Bringing psychiatric nursing into the twenty-first century

Psychiatric nursing stands at a crossroads, in danger of losing both its identity and standing within the larger body of nursing. Enrollment in graduate programs is at an all time low and many traditional employment opportunities for psychiatric nurses are disappearing. Many explanations have been proposed to account for the crisis in psychiatric nursing practice. Although many of the identified external forces have had real impact on psychiatric nursing, these factors have impacted all of nursing. Yet our Nurse Practitioner (NP) peers are thriving, with proliferation of NP programs with unprecedented enrollment for this nationally accepted and understood role. The psychiatric nursing crisis may be most directly related to the reality that we as a professional group have thus far failed to adequately respond to external realities that have dramatically altered the environment in which psychiatric nursing occurs. This article argues for reframing the discipline of psychiatric nursing, accomplished as a national consensus building process, and including 4 critical components: (1) reconceptualization of what constitutes the core of psychiatric nursing content and represents the epistemological heart of the profession; (2) identification of the critical clinical competencies that reflect the core content, represent the role and scope of psychiatric nursing, and that match current and anticipated practice realities; (3) identification and standardization of measurable clinical outcomes, predicated on both content and competencies, which will allow psychiatric nurses to measure, in meaningful ways, the impact of their practice on patients' health; and (4) establishment of a research agenda that will allow psychiatric nursing to expand its unique knowledge base.