Intra-disciplinary Consultation: Teaching Collaborative Practice with Primary Care and Psychiatric/Mental Health Nurse Practitioner Students

In the context of an ever evolving and increasingly complex health care environment, educators are charged with ensuring that graduates of their programs meet NP competencies specific to the specialty practice as well as the core competencies germane to all specialties.  The NP’s ability to recognize the limits of his/her scope of practice, make appropriate and timely referrals and consultations, and, effectively collaborate in providing care are competencies included in Domains 1, 4 and 5 of the NONPF NP core competencies. This presentation describes one School’s innovative plan to address these competencies over the past three years. Within this school of nursing, once past the core courses, there is minimal interaction among students in different specialties. In this ‘project’, students from the family, adult and psychiatric mental health specialties meet once in a clinical seminar during their final semester of NP education. Early in the semester the students from each specialty are made aware of ‘consultation day’.  They are informed that the purpose of this seminar is to provide an opportunity for each participant to present and seek consultation on a case they encountered which was beyond their level of expertise. Providing this information at the beginning of the semester allows the student sufficient time to choose an exemplar case.  Students are afforded the advantage of presenting ‘real’ clients they have encountered over the course of the semester within the context of a safe learning environment where questions can be asked and mistakes made.  The ‘consultation’ can be used to evaluate a student’s ability to demonstrate case presentation skills, provide an opportunity to discuss the limits of scope of practice, to share knowledge relative to another specialty area, to more fully consider differential diagnoses, and, to discuss how to negotiate shared care. This simulation potentially provides teachable moments relative to appropriateness of referral, diagnostic formulation and discussion of a holistic approach to care in complex patients.  An unintended benefit of this experience was the ‘consultants’ increase in self-confidence and recognition of knowledge attainment in their specialty area.