NU501 Unit 7 shadowing report example

Twenty-Minute Visits and a Therapy Credential Left Unused: A Shadowing Report on an Outpatient Psychiatric Mental Health Nurse Practitioner

[Student Name]

Purdue University Global

NU501: Advanced Nursing Roles

Unit 7 Assignment

[Instructor Name]

[Date]

Every specific from the visit is bracketed for the student to supply; the host and practice are not identifiable.

Context

Before settling on the educator track, I had weighed psychiatric mental health nurse practitioner practice as my second choice, and this unit gave me the chance to test that option against its documents. I spent [one clinic day] with a [PMHNP], [employed by a community behavioral health organization], [in the role for about six years]. The purpose was to compare the role as it is written in a regional vacancy notice and in the certifier's eligibility rules with the role as it is practiced. The host reviewed this report for anything identifying, and I have generalized the practice's location and size. Arranging the visit and confirming the details below were my own responsibility.

Finding 1: The Schedule Was Medication Management

The composite posting I reviewed for this track describes the role as providing "psychiatric evaluation, medication management and individual psychotherapy." On the day I observed, the host saw [18] patients. [Sixteen] were scheduled as brief medication follow-ups of about twenty minutes, one was a new evaluation, and one was a longer visit for a patient in crisis. No session was scheduled as psychotherapy.

The certifying body sets a different expectation. To sit for the PMHNP-BC examination, a candidate must have completed clinical training in at least two psychotherapeutic treatment modalities, along with the core courses and supervised clinical hours required of every nurse practitioner candidate (American Nurses Credentialing Center, n.d.). The certifier treats therapy as part of the role's foundation, the posting lists it as a duty, and the schedule leaves no room for it. When I asked about this, the host said that therapy skills show up inside the brief visits, in how questions are asked and how a relapse is framed, but that a full therapy hour had not been on the schedule in [about two years].

Finding 2: The Visit Length Was Set Outside the Room

The twenty-minute slot was not the host's choice. The host described the schedule template as set by the organization's operations team to meet access targets, with a waitlist for new patients of [about ten weeks]. The posting does not mention visit length or productivity expectations at all. This finding explains Finding 1: the gap between the certified role and the practiced role is produced by an organizational decision, not by the practitioner's preference.

Finding 3: Much of the Day Happened After the Visits

Between and after visits, the host spent [about two hours] on documentation, prior authorization requests for two medications, calls with a pharmacy about a controlled substance refill and coordination with a patient's primary care office. None of this appears in the posting's duty list, which describes clinical work only. Hardy and Conway (1988) describe role overload as expectations that exceed the time available to meet them, and the host's day matched that description: the clinical expectations filled the schedule, and the administrative expectations were met in time that was not scheduled at all.

Finding 4: Autonomy Was the Thing the Host Valued Most

Asked what kept them in the role, the host named the freedom to make treatment decisions, and said that the prior employer had required a physician co-signature on every medication change, which the host described as the reason for leaving. In a national sample of 177 new primary care nurse practitioners in their first year, greater professional autonomy stood out as a critical factor in whether they intended to leave (Faraz, 2017). The host works in psychiatric rather than primary care, but the account fits that finding, although one practitioner's view is an illustration, not evidence.

Analysis

Read together, the findings describe a role under two kinds of strain. The first is overload, visible in Finding 3. The second is closer to role incongruity: the role as the host was trained and certified for it includes psychotherapy, and the role as the organization schedules it does not. Hardy and Conway (1988) describe incongruity as a mismatch between a role's demands and the role holder's own values or preparation. The host appeared to have resolved it by folding therapy skills into medication visits, which is a reasonable adaptation, but it means the posting's description of the role is out of date and the certifier's description is aspirational in this setting.

The pattern also explains why the gap exists rather than only that it does. Access targets and waitlists push organizations toward shorter visits; shorter visits favor medication management; and a posting written years ago keeps listing therapy because no one has revised it. Barnes (2015) found that, among 352 nurse practitioners, a formal orientation was the only factor in the regression model significantly associated with a smoother transition into the role. A new PMHNP in this organization would benefit from an orientation that describes the role as it is scheduled, not as it is advertised.

Limits of One Visit

A single clinic day is a small sample, and this report should be read with that in mind. The day I observed may have been lighter or heavier than usual, and the host knew a student was present, which may have changed how the host spoke about the organization. I saw one practitioner in one organization; a PMHNP in private practice, or in an organization that bills for therapy separately, might keep therapy hours on the schedule. The findings are therefore best read as questions to test in other settings rather than conclusions about the role. What the visit does establish is that the role can be practiced very differently from how it is written, and that the difference can be traced to specific organizational decisions that a candidate can ask about before accepting an offer.

Implications for My Plans

The visit confirmed my choice of the educator track, but not for the reason I expected. I had thought I would prefer education because I enjoy teaching. The visit showed me that I also value time for depth, and that a role can be designed, by schedule templates I would not control, in a way that removes depth. The question I will now ask any future employer, in either track, is how the role's time is actually scheduled and who decides it. I have also moved "reading a schedule template" higher on my development list, since it is a document that the postings and handbooks I have analyzed so far never mention.

References

American Nurses Credentialing Center. (n.d.). Psychiatric-mental health nurse practitioner (across the lifespan) certification (PMHNP-BC). American Nurses Association. https://www.nursingworld.org/our-certifications/psychiatric-mental-health-nurse-practitioner/

Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2), 178-183. https://doi.org/10.1016/j.nurpra.2014.11.004

Faraz, A. (2017). Novice nurse practitioner workforce transition and turnover intention in primary care. Journal of the American Association of Nurse Practitioners, 29(1), 26-34. https://doi.org/10.1002/2327-6924.12381

Hardy, M. E., & Conway, M. E. (1988). Role theory: Perspectives for health professionals (2nd ed.). Appleton & Lange.