CLINICAL QUALITY OF CARE – PRACTICE PARAMETERS 

Office of the Chief Medical Officer 
Clinical Operations 


Psychiatric Mental Health Nurse Practitioner Standardized Procedures 

PMHNP - 01
 
Category: PMHNP
Published Date: April 2025

  1. INTRODUCTION 

  1. The purpose of this document is to outline the Scope and Standards of Practice for Psychiatric Mental Health Nurse Practitioners (PMHNP) in the Los Angeles County Department of Mental Health (DMH). 

  1. These standards are in compliance with: 

  1. AB 890 and the California Board of Registered Nursing 

  1. California Business and Professions Code § 2836 

  1. California Business and Professions Code § 2837.103 and § 2837.104 

  1. California Business and Professions Code § 4076 

  1. California Business and Professional Code § 4081 and § 4181 

  1. California Code of Regulations § 1379 

  1. California Code of Regulations § 1474 

  1. Health & Safety Code § 11056 

  1. Medical Board of California and SB 1375 

  1. APPROVALS 

  1. These standards are the legal mechanism for the PMHNP to perform functions within their scope of practice. 

  1. These standards incorporate all policies, procedures, and parameters of DMH employees. 

  1. The standardized procedures for furnishing by PMHNPs consists of the content of the DMH Policy 353.02 Furnishing Supervision and all DMH Clinical Parameters for the Medication Use. 

  1. DEFINITIONS 

  1. Advanced Practice Registered Nurse (APRN): An RN with a master's or doctoral level nursing education who is formally recognized by the California Board of Registered Nursing (CA BRN) with an identified clinical specialty.   

  1. Psychiatric Mental Health Nurse Practitioner (PMHNP): An Advanced Practice Registered Nurse (APRN) licensed to diagnose and treat mental health conditions in accordance with state regulations. PMHNPs are classified into three categories: Standard PMHNP, 103 PMHNP, and 104 PMHNP, each with varying levels of autonomy. 104 PMHNP is not currently recognized by DMH. 

  1. SETTING 

  1. The PMHNP may function within any setting operated through DMH. 

  1. SCOPE OF PRACTICE 

  1. Standard PMHNP:  

  1. Assumes principal responsibility for the mental health care of clients under: 

  1. DMH written standardized procedures, and 

  1. Supervision of a DMH Psychiatrist. 

  1. 103 PMHNP:  

  1. Practices independently within a defined scope without standardized procedures, under the provisions outlined in BPC Section 2837.103. 

  1. Works in a group setting with at least one psychiatrist. 

  1. 104 PMHNP (not currently recognized by DMH):  

  1. Practices independently within a defined scope without standardized procedures, under the provisions outlined in BPC Section 2837.104. 

  1. May work outside of a group setting and without a psychiatrist. 

  1. Special populations: 

  1.  Child and maternity cases require approvals from the Chief Medical Officer. 

  1. PMHNP STANDARDIZED PROCEDURES  
    (Note: this section only applies to Standard PMHNPs) 

  1. Development, Approval, and Review Process  

  1. Developed by an interdisciplinary committee of psychiatrists, nurses, and administrators. 

  1. Approved through the Clinical Policy Committee. 

  1. Reviewed every three (3) years or sooner according to applicable changes in legislature. 

  1. The Chief Medical Officer shall review and approve these standards for publishing in congruence with all clinical policies, procedures and parameters. 

  1. A review and acceptance of these standards shall be required by supervisors and PMHNP at evaluation intervals of the county. 

  1. RESPONSIBILITIES 
    (Note: this section only applies to Standard PMHNPs) 

  1. Clinical Responsibilities of the Standard PMHNP 

  1. Provide psychiatric care in compliance with the Standard PMHNP’s licensure and the supervision guidelines set forth by the psychiatrist. 

  1. Communicate regularly with the psychiatrist regarding client care, especially for complex or difficult cases. 

  1. Ensure that all client records, treatment plans, and prescriptions are documented appropriately and co-signed by the psychiatrist as required. 

  1. Abide by all applicable laws and ethical guidelines, including those set forth by the California Board of Registered Nursing, the California Board of Medicine, and the federal Drug Enforcement Administration (DEA) regarding prescribing practices. 

  1. Not prescribe controlled substances unless specifically authorized by the psychiatrist and ensure that all prescriptions follow the appropriate protocols. 

  1. Complete an initial medication assessment which includes a psychiatric diagnosis and provide ongoing medication management and psychiatric care. 

  1. Furnish medications as indicated for clients according to the DMH Policy 353.02 and the DMH Clinical Parameters for Medication Use. 

  1. Complete and sign any client correspondence as defined in DMH Policy 300.03 Clinical Correspondence Concerning Clients which is within their Scope of Practice. 

  1. Order and interpret specific laboratory tests for the client when indicated. 

  1. Complete documentation in accordance with DMH Policy 401.02 Clinical Records Contents and Documentation Entry. 

  1. Supervisory Responsibilities of the Psychiatrist 

  1. Be available for consultation with the Standard PMHNP when needed. 

  1. Appoint a backup psychiatrist in their absence.  

  1. Provide clinical oversight to ensure that the care provided by the Standard PMHNP is consistent with current psychiatric standards and legal requirements.  

  1. Review and co-sign patient records, treatment plans, and prescriptions, as required.  

  1. Ensure that the Standard PMHNP adheres to ethical and legal standards in providing care to clients.  

  1. Review and approve any proposed changes to client care protocols, including medication prescribing or adjustments. 

  1. MANAGEMENT OF CONTROLLED SUBSTANCES 
    (Note: this section only applies to Standard PMHNPs) 

  1. Standard PMHNPs participation in the process of furnishing and ordering controlled substances under Standardized Procedures includes: 

  1. Application to the United States Drug Enforcement Administration (DEA) for a Schedule II registration number. 

  1. Compliance with the DMH Clinical Parameters for the Medication Use. 

  1. The controlled substances shall be furnished or ordered in accordance with a specific protocol approved by the treating or supervising physician. 

  1. A copy of the section of the PMHNP standardized procedure relating to controlled substances shall be provided to any licensed pharmacist who requests.  

  1. EDUCATION 

  1. Master or Doctoral degree in Nursing from an accredited college or university with a specialty in Psychiatric/Mental Health Nursing AND completion of an approved Adult, Child, or Family Nurse Practitioner program, or 

  1. Completion of an approved Master or Doctoral level Psychiatric Mental Health Nurse Practitioner Program issued by an accredited college or university.  

  1. Licenses and Certification:  

  1. Standard PMHNPs: 

  1. Currently licensed by the State of California Board of Registered Nursing as a Registered Nurse 

  1. Currently certified by the State of California as a Psychiatric Mental Health Nurse Practitioner 

  1. Possession of a California State-issued medication Furnishing Number 

  1. Possession of an American Nurses Credentialing Center (ANCC) National Board Certification as a PMHNP 

  1. 103 PMHNPs:  

  1. Has completed the requirements of a Standard NP. 

  1. Holds a National Certification by a certifying body accredited by the National Commission for Certifying Agencies or the American Board of Nursing Specialties, recognized by the Board. 

  1. Has completed a transition to practice in California within the category of their National Certification, consisting of a minimum of three (3) full-time equivalent years or 4,600 hours of clinical practice within 5 years of the application date. 

  1. Must meet the qualifications under BPC Section 2837.103 to practice independently in a group setting with at least one physician and surgeon. 

  1. 104 PMHNPs (not currently recognized by DMH):  

  1. Has completed the requirements of a 103 NP. 

  1. Must have practiced as a 103 NP in good standing for at least three full-time equivalent years or 4,600 hours in direct patient care. 

  1. Must meet the qualifications under BPC Section 2837.104 to practice independently without physician supervision.