63 Population-Focused Nurse Practitioner Competencies

Psychiatric-Mental Health Nurse Practitioner Competencies

These are entry-level competencies for the psychiatric-mental health nurse practitioner (PMHNP) and supplement

the core competencies for all nurse practitioners.

The PMHNP focuses on individuals across the lifespan (infancy through old age), families, and populations

across the lifespan at risk for developing and/or having a diagnosis of psychiatric disorders or mental health

problems. The PHMNP provides primary mental health care to patients seeking mental health services in a wide

range of settings. Primary mental health care provided by the PMHNP involves relationship-based, continuous

and comprehensive services, necessary for the promotion of optimal mental health, prevention, and treatment of

psychiatric disorders and health maintenance. This includes assessment, diagnosis, and management of mental

health and psychiatric disorders across the lifespan.

See the “Introduction” for how to use this document and to identify other critical resources to supplement these

competencies.

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies Neither required nor comprehensive, this list reflects only

suggested content specific to the population

Scientific

Foundation

Competencies

1. Critically analyzes data and

evidence for improving advanced

nursing practice.

2. Integrates knowledge from the

humanities and sciences within

the context of nursing science.

3. Translates research and other

forms of knowledge to improve

practice processes and outcomes.

4. Develops new practice

approaches based on the

integration of research, theory,

Neurobiology

Advanced Pathophysiology, Advanced

Pharmacotherapeutics, Advanced Health

Assessment

Psychotherapy theories

Genomics

Developmental neuroscience

Interpersonal neurobiology

Recovery and resiliency

64 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

and practice knowledge

Trauma informed care

Toxic stress

Adverse Childhood Events Studies (ACES)

Studies

Allopathic stress

Advanced Practice and Interprofessional

psychiatric theoretical frameworks

Theories of change in individuals, systems

Stigma issues

Role of the PMHNP in changing policies

Aging Science

Caregiver stress

Leadership

Competencies

1. Assumes complex and advanced

leadership roles to initiate and

guide change.

2. Provides leadership to foster

collaboration with multiple

stakeholders (e.g. patients,

community, integrated health care

teams, and policy makers) to

improve health care.

3. Demonstrates leadership that

uses critical and reflective

thinking.

4. Advocates for improved access,

quality and cost effective health

care.

1. Participates in community and population-

focused programs that promote mental

health and prevent or reduce risk of mental

health problems and psychiatric disorders.

2. Advocates for complex patient and family

medicolegal rights and issues.

3. Collaborates with interprofessional

colleagues about advocacy and policy issues

at the local, state, and national related to

reducing health disparities and improving

clinical outcomes for populations with mental

health problems and psychiatric disorders.

Interprofessional practice competencies

65 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

5. Advances practice through the

development and implementation

of innovations incorporating

principles of change.

6. Communicates practice

knowledge effectively both orally

and in writing.

7. Participates in professional

organizations and activities that

influence advanced practice

nursing and/or health outcomes of

a population focus.

Quality

Competencies

1. Uses best available evidence to

continuously improve quality of

clinical practice.

2. Evaluates the relationships among

access, cost, quality, and safety

and their influence on health care.

3. Evaluates how organizational

structure, care processes,

financing, marketing and policy

decisions impact the quality of

health care.

4. Applies skills in peer review to

promote a culture of excellence.

5. Anticipates variations in practice

and is proactive in implementing

interventions to ensure quality.

Evaluates the appropriate uses of seclusion and

restraints in care processes.

QSEN competencies

Reflective Practice

Self-awareness and self-care

QI process in measuring outcomes of care

66 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

Practice Inquiry

Competencies

6. Provides leadership in the

translation of new knowledge into

practice.

7. Generates knowledge from clinical

practice to improve practice and

patient outcomes.

8. Applies clinical investigative skills

to improve health outcomes.

9. Leads practice inquiry, individually

or in partnership with others.

10. Disseminates evidence from

inquiry to diverse audiences using

multiple modalities.

11. Analyze clinical guidelines for

individualized application into

practice

Research knowledge of:

 Research utilization

 Research process

Skill in use of EBP:

 Evaluating outcomes


 Integrating results into practice

Technology and

Information Literacy

Competencies

1. Integrates appropriate

technologies for knowledge

management to improve health

care.

2. Translates technical and scientific

health information appropriate for

various users’ needs.

2.a Assesses the patient’s and

caregiver’s educational needs

to provide effective,

personalized health care.

2.b Coaches the patient and

caregiver for positive

behavioral change.

3. Demonstrates information literacy

Electronic medical records

Electronic prescriptions

Virtual patient care

Distance linked services

(Telemedicine/Telepsychiatry)

Social networking

Laws for technology

Cultural and Linguistic literacy

Data banks and quality assurance findings

matched by evidence based best practices in

Web-based, tele-, written, oral and electronic

67 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

skills in complex decision making.

4. Contributes to the design of

clinical information systems that

promote safe, quality and cost

effective care.

5. Uses technology systems that

capture data on variables for the

evaluation of nursing care.

communications to enhance care.

Policy

Competencies

1. Demonstrates an understanding of

the interdependence of policy and

practice.

2. Advocates for ethical policies that

promote access, equity, quality,

and cost.

3. Analyzes ethical, legal, and social

factors influencing policy

development.

4. Contributes in the development of

health policy.

5. Analyzes the implications of health

policy across disciplines.

6. Evaluates the impact of

globalization on health care policy

development.

Employs opportunities to influence health policy

to reduce the impact of stigma on services for

prevention and treatment of mental health

problems and psychiatric disorders.

Healthcare/public policy knowledge of:

 Laws and regulations (e.g., Health

Insurance Portability and Accountability

Act [HIPAA], Center for Medicare and

Medicaid Services [CMS], The Joint

Commission, Accreditation Healthcare

Organizations, documentation,

coding/reimbursement, American with

Disabilities Act, mental health parity),

 Principles of advocacy to influence socially

responsible policy, including consumer

focused care .

 Laws, procedures for seclusion and

restraint for hospitals/psychiatric units,

long term care (LTC is inclusive of nursing

homes)

Health Delivery

System

Competencies

1. Applies knowledge of

organizational practices and

complex systems to improve

health care delivery.

2. Effects health care change using

Interprofessional practice competencies

Scope of practice knowledge of:

 Scope and Standards of Practice

 Legal/ethical issues

68 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

broad based skills including

negotiating, consensus-building,

and partnering.

3. Minimizes risk to patients and

providers at the individual and

systems level.

4. Facilitates the development of

health care systems that address

the needs of culturally diverse

populations, providers, and other

stakeholders.

5. Evaluates the impact of health

care delivery on patients,

providers, other stakeholders, and

the environment.

6. Analyzes organizational structure,

functions and resources to

improve the delivery of care.

7. Collaborates in planning for

transitions across the continuum

of care.

 Regulatory agencies

Coordination of services knowledge of

available resources (e.g., consultation

resources, evidence based practice,

community resources, government funded

studies/grants, school resources)

Models of integrative care skill in:

 Obtaining and utilizing appropriate

collateral information

 Providing and utilizing consultations and

referrals

 Communicating with other health care

providers

Ethics

Competencies

1. Integrates ethical principles in

decision making.

2. Evaluates the ethical

consequences of decisions.

3. 3. Applies ethically sound

solutions to complex issues

related to individuals, populations

and systems of care.

Boundaries, duty to report, duty to warn,

confidentiality, reporting abuse, seeks

consultation, knowing scope of practice,

knowing personal limits, safety

State mental health laws

State laws related to involuntary

hospitalization and commitment

Influence on policy by monitoring of policy and

69 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

active communication to appropriate parties to

affect policy for optimal healthcare.

Independent

Practice

Competencies

1. Functions as a licensed

independent practitioner.

2. Demonstrates the highest level of

accountability for professional

practice.

3. Practices independently managing

previously diagnosed and

undiagnosed patients.

3.a Provides the full spectrum of

health care services to

include health promotion,

disease prevention, health

protection, anticipatory

guidance, counseling, disease

management, palliative, and

end of life care.

3.b Uses advanced health

assessment skills to

differentiate between normal,

variations of normal and

abnormal findings.

3.c Employs screening and

diagnostic strategies in the

development of diagnoses.

3.d Prescribes medications within

scope of practice.

3.e Manages the health/illness

status of patients and families

over time.

1. Develops an age-appropriate treatment plan

for mental health problems and psychiatric

disorders based on biopsychosocial theories,

evidence-based standards of care, and

practice guidelines.

2. Includes differential diagnosis for mental

health problems and psychiatric disorders.

3. Assess impact of acute and chronic medical

problems on psychiatric treatment.

4. Conducts individual and group

psychotherapy.

5. Applies supportive, psychodynamic

principles, cognitive-behavioral and other

evidence based psychotherapy/-ies to both

brief and long term individual practice.

6. Applies recovery oriented principles and

trauma focused care to individuals.

7. Demonstrates best practices of family

approaches to care.

8. Plans care to minimize the development of

complications and promote function and

quality of life.

9. Treats acute and chronic psychiatric

disorders and mental health problems.

10. Safely prescribes pharmacologic agents for

patients with mental health problems and

psychiatric disorders.

11. Ensures patient safety through the

appropriate prescription and management of

Age Specific Psychiatric Disorders for:

 Aging adult (65 years and older)

 Adult (18-64 years)

 Adolescent (13-17 years)

 Pre-Adolescent (10-12 years)

 Child (3-9 years)

 Infant (Prebirth-2 years)

Evaluation:

 History and Physical Exam

 Psychiatric Evaluation

 Mental Status Exam Concepts related to

screening instruments (e.g., specificity and

sensitivity, reliability and validity)

Type of screening instruments (e.g.,

depression screening, Mini Mental Status

Exam (MMSE), alcohol screening, ADHD

screening, anxiety screening, drug screening,

serum screening)

Clinical guidelines

Screening tools

Clinical evaluation tools

Medical co-morbidities and differentials

Theoretical foundations of individual, group

and family approaches

70 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

4. Provides patient-centered care

recognizing cultural diversity and

the patient or designee as a full

partner in decision-making.

4.a Works to establish a

relationship with the patient

characterized by mutual

respect, empathy, and

collaboration.

4.b Creates a climate of patient-

centered care to include

confidentiality, privacy,

comfort, emotional support,

mutual trust, and respect.

4.c Incorporates the patient’s

cultural and spiritual

preferences, values, and

beliefs into health care.

4.d Preserves the patient’s

control over decision making

by negotiating a mutually

acceptable plan of care.

pharmacologic and non-pharmacologic

interventions.

12. Explain the risks and benefits of treatment to

the patient and their family.

13. Identifies the role of PMHNP in risk-mitigation

strategies in the areas of opiate use and

substance abuse clients.

14. Seeks consultation when appropriate to

enhance one’s own practice.

15. Uses self-reflective practice to improve care.

16. Provides consultation to health care

providers and others to enhance quality and

cost- effective services.

17. Guides the patient in evaluating the

appropriate use of complementary and

alternative therapies.

18. Uses individualized outcome measure to

evaluate psychiatric care.

19. Manages psychiatric emergencies across all

settings.

20. Refers patient appropriately.

21. Facilitates the transition of patients across

levels of care.

22. Uses outcomes to evaluate care.

23. Attends to the patient- nurse practitioner

relationship as a vehicle for therapeutic

change.

24. Maintains a therapeutic relationship over time

with individuals, groups, and families to

promote positive clinical outcomes.

25. 25. Therapeutically concludes the nurse-

patient relationship transitioning the patient to

other levels of care, when appropriate.

Theoretical foundations of trauma-focused

care and recovery models of care

Gender differences and equality

Foster care, caregiver stress

Simulation of crisis intervention, risk

assessment, other pertinent areas

Epidemiology/risk analysis knowledge of:

 Prevalence of disorders or behaviors in

diverse populations across the life span

 Contributing risk factors and potential

barriers to health promotion and disease

prevention (e.g., 
socioeconomic,

biological, environmental, community

specific variables)

Epidemiology/risk analysis skill in:

 Risk assessment (e.g., violence, abuse,

neglect, suicide, psychopathology)

Health Promotion and Disease Prevention

Health behavior knowledge of:

 Health behavior guidelines (e.g., gender-

based recommendations, exercise,

lifestyle, familial factors that predisposes

one to disease, cultural and societal

influences/stigmas)


Health behavior skills in:

 Selecting and implementing appropriate

health behavior guidelines to specific

situations based on individual patient

71 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

26. Demonstrates ability to address

sexual/physical abuse, substance abuse,

sexuality, and spiritual conflict across the

lifespan.

27. Applies therapeutic relationship strategies

based on theories and research evidence to

reduce emotional distress, facilitate cognitive

and behavioral change, and foster personal

growth

28. Apply principles of self-efficacy/

empowerment and other self-management

theories in promoting relationship

development and behavior change.

29. Identifies and maintains professional

boundaries to preserve the integrity of the

therapeutic process.

30. Teaches patients, families and groups about

treatment options with respect to

developmental, physiological, cognitive,

cultural ability and readiness.

31. Provides psychoeducation to individuals,

families, and groups regarding mental health

problems and psychiatric disorders.

32. Modifies treatment approaches based on the

ability and readiness to learn.

33. Considers motivation and readiness to

improve self-care and healthy behavior when

teaching individuals, families and groups of

patients.

34. Demonstrates knowledge of appropriate use

of seclusion and restraints.

35. Documents appropriate use of seclusion and

restraints.

variances

Growth and development across the lifespan

knowledge of:

 Growth and development theories and

concepts (including spiritual, cultural,

cognitive, emotional, psychosexual,

physical abilities)

 Variances

Growth and development across the lifespan

skill in:

 Developmental assessment

Screening instruments (including invasive and

noninvasive screenings) skill in:

 Selecting and implementing appropriate

screening instrument(s), interpreting

results, and making recommendations and

referrals

Prevention activities knowledge of:

 Primary, Secondary and Tertiary

Prevention activities (e.g., health

promotion, immunizations, anticipatory

guidance, parenting skills, lifestyle

modifications, psychosocial rehabilitation

activities, in- home family treatments, risk

reduction, pharmacology, CAM, self-care)

 Access to care to underserved populations

Prevention activities skill in:

 Guidance, teaching, coaching,

collaborating (with patient, family, and

community)

72 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

 Assessing readiness and capacity (e.g.,

change, learning, health literacy)

 Implementing early intervention activities

Assessment of Acute and Chronic Illness

Anatomy, physiology, development and

pathophysiology across the lifespan

knowledge of:

 Normal anatomy and physiology (including

genetics, normal aging)

 Pathophysiology

Comprehensive psychiatric evaluation

knowledge of:

 Psychopathology (including DSM V signs

and symptoms and neurobiology)

Comprehensive psychiatric evaluation skills in:

 Recognizing clinical signs and symptoms

of psychiatric illness

 Differentiating between pathophysiological

and psychopathological conditions

 Performing and interpreting a

comprehensive and/or interval history and

physical examination 
(including

laboratory and diagnostic studies)

 Performing and interpreting a mental

status examination

 Performing and interpreting a psychosocial

assessment and family psychiatric history

 Performing and interpreting a functional

assessment (activities of daily living,

occupational, social, 
leisure, educational,

73 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

coping skills)

Diagnostic reasoning knowledge of:

 Diagnostic reasoning process

 Diagnostic criteria (e.g., DSM V current

International Classification of Disease)

Diagnostic reasoning skill in:

 Developing and prioritizing a differential

diagnoses list

 Formulating diagnoses according to DSM

V based on assessment data

 Differentiating between normal/abnormal

age related physiological and

psychological symptoms/changes

The Nurse Practitioner and Patient

Relationship

Therapeutic communication knowledge of:

 Therapeutic communication principles,

techniques and ethics (e.g., boundaries,

phases of the therapeutic relationship,

conflict of interest, self-awareness,

negotiation and collaboration)

 Principles of family dynamics and social

support systems

 Cultural competency (e.g., language,

ethnicity, race, religious, spiritual,

biopsychosocial, urban/rural, 
homeless,

migrant, Gay-Bisexual-Lesbian-

Transgender/Transexual orientation,

corrections/forensic, uninsured and

underinsured, health disparities)

74 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

Therapeutic communication skill in:

 Initiating a therapeutic relationship with

patient and family/support system (e.g.,

developing 
therapeutic alliances,

assessing literacy, health literacy, spiritual

needs, and barriers to communication)

 Maintaining a therapeutic relationship with

patient and family/support system (e.g.,

encouraging 
adherence and clinical

engagement, maintaining therapeutic

boundaries)

 Terminating a therapeutic relationship with

patient and family/support system (e.g.,

evaluating the 
effectiveness of a

therapeutic relationship, appropriate

closure and transitioning)

Legal/business/ethical issues knowledge of:

 Ethical principles and issues (e.g.,

termination, risk/benefit of disclosure,

professional boundaries, patient

autonomy, advocacy, consent/assent to

treatment, consumer focused care)

 Legal principles and issues (e.g., conflict

of interest, patient rights and

responsibilities, Health Information

Portability and Accountability Act [HIPAA],

professional obligations, duty to warn)

 Business principles and issues (e.g.,

financial agreements, contracts for

services)

75 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

Clinical Management

Pharmacotherapuetic knowledge of:

 Current pharmacological concepts (e.g.,

pharmacodynamics, pharmacokinetics,

interactions, Complementary/Alternative

medicines [CAM])

 Standards of practice and clinical

guidelines, evidenced-based practice

 Safety and continuous quality

improvement

Pharmacotherapuetic skills in:

 Selecting appropriate medication plan

(e.g., risk/benefit, patient preference,

developmental 
considerations, financial,

the process of informed consent, symptom

management)

 Evaluating patient response and modify

plan as necessary

 Documenting (e.g., adverse reaction,

patient response, changes to plan of care)

Psychotherapy, psychoeducation,

complementary/alternative medicine

knowledge of:

 Theories of treatment modalities (models

and practices)

 Standards of practice and clinical

guidelines, evidenced-based practice

 Safety and continuous quality

improvement

76 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

Psychotherapy, psychoeducation,

complementary/alternative medicine skill in:

 Selecting appropriate therapeutic plan

(e.g., risk/benefit, patient preferences,

developmental 
considerations, financial,

the process of informed consent)

 Implementing appropriate therapeutic plan

 Evaluating patient response and modify

plan as necessary

 Documenting (e.g., adverse reaction,

patient response, changes to plan of care)

Crisis management (e.g., chemical and

physical restraints, seclusion, reporting abuse

and neglect, involuntary hospitalization, safety

assessment, duty to warn, end of life,

institutionalization, residential treatment, foster

care, military service)
knowledge of:

 Theories and concepts associated with

crisis management (e.g., intervention risk

vs. benefit, level of risk, safety, lethality

assessment, stress adaptation, crisis

theories, disaster response)

 Standards of practice and clinical

guidelines, evidenced-based practice

 Safety, continuous quality improvement,

and patient rights

Crisis management skill in:

 Selecting appropriate intervention (e.g.,

risk/benefit, patient preference,

developmental 
considerations, the

77 Population-Focused Nurse Practitioner Competencies

Competency Area

NP Core Competencies Psychiatric-Mental Health

NP Competencies

Curriculum Content to Support

Competencies

Neither required nor comprehensive, this list reflects only

suggested content specific to the population

process of informed consent, least

restrictive environment/invasive treatment)

 Implementing appropriate intervention

 Evaluating patient response and modify

plan as necessary

 Documenting (e.g., adverse reaction,

patient response, changes to plan of care)

 Seclusion & restraint

Neurobiology and genetics of mental illnesses

Theories and application of behavior change