McLean Hospital 115 Mill Street Belmont, MA 02478
In partnership with a private foundation, McLean is embarking on a pilot effort to enhance the clinical workforce in mental health by offering a one-year fellowship to an advanced practice nurse. The Nellie Blumenthal Fellowship is the nursing equivalent of a medical residency program: it gives a newly minted master’s-level psychiatric nurse invaluable experience—under the supervision of seasoned clinicians—in the process expanding McLean’s ability to deliver high-quality patient care.
There has never been a more important time for such specialized training. Ironically, at the same time psychiatric medications and therapies have advanced through research and practice, a nationwide shortage of psychiatrists is preventing quality care from being delivered to all who need it, especially when that treatment involves medication.
Psychologists, nurses, social workers, and allied health professionals have long played important roles in patient care at McLean and elsewhere. However, there are illnesses where medication is critical, and in these cases psychologists and social workers cannot provide the necessary treatment. One way to fill the gap is to employ advanced practice nurses—master’s-level practitioners who have prescribing authority in certain states, including Massachusetts.
A lack of post-graduate training opportunities, however, limits these nurses’ ability to gain expertise in subspecialties such as managing bipolar disorder.
“Fellowships like this one are few and far between—yet they are essential for facilitating the transition from an academic environment to professional practice,” said Linda Flaherty, RN/PC, senior vice president of patient care services. “Having a new advanced practice nurse see a patient every 15 minutes for medication assessment or review is a tremendous expectation and very stressful. So, a significant component of the Nellie Blumenthal Fellowship will focus on medication management.”
There are other systemic reasons why transition-to-practice programs are greatly needed. First, an ongoing nursing shortage has resulted in the creation of many accelerated nursing programs that allow students with undergraduate degrees in non-nursing fields to obtain a bachelor’s and master’s degree in nursing in just two years. These students have even less hands-on clinical experience than their traditionally trained counterparts, according to Flaherty.
And as national healthcare reform compels the system to deliver more patient-centered, coordinated, prevention focused care, nurses—who represent the largest segment of providers nationally and are trained in this approach—will take on a larger role. Recognizing that fact, the Institute of Medicine has called for a number of changes to nurses’ responsibilities and training, including the creation of nurse residency programs like this one.
McLean currently employs 15 advanced practice nurses in programs throughout the hospital among a nursing workforce of more than 200 registered nurses. Both the hospital and the foundation hope to expand this fellowship program in the future and hope it will serve as a model for similar training opportunities across the country.
Katherine Cederbaum, RN, PMHNP, was appointed the Nellie Blumenthal Fellow in September 2012. Ms. Cederbaum, a nurse practitioner who earned her master’s in family psychiatric mental health from Boston College last spring, was chosen from a pool of outstanding applicants. Over the next year, she will be mentored by senior-level practitioners such as a medical director and a psychiatrist.
Ms. Cederbaum will spend about two-thirds of her time within a multidisciplinary team in McLean’s First Episode Clinic, where she will work with patients who have recently been diagnosed with a psychotic disorder and their families educating them about their illnesses and providing therapy and medication management. The rest of her clinical time will be spent in McLean’s Clinical Evaluation Center, honing her diagnostic and treatment planning skills. There will be ample opportunity to take in educational offerings such as Grand Rounds and conferences, participate in a research project and spend time in other clinical settings.
McLean President and Psychiatrist in Chief Scott L. Rauch, MD, said that the Nellie Blumenthal Fellowship is an exciting way for the hospital to fulfill its mission as a leader in training the next generation of mental health clinicians and researchers. “Advanced practice nurses will play an increasingly important role in the transformation of health care into a higher quality, team-based, patient-centered system,” said Rauch. “We are incredibly thankful to the foundation for enabling us to launch this pioneering program.”