A view of prescriptive practice collaboration: Perspectives of psychiatric-mental health clinical nurse specialists and psychiatrists

A majority of states require collaborative prescribing agreements between advanced practice nurses and physicians. Unfortunately, there is limited research describing the collaboration that occurs between the clinicians who have such prescribing agreements. This exploratory study identifies the characteristics, activities, and outcomes of collaboration between psychiatric-mental health clinical nurse specialists (CNSs) with prescribing agreements and their collaborating psychiatrists. Surveys were sent to all the 73 prescribing psychiatric-mental health CNSs identified by the Minnesota Board of Nursing in 1998 and their primary collaborating psychiatrists. Forty-nine CNSs and 32 psychiatrists returned the surveys with 31 matched collaborating dyads identified. Overall satisfaction with the collaborative relationship was high, CNSs (x̄ = 4.34/5) and psychiatrists (x̄ = 4.46/5). Good communication, trust, shared goals for patient outcomes, shared professional values, and respect for clinical competency were identified as important characteristics for effective collaboration. CNSs identified increased professional growth and job satisfaction as professional benefits, while psychiatrists reported shared workload responsibilities. Fewer than half of the CNSs and psychiatrists perceived professional liability as a professional constraint. Psychiatric-mental health CNSs and psychiatrists agreed that the continuity of patient care and efficient access to mental health care were patient benefits. The statistically significant differences between the CNSs' and psychiatrists' responses were related to the number of years they had been in practice, the number of years the CNS had been a prescriber, and the length of time the CNS and psychiatrist had worked together within a collaborative prescribing agreement.