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.
Introduction:
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.
Group discussions
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.
• Containment
• 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:
Statement
More research (nursing research) and study as part of our role
Be more vocal and articulate/describe what they do
Containment
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.
Prescribe medication.
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.
Caring.
Diverse careers, roles and practice.
Unclear identity.
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.
Hope.
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.
Nurse prescribers.
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.