Spravato Staffing Requirements Explained: Build Your Team Without Overhiring Or Burning Out

You're ready to add Spravato (esketamine) to your practice. You've done the research, run the numbers, and maybe even completed the Risk Evaluation and Mitigation Strategy (REMS) certification for your clinic. But then comes the question that stops most providers in their tracks:

Who actually needs to be in the room?

And more importantly: How can I build this team without overstaffing or setting myself up for burnout?

Here's the thing most Spravato (esketamine) guides won't tell you: there's the "textbook" answer about who you need on your team, and then there's what actually works in a busy practice. Today, I'm walking you through both so you can staff smartly from day one.

Understanding Spravato staffing requirements

Let's start with the basics. Spravato (esketamine) is a nasal spray administered in your clinic with direct observation for two hours post-dose. It's not a "hand them the medication and send them home" situation. Certified REMS clinics, providers, and pharmacies must be involved in the process, with qualified clinicians present, monitoring, and ready to respond.

That observation requirement is where staffing becomes crucial. You can't drop two-hour observation blocks into your current schedule and assume your team will figure it out. I've watched practices try, and it doesn't end well: burned-out staff, scheduling chaos, and patients who don't get the attention they need during those critical two hours.

The core team: Who you actually need

The good news? You don't need a massive team to launch Spravato successfully. The better news? Most practices can start with 2-3 key roles and scale from there. Let's break down who does what and, more importantly, who you can't afford to skip.

The Provider/Prescriber: Psychiatrist, NP, CRNA, or PA

A REMS certified provider has to evaluate the patient, confirm treatment-resistant depression, write the prescription, and own the treatment plan. In many practices, that's a psychiatrist. But here's what matters: it doesn't have to be.

Physicians with other specialties, Psychiatric Mental Health Nurse Practitioners (PMHNPs), Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), and physician assistants can prescribe Spravato in most states. However, these providers will need prescribing authority and the ability to obtain a DEA in their state (check your state regulations). I've worked with successful Spravato clinics led by Physicians, PMHNPs, NPs, CRNAs, and PAs who handle everything from evaluation to ongoing management, in collaboration with a mental health specialist.

What they're responsible for:

• Initial assessment and obtaining documentation to confirm a patient's diagnosis

• Determining if Spravato is appropriate

• Prescribing and adjusting the treatment protocol

• Monitoring for side effects and response

The Spravato Dose administrator: Who's in the room during treatment

Here's where Spravato staffing requirements get flexible. The person physically administering the nasal spray and providing that two-hour observation doesn't have to be your REMS certified provider. However, the REMS certified provider should be present and immediately available. The clinician overseeing the self-administered Spravato needs to be a healthcare professional, but the specific credentials vary by state.

In many practices, this role falls to:

• A registered nurse (RN)

• Licensed practical nurse (LPN) or medical assistant (in states where permitted)

• The prescribing Physician, PMHNP, NP, CRNA, or PA (in smaller or solo practices)

The clinician observing the patient has responsibilities that include:

• Helping the patient self-administer the Spravato nasal spray

• Monitoring patients during the full observation period

• Educating patients about what to expect (like the fact that effects typically begin within 24 hours)

• Documenting vital signs and any side effects

The strategic question here: Do you want your provider sitting in observation for two hours, or seeing other patients? The math on that decision matters. High-volume clinics separate these roles. Lean practices often combine them. There's no wrong answer — just different models with different economics.

Registered nurses: Your safety net

If you're separating the provider and administrator roles, an RN is often your best bet for the observation period. They're trained to spot problems early and if properly trained, will know what to do when a patient experiences side effects.

What your RN handles:

• Pre-treatment vitals and medical history review

• Real-time monitoring during the two-hour observation window

• Catching adverse reactions early (about 5% of patients experience side effects like elevated blood pressure—nothing catastrophic, but you need someone who knows what to watch for)

• Post-treatment instructions and clearance to leave

Here's the reality: RNs cost more per hour than MAs, but they bring clinical judgment that matters during those observation periods.

Clinical psychologist or therapist: The integration play

Spravato works fast. Patients often report relief within 24 hours. The Food and Drug Administration (FDA) recently approved Spravato as a standalone mono-therapy. However, many leading psychiatrists recommend integrating psychotherapy for sustained results.

Incorporating Psychotherapy Involves:

• Providing structured therapy sessions alongside Spravato treatment

• Help patients process the rapid shifts they're experiencing

• Teach practical coping strategies that stick after treatment ends

• Coordinate with your medical team so everyone's on the same page

  
  

Now, does this person need to be on-site during administration? No, in fact, I've seen many practices incorporate virtual psychotherapy. Some practices have in-house therapists, as some patients prefer the in-person face-to-face approach. Others build strong referral networks with local therapy providers, who meet the patients for their Spravato session. Both can work.

Administrative staff: The glue that holds it together

You can have the best clinical team in the world, but if your front office is a disaster, your Spravato program will struggle. I've seen it happen.

Your administrative team handles the unglamorous work that makes everything else possible:

• Scheduling those two-hour blocks without creating workflow chaos

• Managing patient intake and keeping records REMS-compliant

• Wrestling with insurance verification and prior authorizations

• Gathering documentation and submitting the billing claims correctly so you actually get paid for the work you're doing

The practices that scale their practice? They invest in training their admin team on the specific Spravato requirements. The ones that don't? They tend have many priot authorizations declined, claims denied, and a large accounts receivable (A/R) balance that is greater than 120 days old.

Training and compliance

Here's what I tell every practice adding Spravato: your team is only as good as their training, and I'm not talking about checking a box with a 10-minute orientation. Everyone involved in this program needs to understand how Spravato works, what to expect during treatment, the observation protocols, what red flags look like and your state's specific regulations — because they vary more than you'd think. They also need to know the REMS requirements and documentation standards like they know the back of their hand.

Begin with foundational training, followed by semi-annual refreshers. Update your team when protocols change. The investment in a team training session will save you hours of fixing mistakes later. A well-trained team feels confident when a patient asks a question or something unexpected happens. Confidence comes from competence, and competence comes from training.

Fostering team collaboration

Let's skip the corporate speak about "fostering collaborative environments." Here's what actually works: weekly 15-minute huddles where your team can flag issues before they become problems. That's it.

No elaborate team-building exercises. No monthly all-hands meetings with PowerPoints. Just quick check-ins where your RN can tell your admin staff that three patients this week mentioned anxiety about the observation period, so the staff can adjust their approach.

Or your admin team can say insurance is denying claims for a specific reason, so your provider knows to document differently. When information flows between team members, your patients get better care and your practice runs smoother. The goal is making sure everyone has the context they need to do their job well.

The bottom line: Build smart, not big

Understanding spravato staffing requirements is about matching your team structure to your patient volume, your practice model, and your growth goals. Some practices start with just a psychiatric NP and an RN. Others build a full integrated team from day one. There's no single right answer, but there are plenty of expensive wrong answers—and they usually involve either overstaffing too early or understaffing too long.

Ready to build your Spravato program the right way? I've helped dozens of practices navigate these exact decisions through my Spravato FastTrack program. We'll map out your specific staffing needs, avoid the costly mistakes I see practices make, and get you operational faster. If you're serious about adding Spravato without the trial-and-error, let's talk. You can also learn more about Ketamine Academy's Spravato FastTrack here.