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For psychiatric care, nurse practitioners need time, mentoring before practicing alone

Re “Let nurse practitioners work alone” (Editorial, Jan. 8): The nurse practitioners in the community mental health centers where we work are smart, caring, and dedicated. But their education does not provide the tools or experience to practice independently at the outset. Governor Baker’s proposal to allow nurse practitioners to practice independently in Massachusetts should be opposed in its current form.

In community mental health centers like ours, the demand for psychiatric care is overwhelming. Patients with severe mental illness engage with our collaborative treatment teams, and without nurse practitioners, we would fail to meet our community’s needs. However, their limited formal education is insufficient to allow nurse practitioners to lead these teams or practice independently. When compared with psychiatrists’ eight or more years of comprehensive medical training, psychiatric nurse practitioners often complete just two years in a part-time degree program, which may be online, and they may only shadow other clinicians prior to final certification.


To address this readiness gap, we have developed a mentorship program in our community mental health centers that provides intensive physician supervision to nurse practitioners entering the field. Nurse practitioners learn to assess and manage challenging clinical situations, navigate a complex health care system, and recognize areas for professional growth. Supervision is reduced as competence increases, and we can imagine a time when each of these promising clinicians will be able to practice independently.

Massachusetts should lead the way in setting the standard for nurse practitioner graduate and postgraduate training and establishing nurse practitioner roles in each setting. Expectations of competency for independent practice must mirror those of physicians. One cannot possibly equate the rigorous training experience of physicians with that of new nurse practitioners, but the path to expertise need not be the same — physicians can and should support our nurse practitioner colleagues in developing proficiency in practice so that we can meet the demands of our communities together.


Dr. Alana Nagle


Dr. Hannah Larsen


The writers are psychiatric physicians and community mental health center medical directors.