Perceptions of barriers to psychiatric-mental health CNS practice.

This descriptive study of practice barriers compared the perceptions of 67 psychiatric/mental health clinical nurse specialists (PMH-CNSs) with those of 767 nurse practitioners (NPs) in a single state. In addition, it contrasted the barriers identified by the rural and urban PMH-CNS study participants (n=14 and 53, respectively). Though all participants found the practice climate moderately restrictive on a 5-point Likert scale (1=very restrictive to 5=not restrictive), the PMH-CNSs found the practice environment significantly more restrictive than the NPs (3.13 versus 3.61, p<.001). Lack of public knowledge of their advanced practice role was the top-ranking practice barrier for both NPs and PMH-CNSs (60% and 44%, respectively). Lack of understanding of their role was the next highest in rank (PMH-CNSs at 49%; NPs at 39%). CMH-CNSs noted resistance from physicians and/or psychologists as their third-highest barrier (42%); the NPs did not rank this barrier in their top five. Rural PMH-CNSs perceived a lack of a peer network as a considerable barrier (57%); however, urban PMH-CNSs did not rank this in their top barriers, indicating that rural professional isolation needs to be addressed. These findings indicate that efforts to educate the public and other professionals about advanced practice nursing roles and issues must be a priority, and other barriers such as salary and isolation continue to hamper the role success of PMH-CNSs.