New Ways of Working for Mental Health Nursing

Mental health nurses make up the largest professional group in mental health services, with 48,000 registered nurses working in the National Health Service in England. There are also over 30,000 non-professionally qualified staff working with nurses and making a vital contribution (see Section 7, Chapter 5). Nurses work in every area of practice, and are numerically predominant in many areas, such as in-patient settings. In the last few years, a number of new roles have been introduced, for example modern matrons and nurse consultants, and new skills have been developed, for example nurse prescribing and psychosocial interventions. These changes provide opportunities for NWW that can help services become more service-user-centred and effective.

Nurse consultant in primary care mental health

An innovative nurse consultant role provides a clinical focus for mental health workers and practice nurses working within primary care over a large geographical area (1,000 square miles) in County Durham. The role is to improve access to psychological interventions through training staff in the use of patient-empowering models of care, such as guided self-help and depression case management, and to provide consultation on developing computerised CBT, psycho-education and bibliotherapy services. Advice on the development of new (graduate and gateway workers) and established (practice nurse and community mental health nurse) roles has supported new ways of working within a stepped model of care. Contact: David Ekers at This email address is being protected from spam bots, you need Javascript enabled to view it

Nurse-led clinic

Mary Bentley, a community psychiatric nurse, has set up a lifestyle clinic for service users in Bradford on Avon, Wiltshire. Mary’s training as a supplementary prescriber made her more aware of the need to work with service users on issues such as smoking, diet and exercise, and to have discussions about medication and optimising prescribing practice in order to minimise side effects. In the clinic, Mary is able to do basic measurements, including blood tests, and to liaise with colleagues in primary care to manage physical health problems, such as diabetes, collaboratively. Contact: Mary Bentley at This email address is being protected from spam bots, you need Javascript enabled to view it

From Values to Action: The Chief Nursing Officer’s review of mental health nursing was published in April 2006 25 DH (2006): From Values to Action: The Chief Nursing Officer’s review of mental health nursing. DH Publication Ref 273612. and made a series of recommendations supporting NWW by nurses. These were developed in the light of a national consultation, which sought views as to how mental health nurses could best improve the care provided to people with mental health problems. A subsequent publication, Modernising nursing careers (October 2006),26 DH, Welsh Assembly, Scottish Executive and Department of Health, Social Services and Public Safety for Northern Ireland (2006): Modern nursing careers – setting the direction. provides a broad strategy for the future of all kinds of nursing across the United Kingdom. It proposes actions that support many of the concepts of NWW and the recommendations of the Chief Nursing Officer’s review.

Recommendations

• service providers to review current nursing roles and evaluate whether they make best use of the range of nursing skills – i.e. that nurses focus on working directly with individuals who have higher levels of need and/or support other workers in meeting less complex needs;
• service providers to develop shared roles between in-patient and crisis-home treatment staff;
• service providers to review how non-professionally qualified roles can make a greater contribution to care directly and indirectly, and the developments needed to support this;
• service providers to evaluate the requirements for senior nursing posts, such as nurse consultant roles, as part of a wider review of senior clinical roles, taking into account factors such as:
  
  - service user needs
  
  - legal developments
  
  - shortages of any particular profession/skill; and
• service providers to put in place arrangements to support and implement nurse prescribing, based on local need and taking into account the potential for service redesign and skill mix review.

Improving physical healthcare for in-patients

Bolton, Salford and Trafford Mental Health NHS Trust has established a physical healthcare team for its in-patient wards, led by a dual-qualified nurse. Over 95% of service users are now receiving an initial physical healthcare screening. The screening includes tests for a range of common conditions, such as asthma, diabetes and cardiac problems, and can also lead on to other services, such as cervical screening and ‘well man’ and ‘well woman’ clinics. Smoking cessation support is also provided. Contact: Sheila Jenkinson at This email address is being protected from spam bots, you need Javascript enabled to view it

Further developments

Research looking at the process of implementation and the impact of From Values to Action is expected to commence by summer 2007.

Following the Chief Nursing Officer’s review, three additional nursing-led projects were established to further support NWW for Mental Health Nursing. The projects aim to respond to challenges that commonly arise when implementing new roles and new ways of working.

Since the issues covered by the projects are also important for other professions, a range of disciplines were involved in each project, and brief sections describing their findings are included elsewhere in this report:

• Non-medical prescribing in mental health settings. There are a number of challenges that arise in trying to implement nurse prescribing (and other non-medical prescribing) in a way that benefits service users and service delivery organisations. Factors supporting successful implementation are briefly described in Section 4.6 of this report. A future electronic publication is planned to consider implementation issues in more detail.
• Accountability and new roles. The creation of new roles, such as Associate Practitioners, has led to challenges for professionals, such as nurses, regarding their professional accountability when working with those in new roles. Accountability and responsibility issues are discussed in Section 4.11 of this report. In relation to nursing, the Nursing and Midwifery Council plans to clarify current guidance on this issue.
• Senior clinical nursing roles. From Values to Action recognises the importance of clinical leadership in creating and sustaining good practice. Challenges exist in successfully implementing senior clinical roles in an effective way and in ensuring their sustainability. These issues are discussed briefly in Section 4.7 of this report. More detailed guidance will be developed and is planned to be available on the NWW website: www.newwaysofworking.org.uk

Contact: Neil Brimblecombe at This email address is being protected from spam bots, you need Javascript enabled to view it