Addressing the mental health nurse shortage: Undergraduate nursing students working as assistants in nursing in inpatient mental health settings

The population of mental health nurses is ageing and in the next few years we can expect many to retire. This paper makes an argument for the employment of undergraduate nursing students as Assistants in Nursing (AINs) in mental health settings as a strategy to encourage them to consider a career in mental health nursing. Skill mix in nursing has been debated since at least the 1980s. It appears that the use of AINs in general nursing is established and will continue. The research suggests that with the right skill mix, nursing outcomes and safety are not compromised. It seems inevitable that assistants in nursing will increasingly be part of the mental health nursing workforce; it is timely for mental health nurses to lead these changes so nursing care and the future mental health nursing workforce stay in control of nursing.     

Implementing a major stream in mental health nursing: Barriers to effectiveness

Changes to the educational preparation of the nursing workforce in mental health continue to have profound effects on the availability of sufficient numbers of skilled graduates willing to work in this field. The longevity of the problem has focused attention on possible solutions. Introducing a major stream in mental health nursing in undergraduate Bachelor of Nursing programmes was proposed and supported as a potentially beneficial strategy, adopted by some Australian universities. Despite the promise invested in this strategy, systematic evaluations to determine the effectiveness or otherwise of this approach were not initiated. A qualitative exploratory study was undertaken with Australian universities, which had implemented the major stream, regarding their experiences and observed outcomes. In‐depth interviews were conducted with a mental health nurse academic from each university. The barriers to the effectiveness of the major in mental health nursing are the specific focus of this paper. Thematic data analysis revealed three main barriers: clinical placements, lack of support from other academics, and integrated curricula. These barriers substantially limited the effectiveness of this strategy – in some instances, leading to the programme's termination – and must be assertively addressed to maximize the potential of the major in mental health nursing.     

The challenges of mental health care reform for contemporary mental health nursing practice: delivery of nursing care

This ethnographic account of mental health nursing in a 22-bed acute inpatient facility in New South Wales, Australia, uncovered cultural meaning and cultural realities associated with the delivery of nursing care within the context of current challenges, demands, and influences brought about by service reforms. The findings demonstrate that mental health nurses have been responsive to changes brought about by the reforms. The ability of nurses to readily identify service gaps in their everyday practice provides them with the opportunity to develop strategies to respond to workplace challenges. As such, findings of the study contribute to current discussions concerning acute inpatient mental health nursing practice.     

Changing practice using recovery‐focused care in acute mental health settings to reduce aggression: A qualitative study

Consumer aggression is common in acute mental health settings and can result in direct or vicarious psychological or physical impacts for both consumers and health professionals. Using recovery‐focused care, nurses can implement a range of strategies to reduce aggression and empower consumers to self‐regulate their behaviour, when faced with challenging situations, such as admission to the acute care setting. Currently, there is limited literature to direct nurses in the use of recovery‐focused care and how it can be used to reduce consumer aggression. Twenty‐seven mental health nurses participated in this study. The constructivist grounded theory method guided data collection and analysis to identify categories that accurately described participants’ experiences. Five categories emerged that described how nurses can implement recovery‐focused care clinically to reduce the risk of consumer aggression: (i) identify the reason for the behaviour before responding; (ii) being sensitive to the consumer's trigger for aggression; (iii) focus on the consumer's strengths and support, not risks; (iv) being attentive to the consumer's needs; and (v) reconceptualize aggression as a learning opportunity. As the importance of promoting consumer recovery is now embedded in mental health policies internationally, nurses need to prioritize the application of recovery‐focused care clinically. Further research to provide evidence‐based outcomes supporting the use of recovery‐focused care is needed.     

Towards a Foucauldian reading of the Australian mental health nursing workforce

This article reflects on the findings of the recently published Scoping Study of the Australian Mental Health Nursing Workforce from the perspective of Foucault's work on 'governmentality'. First, the policy background to the scoping study is described. This is followed by a discussion of Foucauldian concepts and method that will be used to explore selected aspects of the scoping study. The related concepts of 'governmentality' and 'technologies of the self' are used to begin a theoretically grounded analysis of mental health nursing education and practice, with particular attention to discourses of 'change' and 'survival'. The examples chosen are used to support the argument that competing discourses order multiple 'readings' of Australian mental health nursing, including whether or not it is thriving or surviving. The article ends with comments on whether a Foucauldian analysis adds anything to what has been reported in the scoping study.     

A selective review of mental health nursing in New South Wales, Australia, in relation to clinical supervision

Recent reports have suggested that mental health staff have added stress, which arose from poor working conditions, heavy workloads, and lack of resources, within a culture in which there was a large degree of burnout, low morale, lack of job satisfaction, poor status, insensitivity and indifference. This is particularly so for mental health nurses, who create the ambience in clinical settings. Previous research has shown that the introduction of clinical supervision, as a central plank of clinical governance arrangements, has a positive effect in some of these respects, but remains underdeveloped in Australia. The present scoping study examined the extent to which this was so in mental health nursing services in the state of New South Wales. Individual mental health nurses (n = 601) and Area Health Services (n = 17) provided data about their local circumstances. Findings revealed that mental health nursing in New South Wales was a committed, late middle-aged workforce, working in services about which there was a width of opinion with the prevailing management arrangements, yet to fully exploit their therapeutic potential, or engage the educational opportunities that would assist them in their endeavour. More specifically, it remained a workforce that has yet to engage clinical supervision in a systematically coherent manner. The study concluded, therefore, that clinical supervision offered a possible practical remedy to address the causes and the effects of suboptimal service provision and that the ready availability of dedicated funding and the immediate access to service development and research expertise was a rare and timely confluence.     

Scandals in health‐care: their impact on health policy and nursing

Through an analysis of several high‐profile scandals in health‐care in the UK, this article discusses the nature of scandal and its impact on policy reform. The nursing profession is compared to social work and medicine, which have also undergone considerable examination and change as a result of scandals. The author draws on reports from public inquiries from 1945 to 2013 to form the basis of the discussion about policy responses following scandals in health‐care. In each case, the nature of the scandal, the public and government discourses generated by events and the policy response to those failings are explored. These scandals are compared to the recent scandal at Mid Staffordshire Hospital. Conclusions are drawn about the impact of these events on the future of the profession and on health policy directions. Recent events have raised public anxieties about caring practices in nursing. Health policy reform driven by scandal may obscure the effect of under resourcing in health services and poses a very real threat to the continued support for state‐run services. Understanding the socially constructed nature of scandal enables the nurse to develop a greater critical awareness of policy contexts in order that they can influence health service reform.     

Stressors, burnout and social support: nurses in acute mental health settings

AIMS: This paper reports a study which aims (1) to investigate and compare levels of stressors and burnout of qualified and unqualified nursing staff in acute mental health settings; (2) to examine the relationships between stressors and burnout and (3) to assess the impact of social support on burnout and stressor-burnout relationships. BACKGROUND: Several studies have noted that the work of mental health nurses can be highly stressful, but relatively few have focused specifically on staff working in acute inpatient settings. Although many of the pressures faced by this group are similar to those in other nursing specialties, a number of demands relate specifically to mental health settings, including the often intense nature of nurse-patient interaction and dealing with difficult and challenging patient behaviours on a regular basis. METHODS: A convenience sample of 93 nursing staff from 11 acute adult mental health wards completed the Mental Health Professionals Stress Scale, Maslach Burnout Inventory and House and Wells Social Support Scale. RESULTS: Lack of adequate staffing was the main stressor reported by qualified staff, while dealing with physically threatening, difficult or demanding patients was the most stressful aspect for unqualified staff. Qualified nurses reported significantly higher workload stress than unqualified staff. Approximately half of all nursing staff showed signs of high burnout in terms of emotional exhaustion. A variety of stressors were positively correlated with emotional exhaustion and depersonalization. Higher levels of support from co-workers were related to lower levels of emotional exhaustion. Higher stressor scores were associated with higher levels of depersonalization for staff reporting high levels of social support, but not for those reporting low levels of support (a reverse buffering effect). CONCLUSIONS: Qualified and unqualified nursing staff differed in terms of the prominence given to individual stressors in their work environment. The findings were consistent with the notion of burnout developing in response to job-related stressors. While staff support groups may be useful in alleviating feelings of burnout, the reverse buffering effect suggests that they should be structured in a way that minimizes negative communication and encourages staff to discuss their concerns in a constructive way.     

The place of the unconscious in mental health nursing

ABSTRACT:  This paper acknowledges the concept of the unconscious in psychiatric discourse and explores the importance of this for mental health nursing practice. Mental health nursing practice has always been strongly influenced by psychiatric discourse because of its dominance in the clinical setting. The most recent edition of the American Psychiatry Association's Diagnostic and Statistical Manual has signalled that the concept of the unconscious is re-emerging in psychiatric discourse. This re-emergence provides the opportunity for mental health nurses to re-affirm or develop their psychotherapeutic skills in the nurse−patient relationship. The psychotherapeutic relationship could focus on ways for the patient to find meaning in their lives that recognize and value difference and multiple ways of being.     

Promoting mental health nursing: employing undergraduate nursing students as assistants in mental health

The difficulty in attracting graduates of nursing programmes into mental health nursing (MHN) remains an ongoing challenge. Moreover, it is frequently claimed that undergraduate nursing students do not always regard MHN favourably for future employment. Although undergraduate nurses are employed as assistants in nursing (AIN) in mental health settings, there is no published research exploring their role, the career trajectory into MHN, or its effectiveness as a recruitment strategy. In this paper, we draw on the literature to delineate factors that might contribute to the desire of AIN to work in MHN. Nine factors were identified: acceptance by nurses, fitting in with the culture, managing the workload, developing a realistic appraisal of the effectiveness and limits of psychiatry, constructive learning from direct interpersonal interactions with clients, practising communication skills, being supported in a structured way, working with positive role models, and the overall quality of the employment setting. A comprehensive understanding of these factors can enhance the experience of undergraduate nursing students working as AIN, and potentially increase recruitment into MHN.     

Calculating nurse staffing in community mental health and community health settings in South Australia

AIM. The article reports the development of and data from a preliminary evaluation of a staffing methodology equalization tool (SMET) designed for the South Australian Department of Health to equalize the workload of community mental health and community health nurses working within multidisciplinary teams. BACKGROUND. Shorter admissions, increasing patient acuity, and shortages of beds have intensified the work of community nurses. Existing workload models have limitations for community nursing settings. METHOD. A workload tool for community mental health and community nurses was developed in consultation with a reference group of nurses. A trial was conducted at six sites, and the tool was evaluated using qualitative and quantitative data. RESULTS. The tool increased transparency and equity of workloads in community teams and provided a means of reducing workload through demonstration of a capacity to take new clients, however, further work is required to factor the intensity of caseload into the tool. CONCLUSIONS. The tool needs further evaluation to determine its applicability to a range of clinical settings.     

The slow death of psychiatric nursing: what next?

Nursing has always struggled for recognition and status, and there has always been exploitation and shortages, and no more so than in psychiatric settings. Today, however, nursing is in truly dire straits and, as a consequence, psychiatric nursing is more precariously positioned than ever. In order to think constructively about psychiatric nursing's future, it is crucial that this wider context in which it operates is fully appreciated, and this paper begins by summarizing the key features of this context from an international perspective. It is argued that dramatic changes occurring in 'Western' societies call for radical changes in public and professional thinking, and in their vision for health care in the future. Beginning with the general nursing context, this paper depicts the perilous state of psychiatric nursing and mental health care in Australia and elsewhere, and suggests some of the causal factors. It concludes by arguing that the future mental health workforce should be a graduate specialist who stands outside existing disciplinary identities.