1
Ethical and Legal implications of the PMHNP
Introduction
Psychiatric-Mental Health Nurse Practitioners (PMHNPs) work in a very complex healthcare
setting that is tied closely to ethical and legal considerations and impacts patient outcomes.
Professional standards for psychiatric and psychological care are evident in psychotherapy and
psychiatric interventions, such as Standards of Psychiatric-Mental Health Nursing Practice and
Standards of Professional Performance. They serve as guidelines to help nurses provide safe,
ethical, evidence-based care, uphold patient rights, keep patient confidentiality, and promote
patient dignity (American Nurses Association [ANA], 2022). Ethics, specifically Standard 7, is
critical because PMHNPs must incorporate the values of autonomy, beneficence, nonmaleficence
and justice into every facet of care. This paper highlights two core psychiatric mental health
registered nurse competencies and two other competencies as well as practical clinical
interventions to illustrate their use in PMHNP practice.
Registered Nurse competencies related to Psychiatric Mental Health.
1.1 Competency: Therapeutic Communication
Therapeutic communication is a basic skill of psychiatric mental health nurses. It includes
meaningful communication that enables patients to share their thoughts, feelings, and concerns in
a safe, non-judgemental space. The ANA (2022) states that communication is critical in building
trust and optimal treatment outcomes in mental health.
The competency may be applied by a PMHNP in psychotherapy sessions through active
listening, open-ended questioning, and empathy. The nurse can, for instance, ask a patient with
depression, "Can you tell me more about how you have been feeling this week? This will
, 2
facilitate emotional expression and enhance the therapeutic relationship. Therapeutic
communication has been shown to increase patient engagement in care and to decrease the
severity of symptoms (Townsend & Morgan, 2021). Show an understanding of patient safety and
risk assessments. Demonstrates knowledge of patient safety and risk assessment.
Assessing and managing patient safety risk, including issues of self harm, suicide and violence is
another key competency. PMHNPs have a legal and ethical responsibility to keep their patients
safe and maintain the patient's autonomy (American Psychiatric Nurses Association [APNA],
2021).
A practical intervention is to perform structured suicide risk assessments with validated tools
such as the Columbia Suicide Severity Rating Scale (C-SSRS). If the patient is determined to be
high-risk, the PMHNP may begin safety planning, may include family support (if appropriate)
and may monitor the patient closely or hospitalize the patient as needed. Research indicates that
early identification of risk is crucial in decreasing outcomes related to suicide (Brodsky et al.,
2018).
2. Additional PMHNP Competencies
2.1 Competency: Ethical Decision-Making (Standard 7: Ethics)
The capacity to apply ethical principles to complex clinical conditions is an essential advanced
competency for PMHNPs and is a core skill in ethical decision making. This involves weighing
confidentiality and duty to warn, respecting patient autonomy and ensuring safety. Ethical
accountability is a key focus in all clinical decisions (ANA, 2022) as outlined in Standard 7.
At some point, a PMHNP might encounter a patient who reveals his or her intention to harm
another person. The nurse would have the ethical obligation to violate confidentiality in this
Ethical and Legal implications of the PMHNP
Introduction
Psychiatric-Mental Health Nurse Practitioners (PMHNPs) work in a very complex healthcare
setting that is tied closely to ethical and legal considerations and impacts patient outcomes.
Professional standards for psychiatric and psychological care are evident in psychotherapy and
psychiatric interventions, such as Standards of Psychiatric-Mental Health Nursing Practice and
Standards of Professional Performance. They serve as guidelines to help nurses provide safe,
ethical, evidence-based care, uphold patient rights, keep patient confidentiality, and promote
patient dignity (American Nurses Association [ANA], 2022). Ethics, specifically Standard 7, is
critical because PMHNPs must incorporate the values of autonomy, beneficence, nonmaleficence
and justice into every facet of care. This paper highlights two core psychiatric mental health
registered nurse competencies and two other competencies as well as practical clinical
interventions to illustrate their use in PMHNP practice.
Registered Nurse competencies related to Psychiatric Mental Health.
1.1 Competency: Therapeutic Communication
Therapeutic communication is a basic skill of psychiatric mental health nurses. It includes
meaningful communication that enables patients to share their thoughts, feelings, and concerns in
a safe, non-judgemental space. The ANA (2022) states that communication is critical in building
trust and optimal treatment outcomes in mental health.
The competency may be applied by a PMHNP in psychotherapy sessions through active
listening, open-ended questioning, and empathy. The nurse can, for instance, ask a patient with
depression, "Can you tell me more about how you have been feeling this week? This will
, 2
facilitate emotional expression and enhance the therapeutic relationship. Therapeutic
communication has been shown to increase patient engagement in care and to decrease the
severity of symptoms (Townsend & Morgan, 2021). Show an understanding of patient safety and
risk assessments. Demonstrates knowledge of patient safety and risk assessment.
Assessing and managing patient safety risk, including issues of self harm, suicide and violence is
another key competency. PMHNPs have a legal and ethical responsibility to keep their patients
safe and maintain the patient's autonomy (American Psychiatric Nurses Association [APNA],
2021).
A practical intervention is to perform structured suicide risk assessments with validated tools
such as the Columbia Suicide Severity Rating Scale (C-SSRS). If the patient is determined to be
high-risk, the PMHNP may begin safety planning, may include family support (if appropriate)
and may monitor the patient closely or hospitalize the patient as needed. Research indicates that
early identification of risk is crucial in decreasing outcomes related to suicide (Brodsky et al.,
2018).
2. Additional PMHNP Competencies
2.1 Competency: Ethical Decision-Making (Standard 7: Ethics)
The capacity to apply ethical principles to complex clinical conditions is an essential advanced
competency for PMHNPs and is a core skill in ethical decision making. This involves weighing
confidentiality and duty to warn, respecting patient autonomy and ensuring safety. Ethical
accountability is a key focus in all clinical decisions (ANA, 2022) as outlined in Standard 7.
At some point, a PMHNP might encounter a patient who reveals his or her intention to harm
another person. The nurse would have the ethical obligation to violate confidentiality in this
