Much work has been done and is underway to define and articulate the roles and competencies of advanced practice nurses (APNs) and mental health nurses working at an advanced level. In this chapter the continuum between advanced practice and entry-level practice is explained. The role of advanced practice mental health nursing (APMHN) is discussed in an international context with a special emphasis on the European landscape. The ongoing debate regarding the differentiation between the role of the APN, the nurse practitioner (NP), and the clinical nurse specialist (CNS) and what that means for APMHNs is also explored. The four pillars of advanced nursing practice competencies are discussed, and examples given from diverse sources for each one, all the while acknowledging the diversity of healthcare cultures, regulations, and legislations that govern advanced nursing practice in Europe.
- Advanced practice nursing
- Advanced practice mental health nursing
- Role development
This is a preview of subscription content, access via your institution.
Tax calculation will be finalised at checkout
Purchases are for personal use onlyLearn about institutional subscriptions
Schober M, Lehwaldt D, Rogers M, Steinke M, Turale S, Pulcini J, et al. Guidelines on advanced practice nursing. Geneva: International Council of Nurses; 2020. https://www.icn.ch/system/files/documents/2020-04/ICN_APN%20Report_EN_WEB.pdf.
Kane CF. The 2014 scope and standards of practice for psychiatric mental health nursing: key updates. OJIN. 2015;20(1):1.
Stuhlmiller C. Rethinking mental health nursing education in Australia: a case for direct entry. Int J Ment Health Nurs. 2005;14(3):156–60.
de Stegge CA, Oosterhuis H. Psychiatric nursing in the Netherlands and great britain: class, status and gender in the making of a profession. Soc Hist. 2018;43(4):455–83.
APRN Joint Dialogue Group. Consensus model for APRN regulation. NCBN APRN Committee; 2008. https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf.
Gardner G, Chang AM, Duffield C, Doubrovsky A. Delineating the practice profile of advanced practice nursing: a cross-sectional survey using the modified strong model of advanced practice. J Adv Nurs. 2013;69(9):1931–42.
National Organization of Nurse Practitioner Faculties. The doctor of nursing practice degree: Entry to nurse prac-titioner practice by 2025. 2018. Retrieved on January 31st, 2022 from https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/dnp/v3_05.2018_NONPF_DNP_Stateme.pdf.
Drew BL. The evolution of the role of the psychiatric mental health advanced practice registered nurse in the United States. Arch Psychiatr Nurs. 2014;28(5):298–300.
Dowling M, Beauchesne M, Farrelly F, Murphy K. Advanced practice nursing: a concept analysis. Int J Nurs Pract. 2013;19(2):131–40.
Brook S, Rushforth H. Why is the regulation of advanced practice essential? Br J Nurs. 2011;20(16):996–1000.
Bjornsdottir K, Thome M. Sérfræðingar í hjúkrun: Skilgreining, viðurkenning og nám. Tímarit Hjúkrunarfræðinga. 2006;1(1):28.
National Health Services. Advanced practice toolkit. 2022. https://www.e-lfh.org.uk/programmes/advanced-practice-toolkit/.
American Psychiatric Nurses Association, & International Society of Psychiatric-Mental Health Nurses. Psychiatric-mental health nursing: scope and standards of practice. Maryland: American Nurses Association; 2007.
APNA. APNA position statement on LACE recommendations. Falls Church: American Psychiatric Nursing Association; 2020.
Kaas MJ. Will we be ready? Preparing psychiatric-mental health nurses for future practice. J Am Psychiatr Nurses Assoc. 2020;26(1):112–9.
National Organization of Nurse Practitioner Faculties. Population-focused nurse practitioner competencies. Washington: NONPF; 2013. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Population-Focused-NP-Competencies-2013.pdf.
Hein LC, Scharer KM. A modern history of psychiatric–mental health nursing. Arch Psychiatr Nurs. 2015;29(1):49–55.
Nursing and Midwifery Board of Ireland. Advanced practice (nursing) standards and requirements. 2017.
National Health Services: Health Education England. Advanced practice mental health curriculum and capabilities framework. England: National Health Services; 2020. https://www.hee.nhs.uk/sites/default/files/documents/AP-MH%20Curriculum%20and%20Capabilities%20Framework%201.2.pdf.
Royal College of Nursing. Advanced level nursing practice: introduction. London: Royal College of Nursing; 2018. https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2018/july/pdf-006894.pdf?la=en.
Scheydt S, Hegedüs A. Tasks and activities of advanced practice nurses in the psychiatric and mental health care context: a systematic review and thematic analysis. Int J Nurs Stud. 2021;118:103759.
Mullen C, Gavin-Daley A, Kilgannon H, Swift J. Nurse consultants 10 years on: an insight to the role for nurse managers. J Nurs Manag. 2011;19(6):820–31.
Barron D, Snowden A, Martin CR. The role of research in the mental health nurse consultant. Br J Ment Health Nurs. 2013;2(2):93–8.
ter Maten-Speksnijder A, Grypdonck M, Pool A, Meurs P, van Staa A. A literature review of the Dutch debate on the nurse practitioner role: efficiency vs. professional development. Int Nurs Rev. 2014;61(1):44–54.
Boeijen ER, Peters JW, van Vught AJ. Nurse practitioners leading the way: an exploratory study on the added value of nurse practitioners in outpatient care in the Netherlands. J Am Assoc Nurse Pract. 2020;32(12):800–8.
Lambregts J, Grotendorst A. Zo zien verpleegkundig specialisten hun beroep in 2020. Historielijn en uitkomsten rondetafelgesprekken [Perceptions of nurse specialists on their profession in 2020]. Utrecht: V & VN; 2011.
Frank JR, Snell L, Sherbino J. CanMEDS 2015 physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2017; 2015. Google Scholar
European Federation of Nurses Associations. EFN competency framework. EFN guideline to implement article 31 into national nurses’ education programmes. Brussels: European Federation of Nurses Associations; 2015. http://www.efnweb.be/wp-content/uploads/EFN-Competency-Framework-19-05-2015.pdf.
Sevilla Guerra S, Zabalegui A, Comellas Oliva M, Estrem Cuesta M, Martín-Baranera M, Ferrús Estopà L. Advanced practice nurses: analysis of their role from a multicentre cross-sectional study. Int Nurs Rev. 2022;69:30–7.
Skärsäter I, Keogh B, Doyle L, Ellilä H, Jormfeldt H, Lahti M, Higgins A, Meade O, Sitvast J, Stickley T, Kilkku N. Advancing the knowledge, skills and attitudes of mental health nurses working with families and caregivers: a critical review of the literature. Nurse Educ Pract. 2018;32:138–46.
Doyle L, Ellilä H, Jormfeldt H, Lahti M, Higgins A, Keogh B, Meade O, Sitvast J, Skärsäter I, Stickley T, Kilkku N. Preparing master-level mental health nurses to work within a wellness paradigm: findings from the eM enthe project. Int J Ment Health Nurs. 2018;27(2):823–32.
Tamminen N, Solin P, Kannas L, Linturi H, Stengård E, Kettunen T. Mental health promotion competencies in the health sector based on a delphi study. J Mental Health Train Educ Pract. 2018;13(6):297–306.
Stickley T, Higgins A, Meade O, Sitvast J, Doyle L, Ellilä H, Jormfeldt H, Keogh B, Lahti M, Skärsäter I, Vuokila-Oikkonen P, Kilkku N. From the rhetoric to the real: a critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula—the eMenthe project. Nurse Educ Today. 2016;37:155–63. https://doi.org/10.1016/j.nedt.2015.11.015.
Leamy M, Bird V, Le Boutillier C, Williams J, Slade M. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Br J Psychiatry. 2011;199(6):445–52.
Lahti M, Ellilä H, Jormfeldt H, Skärsäter I, Doyle L, Higgins A, Keogh B, Meade O, Stickley T, Sitvast J, Kilkku N. The required knowledge for lifespan mental health promotion and prevention for master’s level mental health nurse education—the eMenthe project. Int J Health Promot Educ. 2018;56(3):143–54.
Jormfeldt H, Doyle L, Ellilä H, Lahti M, Higgins A, Keogh B, Meade O, Stickley T, Sitvast J, Skärsäter I, Kilkku N. Master’s level mental health nursing competencies, a prerequisite for equal health among service users in mental health care. Int J Qual Stud Health Well Being. 2018;13(sup1):1502013. https://doi.org/10.1080/17482631.2018.1502013.
Hannigan B, Simpson A, Coffey M, Barlow S, Jones A. Care coordination as imagined, care coordination as done: findings from a cross-national mental health systems study. Int J Integr Care. 2018;18(3):12.
Shalala D, Bolton LB, Bleich MR, Brennan TA, Campbell R, Devlin L. The future of nursing: leading change, advancing health. Washington, DC: The National Academy Press; 2011. https://doi.org/10.17226/12956.
Ferguson SL, Al Rifai F, Maay'a M, Nguyen LB, Qureshi K, Tse AM, et al. The ICN leadership for change™ programme–20 years of growing influence. Int Nurs Rev. 2016;63(1):15–25.
World Health Organization. Global strategic directions for nursing and midwifery 2021–2025. 2021.
Lamb A, Martin-Misener R, Bryant-Lukosius D, Latimer M. Describing the leadership capabilities of advanced practice nurses using a qualitative descriptive study. Nurs Open. 2018;5(3):400–13.
Heinen M, van Oostveen C, Peters J, Vermeulen H, Huis A. An integrative review of leadership competencies and attributes in advanced nursing practice. J Adv Nurs. 2019;75(11):2378–92.
Elliott N, Higgins A, Begley C, Lalor J, Sheerin F, Coyne I, Murphy K. The identification of clinical and professional leadership activities of advanced practitioners: findings from the specialist clinical and advanced practitioner evaluation study in I reland. J Adv Nurs. 2013;69(5):1037–50.
Happell B, Scholz B. Doing what we can, but knowing our place: being an ally to promote consumer leadership in mental health. Int J Ment Health Nurs. 2018;27(1):440–7.
Jansson I, Forsberg A. How do nurses and ward managers perceive that evidence-based sources are obtained to inform relevant nursing interventions?–an exploratory study. J Clin Nurs. 2016;25(5–6):769–76.
Veeramah V. The use of evidenced-based information by nurses and midwives to inform practice. J Clin Nurs. 2016;25(3–4):340–50.
Reynolds S. Evidence based practice and psychotherapy research. J Ment Health. 2000;9(3):257–66.
Sackett DL, Rosenberg WM, Gray JM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312(7023):71–2.
Gerrish K, McDonnell A, Nolan M, Guillaume L, Kirshbaum M, Tod A. The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses. J Adv Nurs. 2011;67(9):2004–14.
Melnyk BM, Gallagher-Ford L, Long LE, Fineout-Overholt E. The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews Evid-Based Nurs. 2014;11(1):5–15.
Stewart D, Wilson R, Selby P, Darbyshire J. Patient and public involvement. Ann Oncol. 2011;22:vii54–6.
Ventura CAA, Austin W, Carrara BS, de Brito ES. Nursing care in mental health: human rights and ethical issues. Nurs Ethics. 2021;28(4):463–80.
Wall S. Living with grey: role understandings between clinical nurse educators and advanced practice nurses. 2006.
Eraut M. Non-formal learning and tacit knowledge in professional work. Br J Educ Psychol. 2000;70(1):113–36.
Elsom S, Happell B, Manias E. Mental health nurse practitioner: expanded or advanced? Int J Ment Health Nurs. 2005;14(3):181–6.
Daly WM, Carnwell R. Nursing roles and levels of practice: a framework for differentiating between elementary, specialist and advancing nursing practice. J Clin Nurs. 2003;12(2):158–67.
Lowe G, Plummer V, O’Brien AP, Boyd L. Time to clarify—the value of advanced practice nursing roles in health care. J Adv Nurs. 2012;68(3):677–85.
Fulton JS, Mayo A, Walker J, Urden LD. Description of work processes used by clinical nurse specialists to improve patient outcomes. Nurs Outlook. 2019;67(5):511–22.
Elliott N, Begley C, Sheaf G, Higgins A. Barriers and enablers to advanced practitioners’ ability to enact their leadership role: a scoping review. Int J Nurs Stud. 2016;60:24–45.
Flanders SA. Effective patient education: evidence and common sense. Medsurg Nurs. 2018;27(1):55–8.
Yeh M, Wu S, Tung T. The relation between patient education, patient empowerment and patient satisfaction: a cross-sectional-comparison study. Appl Nurs Res. 2018;39:11–7.
Bryant-Lukosius D, DiCenso A. PEPPA framework: a participatory, evidence-based, patient-focused process for advanced practice nursing (apn) role development, implementation, and evaluation. J Adv Nurs. 2004;48(5):530–40.
McNamara S, Giguère V, St-Louis L, Boileau J. Development and implementation of the specialized nurse practitioner role: use of the PEPPA framework to achieve success. Nurs Health Sci. 2009;11(3):318–25.
Editors and Affiliations
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Kristofersson, G.K., Higgins, A., Kilkku, N. (2022). Role and Competencies of Advanced Practice Mental Health Nurses. In: Higgins, A., Kilkku, N., Kort Kristofersson, G. (eds) Advanced Practice in Mental Health Nursing. Springer, Cham. https://doi.org/10.1007/978-3-031-05536-2_2
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-05535-5
Online ISBN: 978-3-031-05536-2