We will be formally launching our report into the work of graduate registered mental health nurses on Monday 27th February 2017 at the Kings Fund in London. The report is being viewed now by a group of ‘critical readers’ and will be edited in time for our launch date.
During 2016 The Foundation of Nursing Studies (fons.org.uk) is examining the work of mental health nurses across the UK. With competing demands to respond to national mental health policies, nursing strategies as well as educational and workforce re-design it is essential that graduate mental health nurses can articulate their own contribution and describe a forward view for mental health nursing and their work with people who use services.
Following an initial scoping meeting in March 2016 and by using a platform of informing blog papers on the site mhnurses.wordpress.org, three Twitter-based conversations were held in May, June and July 2016. When data were exposed to thematic analysis five overarching outputs emerged from these social media conversations
– Education and training
– Employment, staffing and capacity to improve
– Creating and managing therapeutic environments, engagement with people and building design
– Care systems – the contribution of MH nurses
– Mental health nursing identity
A conversation paper was developed and has been used as a basis for 9 roundtable conferences across the UK. These will be complete in December and outputs from all of them can be found on this blog site – please see all the posts from each event on this site.
We have presented our work to a conference of 500 mental health nursing students in October and will meet with the Standing Conference of Nurse Directors in November.
We organised a roundtable event for senior mental health nurse educators and the outputs from that are on this blog site. It was most encouraging to note that a purposeful and evidence- based curriculum can now be quickly developed.
A progress paper was presented to the Mental Health and Learning Disability Nurse Directors and Leads forum on Friday November 18th.
Our work will be complete by the end of 2016 and a first draft report will be made available for critical consultation in January 2017.
It is likely that our report will include suggestions for some necessary work to take the profession forward and it is pleasing to note that collaborative work with the Royal college of Nursing and with Mental Health Academics UK is already underway.
Tony Butterworth, Chair, Foundation of Nursing Studies
30 people present: Students, practitioners, nurse educators, service users and carers
Individuals introduced themselves and were asked to share one thing to be remembered for.
Tony Butterworth outlined the purpose of the event, 7th of 9 roundtable events. Explained that he is Chair of the Foundation of Nursing Studies, a charity, and why he is looking for and gaining views on the work of graduate mental health nurses and where the impetus and initial views came from.
Working with independent charity, FONS provides an independent voice. Tony will take all comments with him at the end of the day and write a report about the work of graduate mental health nurses.
Series of twitter based conversations have taken place, now taking round table discussions across country. It was explained what a roundtable event is. Aiming for a report in place by next year.
Need to identify what it is that mental health nurses are good at and can do, so consult with mental health workers, people who use services and other professionals and offer a chance to comment on mental health nursing and its work and suggest some new ideas. Match (or change) the work of mental health nurses and meet the demands of emerging mental health policies
MHN as a graduate profession therefore want to be involved and influential in managing our future and how to best contribute to nation’s health and policy agenda.
3 social media events – we mental health nurses, blog site.
Key issues: five themes informed today’s activities.
It was explained to the participants what came through via twitter.
Speaking to other disciplines, recognise the need for MH nurses, but not aware how best to employ them. Want to be able to say these are the skills we have, this is what we can do, and this is where we fit in. What’s mental health nursing – difficult to answer but need to do it more.
Who looks after the interests of the MH Nursing? RCN president summit meeting soon, to look at how this can be achieved with greater emphasis on ‘how can we do more for mental health nurses?’
Aim of today to give everyone to feel they have a chance to express a view and offer something to this work.
Each table has sticky notes and is asked to answer the following questions.
Use of group identifying the top five statements (with five spots each per page)
1. Things we already know about mental health nurses?
2. Something you’d like mental health nurses to do differently?
3. Some new things you would like mental health nurses to do?
Participants asked to use sticky notes to offer suggestions and then asked to rate their top five.
Things we already know about mental health nurses;
We know who they are
Communicators, people’s person, versatile, jack of all trades, compassionate and caring
Respect the diversity, selfless staff, open mindedness
Generally enter the profession with the best intentions and are compassionate practitioners and have good communication skills.
Tolerant, dedicated, sense of humour, people skills, stressed
Some things you’d like mental health nurses to do differently;
Understand that mental health is not all about illness, it’s about prevention, it’s not all about therapy and gatekeepeing so the ? of individuals.
Have more time to be people, mental health promotion and wellbeing, more visible in the community and other areas of healthcare.
Some discussion on making decisions took place.
Some new things you would like mental health nurses to do?
Outreach services, going to schools, youth groups etc and Mums groups, promotion of mental wellbeing.
More mental health first aid delivery for all nurses and all mental health nurses need to physically assess people.
Speak in sports halls, family drop in services. Working in schools and education. Political role, need to be louder in the defence of mental health care, adequate facilities to meet demand, need more joint services working together.
Need a shift to primary care with stronger emphasis on primary prevention.
Discussion of waiting times for treatment took place. Top three scores off each of the questions to be taken.
Group asked to consider and discuss the following and put thoughts on to a sticky note again for uploading on to boards;
Education of mental health nurses
Employment of mental health nurses
Short discussion of the Mental Health (Wales) Measure 2010 and its requirement, it is legislation in Wales, in relation to the role of the mental health worker.
Group then asked to rate comments in all three areas and to consider three possible ways of describing the work of registered graduate mental health nurses defined by the facilitator. Individuals asked to place a dot on the definition they like best.
• The registered mental health nurses engage in continuous therapeutic engagement and active companionship for people with a range of mental illness
• Registered mental health nurses create and sustain safe and beneficial places where people who have mental illness can receive treatment and move towards recovery
• Registered mental health nurses are graduate professionals – they are graduate practitioners who can offer evidence based therapeutic interventions, create places of positive asylum and gives help to those in distress.
Group given the option to develop their own definition too and whether there is something uniquely Welsh about any of this.
Discussion took place.
Mental health provision under primary care falls under the Measure so this adds value to the work of the mental health nurse. Also the Measure allows people discharged from secondary services to directly access services. The Measure has been subject to review and is ongoing. In some areas it has changed things in others not. A survey was conducted a few years back, positive feedback was received by those using primary care services. As the Measure is law rights to access independent mental health advocates provided.
In terms of uniqueness bilingual provision is to be celebrated, with people receiving their care and support through the medium of the language they seek. It doesn’t happen well enough everywhere but there are elements of good practice. As a country it’s something we need to be aware of, in all fields really, the importance of the individual and their family being able to be supported in their first language, that’s to be celebrated and should be done more.
Discussion on the NHS and recovery college/network which Wales already has, noted that rural area services are not as easy to access in Wales and Scotland.
Peri-natal mental healthcare – very much in the community.
Discussion on undergraduate programme led by facilitator.
43 Universities in the UK who educate mental health nurses and they’re all different.
Graduates should understand and work on safe wards, understand psycho-social interventions, I’d expect them to be about caring for people with dementia and use some of those engagement skills in a purposeful way. If you look at the curriculum you won’t find them the same in many places so undergraduate provision needs to look at itself a bit probably. Any thoughts?
Discussion – Things can sometimes come across as too much medical world, learning takes place in the clinical area – ask staff what they think students should do and know. Need for greater collaboration and more clinical staff to teach on the programme. Discussion of existing programme – revalidating March 2017, 50%/50% theory practice experience in line with the NMC Standards, in addition to field competencies and outcomes students also have generic competencies to meet. External speakers are invited to teach on the programme. Also have a requirement to embed bilingual provision into the curriculum. Need to develop voluntary organisations as nursing spoke placements more so students have greater knowledge/understanding of what other services supporting service users and their families do.
Mentorship – students spend a lot of time in practice but no provision is built into people’s time to actually provide the mentorship for that. Would make a great difference is that could be facilitated. It was mentioned that in another discipline ‘mentoring’ staff get paid a small amount of money for the role. Reference made to managing busy environments while supporting a student.
Next steps – facilitator
Start to action some of the points already raised;
What are we going to do about education and mental health nurses? Go to the NMC – no generalist approach – competencies which truly echo the work of mental health nurses.
Nurse educators need to have a standing conference of nurse educators – people who deliver curriculum need to meet together to describe and understand what’s going into those curriculum, already have volunteers for that.
Meeting to think about mental health nurses and academic careers.
Report out in January
Identify 7/8 work streams based on the discussions.
Take all this information to the RPsych – help us move this forward
Things we already know about mental health nurses.
Mental health nurses feel they have the prime opportunity to change the lives of their patients, families and carers.
Their caring and compassionate characteristics and heightened intuition provides an extrasensory perception. Enabling them/us to build therapeutic relationships quickly at time/times of physical/emotional distress.
However mental health nurses feel strongly that they are the least valued branch within the nursing profession, due to increased focus on physical health rather than mental health. With decreased input/support to develop, fund and sustain mental health services.
Mental health nurses also feel that they work on a regular basis with stigma attached to their profession. Although being a dedicated and resilient workforce they are diverse in their application of individualised nursing care. Allowing them to be able to see the patient as a whole person, without focusing entirely on their area of psychological weakness.
Some things we would like Mental Health Nurses to do differently:
To be more visible in practice environments ‘walking the floor’, using their skills developed in UG education, particularly communication skills. Having time for supervision and their own mental well–being.
Have a stronger focus on preventative work in mental health across the health (and social care) territory.
To use technology more effectively (for patients and care delivery).
Offer a united front, be more collaborative and collegiate as a discipline – Develop (or enhance) representation of the discipline (A (Royal) College of MHN?) This needs to promote the profession and enhance its standing both publically and professionally. It can offer views and represent the discipline in service development (Primary care?) and support the role of MHNs in integration programmes.
Less working in silos, more integration (Neighbourhood teams). Have a greater emphasis on ‘Community’ interventions when working with service users (SU). Using time to spend with SU and we should have pride in our work and contribution. It might be that we have too great a cynical edge and we need to become more imaginative, vocal, confident and certain about our contribution, particularly our psycho-therapeutic skills.
Some ‘new’ things we would like mental health nurses to do
To raise awareness of Mental Health across ALL healthcare and services- Increase input of mental health awareness through school nursing, health visiting, youth workers and ensuring patients mental health needs are prioritised alongside medical needs in medical services.
MH nurses should be empowered to be innovative- To support nurses to grow creatively, and create platforms to support innovation and to promote advanced clinical practice, specialist training and career progression.
Co-develop and co-deliver services using staff with lived experience.
Collaborate and merge clinical practice and academia- to improve different and varied career opportunities, develop roles of clinical academic practitioners.
Get involved in and appreciate research- develop research roles amongst MH nurses.
MH nurses need to celebrate ourselves and our skills, we need to speak up more and take ownership for our actions.
Learn use of new technologies, both social and organisational.
Reduce the need for restraining patients; should it be a nurses’ role to restrain?
———————————- Part two of the consultation ————–
Education and Mental Health Nurses
Mentorship and preceptorship are both critical aspects of the preparation of MHN but both are inconsistently applied, we need to understand the reasons and solutions for this.
Involvement of service users within education and in practice needs to improve but be genuinely sought and utilised.
The education of MHNs should have a focus on prevention as well as supporting people who develop long terms mental health problems.
The preparation of MHNs should develop skills and knowledge in genuine participative care planning, risk assessment and management. Education should teach skills in MHN formulation.
More physical health training in MH education and a greater breadth to a range of services for students (not all hospital based) and to include diverse placement opportunities (midwifery?).
The curriculum feels crammed and innovation stifled by regulatory requirements. What about an extended MHN programme to allow some nurses to become dual qualified
Less reliance on a medical model and one which has a greater emphasis on psycho-social explanations. An education programme which has a strong experiential psycho-therapeutic skill development at its core. This would focus on self-awareness on the part of the nurse in understanding their motivation to help, their empathy and skills of helping people in all spheres of practice.
There were comments related to using e-learning to enable longer practice placements. Mental Health nurses to provide MH 1st aid and this to be integrated into the nursing curriculum.
Employment of Mental Health Nurses
The most selected theme for employment was in favour of the employment of other fields of nursing into Mental Health environments. The discussion around this advocated for a collaborative and holistic approach to patient safety and care, with a focus upon physical health and the importance of parity of esteem. Up next came the importance of high quality support delivered through preceptorship to newly qualified Nurses and the influence that preceptors have in those first twelve months after qualifying. This led us to “career development, not employment” and the influence that workforce development can have upon employee retention and ultimately patient care. We spoke of the younger generation and their mobility in employment and their thirst for progression and success. Following this came positive role-modelling and the impression that our colleagues have upon us throughout education, in our work place and beyond. Positive role-modelling may have an exponential effect upon a workforce and those who feel positively influenced may be more likely to contribute positively to their clients, workplace and community. The final of our top five was the opportunity to take part in rotational posts allowing Nurses to experience four different areas over a two-year contract, encouraging mobility and providing a varied and engaging learning experience upon qualifying.
Professional Identity and MHNs
To educate and facilitate learning of future generations of nurses. To focus on post qualification learning opportunities to support our identity development. Our identity development is a slow personal process, we need to walk before we can run.
Our identity is wrapped up in our ability as skilled communicators for all people in all walks of life who need a MHN.
Our identity is critical, but if we cannot define it amongst ourselves and to others how can we communicate it to students?
How has our history shaped our identity – are we proud of our history? Do we celebrate it? Has our history shaped our image (for the better or worse?). Have we always been a ‘jack of all trades and master of none’? Is that an accurate description of MHN? Is it a positive thing to have many abilities to our bow. We need to promote and protect our identity but without clarity on our identity we will not know when it is under threat.
Is this issue of identity a wider issue for nursing and not just MHN?
As part of our work with mental health nurses The Foundation of Nursing Studies (FoNS) hosted a roundtable conference for mental health nurse educators on Monday 31st October at the Kings Fund, London. A group of senior academic teachers from across the UK met to discuss the present and future education of mental health nurses.
The day was informed by a FoNS paper from the blog site – mhnurses.wordpress.com, developed from the thematic analysis of three social media events conducted earlier in 2016. In that paper and in several conferences since, it has become clear that the pre-registration and post-registration education of mental health nurses should be analysed and reframed to best equip nurse to work effectively both today and tomorrow. ‘Generic nurse’ models being promulgated by regulatory and non-regulatory Government bodies particularly in England raise important questions about the nature of mental health nursing and how best to prepare students to work in services being constantly redefined and changed. The work of graduate mental health nurse is common to all countries although the shape of servcies and policies will have differences.
7 significant outputs from the meeting
Participants were in no doubt as to the importance of properly describing mental health undergraduate education and identifying the uniqueness of the work mental health nurses.
1. It was agreed that mental health nursing is very particular, and is different to other more generic nursing activity
They were clear that It is possible to articulate that difference in a way that uses evidence from social and behavioural sciences, from evidence based interventions and from the interpersonal and experiential approaches that are now well enough known and can be described.
2. There Is a well-found evidence base to curriculum content that is specific to specialist mental health nursing activity
In describing the work that mental health nurses do, it is possible to describe their activities within areas of expertise such as skilled and sustained engagement with people in distress or with those resistant to interpersonal exchanges because of their illness.
3. Working with and alongside people on a 24 hour basis who are vulnerable and distressed as a result of their mental illness is a particular and high level skill offered by mental health nurses
Mental health nurses have been in the vanguard of developing services, creating therapeutic environments and offering interventions that are innovative, safe, productive and accessible for example – star wards/safe wards, Thorn PSI training and Admiral nurses.
4. Mental health nurses have created and regularly use evidence-based interventions in their work – students on undergraduate programmes should be introduced to these skilled processes.
Mental health nurses are working productively in primary care in accident and emergency centres and with other agencies such as the police and ambulance services. While calls for ‘more training’ for general practice nurses, prison and police services are frequent, the combination of their own expertise and that of mental health nurses adds new dimensions to multidisciplinary working. There is evidence based output from such work and students must experience it (if possible) or at least understand the benefits to those at risk.
5. The potential for graduate mental health nurses working in a variety of settings closer to those at risk and using their particular expertise collaboratively, must be better understood and utilised.
The group were convinced that the role of critical reflection and clinical supervision has a firm place in the work of mental health nurses and that it is much more than a reflective conversation that can be seen for example in professional re-registration processes. Students must be exposed to dynamic models of supervision throughout their education programmes. There are models that can use a ‘closed group’ social media platform to learn from these valuable insights and experiences.
6. Critical reflection and clinical supervision is part of the everyday work of mental health nurses. Students need to be familiar and comfortable with its processes and practice.
There was extensive discussion on the capability of mental health nurses to create therapeutic environments and the use of psychological therapies in settings in which mental health nurses operate. A tendency to undervalue this demanding and difficult work was concerning.
7. There was a view that all nurses and carers should understand and use mental health ‘first aid’ techniques and that should include graduate mental health nurses. Work relating to acute in-patient settings, care in the community, care in people’s homes and with particular groups (elder care as well as children and young people) requires a particular and more advanced skill set.
The shape of the meeting
Following a short introduction on the work of the Foundation of Nursing Studies attendees were asked to think about a series of questions relating to the education of mental health nurses. Participants offered their expert views on each and then rated the outputs as to importance and relevance.
Some questions asked
Questions were crafted around
1. How do you prepare students to uniquely become mental health nurses?
2. How do you teach students to create and manage care settings?
3. Do you think undergraduate students should be exposed to basic psychosocial intervention skills?
4. What core therapeutic skills must undergraduate mental health nurse students acquire?
5. Do you have a view on mental health first aid?
6. How is the acquisition of skills assessed in you programme?
7. Are there particular skills need in dementia care?
Table conversations produced ideas and views that were displayed to the whole meeting and then rated as to value and importance by individuals.
Some other top rated points from each area
Preparation of students
Careful and purposeful recruitment, developing capacity to tolerate uncertainty, being unafraid to challenge, enhancing political awareness, developing professional identity, being sensitive to and using ‘social and emotional intelligence.
Teaching the management of care settings
Being able to resist doing the things that are ‘always done’, challenging conventional perceptions of risk and discussing with service users, being sensitive to organisational cultures, understanding socialisation but maintaining critical companionship, positive role-modelling.
Core therapeutic skills must students acquire
Co-production in care planning, capability to form relationships/alliances but managing boundaries, care based on evidence -based practice, skilled bio-psycho-social assessment skills, critical thinking related to service delivery, understanding supervision and psycho-social intervention skills. MHNurse education aims to understand, use and translate complex medical information and in doing so support shared decision making, safe medication reconciliation or the management of certain behaviours. Experiencing and using these interventions requires the application of biological as well as psycho-social knowledge.
The need for basic PSI skills as part of a therapy toolkit
A need to understand the use of evidence based interventions (PSI, DBT etc) , helps with recovery, stability and understanding complex medication management strategies. It is challenging to fit into a curriculum but there is a need to experience in practice if possible.
Views on mental health ‘first aid’
a positive frame of reference for all health workers, need to understand mental health literacy, important when working with other non-health services, challenging to MH stigma, helpful in building confidence for all public services.
Measuring the acquisition of skills
Formative skills simulation, some assessment involving service users, a need for properly qualified assessors, testing of appropriate behaviour and attitudes, a willingness to fail students.
Particular skills in dementia care?
The group thought that this was a hard question to answer. There are significant strides being made in public awareness of dementia but a need for students to ‘work with purpose’ in dementia is important. This was an area where the physical and mental health needs of people demanded skilled interventions across the board.
Participants were asked about the value of having a standing conference on mental health nurse education. There was considerable support for such a group. It could be ‘nested’ within Mental Health Nurse Academics UK.
Tony Butterworth November 2016
Individuals identified themselves and offered one thing people wouldn’t know about them.
Tony Butterworth outlined the purpose of the event. The only one being conducted in NI.
Series of twitter based conversations, now taking round table discussions across country. Aiming for a report in place by end of calendar year.
Aim is to identify and create work streams with recommendations to continue to raise profile further
Senior people in MH asking what can be done, to inform the future of working effectively as a graduate MH nurse?
Working with independent charity, FONS.
Some asking why doing this? Provides an independent voice.
MHN is a graduate profession therefore want to be/ should be involved and influential in managing our future and how to best contribute to nations health and policy agenda Speaking to other disciplines, recognise need for graduate MH nurses, but not aware how best to employ them . Want to be able to say these are the skills, this is what we can do, and this is where we fit in.
3 social media events. Using #FoNS and #mehmns. All papers based on the web blog site mhnurses.wordpress.org
Key emerging issues: five themes informed the days activities
MH nursing identity
Aim of today, speak openly, critically and discuss what MHN is and how to strengthen skills.
The ‘outputs’ presented here are brief and in headline format – much more detail underpins them
Use of small groups to identify the top statements (these were rated with each individual using five spots each per theme page)
1.What do we already know about what mental health nurses do ?
1. MHNursing is a transformational relationship rather than a transactional relationship
2. MHNursing offers the chance to be a ‘named nurse’ which is important for continuity of car, it is a ‘constant conduit of care
3. MHNursing can be overburdened with admin and bureaucracy
4. MHNurses approach care holistically based on an understanding of mental ill health and its impact(s)
5. MHnurses have the capacity to intervene therapeutically and with purpose
2: What would you like mental health nurses do differently?
1. MHNurses being ‘around the table’ and influencing the development of care systems
2. A purposeful enhancement of PSI skills
3. Pay more attention to improving physical health outcomes linked to anti-psychotic meds
4. Become more outcome focussed
5. Be more purposeful in formulating care using carefully assembled data
3: What are the new things we should be doing?
1. developing a clinical career pathway
2. enhancing evidence based interventions
3. Earlier interventions with people in need
4. Moving the workforce closer to primary care
5. Changing from directive styles to more coaching/facilitating
4: Education of mental health nurses
1: More Standardisation of curriculum, assessment and outcomes
2.More on medication management and man’ment of side effect
3.Consistency and progression of clinical placements
4. Understanding and recognising the specialness of MH nursing
5. Some emphasis on prevention as well as treatment
6. Educators need to deliver more in the clinical environment
7. Undergraduate progs should provide a ‘toolkit of skills
5: Employment of MHNs
1. GPs should have access to MH Nurses
2. Enhance access to schools and occupational health
3. Enable rotation across different services
4. Develop clinical carer pathways
5. Develop early intervention teams and encourage MH nurses working in A&E and Prisons
6: Professional identity
1. Being able to articulate interventions clearly
2. Develop a language for person centred- holistic engagement
3. Create a structure for advanced practice
4. ‘Regain the edge’ in psychological engagement
5. Restoration of the model of ‘context’
6. Raise the profile of MH nursing with the public
7. Parity of esteem and valuing MH nurse work
Any other issues/matters of interest?
It was very pleasing to see the active establishment of ‘recovery colleges’ in NI – they provide a very positive working model for organisational change, access and recovery
16 people attended the round table event. Attendees represented an extensive background associated with MHN ranging from professors of mental health research, directors of nursing departments, lecturers and practising specialists. One research associate was present to take notes.
Building upon the previous success of several social media events and other round tables in which evoked a variety pertinent themes associated with mental health nursing (MHN) such as education and training, employment, staffing and capacity to improve (to give a few examples); the current roundtable is dedicated to building upon these issues of concern in a format dedicated to comprehensively discussing these issues. These discussions would be presented as a list of statements on post-it notes. As a group collective, attendees were to dot which statement they felt were most pertinent to the topic. These were ranked.
Question 1: What do we already know about MHN Nursing ?
1. No strong sense any more of professional identity
2. The expansion of the role has led to blurring of the role of the mental
health as we span across the MDT
3. Difficult to articulate to the general public who we are and what we do
4. We are of great value to those we work with and their families and other
5. Jack of all trades
7. Collaborative decision making
8. Lack confidence in decision making
9. Largest workforce in mental health
10. Brokering of relationships
11. Mental health and its attached stigma can affect the view of people in
mental health including mental health nurses
12. Lack of national leadership
13. 50,000 UK
14. Invisible profession
15. Mental health nurses are flexible and complete practitioner offering a wealth of resources
16. Call self-everything but a nurse
17. Confusing titles
18. It is difficult for us now to articulate who our client groups are, as the whole breadth of emotional distress becomes ‘mental health’ (rather than people who may have been traditionally termed mentally ill’
19. Removal of senior leadership in senior environments
20. Supportive and compassionate
21. Different types of advanced role in different organisations
22. Different ideologies about mental health nurses (sometimes driven through academics) can be driven through pre-registration training to develop the next generation
24. Become more custodial or one hand but patients have much more choice
25. Nurses undertake positive risk-taking but are stopped by others in MD
26. Still entrenched in secondary care and a subsequent lack of focus on wellbeing preventive work
Question 2: What would you like mental health nurses to do differently?
1. National leadership must improve the identity of MHN, MDT leaders
2. Commonality and consistency. Need core role defined then specialise
3. Be less defensive
4. Treating ourselves as equal amongst other professional groups
5. Promoting and reinforcing the role
6. Have specialisms and occupy these roles. Have accreditation for what is done by MHN.
7. Have more of a collective voice
8. Look after the MHN rather than others
9. Have increased training for higher severity clients rather than lacking compassion (i.e.: personality disorder)
10. Develop skills to meet higher acuity and increasing complex cases
11. Ability to work across roles flexibility
12. Protect people
13. Value MHN and make sure our needs are met
14. Understand the need to deliver service with flexible practitioners whilst at the same time enabling nurses to have specialist interest and develop their careers along a pathway
15. Increase awareness of sub-specialism
16. Be innovative – take more (not clinically) risks and be brave professionally with regard to service development and research
17. Be more politically active
18. Increased national presence
19. Ask for job plans and CPD parity with medical colleagues
20. More cohesion
21. Higher profile
22. Manage our boundaries: spanning roles better
23. Invest in new staff (emotional and time)
24. Demand appropriate resources
3. Question 3: What are the new things we should be doing?
1. Know where we came from: what our legacy is going to be. Appreciate the history and cultural context from which MHN profession has come from
2. Be more politically astute and business minded
3. Be in senior nursing posts (RCN and NMC)
4. Preventive as still embedded in medical model
5. Physical health to be an absolute not an option
6. Do more to work on public perception
7. Say ‘no’ in order to define the MHN role
8. Primary care should be needs based
9. Not enough learning from when things go right; focus to much on negativity as they prompt enquiry
10. To make every contact count as a profession
11. Louder voice STPs
12. Network on a national scale
13. Recognise and value one treatment they are already delivering
14. Need to better respond to psycho-social needs
15. Louder voice at CCG meetings
16. Actively engage with families (rather than devolve)
17. Challenge the MHA + MCA
18. To join properly with the nursing family
19. More deprescribing
20. More R/Cs and A/Cs as MH nurses
21. Work in wellbeing and preventative services (especially with children and young people) when they are not unwell
22. Define generic
23. Inreach as clinical leads in care homes
24. Be more entrepreneurial
25. identify gaps in provision and services
26. suggest ways nurses could provide help with gaps in nurses
27. Train GPs
28. Work in other areas such as cancer services
4. Question 4: The education of mental health nurses.
1. CPD to fulfil role requirements and how it enhances care
2. Keep nurse education free
3. Need to bring the real world of clinical practice into the HEI
4. Skill people up to recognise opportunities for their career
5. First and foremost, individuals are students of nursing
6. Critically examine other modules of healthcare education seeking to take the best of the HEI’s and practice experience and keep them
7. Should there be adult mental health dual registration – would the need to be a 4-year course.
8. Culture is very powerful ad how people fit in. Newly registered staff should be encouraged to challenge and innovate rather than become side-lined and unpopular
9. Pre-registration standards should have core mental health competencies for all pre-registration nurses
10. Undergraduate courses are regulated while advances practice is open to interpretation
11. The involvement of clinical mentorship would increase the credibility of MHN education
12. Career pathways for research active clinicians must be improved with increased flexibility
13. Address deficits in clinical practice by partnerships with clinics for real world experience
14. Tutors in practice
Question 5: The employment of mental health nurses
1. NHS image and reputation has been tarnished
2. Need to make role of MHN more attractive
3. When thinking about employing you also need to think about retention
4. Look at non-nursery tasks – devolve to others (such as admin) then would enhance the identity of MHN
5. Primary care is associated with isolation and demand likely to be in response to crisis
6. Increased visibility of MHN employed in GP practices
7. Address remedies for potential burnout
8. Allow and potentially encourage career stoicism; advanced training may not always be wanted or desired.
Question 6: The professional identity of mental health nurses
1. MHN are the therapeutic tool rather than specific skills (ability to set up a drip)
2. There should be an increase in comprehensively understanding who is coming to the profession and understand what they are bringing and how they will apply it to shape the future of the profession
3. We are defined by the most negative (and arguably the smallest part of what we do) this needs to be readdressed
4. Need to articulate own MHN contribution to care delivery
5. Opinions about MHN and the image of this should be managed
6. Problems of perceived identity
7. Collective identity conflates MHN identity issues
8. A champion to help coalesce MHN identity
9. Format and create cohesion within MHN identity and address this with new nurses
10. Wounded healer and lived experiences
Attendees: 17 people attended including nurses at band 6, 7, 8a, 8b, two directors of nursing, one associate professor from a HEI, a representative from Healthy London Partnership, one student nurse, one service user representative. Two research associates were present to take notes.
Professor Butterworth provided a presentation outlining the background to the roundtable events. The Foundation of Nursing Studies (FoNS) in collaboration with the WeMHNurses group hosted three twitter based conversations discussing the work of mental health nurses in primary, secondary and tertiary care. A thematic analysis of three twitter based conversations was conducted by Dr. Ian Holt and eight emerging themes arose. These themes were then used to guide the discussions and topics for the roundtable events.
This is the second of eight planned events taking place during October and November across the country. These events are aimed at providing a platform for key mental health nursing stakeholders to discuss key issues within the profession. Initial findings from the events will be presented at two conferences. A final report based on the overall findings, recommendations and future directions will be produced early next year.
The layout of the meeting was then outlined to attendees and group discussions began.
The groups were asked to discuss the main themes which resulted from the twitter analysis. The discussions lasted between 10-20 minutes. Researchers were seated at 2 of the 4 groups and their purpose was to take notes of the discussion to contextualise some of the statements and key themes.
A list of statements were produced by each group and written on post-it notes. These were then collated, and placed under the relevant theme heading. Each participant then placed a dot on the statements they felt were most pertinent to the topic (see pg. 5-10) and the top ranked statements are listed on pages 10-11.
What do we already know about mental health nurses?
• Nurses are comfortable with illness and challenging behaviours
• Nurses are resilient
Two of the most popular statements related to the personal qualities of mental health nurses. People who choose to be nurses appear to be comfortable with human distress and have the capacity for compassion and are caring by nature. Mental health nursing was also viewed as more than just a job; it was perceived as a vocation and different to your average job.
• Assessing risks and keeping people safe
The next most popular statements seemed to reflect the specific skills that nurses use in their roles. These included very practical skills, such as; administering medication, knowledge of mental illness, assessing risks as well as the personal skills used to manage distress, for example, de-escalation and talking therapies.
What would you like mental health nurses to do differently?
• Mental health nurses to do more nursing related research as part of their role
• Be more vocal and articulate when describing what they do
• Occupy more leadership positions
The most popular statements within this discussion related to the desire to improve the status of mental health nursing and mental health nurses. There was a wish to take on roles which have traditionally been seen as the remit of psychiatrists and psychologists, such as; non-medical prescribing and positioning themselves as therapists.
It was felt that nurses needed to occupy and create more leadership roles within the profession at both a local and national level.
Research was seen as very important to provide an evidence base for the profession, thus increasing their status and aiding in articulating what they do to other medical professionals.
What are the new things we should be doing?
• Branching out into non-traditional roles and settings e.g. police cells, primary care
• Desire to modernise mental health nursing e.g. to use innovative technology within their roles.
• Move to co-production and working alongside service users in training and in practice.
There was some repetition from the previous session pertaining to leadership roles, being more vocal and taking on greater responsibilities, such as prescribing. With regards to new directions for mental health nursing there was an emphasis on the need to branch out of mental health services and occupy a space within primary care and police services with more focus on prevention. However, there was a concern about inpatient nursing and how this was an area requiring improvement.
It was acknowledged that co-production is going to become a necessary part of mental health nursing from training to working alongside service users.
There was an interest in working with new technologies which improves the service which can be provided, for example, skype consultations, use of video conferencing for CPA meetings to allow family members to attend etc.
The employment of mental health nurses.
• Pathways and career progression
• Potential for STPs to trial a model of flexible practitioners
• Cost of living in London and providing financial incentives
• More rigorous revalidation threshold
There was lots of discussion relating to the need for more clarity in the available career paths for mental health nurses and the need for more senior clinical roles (not managerial).
The concept of flexible practitioners was raised in various different ways, in particular the desire for rotational models of employment was highlighted which would allow nurses to move between different settings, specialities and roles.
It was mentioned that nursing pay scales should be higher to attract people to the profession and also to high-cost areas by providing further financial incentives.
A discussion surrounding the quality of the workforce came up in numerous ways, including the need for a more rigorous revalidation process.
The education of mental health nurses.
• Joint clinical/academic posts
• More consistency in training and core competencies
• More service user involvement in education and development of training
• Preparing mental health nurses to work in specialist roles e.g. CAMHS, forensics
Increasing the number of roles available to nurses to allow time and recognition to academic and research activity within the profession.
The topic of the content of the training was highly contentious. There was little agreement on whether the courses should be standardised, whether the course provider should have the flexibility to choose the structure and content of the course and whether a common foundation model should be used, with further specialisation in mental health. It was also mentioned that there is a lack of placements within specialist settings, for example, it was noted that newly qualified nurses may not feel competent to work in CAMHS.
The professional identity of mental health nurses.
• Specialist roles: would that create a stronger or weaker identity?
• Need for senior clinical posts
• General uncertainty of what the identity of mental health nurses is
There was general agreement that nurses need to be more confident in their professional identities, clarify exactly what is unique about their profession and to articulate this within the mental health field.
It was questioned as to whether specialist roles would create a stronger or weaker professional identity. It was clear that there was a desire and a need for clinical leadership roles to mentor and inspire newer nurses.
General discussion and closing statement
Several people raised the issue that there should be a more positive approach to developing the profession rather than focusing on the failings. It was mentioned that there should be a focus on learning from what others in the profession do well and how this can be used to strengthen the field.
The top ranked statements were as follows:
More research (nursing research) and study as part of our role
Be more vocal and articulate/describe what they do
Being comfortable with illness and challenging behaviours.
Pathways and career progression.
Joint clinical academic posts and clinical academic career pathways.
Specialist roles – stronger or weaker identity?
Senior voice- clinically relevant- dissemination and feedback.
More service users involved at designing and developing training at every stage.
At risk of loss of identity due to so many different roles.
Unique selling point? What do we do that others don’t?
Highly banded clinical posts have been reduced should be increased e.g. practice development/ nurse consultant.
Potential for STPs to trial a model of flexible practitioners.
Preparing RMNs to work in other areas, such as; CAMHS, dual diagnosis, D&A, L.D, forensic etc.
Introduce flexible and innovative degrees e.g. psychology & nursing, MH nursing & social work to change branding of nursing.
Assessing risks and keeping people safe.
25% are over 50. Ageing population.
We are resilient.
Occupy more leadership positions e.g. Health Secretary, Chief Executive.
Positioned in police cells, on the beat, British Transport Police, MH awareness training.
More technology that works and improves efficiency.
How to manage under-performing staff.
Content of pre-registration training should be standardised up to 80%.
Seniors should work clinical hours as part of their regular hours to stay relevant/mentor junior staff and motivate.
Are we seen as a profession with good career pathways and options?
Talking & therapies.
Better recruitment – trial of job first.
More co-production with service users.
Inpatient specific training and career pathway to make working on wards more attractive
Cost of living in London- financial incentives.
Improved feedback from universities & service providers.
Diverse careers, roles and practice.
Challenge: system, perceptions, status and others.
Head services and teams.
More evidenced based and research (with direct engagement of the profession).
Confidence in decision-making (and authority).
New roles: non-medical prescribing, primary care, talking therapies, schools/universities.
New models of working.
Innovation should be incentivised e.g. flexibility within roles.
More rigorous revalidation threshold.
Creative partnerships between sectors and agencies.
Rotations across sectors; social care, police, private sector.
Education needs more uniformity and consistency of core skills, but still keeps flexibility to create more specific/unique training.
Confidence in our identity and greater clarity about our identity professionally.
Positive media campaigns – MH nurses are here to help.
Academic identity and status: where would we position BSc, PG Dip., MSc, and Doctorate/PhD?
Interest in people.
Struggle to articulate role.
MH nurses are often frustrated by having to deal with heavy workload of paperwork to the detriment of therapeutic activity.
MH nurses work with only 5% of people with serious mental illness.
Prioritising and valuing the core of the patient- knowing the patient’s story.
Less office based.
More solution focused (less orientated to problems).
Use a model of health promotion throughout life span.
Positioning ourselves as experts and therapists.
Remembering we are a graduate profession.
Better management, training & development and clinical leadership.
MH nurses should be accountable for care – use responsible clinician role.
More therapeutic education, delivery and use in practice.
Rotations across different employers – how to make this happen?
Trial in job before signing contract.
Articulate clearly the role of MH nurses in primary care.
Understanding what students want from employment? Expectations?
New role -How does that happen-How do we sell ourselves.
More structural pathways and management of careers.
Discrepancy in banding – lower paid than therapists for the same job.
Loss of bursary.
We are well underway with our nine ‘Roundatable events’ that we promised to undertake following the twitter activity previously reported here.
Our Manchester event took place on October 24th at the ‘Curve’ Prestwich Hospital . Sincere thanks for hosting and organisation must go to Celeste Foster, Tim McDougall and Steven Pyjmachuk. Big thanks are also due to the attendees who gave so generously of their time. I have received a detailed feedback from Steven and it will go towards an analysis of all our roundtable activity and outputs taking place over the next 8 weeks. Some key messages are listed at the end of this blog but clearly there will be much more to say later.
Structure of the event
We followed our usual half day programme in order to have consistency in all our events.
- Introductions and Welcome – Tony Butterworth
- Small group discussions and debate in 3 areas – things we already know about mental health nurses – some things we would like mental health nurses to do differently – some ‘new things’ we would like mental health nurses to do
- Feedback and agreement on a ‘list’
- Small group discussion and debate in 3 further areas – Education of mental health nurses – Employment and mental health nurses – Professional identity and mental health nurses
Final round up discussion and agreeing key mesages
Some key outputs and messages
- We aspire to be nurses who spend time with services users but struggle with the demands of ‘defensible practice’.
- Frustrations with the quality and quantity of pre-reg education.
- Get better at naming, explaining and feeling proud of the craft of MH Nursing
- A need to move around different clinical specialities (eg adult to CAMS)
- Undergraduate education is only the first part of being competent
- Needs and issues must be reflected in pre-reg educaton – walking in the shoes of others – ie people who use services
- Pride in being a mental health nurse
- A need to stregthen the voice of MHNurses
- Work opportunites should be further created in primary care, schools and General Practice
- Some clarity/research needed that graduate nurses lead to better patient outcomes
- Retain a specialist route for mental health nursing
- Greater involvement of service users in pre-reg education
- Can we create a more up to date ‘school of nursing’ model linked and joined to Univestities?
- Practitioner burnout must be taken seriously
- An urgent need for MHNurses to be more actively engaged in policy development
- Do we need a ‘College of Mental Health Nursing’.
- This is a very abriged version of events and there is much more to come – watch this space.Tony Buterworth October 2016