Psychiatric/Mental Health Nurse Practitioner Residency Program (PMHNP)

The mission of the NPR program is to prepare novice PMHNPs to work as independent practitioners within the VA Health Care System. The program will allow Residents to accelerate their growth beyond entry-level professional competence in patient-centered care and operational services and to develop additional leadership skills that can be applied to address the complex needs of the Veteran population in any practice setting.

The overarching goal of the Residency Program is to provide newly graduated, licensed, and board-certified NPs a foundation for a practice embedded with scientific knowledge, clinical expertise, and professionalism. The Residency Program hopes to recruit, educate, and retain NPs to improve the quality and accessibility of healthcare services and accessibility for Veterans.

1. Provide a year-long training program that prepares new graduate PMHNPs for independent practice.
2. Residents will demonstrate competence in the ability to perform as licensed independent practitioners.
3. Residents will gain confidence in the role of a licensed independent practitioner.
4. Integrate evidence-based knowledge, ethical principles, and clinical excellence in advanced practice nursing while caring for the Veteran population.
5. Increase access to mental health care for Veterans through active recruitment, training, and retention of residents within the VA.
6. Develop collaborative skills through interprofessional relationships and the team-based care approach.
7. Provide new NPs with the depth, breadth, and diversity of clinical training necessary to serve as primary mental health providers at VA.

The VA is committed to improving the mental health of the nation's Veterans and is investing in innovative programs to enhance training for mental health providers. The overarching goal of the Residency is to support optimal care for our Veterans by offering educational processes and activities that are robust, evidence-based, and likely to result in successful implementation throughout the year. Based on four curricular anchor themes, the Residency may include:

• PMHNP/ Advanced Practice Registered Nurse (APRN) role development 
• Interprofessional collaboration
• Systems improvement and leadership
• Self-reflective practice

The above four curricular anchor themes are the framework for the overarching program goals and are unique to our Residency training curriculum. Advanced clinical education of the PMHNP has yet to be a part of the fabric of VA training historically. Therefore, it is important to scaffold the Residency objectives, starting with the individual and leading to systems-level impact. Throughout the year, the Residency will do the following to meet the Curricular goals:

1. Provide didactic and experiential learning opportunities with PMHNP faculty and interprofessional clinicians role modeling Veteran-centric care and leadership to build knowledge and skills and develop appropriate attitudes for the PMHNP role.
2. Engage with interprofessional colleagues and build collaborative experiences in workplace-based environments to build competency and focus on team-based care and collaboration. 
3. Provide opportunities to impact systems and build leadership through focused quality improvement experiences and a capstone project. 
4. Engage learners in mentored self-reflective practice and critical reflection to build a culture of self-awareness of lifelong learning. 
5. Contribute to building and supporting the ongoing scholarship and quality improvement culture within advanced practice nursing. 

The program is designed to provide the resident with advanced competencies in a complex, Veteran-centric healthcare environment leading to specialized clinical and leadership skills. The VA's Office of Academic Affiliations (OAA) has developed a set of competencies that align with national accreditation standards across three domains: 14 Core Competencies, 4 Mental Health Competencies, and 6 Patient Care Competencies.

Successful completion of the Residency depends on the resident's ability to meet these competencies. Throughout the year, residents will be evaluated by faculty in competency progression. Below are some of the competencies and examples of behaviors residents should demonstrate by the end of each quarter.

1st Quarter: Unit 1 Orientation and Foundations of Veteran-Centric Behavioral Health Care

• Core Competency III: Communication
• Demonstrated by: the resident will give a concise report that can be used across services to communicate patient care to other healthcare team members.
• Mental Health Competency II: Knowledge of Adult Mental Health Disorders Diagnostic Criteria
• Demonstrated by: resident will increase the accuracy of diagnosis during intake assessments.
• Patient Care Competency VI: Assessment of Health
• Demonstrated by: resident will demonstrate the ability to place appropriate referrals to specialty services.

2nd Quarter: Unit 2 Formulation and Applications of Veteran-Centric Behavioral Health Care

• Core Competency I: Practice-Based Learning
• Demonstrated by: resident will research and present on topics related to advanced nursing practice to peers.
• Mental Health Competency I: Knowledge of Basic Science, Theories, and Models of Care
• Demonstrated by: resident will identify psychosocial factors connected to diagnoses and implement this knowledge to customize the treatment plan.
• Patient Care Competency XI: Patient and Family Education
• Demonstrated by: resident will integrate evidence-based tools and resources to enable patients to assume greater responsibility for self-care management of health and wellness.

3rd Quarter: Unit 3 Systems and Impact of Veteran-Centric Behavioral Health Care

• Core Competency XII: Clinical Leadership
• Demonstrated by: resident will engage in supervised training of junior residents.
• Mental Health Competency III: Knowledge of Psychotherapeutic Treatment Modalities
• Demonstrated by: using appropriate testing/screeners to shape clinical decision-making, diagnosis formulation, and development of Veteran care plan.
• Patient Care Competency: X Promotion of Optimal Health
• Demonstrated by: resident will integrate health promotion programs or community resources in the Veteran's treatment plan.

4th Quarter: Unit 4 PMHNP Leadership in Veteran-Centric Behavioral Health Care

• Core Competency II: Quality Improvement & Patient Safety/Evidence-Based Practice
• Demonstrated by: resident will have designed, implemented, and disseminated results of a quality improvement project.
• Mental Health Competency IV: Knowledge of Psychopharmacology
• Demonstrated by: resident will apply scientific knowledge of pharmacotherapy in clinical problem solving, judgment, and decision making in the delivery of Veteran care.
• Patient Care Competency IX: Follow-Up & Evaluation of Patient Status
• Demonstrated by: resident will successfully manage a panel and adjust treatment plans when necessary based upon data collected at follow-up interviews.

Under the clinical supervision of faculty nurse practitioners and psychiatrists, residents will provide care via face-to-face, video, and phone to Veterans onsite at Mather or Martinez. The following list is an example of clinical offerings (may change at any time depending on faculty availability):

• Outpatient Mental Health
• Substance Use Disorders
• Primary Care/Mental Health Integration
• Post-Traumatic Stress Disorder
• Psychotherapy
• Inpatient Psychiatry

Each resident will rotate through multiple settings, providing a comprehensive experience to prepare the graduate to work and lead in a complex healthcare environment. In addition to pharmacotherapeutic treatment, residents will be provided with supervised expertise in evidence-based psychotherapy. Below are the rotation types, examples of clinical settings, and the approximate number of hours in each setting.

Continuity Clinic: designed to give the resident an opportunity for long-term panel management. The resident will spend the largest block of time in this clinic.

• Clinic examples: General Mental Health
• Number of hours per week: approximately 10-15
• Number of weeks: 52

Long Specialty: designed to allow the resident to rotate through specialty clinics for short-term panel management.

• Clinic Examples: Addiction Recovery Treatment Services, PTSD Clinical Team
• Number of hours per week: approximately 5-10
• Number of weeks: 26

Short Specialty: designed to allow the resident to rotate through specialty clinics focusing on short-term interventions or rapid stabilization vs. panel management.

• Clinic Examples: Behavioral Health Intensive Care Unit (psychiatric inpatient), ACCESS team, Primary Care Mental Health Integration
• Number of hours per week: approximately 5-10
• Number of weeks: 13

Residents receive protected time for weekly didactic sessions. Industry experts lead these sessions from inside and outside the VA. Past topics have included:

• Addiction and Trauma
• Motivation Interviewing and Motivational Enhancement
• Diversity: Bias in Charting
• Substance Use Disorders and Schizophrenia Spectrum Disorders
• Coping with Patient Death
• Mental Health Care for Transgender Veterans
• Food, Metabolism, and Psychiatric Disease
• Psychodynamics of Addictions
• Transference, Countertransference, and Clinical Boundaries

• Must be onsite for the entire tour of duty
• Must be able to deliver care via face-to-face, video, and phone from the VA medical centers
• Must have the ability to travel:
• For those stationed at Mather, travel to the McClellan Outpatient Clinic
• For those stationed at Martinez, travel to David Grant Medical Center
• Must be able to adapt writing style to multiple faculty

• Stipend: $90,532 (as of AY 2023)
• A comprehensive benefits package that includes paid vacation, sick leave, paid holidays, and health benefits
• Hiring preference for open positions upon completion of the Residency
• Active and ongoing professional development, which includes recruitment into open positions in VANCHCS and other VA facilities

Summer Cohorts:

• Applications accepted February 1st - March 30th 
• Interviews conducted April 15th - April 30thDecisions sent no later than May 5th
• Residency begins mid-August

Winter Cohorts:

• Applications accepted September 1st - October 15th
• Interviews conducted November 1st - November 15th
• Decisions sent no later than November 25th
• The Residency begins med-February the following year

• U.S. Citizen,
• Graduate of an accredited advance practice psychiatric nursing program within the past 12 months,
• Never have worked as a PMHNP,
• Hold national credentialing as PMHNP through ANCC or eligible for ANCC board exam completion within 90 days of employment,
• Licensure: Current, complete, active, and unrestricted registration as a registered nurse in a State, Territory, or Commonwealth (e.g., Puerto Rico) of the United States or the District of Columbia. Current DEA with prescriptive authority/furnishing license (or eligibility to apply for as above),
• Proficient in written and spoken English,
• Pass a background/security investigation as required by the Veterans Health Administration,
• Random drug testing may be required.

• Application checklist
• Curriculum vitae
• One-page cover letter including:
  • Interest in completing a PMHNP residency,
  • How Residency fits in with your career aspirations,
  • Include specific interests in Veterans' health care,
• Unofficial transcripts (redact sensitive information),
• Application for Health Professions Trainees VA form 10-2850D (omit SSN),
• Three (3) letters of recommendation: one from an academic instructor, one from a preceptor, and one from a place of employment.