A New ANCC Exam Topic: Psychiatric Nurse Case Management

Psychiatric nurse case management is a relatively new topic that’s been added to ANCC’s PMHN exam.  Unfortunately, ANCC provides little exam prep information on this topic on their website or literature.  So I wanted to give you a summary of what it is and how it might present on your exam.

Defining Psychiatric Nurse Case Management

At its core, psychiatric nurse case management involves coordinating care for individuals with mental health conditions across multiple systems. This role bridges the clinical, social, and administrative parts of our healthcare system, ensuring that patients receive continuous, individualized, comprehensive, and holistic support throughout their treatment journey.

Nurse case managers are hands-on health care providers themselves.  In addition to creating and maintaining a therapeutic relationship with the patient, they also:

·         assess patient needs

·         facilitate access to resources

·         monitor treatment effectiveness, and

·         advocate for client-centered goals.

·         collaborate with a wide range of providers—psychiatrists, social workers, primary care clinicians, housing authorities, and community organizations

Scope of Practice and Standards

The scope of psychiatric nurse case management is shaped by several key frameworks:

• American Nurses Association (ANA) Nursing: Scope and Standards of Practice outlines care coordination as a critical nursing responsibility, emphasizing accountability, continuity, and advocacy.

• American Psychiatric Nurses Association (APNA) highlights the role of PMH nurses in integrating mental and physical health care, supporting recovery models, and promoting resilience.

• Substance Abuse and Mental Health Services Administration (SAMHSA) provides guidelines for trauma-informed, culturally competent, and recovery-oriented care—all vital to effective case management.

  
  

The PMHN-BC exam may ask questions about these standards, particularly involving interdisciplinary coordination, ethical practice, and evidence-based interventions. 

Key Competencies for the Exam

The exam is looking for competency and proficiency in:

1. Assessment and Planning

Case managers perform comprehensive biopsychosocial assessments and identify ongoing psychiatric symptoms, medical comorbidities, functional limitations, social determinants, and treatment history. Planning is collaborative and goal-oriented.  The plan of care also adjusts and adapts, based on the patient's response and preferences.

Expect exam items that test your understanding of prioritizing care, creating individualized care plans, and aligning interventions with both short-term stabilization and long-term recovery.

2. Care Coordination

This includes scheduling appointments, facilitating referrals, ensuring medication adherence, and integrating behavioral health with primary care. PMHN-BC questions may ask about navigating various parts of the healthcare system, managing transitions of care (e.g., from inpatient to outpatient), or identifying gaps in services.

3. Advocacy and Client Rights

Psychiatric nurse case managers serve as patient advocates, ensuring informed consent, privacy, equitable access to care, and respect for autonomy. They must understand legal mandates, including the Americans with Disabilities Act (ADA), HIPAA, and involuntary treatment laws. Exam questions may address the nurse’s ability to balance safety with autonomy or identify ethical responses in scenarios involving conflicting needs.

4. Cultural and Trauma-Informed Care

Cultural competence goes beyond language and ethnicity—it includes understanding belief systems, stigma, gender identity, and historical or generational trauma. Trauma-informed care requires recognizing signs of trauma, avoiding activation of trauma symptoms, consciously avoiding re-traumatization, and promoting empowerment and trust.

You might see case-based items that test knowledge of implicit bias, culturally relevant interventions, or trauma-informed responses during crisis intervention.

5. Recovery-Oriented Practice

The recovery model starts with the understanding that recovery is possible.  This challenges the old model of seeing psychiatric and substance abuse diagnoses as life-long disorders from which there is no recovery.  The recovery model emphasizes hope, self-determination, and creating a meaningful role in society for each individual. Case managers support patient life goals, not just symptom reduction. This involves engaging peer support, integrating strengths-based planning, and respecting the patient’s definition of wellness.

The PMHN-BC exam often weaves this philosophy into case scenarios or asks about care plan elements that reflect recovery principles.

Interprofessional Collaboration

Psychiatric nurse case management thrives in team-based environments. It requires collaboration with:

• Psychiatrists for medication management

• Social workers for housing and benefits

• Occupational therapists for functional recovery

• Peer specialists for lived-experience support

• And sometimes law enforcement

Look for cues in questions involving role clarity, communication strategies (e.g., SBAR), and resolving team conflict or coordination lapses.

Bringing It All Together

In your practice, nursing case management may seem like it requires accomplishing a list of discharge planning tasks—tracking labs, following up on missed appointments, or coordinating with parole officers.  But remember that psychiatric nurse case management must filter all of these tasks through the lens of that specific patient’s needs, limitations, and resources.  It’s much more nuanced than merely performing a list of tasks.

One tip: The exam often presents multifactorial scenarios, where you're asked to identify the best or most appropriate response.  Choosing the answer that aligns with recovery-oriented, client-centered, and ethically sound care will help you discern the correct answer.

Understanding the interplay between systems, ethical standards, and patient needs will not only prepare you for certification but deepen your impact as a psychiatric-mental health nurse.

Final Note

ANCC offers a board certification exam on nursing case management (medical, not psychiatric, nursing case management), and I found the practice questions for that exam to be pretty informative all by themselves. CLICK HERE to see them. And as always, good luck on your exam!