hospital. They provide fun wardrobes and props. A common area in the hospital is transformed into a studio with lighting and backdrops. Parents are provided with a full set of photos of their child at no cost — a priceless keepsake. These photo sessions give patients and their families a break from cancer treatment while providing lasting memories. 

The use of the arts can help not only patients cope with traumatic events but also hospital staff. For example, immediately after the September 11th terrorist attack, artists were deployed to New York City schools by ArtCares to help children express and address their emotions of having witnessed the horrific event. The same idea can be used for frontline healthcare workers who have experienced trauma throughout the COVID-19 pandemic.  

Cedars-Sinai created an art exhibit with artwork made by their employees. Art pieces were made by Nurses, Doctors, Scientists, Pharmacists, Data analysts and more! Many participants were fueled with creativity from their experiences during the pandemic.

John Lange, Manager of Art Curation at Cedars-Sinai said, "A few of them are literal translations of what their experience with COVID-19 was—or maybe it is a painting of a Nurse with their mask on and things like that—while for others, the pandemic was the catalyst for them to start making work for the first time, or to revisit and make more art."

Creating art is just as important as treating patients in an environment filled with art. 

The Children’s Hospital Los Angeles teamed up with the nonprofit RxART to transform their 207-foot-long hallway into a magical forest. 

rxart-nicolas-party-childrens-hospital-los-angeles

“It’s been a privilege to think about how artwork can make a difference in the context of a children’s hospital. The colorful forest I painted for this long corridor will hopefully do a little to make this experience a bit more tolerable," said Swiss artist Nicolas Party.

With all of the positive effects art has on mental health and cognitive functions, we are excited to see more health systems implementing these types of art programs.  

Topics: mental health, hospital art, art therapy program, art therapy, hospital art therapy, art programs

Cultural Mental Healthcare Disparities

Posted by Erica Bettencourt

Wed, Feb 02, 2022 @ 11:39 AM

GettyImages-1308910334There are large disparities in mental healthcare across races and ethnicities in the U.S. Many factors contribute to the poor mental health outcomes of minority populations. Such as:

  • Inaccessible mental healthcare services
  • Transportation issues, difficulty finding childcare/taking time off work
  • Lacking health insurance coverage
  • Cultural stigma regarding mental healthcare
  • The lack of Black, Indigenous, and people of color (BIPOC) healthcare professionals
  • Racism, bias, and discrimination in healthcare
  • Language barriers

African Americans develop mental health conditions at a similar rate as the general population however, they are less likely to seek care. 

Statistics tell us that about 25% of African Americans seek mental health care, compared to 40% of whites.

Only 1 in 3 Black adults who need mental health care receive it, according to the American Psychiatric Association’s (APA) Mental Health Facts for African Americans guide. 

Research shows American Indian/Alaska Native populations have disproportionately higher rates of mental health problems than the general population.

The overall death rate from suicide for American Indian/Alaska Native adults is about 20% higher compared to the non-Hispanic white population.

In 2019, suicide was the second leading cause of death for American Indian/Alaska Natives between the ages of 10 and 34. 

According to Mental Health America (MHA), Asian American and Pacific Islanders (AAPI) are the least likely racial group in the U.S. to seek mental health services.

Findings from the National Latino and Asian American Study also found that 17.3% of Asian Americans will be diagnosed with a psychiatric condition at some point in their lifetime.

The APA Mental Health Facts for Hispanics and Latinos/as guide reported Hispanics are at lower risk of most psychiatric disorders compared with non-Hispanic whites.

Also Hispanics are more likely to report poor communication with their health provider. Several studies have found that bilingual patients are evaluated differently when interviewed in English as opposed to Spanish and that Hispanics are more frequently undertreated.

It will take enormous effort to reduce disparities in the U.S. In order to achieve mental health equity we must improve access, hire more multicultural providers, offer better insurance coverage, and provide education surrounding stigma and misconceptions.

Resources

African American Mental Health Providers

Black Emotional and Mental Health Collective

Inclusive Therapists

Therapy for Black Men

The National Asian American Pacific Islander Mental Health Association

Find an Asian Therapist

Center for Traditional Medicine

One Sky Center

Indian Health Service

American Society of Hispanic Psychiatry

Therapy for LatinX

The National Alliance for Hispanic Health

SAMHSA’s National Helpline

National Institute of Mental Health brochures and fact sheets

Podcasts

Homecoming Podcast

All My Relations Podcast

The Melanated Social Work Podcast

Between Sessions Podcast

The Full Well Podcast

MannMukti: Mental Health Podcast

Asian Mental & Emotional Health Podcasts

Latinx Therapy Podcast

The Latinx Mental Health Podcast

Topics: mental health, minority mental health, cultural mental health disparities, mental health disparities

Chief Wellness Officer - More Healthcare Organizations Are Adding CWO’s To Their C-Suite

Posted by Erica Bettencourt

Fri, Oct 08, 2021 @ 03:06 PM

wellnessEven before the pandemic, healthcare providers experienced burnout and other negative mental health issues. Now more than ever, it is critical health systems take steps to support their staff's well-being.

Recently, more healthcare organizations have started to hire Chief Wellness Officers (CWO), as a strategy to address burnout, mental health, and compassion fatigue.

Jonathan Ripp MD, MPH, Chief Wellness Officer at the Icahn School of Medicine at Mount Sinai, said there were only a handful of Chief Wellness Officer positions when he was appointed to the role in May 2018. “There has been at least a dozen more who have been named in the past year, and several more places that are looking to create the position,” said Dr. Ripp. “I would not be surprised if, 10 years from now, it's commonplace for most large organizations to have a Chief Wellness Officer or equivalent, taking this challenge on, and doing so in a way that is effective.”

The ultimate goal of this role is to aid system-wide changes that enable staff to practice in a culture that prioritizes and promotes mental health and well-being.

The CWO is responsible for measuring well-being across their organization. Then, they create and implement wellness programs that address the current environment causing burnout and stress.

The hiring of a CWO is not a remedy all on its own. The CWO works in collaboration with other leaders and staff to prioritize well-being and would ultimately lower costs and improve patient care.

According to Beckers Hospital Review, burnout and depression result in major costs to health systems due to an increase in medical errors, reduced quality of care, and turnover. Research has found that for every dollar invested in wellness, hospitals can see a $3 to $6 return on investment.

Medical Schools are also following the hiring trend.

According to Brown University’s Warren Alpert Medical School, medical students are more likely to experience burnout and depression than peers on different career paths. To confront the challenge head-on, they appointed their first Chief Wellness Officer, Dr. Kelly Holder.

Holder said, "Mental and emotional wellness is essential to complete health. We simply cannot ignore this fact. I view my role as another way to serve the students, faculty and physicians in Brown’s medical school, and aid them in not just meeting their immediate self-care needs but also creating and developing plans that can help them learn more about how to take care of themselves in a way that's sustainable for a profession that demands a lot."

“Wellness and self-care is more important than ever before. These next few years will be critical for health care workers as we address the mental and physical burdens from COVID-19,” said George Washington University's Chief Wellness Officer, Lorenzo Norris, MD.

Hopefully this position sticks around, even after the pandemic passes, because burnout and mental health have been issues in the healthcare field all along.

Topics: mental health, compassion fatigue, burnout, hospitals, Nurse burnout, healthcare organizations, frontline workers, front line workers mental health, compassion fatigue in nursing, C-Suite, Chief Wellness Officers, CWO

Hospitals Seeing Increase In Children and Teen Suicide Attempts

Posted by Erica Bettencourt

Mon, Jun 07, 2021 @ 03:31 PM

mentalhealth-1Hospitals are seeing more cases of severe depression and suicidal thoughts among children, particularly attempts to overdose. 

The coronavirus pandemic has drastically changed the way children and teens learn, play and socialize. Many studies found forced isolation and loneliness among children correlated with an increased risk of depression.

Children’s Hospital Colorado, declared a "State of Emergency" in youth mental health. Jena Hausmann, CEO said, "It has been devastating to see suicide become the leading cause of death for Colorado’s children." 

According to the CDC, the proportion of children who arrived in emergency departments with mental health issues increased 24% from March through October 2020, compared with the same period in 2019. Among preteens and adolescents, it rose by 31%. 

Matthew Davis, MD, MAPP, Chair of the Department of Medicine at Lurie Children’s, emphasized the need for accessible, affordable mental health care for pediatric patients has greatly increased because of the pandemic. In fact, nearly 1 in 5 parents said they were unable to access  mental or behavioral health care for their child at some point, most often because they could not find a specialty provider, they could not afford it, or they could not get an appointment in a timely fashion.

Some hospitals like Cincinnati Children’s Hospital Medical Center in Ohio report running at full capacity and having more children “boarding,” or sleeping in EDs before being admitted to the psychiatric unit. 

Terrie Andrews, a Psychologist and Administrator of behavioral health at Wolfson Children’s Hospital in Florida said, "Up to 25 children have been held on surgical floors while waiting for a spot to open in the inpatient psychiatric unit. Their wait could last as long as five days."

Hospitals are not only seeing a higher volume of patients, but these patients have more intense illnesses.

Dr. Jennifer Downs, a pediatric psychiatrist at Connecticut Children’s said, “Instead of seeing kids who are saying, ‘I’m thinking about suicide,’ we’re seeing kids who have had attempts. Instead of seeing kids who are maybe brought in because of parents who feel that they’re verbally out of control, yelling, screaming, saying awful things, we’re seeing kids who are having physical aggression.”

According to The American Academy of Pediatrics, if you notice any of the following symptoms in your children, be sure to contact your child’s Physician as soon as possible:

– unusual changes in mood, such as ongoing irritability, feelings of hopelessness or rage, and frequent conflicts with friends and family
– changes in behavior, such as stepping back from personal relationships
– a loss of interest in activities previously enjoyed
– a hard time falling or staying asleep, or starting to sleep all the time
– changes in appetite, weight, or eating patterns
– problems with memory, thinking, or concentration
– less interest in schoolwork and drop in academic effort
– changes in appearance, such as lack of basic personal hygiene
– an increase in risky or reckless behaviors, such as using drugs or alcohol

If you have contemplated suicide or someone you know has talked about it, call the National Suicide Prevention Lifeline at 1-800-273-8255, or use the online Lifeline Chat, both available 24 hours a day, seven days a week.

Topics: mental health, depression, children, teens, suicide, attempted suicide, overdose

Creative Ways Hospitals Are Supporting Nurses Mental Health

Posted by Erica Bettencourt

Wed, May 12, 2021 @ 02:41 PM

nursestressBefore the COVID-19 pandemic, Nursing was known to be a stressful profession. There was plenty of data showing burnout to be a significant problem among US Nurses.

With increasing stress placed on front line Nurses during this pandemic, hospitals are investing in initiatives and programs to support the mental health of these employees.

Mount Sinai Health System, created recharge rooms for healthcare workers. Dr. Putrino and his team created multi-sensory experiences that can reduce stress in just 15 minutes. These rooms are filled with faux plants and candles, illuminated with calming lights and one wall displays relaxing scenes and sounds. Slider5-Episode38-Recharge-750x400Putrino said, "Listen, what we need is a space or a series of spaces where our healthcare workers can sit down and for just a moment have a lot of their stress just relieved and taken away from them."

Stony Brook Medicine used a similar idea when creating a respite room called "Resilience at the Brook." The large, peaceful area features plants, calming wall art, a pod for private mediation, and relaxing materials, such as coloring books and miniature Zen gardens, to help employees rejuvenate. Employees can also add encouraging messages and quotes to inspire each other on the Motivation Mural Wall.

CharminOhio State University Medical Center (OSUMC) Stress, Trauma and Resilience (STAR) Program uses the Buckeye Paws program. A group of certified therapy dogs visit to provide comfort and emotional support to healthcare staff.

Emily Fawcett, R.N., a float Nurse on all floors at Lenox Hill hospital, started "hope huddles." Hope huddles are held at the beginning of shift changes and Nurses gather together to share news of patients recovering and other inspiring, and even humorous, stories.

Cody Regional Health created a wellness area for employees. The new space, staffed 24/7, includes a meditation room, eight bedrooms with private bathrooms, laundry and shower facilities, on-site access to licensed therapists for emotional support, puzzles and games, and an exercise area to meet employees’ needs.

Elise Phelan, a surgical unit Charge Nurse at UCHealth created the Resilience Program. Phelan would bring in massage therapists, movement therapists, yoga instructors, nutritionists and sometimes therapy puppies.

Code Lavender began in 2008 with Earl Bakken at North Hawaii Community Hospital. Calling the code signals to the Code Lavender team that an individual or group of individuals are in need of emergency psychological assistance.

Many hospitals like Cleveland Clinic have started implementing this code. The Code Lavender team usually comprises representatives from the spiritual care and healing services departments, and other hospital-based support services (such as employee assistance, music therapy, wellness, the ethics consultation service, and art therapy), and volunteers.
Code-Lavender

Bayhealth offers staff Code Lavender Kits. Kits include a back massager, aromatherapy inhalers, LED candles, a sound machine, Code Lavender journals, and a tote to store everything in.

It's very clear there is a need for this kind of support and innovation. The well-being and morale of front line workers should remain a top priority even after the pandemic.

Topics: mental health, mental health nursing, front line workers mental health, mental health support programs, nurses mental health

Health Care Workers Are Facing a Mental Health Crisis During The COVID-19 Outbreak

Posted by Erica Bettencourt

Tue, May 05, 2020 @ 11:25 AM

mentalhealthMany Nurses and Doctors said in interviews with TIME, that fighting COVID-19 is making them feel more dedicated to their chosen career, and determined to persevere and help their patients. But, many also said they were struggling with negative feelings.

Healthcare workers are afraid of spreading the virus to their families, frustrated about the lack of PPE, and feel they can’t do enough for their patients. First responders are tired from long shifts, and are extremely sad for their dying patients, of which many are passing away alone. This is heartbreaking.

Dr. Jay Kaplan, an emergency room Physician and wellness specialist at LCMC Health system in New Orleans, lets his staff know they aren't alone. He listens as Nurses and Doctors share their fears and problems.

Kaplan tells them it’s okay to get sad or angry over the coronavirus. He reads them his poems. He shares that one day he came home and cried to his wife because he was  overwhelmed by the rate of dying patients.

“We need to break the culture of silence and let people know it’s okay not to have it all together all the time,” he said.

Kaplan’s “wellness visits” are a key strategy in preventing healthcare workers from spiraling into depression and post-traumatic stress disorder during the pandemic. Many hospitals across the U.S. are launching similar initiatives.

Mount Sinai hospitals in New York City ramped up initiatives, such as a 24/7 mental health crisis line and one-on-one counseling. It also launched a wellness and resilience center that will track staffers' mental health long term.

Dr. Deborah B. Marin, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai and Director of the new center said,  “This multi-disciplinary center will consider the physical, emotional, mental and spiritual needs of our entire health care community, including those on the frontline and in supporting roles. Working closely with every department across the health system, our aim is to not only address  but to also prevent the development of mental health issues before they occur by intervening early, offering resilience training and treatment for every health care working in need. It’s important that we launch now as this crisis continues to evolve and take a toll on our community.”

Several healthcare workers in the TIME interviews said, among all the uncertainty and fear, they have found some relief in support from their families, communities, and one another.

We’re offering this article during Nurses Week as a reminder to all to be as patient, kind and loving to our Nurses, Healthcare workers, first responders, grocery store employees and all the people out there working to keep us safe. Thank you!

Topics: mental health, first responders, mental health nursing, COVID-19, coronavirus, healthcare workers

Psychiatric-Mental Health Nurses - The Growing Demand

Posted by Erica Bettencourt

Fri, Jan 24, 2020 @ 09:41 AM

mentalhealthnursingApproximately 56 million American adults are struggling with a mental illness or substance use disorder, according to the American Psychiatric Nurses Association (APNA).

An article from mentalhealth.gov, shows the current mental health workforce shortage is projected to grow and would leave the country 250,000 professionals short by 2025.

Only 44% of adults and 20% of children in the U.S. receive the mental health and substance use care they need because there is a growing shortage of qualified professionals trained to provide timely and effective treatment.

This lack of treatment significantly contributes to one of the leading causes of death in the U.S, suicide.

According to the same mentalhealth.gov article, suicide is the 10th leading cause of death in the United States. It accounts for the loss of more than 41,000 lives each year, more than double the number of lives lost to homicide.

An article in the Journal of the American Medical Association (JAMA) discusses the increase in children under 18 going to emergency departments due to attempts of suicide or suicidal ideation.

According to a Hard Cases article, more than 75% of all U.S. counties have a shortage of any type of mental health worker and 96% of all counties have an unmet need for mental health prescribers. This care gap is most profound in rural states where 111 million Americans live in mental health professional shortage areas.

One reason demand for mental health professionals has increased is because more Americans are gaining health coverage. It's the law per the Affordable Care Act that insurers can no longer deny coverage to people who have diagnosed mental illnesses.

Also fewer medical students are specializing in psychiatry because psychiatry jobs don't pay as well as other fields. Students facing high medical school debt are more likely to pick the jobs offering better pay.

There has also been a surge in substance use disorders and greater public awareness of mental illness. Increased public awareness means more people living with mental illness will seek treatment.

Healthcare providers and the medical community at large need to implement a more supportive environment for the psychiatry profession. There should also be increased compensation for psychiatry jobs and student loan forgiveness or free/low-cost psychiatry schooling.

Policy makers should support and enact quality mental health services that will improve public health, particularly populations who most often have no access to mental health services.

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Topics: mental health, substance use disorder, mental health nursing, psychiatry, mental illness, psychiatric mental health nurse

Bebe Moore Campbell National Minority Mental Health Awareness Month

Posted by Erica Bettencourt

Tue, Jul 03, 2018 @ 10:18 AM

mental healthMental health conditions do not discriminate based on race, color, gender or identity. Anyone can experience the challenges of mental illness regardless of their background. However, background and identity can make access to mental health treatment much more difficult.

July is National Minority Mental Health Awareness Month and the month offers organizations an opportunity to create mental health awareness in diverse communities. 

In May of 2008, the US House of Representatives announced July as Bebe Moore Campbell National Minority Mental Health Awareness Month.

The resolution was sponsored by Rep. Albert Wynn and cosponsored by a large bipartisan group to improve access to mental health treatment and services and promote public awareness of mental illness.

quote-as-i-grow-older-part-of-my-emotional-survival-plan-must-be-to-actively-seek-inspiration-bebe-moore-campbell-72-9-0954-932348-edited

Bebe Moore Campbell was an author, advocate, co-founder of NAMI Urban Los Angeles and national spokesperson, who lost her battle with cancer in November 2006.

One in 5 Americans is affected by mental health conditions. Stigma is toxic to their mental health because it creates an environment of shame, fear and silence that prevents many people from seeking help and treatment. The perception of mental illness won’t change unless we act to change it.

Ways to get involved

America’s entire mental health system needs improvement, including when it comes to serving marginalized communities. With all of our help, we hope this month brings awareness to this issue. 

Topics: mental health, minority mental health, Minority Mental Health Awareness Month, mental health awareness, Bebe Moore Campbell

Doctoring, Without the Doctor

Posted by Erica Bettencourt

Tue, May 26, 2015 @ 02:59 PM

By 

www.nytimes.com 

26NEBRASKA master675 resized 600There are just a handful of psychiatrists in all of western Nebraska, a vast expanse of farmland and cattle ranches. So when Murlene Osburn, a cattle rancher turned psychiatric nurse, finished her graduate degree, she thought starting a practice in this tiny village of tumbleweeds and farm equipment dealerships would be easy.

It wasn’t. A state law required nurses like her to get a doctor to sign off before they performed the tasks for which they were nationally certified. But the only willing psychiatrist she could find was seven hours away by car and wanted to charge her $500 a month. Discouraged, she set the idea for a practice aside and returned to work on her ranch.

“Do you see a psychiatrist around here? I don’t!” said Ms. Osburn, who has lived in Wood Lake, population 63, for 11 years. “I am willing to practice here. They aren’t. It just gets down to that.”

But in March the rules changed: Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor’s oversight. Maryland’s governor signed a similar bill into law this month, and eight more states are considering such legislation, according to the American Association of Nurse Practitioners. Now nurses in Nebraska with a master’s degree or better, known as nurse practitioners, no longer have to get a signed agreement from a doctor to be able to do what their state license allows — order and interpret diagnostic tests, prescribe medications and administer treatments.

“I was like, ‘Oh, my gosh, this is such a wonderful victory,’” said Ms. Osburn, who was delivering a calf when she got the news in a text message.

The laws giving nurse practitioners greater autonomy have been particularly important in rural states like Nebraska, which struggle to recruit doctors to remote areas. About a third of Nebraska’s 1.8 million people live in rural areas, and many go largely unserved as the nearest mental health professional is often hours away.

“The situation could be viewed as an emergency, especially in rural counties,” said Jim P. Stimpson, director of the Center for Health Policy at the University of Nebraska, referring to the shortage.

Groups representing doctors, including the American Medical Association, are fighting the laws. They say nurses lack the knowledge and skills to diagnose complex illnesses by themselves. Dr. Robert M. Wah, the president of the A.M.A., said nurses practicing independently would “further compartmentalize and fragment health care,” which he argued should be collaborative, with “the physician at the head of the team.”

Dr. Richard Blatny, the president of the Nebraska Medical Association, which opposed the state legislation, said nurse practitioners have just 4 percent of the total clinical hours that doctors do when they start out. They are more likely than doctors, he said, to refer patients to specialists and to order diagnostic imaging like X-rays, a pattern that could increase costs.

Nurses say their aim is not to go it alone, which is rarely feasible in the modern age of complex medical care, but to have more freedom to perform the tasks that their licenses allow without getting a permission slip from a doctor — a rule that they argue is more about competition than safety. They say advanced-practice nurses deliver primary care that is as good as that of doctors, and cite research that they say proves it.

What is more, nurses say, they are far less costly to employ and train than doctors and can help provide primary care for the millions of Americans who have become newly insured under the Affordable Care Act in an era of shrinking budgets and shortages of primary care doctors. Three to 14 nurse practitioners can be educated for the same cost as one physician, according to a 2011 report by the Institute of Medicine, a prestigious panel of scientists and other experts that is part of the National Academy of Sciences.

In all, nurse practitioners are about a quarter of the primary care work force, according to the institute, which called on states to lift barriers to their full practice.

There is evidence that the legal tide is turning. Not only are more states passing laws, but a February decision by the Supreme Court found that North Carolina’s dental board did not have the authority to stop dental technicians from whitening teeth in nonclinical settings like shopping malls. The ruling tilted the balance toward more independence for professionals with less training.

“The doctors are fighting a losing battle,” said Uwe E. Reinhardt, a health economist at Princeton University. “The nurses are like insurgents. They are occasionally beaten back, but they’ll win in the long run. They have economics and common sense on their side.”

Nurses acknowledge they need help. Elizabeth Nelson, a nurse practitioner in northern Nebraska, said she was on her own last year when an obese woman with a dislocated hip showed up in the emergency room of her small-town hospital. The hospital’s only doctor came from South Dakota once a month to sign paperwork and see patients.

“I was thinking, ‘I’m not ready for this,’ ” said Ms. Nelson, 35, who has been practicing for three years. “It was such a lonely feeling.”

Ms. Osburn, 55, has been on the plains her whole life, first on a sugar beet farm in eastern Montana and more recently in the Sandhills region of Nebraska, a haunting, lonely landscape of yellow grasses dotted with Black Angus cattle. She has been a nurse since 1982, working in nursing homes, hospitals and a state-run psychiatric facility.

As farming has advanced and required fewer workers, the population has shrunk. In the 1960s, the school in Wood Lake had high school graduating classes. Now it has only four students. Ms. Osburn and her family are the only ones still living on a 14-mile road. Three other farmhouses along it are vacant.

The isolation takes a toll on people with mental illness. And the culture on the plains — self-reliance and fiercely guarded privacy — makes it hard to seek help. Ms. Osburn’s aunt had schizophrenia, and her best friend, a victim of domestic abuse, committed suicide in 2009. She herself suffered through a deep depression after her son died in a farm accident in the late 1990s, with no psychiatrist within hundreds of miles to help her through it.

“The need here is so great,” she said, sitting in her kitchen with windows that look out over the plains. She sometimes uses binoculars to see whether her husband is coming home. “Just finding someone who can listen. That’s what we are missing.”

That conviction drove her to apply to a psychiatric nursing program at the University of Nebraska, which she completed in December 2012. She received her national certification in 2013, giving her the right to act as a therapist, and to diagnose and prescribe medication for patients with mental illness. The new state law still requires some supervision at first, but it can be provided by another psychiatric nurse — help Ms. Osburn said she would gladly accept.

Ms. Nelson, the nurse who treated the obese patient, now works in a different hospital. These days when she is alone on a shift, she has backup. A television monitor beams an emergency medicine doctor and staff into her workstation from an office in Sioux Falls, S.D. They recently helped her insert a breathing tube in a patient.

The doctor shortage remains. The hospital, Brown County Hospital in Ainsworth, Neb., has been searching for a doctor since the spring of 2012. “We have no malls and no Walmart,” Ms. Nelson said. “Recruitment is nearly impossible.”

Ms. Osburn is looking for office space. The law will take effect in September, and she wants to be ready. She has already picked a name: Sandhill Behavioral Services. Three nursing homes have requested her services, and there have been inquiries from a prison.

“I’m planning on getting in this little car and driving everywhere,” she said, smiling, behind the wheel of her 2004 Ford Taurus. “I’m going to drive the wheels off this thing.”

Topics: mental health, AANP, health, healthcare, nurse, medical, patients, medicine, patient, treatment, psychiatrist, psychiatric nurse, health laws

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