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 david.ekers@cddps.northy.nhs.uk
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 mary.bentley@awp.nhs.uk
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
The key recommendations in From
Values to Action include:
• 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 sheila.jenkinson@bstmht.nhs.uk
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 neil.brimblecombe@dh.gsi.gov.uk.
Back to
top.