North West

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What Mental Health Nursing is, and what it can be…

Seán Welsh, Head of Mental Health Nursing, University of Salford.

I am so proud to be a mental health nurse and I am eternally grateful to all the individuals that I have been privileged to care for and work in partnership with.

For me, the beating heart and thriving soul of mental health nursing, boils down to a commitment to forging honest, caring, unique and mutually meaningful professional relationships with each individual person in my care.

I purposely do not refer here to that individual as a “patient”, whilst I recognise and respect that is exactly how they may perceive themselves. I strongly believe that it is of the utmost priority to take every opportunity to uphold and prize that individual’s unique personhood. I fear that labelling people as patients, particularly in mental health services, can sometimes lead their dehumanisation and disempowerment, as well as potentially laying the foundations for a damaging human disconnection between the nurse and the individual in their care. Eric Berne’s transactional analysis is an important underpinning concept here, where we aim for an adult-to-adult connection and interaction, not a dictatorial or judgemental dynamic where the health professional arrogantly and erroneously assumes that they always know what is best for that individual.

Although the genericisation of the fields of nursing practice seems to be a constant and looming spectre, mental health nursing is special and utterly unique from all other professional caring roles, and other fields of nursing practice. As an autonomous and accountable member of the multidisciplinary team it is vital that the mental health nurse has confidence in their own evidence-based practice and has the ability to professionally challenge other members of the team. At the same time the mental health nurse must ensure that the individual remains genuinely placed at the centre of their care, must empower that individual, maximise their autonomy, and if necessary, advocate on their behalf.

Mental health nursing of course brings challenges that reflect the complexities of human existence, and therefore in order to help navigate effective care, we must engage in critical refection, through for example, clinical supervision. This reflective process helps us to develop self-awareness, maintain standards, and recognise successes as well as identify areas for personal and professional development.

Mental health nursing requires commitment to developing genuine, therapeutic, hope-inspiring relationships. These unique relationships value the individual and recognise that our actions can significantly influence upon that individual’s experience of mental health care, as well as being potentially mutually life-changing for both the individual, and the mental health nurse themselves.

I believe that mental health nurses must demonstrate and model commitment through a genuine investment in a therapeutic relationship, aiming to achieve a therapeutic alliance, and to address the inevitable power differential with that individual. This is the absolute antithesis to damaging stereotypes of mental health nurses as hardened, infallible, unquestionable enforcers, and passive medical hand maidens. I lay down the gauntlet and challenge you, reader, to smash those archaic stereotypes and show the world what mental health nursing really is, and what it can be.

Lancashire & South Cumbria NHS Foundation Trust (LSCFT)

Mental Health and Learning Disability Career Progression Pathway

Overview

At LSCFT we have worked very closely with local providers and are now pleased to be able to provide a clinical development pathway, supporting existing and new staff, from band 2 through to band 5. This pathway enables staff to achieve the qualifications they may need, if they wish to progress through the pathway, such as maths, english and NVQ’s in Healthcare. Some staff enter the pathway at different stages, but essentially someone can work their way through starting at Health Care Assistant apprenticeships, through to Trainee Nursing Associate Apprenticeships (TNA) and then the Registered Nurse Degree Apprenticeship top up (RNDA).

This apprenticeship pathway is a true reflection of our Trust believing in growing our own and we are proud to now be recruiting to our 13th TNA cohort, our 4th Mental Health RNDA cohort, 2nd Adult RNDA cohort and just commenced our 3rd Learning Disability RNDA cohort.

LSCFT were the lead organisation for the Lancashire & South Cumbria TNA Partnership and although in the main, this role as lead has become redundant, due to the TNA programmes now being embedded in partner organisations, we continue to support other organisations, encouraging them to start this apprenticeship.

To ensure not only our learners, but other organisations leaners meet the TNA and RNDA programme requirements, we share placements and have reciprocal arrangements, whilst working alongside our memorandum of understanding. As we are the largest provider of MH & LD services, we place a large amount of external learners; between 4th July 2022 and 31st October 2022 we had 117 TNA’s from outside organisations on placement with us for between 1 and 2 weeks each.

Aims

Our aim was to provide clinical developmental opportunities to those wishing to progress and build upon existing skills, experience and knowledge. This was with a view to invest in our staff, encourage new staff into the organisation and improve retention. By doing this we’ve help build upon the Trust’s positive approach to learning and pride ourselves as an organisation who encourages staff to develop.

We wanted to not only embed our TNA and RNDA programmes for staff to access, but also ensure they were supported right from their 1st enquiry about what was available within the Trust, as a clinical member of staff, through to qualifying and providing preceptorship. We manage to achieve this by embedding the support from a practice education perspective, in the form of practice educators, practice education facilitators and a professional registration apprenticeship team.

Why was the initiative needed?

This clinical development pathway was needed to provide opportunities to those staff wishing to develop and continue with their career within our Trust. Lots of staff, were eager and able to progress into higher roles and/or gain qualifications to support existing roles, so a pathway was necessary to achieve this.

The Trust recognised, the need and benefits of embedding the Nursing Associate role in our services and therefore we became a part of the fast follower pilot in 2017. Following this, we recognised staff would need support to gain the entry requirements, so the steps began to take shape to support staff to gain these. For example, we work closely with local colleges for staff to obtain functional skills and NVQ’s in Healthcare.

Following this, in 2021, we utilised the HEE funding and provided the welcomed addition to our pathway, in the form of the RNDA top up, which builds upon the existing foundation degrees of NA’s and AP’s.

What this results in is a pathway for those with the entry requirements, of a 2 + 2 year model, to become a registered nurse. For those that require the entry qualifications to the TNA programme, this may take longer.

Band 4 NA posts and band 5 RN posts are guaranteed upon completion of the apprenticeships and receiving PINs. Through doing this we have enriched the skill mix within our services and supported our RN’s with introducing the NA role.

What did the organisation do?

When embedded our TNA programme, we worked closely with providers and partner organisations, learning from each other and creating a programme fit for purpose and one which met the apprenticeship criteria. We created roles within our practice education team, such as practice educators and the professional registration apprenticeship team, to support with such areas as;

• Inter-Professional Days (providing a more enriched programme, with additional learning and wider exposure, for example AHP days, Library Services, Professionalism and the NMC Code and Clinical Supervision)

• 12 weekly tripartite support with the University

• OCSE’s for both physical and mental health (identifying the need to observe, assess and support staff on these skills)

• Ground level practice support with skills, knowledge, practice assessment documentation and pastoral support

• Hands on supportive approach for assessors, supervisors, managers

• Placement and planner co-ordination for all apprentices

• Recruitment events and adhoc support to perspective applicants

• Lead on recruitment process from start to finish

• Preceptorship for NA’s and RN’s

What are the key benefits, impact, and results?

Since the fast follower pilot started in March 2017 we have:

• TNA’s (Trainee Nursing Associate)

• Trained or have currently in training 143 TNA’s

• 79 have qualified as RNA (we have recruited an additional 6 RNA’s externally in addition to the number qualified)

• 64 are currently in training

• 33 RNA ‘s are currently working in the Trust as RNA’s

RNDA’s (Registered Nurse Degree Apprentices)

• 6 RNDA in Learning Disability are qualified and all were RNA’s

• Total in training 48 (some externally recruited to the course and some are AP’s)

• Adult 5 (2 x RNA’s & 3 Assistant Practitioners - AP’s)

• Mental Health 34 (32 x RNA’s and 2 x AP’s)

• Learning Disability 9 (All are RNA’s)

• Total number of RNDA’s qualified and in training = 54

Staff welcome and appreciate the opportunities available to them and have conveyed how they feel invested in by our Trust. The support from a practice and academic perspective have helped make our programmes a success and our attrition on these programmes is a reflection of this.

Support from our teams throughout the Trust is invaluable and their dedication to provide quality learning environments is a testimony to how our Trust values learners in practice.

We are working to towards embedded NA’s on all our inpatient wards, in line with safer staffing and also are now seeing more and more community teams, coming forward to recruit and support the development of staff in a TNA role, leading to a qualified role within their team.

Whilst the majority of our TNA/NA’s sit within our mental health services we do have some in our adult services, children and learning disability services, with the NA role being a generic role.

With introducing the RNDA programme, it has provided an opportunity for band 4’s within our Trust to progress clinically, which prior to this, they did not have. Therefore we have found the interest is high from our NA’s and AP’s, resulting in the 54 RNDA’s in training / now qualified. From a service perspective, we have received high praise and positive feedback, in terms of the skills and knowledge these RNDA’s bring to the programme and subsequently when they have qualified, through having done both the TNA and RNDA programme.

Outline details of any awards or nominations achieved because of this initiative

Quite a number of our TNA’s/RNDA’s have spoken at internal events and external events, such as HEE conferences, as ambassadors of the role. TNA’s and RNDA’s often take part in our recruitment process in terms of sharing their experience on the apprenticeships and also support our workforce team for wider recruitment drives in the Trust. We celebrate the success and support given on all our apprenticeships at an annual celebration event, where TNA’s and RNDA’s have been nominated and even won awards. This is also the case for the Practice Education Team.

Provide hints and tips for others wanting to do something similar in their organisation

• Provide information events and create FAQ’s / supporting information for all programmes, as potential applicants welcome this and avoids confusion further into the recruitment process.

• Be clear and transparent prior to interview about the expectations of the apprenticeship, for example study time, travel expected for placements and annual leave guidelines.

• Regularly assess progress of assessment documentation and timesheet completion

• Work with providers to create a joined up support system for all learners

• Support and guide assessors and supervisors, when taking on new apprenticeships; regular team / ward visits to provide this

• Embed practice educator roles to provide the hands on clinical skills support and also pastoral support.
  
  

Carol Snape - Senior Nurse Manager Practice Education and Sarah Rampley - Professional Registration Apprenticeship Lead at Lancashire and South Cumbria NHS Foundation Trust.

A journey toward improved care for mental health patients in Primary Care

Given its position as the first point of contact for individuals with mental health disorders Primary Care is central to mental health service provision. It has a crucial role to play in ensuring continuity of care for individuals with mental health disorders and the gatekeeper to additional and more specialised mental health services and treatments.

With this in mind it is imperative that Primary Care functions effectively in the recognition and management of mental health disorders as well as engaging with patients in preventative interventions.

This pathway is a visual representation of how a Primary Care Practice worked with a Student Nurse specialising in Mental healthcare, to assess, develop and redefine the processes and procedures within the Practice to radically improve the annual mental healthcare review process for its patients.

By putting patient need and feedback at the heart of the new process, and ensuring the whole Practice was appropriately trained to deliver it effectively, patients receive a holistic and valuable care experience which actively supports their continuing care.

Take a look and see if something similar could be put in place in your work environment.

MAGGI BRADLEY
General Practice Nurse
Clinical Nurse Lead, Sefton Training Hub
Queens Nurse

@nursemaggi