As the COVID-19 pandemic has unfolded, nurse practitioners (NPs) have been among the health care professionals facing dramatic changes to their roles and responsibilities as well as the mechanisms used to deliver care. In this Q&A, in conjunction with National Nurse Practitioner Week 2020, Brayden Kameg, DNP, PMHNP-BC, CARN, CNE, describes some of those changes, challenges being faced by NPs, and resources that may help NPs better care for themselves and their patients.
Q: What are the most significant impacts the COVID-19 pandemic has had on NPs who treat mental health conditions?
A: The COVID-19 pandemic has precipitated a mental health crisis in the months since March. While social distancing was necessary to slow the spread of COVID-19, this practice resulted in isolation, loneliness, and associated mood and anxiety symptoms. In addition to sequelae related to social distancing, downstream effects of the pandemic itself have resulted in worsening population mental health. For example, individuals who are now unemployed due to pandemic closures, or those experiencing significant financial strain, may note worsening mood and anxiety symptoms. It has been well established that periods of economic volatility are associated with poor mental health outcomes, including suicide. Even individuals with more secure employment, or “essential” workers, such as teachers and nurses, may note worsening mental health symptoms in the context of work stress and uncertainty.
Further, NPs caring for vulnerable populations are critical when it comes to mental health treatment. Individuals who are homeless or who have substance use disorders are disproportionately impacted by this pandemic, and may be at heightened risk for the contraction of COVID-19.
NPs must also recognize the loved ones of the over 230,000 individuals who died from COVID-19. These individuals are grieving, and might develop a variety of mental health symptoms related to this grief.
Q: Have NPs faced any challenges during the pandemic that are unique to the profession?
A: NPs work in a variety of settings, and these settings each come with a unique set of challenges. For NPs treating mental health problems in inpatient psychiatric settings, challenges might include COVID-19 spread within the inpatient units. Inpatient psychiatric units are particularly vulnerable to COVID-19 infection issues, due to the nature of these environments.
Furthermore, NPs working in inpatient settings might contend with not only concerns and worries about the well-being of their patients, but also with concerns over the well-being of staff. Frontline workers are at-risk to contract COVID-19, but are also at-risk for a variety of mental health problems, including depression, anxiety, and burnout. A recent study published in the American Journal of Nursing highlighted that nurses are disproportionately at-risk for death by suicide compared to the general population. It will be interesting to see how the pandemic further influences this data. Therefore, NPs working in inpatient settings may have to act as a source of support for coworkers and colleagues.
NPs working in outpatient settings must contend with evolving population mental health problems. Furthermore, telepsychiatry has emerged as one means to deliver care within the context of a pandemic, and NPs working in community settings may have to evolve their practice in accordance with changing technology.
Q: How has the role of NPs changed since the pandemic began, particularly those who treat mental health conditions?
A: Since the pandemic, the role of NPs treating mental health problems has expanded in a few ways. The most apparent is telepsychiatry interventions, which allow NPs to deliver care to individuals within their geographic area and beyond. NPs must adjust and adapt to telepsychiatry, which has significant advantages in assuring access to care during a pandemic.
NPs treating mental health problems may also notice some expansions to their role, secondary to mental health concerns in the context of the pandemic. NPs may be more likely to provide psychotherapy to those experiencing depression and anxiety related to the pandemic.
Children and adolescents have been very impacted by the disruptions in their education related to the pandemic. Whether attending school virtually, in brick and mortar institutions, or via a hybrid model, there are many uncertainties and inconsistencies for children and adolescents. These youth might experience worsening mental health problems such as depression and anxiety; however, those with ADHD might also struggle with changes to their routine and/or the need to maintain focus and attention within their homes, an often inherently more distracting environment. NPs treating mental health problems are taking on a more expanded role in regard to direct involvement with individualized education programming, and are now often acting as liaison to school officials regarding how to best support children and adolescents struggling with the pandemic.
Q: Are NPs working in primary care seeing more mental health concerns such as depression presenting there?
A: Absolutely! Across the lifespan, NPs working in primary care settings are treating patients with mental health problems that have occurred in or been exacerbated by the pandemic. Given the shortage of mental health providers, these primary care NPs can meet the needs of patients with a variety of mental health problems, including depression, anxiety, and substance use. For more complicated patients that require a higher level of care, primary care NPs should develop close referral networks within their communities for patients with mental health problems. Other unique models include integrated behavioral health care, and there will likely be a growth in the number of integrated behavioral health care settings following the pandemic.
Q: Can you recommend any resources for NPs who are treating mental health issues during the pandemic?
A: There are a few resources that I would recommend for all NPs as it relates to their own mental health and self-care. The American Psychiatric Nurses Association, in conjunction with a few other professional nursing organizations, offers some resources related to self-care and resiliency. The International Society of Psychiatric-Mental Health Nurses also offers a peer support program for frontline workers in need of support during the pandemic.
In regard to resources for NPs providing care to patients with mental health problems, the Substance Abuse and Mental Health Services Administration (SAMHSA) provides a variety of helpful resources. Additionally, the American Psychiatric Association has developed a Telepsychiatry Toolkit that might be useful for those transitioning to telepsychiatry services.
Brayden Kameg, DNP, PMHNP-BC, CARN, CNE, is Assistant Professor of Nursing, Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pennsylvania. She teaches mental health nursing, advanced practice psychiatric nursing, psychotherapy for advanced practice psychiatric nurses, and psychiatric management for primary care providers. Dr. Kameg maintains clinical practice at Psychotherapy Associates, where she treats patients across the lifespan, and the Veterans Administration Pittsburgh Healthcare System, where she works on an inpatient basis. She earned her BSN and her DNP, with a psychiatric-mental health nurse practitioner concentration and minor focus in nursing education, from the University of Pittsburgh.