Title : Building a nurse-led neuromodulation clinic: Expanding access, capacity, and the scope of TMS services

Background: Transcranial magnetic stimulation (TMS) is an established non-invasive treatment for major depressive disorder, with emerging applications across additional psychiatric conditions and populations. As demand for neuromodulation increases, sustainable service models are needed to expand treatment capacity while maintaining quality, safety, and continuity of care. Our neuromodulation program transitioned from a two-machine TMS service in an older clinical space to a purpose-designed clinic with three TMS machines. This transition provided an opportunity to redesign the model of care and expand the scope of services.

Objective: To describe the development of an expanded nurse-led neuromodulation clinic and examine how nursing specialization, centralized scheduling, cross-training, and standardized workflows can support increased capacity and diversification of TMS services.

Approach: The redesigned clinic introduced three TMS treatment stations and centralized patient scheduling through administrative support and a standardized booking system, replacing a model in which individual nurses independently managed treatment schedules and assigned machines. Nurses were cross-trained across neuromodulation services, including TMS and electroconvulsive therapy (ECT), allowing staff to work flexibly across clinical areas according to patient and operational needs. TMS services expanded beyond adult major depression to include protocols for youth depression, youth and adult obsessive-compulsive disorder, and smoking cessation. The clinic also delivers multiple stimulation approaches, including intermittent theta-burst stimulation (iTBS), high-frequency left and low-frequency right dorsolateral prefrontal cortex stimulation, bilateral theta-burst stimulation, and standard bilateral repetitive TMS.

Outcomes: The nurse-led model has supported service expansion while maintaining a stable, specialized neuromodulation workforce. Cross-training and centralized scheduling have increased staffing flexibility and supported sustained treatment volumes across TMS and ECT services. Importantly, the nursing role extends beyond technical treatment delivery. Nurses contribute specialized clinical competencies including mental status assessment, physical health assessment, motivational interviewing, patient education, therapeutic engagement, ongoing monitoring, and identification and escalation of changes in clinical status. Strong staff retention has further supported continuity, preservation of specialized expertise, and consistent service capacity.

Conclusion: Expansion of TMS requires consideration not only of technology and physical capacity, but also of the workforce model supporting treatment delivery. A nurse-led, cross-trained neuromodulation model combines technical expertise with psychiatric and physical health assessment, therapeutic engagement, and care coordination. Centralized scheduling and flexible deployment of specialized nurses may further optimize treatment capacity and workforce sustainability. This model provides a potentially transferable approach for health-care organizations seeking to expand and diversify neuromodulation services.

To be updated shortly..