The psychiatric nurse practitioner 1993-2003: a decade that unsettled a specialty

Between 1993 and 2003, a debate raged in psychiatric mental health (PMH) nursing. It was a decade of discourse about the role and titling of PMH advanced practice nurses. The PMH role evolution that occurred throughout this decade was driven by several forces, not all of which were in the control of PMH nursing. This article traces the multiple dynamics that prompted the evolution of the PMH nurse practitioner role, foremost the ascendancy of primary care and the influence of managed care. It also analyzes the conflict created by the American Nurses Credentialing Center PMH Nurse Practitioner examination that became a lightning rod for the disruption occurring in the traditional PMH role. Although the controversy surrounding PMH advanced practice nurse titling is beginning to clear, with the clarity comes a new set of problems for the development of the PMH workforce.