I thought it would be a good idea to identify the role of the mental health nurse. Occasionally when people find out I’m a mental health nurse, they say, ‘mental health nurses – all they do is sit around talking all day. This, and the general lack of knowledge about the role of the mental health nurse spurred me to start writing. However, I’d dug myself a bigger hole than initially planned. It was a bit like that programme ‘Grand Designs’, my expectation of the job was significantly underestimated and the overall time, cost and obstacles were greater than I’d initially considered. Its complexity was also a reason for writing this piece.
Reading around the subject and looking at roles identified by others I had difficulty distinguishing between role and skill. I came to realise that both come hand in hand. A nurse colleague said to me ‘anyone can fulfil a role but it is the quality of skill that determines the standard of the role delivered’. I like this statement and hope to deliver a learning environment where students develop both. I see ‘role’ as those laid out in a job description usually outlined from a top down approach. In my view ‘skill’ defines the quality of the care and the interventions most appreciated by patients, carers, family and friends. I want to be nursed by a person who cares enough to offer me a personal approach.
So, back to the point. What is the role (and skill) of the mental health nurse?
Paperwork – lots of it!
Bureaucracy! Never ending and it seems forever increasing, it is argued the amount of paperwork detracts from the time nurses have to actually deliver direct patient care but is now the norm. Arguably, too much time is spent on filling in data when it is unclear that anyone really looks at the information (Gowodo and Nolan, 2008). Nevertheless, if you’re a mental health nurse, paperwork is a daily expectation. In conjunction with paperwork runs the Care Programme Approach (CPA) framework. The CPA is HUGE! And does involve more paperwork. The CPA requires the skill to work with the service user, family and carers where appropriate, equally within a multidisciplinary team. If used well, it can promote recovery and independence. Care plans, patient care reviews, involvement of carers and promotion of independence are all parts of the CPA. We’re encouraged to write care plans with patients and carers. Involving service users and carers in CPA is a skill that needs more attention by nurses as we are there to advocate and create an environment that allows for independent thinking and self development by the service user. I feel healthcare workers as a whole are yet to fully embrace this concept as it involves positive risk taking and allowing the individual to have choices we don’t agree with.
A power balance?
Shifting the power balance between service user and professional also has its own struggles, some patients appreciate formal health service offered and some professionals may struggle to give up some of their power. I personally feel a positive mental health approach manages to strike a balance between all. I often say a skill of a mental health nurse is knowing when not to take action or when not to take control in the right context. All people should have the right to learn by making their own right and wrong choices.
Nurses have distinguished their unique contribution to individual care in terms of empathy, being non-judgemental, allowing time, providing support and promoting positive links with friends and family. I see these as skills rather than roles, although I have seen ‘have a non-judgemental attitude’ in a job description. The difficulties with these skills as pointed out by Gowodo and Nolan (2008) is that they are almost impossible to quantify, to evidence. It is difficult to produce evidence that demonstrates the level of skill and care delivered by the nurse and also that this work is being done and continues to be an important aspect enhancing patient care and recovery. Having said that, these skills are the pinnacle of good nursing practice and have a lasting impact in the memory of service users.
The role of the mental health nurse is ever increasing. With the focus on specialised teams, mental health nurses have become specialised in their own right, adapting and developing skills specific to their area of practice. For example, assertive outreach, home treatment, early intervention, primary care, eating disorders, mother and baby to name but a few of the specific areas a mental health nurse can work and will require an individual approach as a team and towards service users. One benefit is that teams have immediate access to specialist skills, expertise and experience to provide a comprehensive and specialised package of care to that particular client group (Department of Health, 2009). The downside of this perhaps is the employability of the mental health nurse as they become more skilled in say eating disorders with a significant loss of experience in other areas.
OK – it is nearly impossible to define!
It is almost impossible to define the role of the mental health nurse and I am becoming increasingly aware that many people have attempted this task dedicating much more time and thought than I have. It’s actually much bigger than I ever anticipated and almost impossible to quantify. I am aware there are many roles and skills that I have not identified within this blog, mostly because at this rate I would be writing a book not a blog. If it has highlighted one thing it is that the skills of a mental health nurse should not be identified as a one shoe fits all approach. Although, having said that, the areas I have identified are relevant to all. I’m confused! If anyone can highlight any work specific to this I’d be interested to hear and appreciate any feedback.
Photos from Flickr creative commons.
1. Construction of our house – Framing : by Lee Coursey
2. Juggling bean bags : madaboutasia