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Exclusive: Rift over proposals to move to ‘generic’ nurse training

  • 23 Comments

A rift among the mental health nursing community has emerged over education reforms which could see a move towards more generic nursing degrees, an investigation by Nursing Times can reveal.

Last year a major review of nurse education recommended a new model that would see students spending more time on general training – including both mental and physical health – before specialising in their final year in either adult, children’s, learning disability, mental health nursing or other new branches such as community nursing.

But mental health nursing experts have warned the proposals could lead to a dilution of mental health as a specialty, despite agreeing that the lack of dual skills in both mental and physical health care among nurses needed to be addressed.

Meanwhile, nursing directors have said a more integrated approach to pre-registration training would ensure nurses are equipped for future models of care.

“The number of mental health academics is much smaller…so we’re going to end up with adult lecturers giving the lion’s share of education”

Joy Duxbury

Professor Joy Duxbury, chair of Mental Health Nurse Academics UK, said the group had concerns about the proposals from the Shape of Caring review and warned dilution of the mental health specialty could have a “devastating” impact.

Moves towards more generic training risked the mental health element sidelined due to lack of resources, she said.

“The number of mental health academics is much smaller than in the adult field so we’re going to end up with a situation where we have a lot more adult lecturers giving the lion’s share of the education in universities,” she added. “So the skillset is going to be significantly skewed.”

The proposed new model also includes a year-long preceptorship with an employer in a student’s chosen field.

“Preceptorship is a good idea but what concerns us is that many services – particularly mental health services – are so overstretched and under-resourced at the moment,” said Professor Duxbury.

“[The proposed move to more generic training] is a broad brush approach that turns off mental health nursing students and is the worst of both worlds”

Chris Hart

She urged policy-makers to look at the evidence from other Western countries where the introduction of more generic nursing qualifications had failed to equip nurses with the competencies to work in mental health.

Chris Hart, consultant nurse in forensic and intensive care nursing at South West London and St George’s Mental Health Trust and principal lecturer at Kingston and St George’s University of London, warned some mental health courses had already been altered to include more generic content, leaving students with the “the worst of both worlds”.

He said adult nursing students did need more mental health skills but that a move to increased generic training in reality meant a “bias” towards adult nursing.

“Mental health students are spending so much time not looking at mental health - but are looking at issues geared towards adult nurses,” he said.

“They need to understand issues to do with physical health tailored to the needs of people with mental health, but this is a broad brush approach that turns off mental health nursing students and is the worst of both worlds.”

“Unless we start developing people with those broader, generic skills we won’t achieve that vision [for integrated physical, mental and social care]”

Stephanie Dawe

The Royal College of Nursing’s professional lead for mental health Ian Hulatt said there was growing recognition physical and mental health were “artificially divided” but agreed it still made sense to retain separate specialties.

“There is a lot of talk about the need for a flexible and responsive workforce, which is coded language for someone who can work pretty much work anywhere,” he said.

“But I wouldn’t want a plumber doing the electrics in my house. You need specialised skills for specialised needs.”

However, directors of nursing have called for more generic training to ensure nurses can provide holistic care in integrated settings.

Claire Johnston, director of nursing at Camden and Islington Foundation Trust, told a recent Nursing Times event the current system for training nurses was “built for asylums” and stood in the way of ensuring mental health was placed on the same footing as physical health.

Meanwhile Stephanie Dawe, chief nurse at North East London Foundation Trust, said she wanted all her nurses to be “dual-competent” in mental and physical health.

While the trust had launched rotational posts to ensure newly-qualified nurses experienced providing both types of care, she said a change in pre-registration training was also required.

“When you look at the Five Year Forward View, it’s all about integrated physical, mental and social care and unless we start developing people with those broader, generic skills then we won’t achieve that vision,” she said.

Professor Tony Butterworth, chair of the Foundation of Nursing Studies, which is currently examining the current and future role of mental health nurses, agreed courses would have to change.

”General nursing and mental health nursing draw in rather different sorts of people and that is one of the problems with having a single portal”

Ian Norman

However, he said NHS organisations also had a role to play: “What employers want are instant puddings but as employers they have the responsibility to get people working in the ways they want them to work,” he said.

Ian Norman, professor of mental health at King’s College London, said there were both benefits and drawbacks to combining adult and mental health training more closely.

“I can understand the attraction for employers. In theory it could lead to a practitioner who has both mental health and adult nursing skills,” he said.

But he said this approach risked diluting the mental health course content and could also be off-putting to those who want specialty training.

“Mental health is a key part of the Five Year Forward View and HEE is working closely with providers and stakeholders to ensure the workforce is equipped”

Lisa Bayliss-Pratt

“In many ways general nursing and mental health nursing draw in rather different sorts of people and that is one of the problems with having a single portal,” he said.

Mental health nursing students tend to be older with more work and life experience, and significant proportion of those applying to do mental health nursing at King’s are graduates with a psychology degree, said Professor Norman.

National workforce planning body Health Education England, which commissioned the Shape of Caring review, is currently looking into the recommended changes to pre-registration training.

It said it was “only right” that mental health had the same importance placed on it as physical health and that this was “a hugely powerful impetus for improvement”.

“Mental health is a key part of the Five Year Forward View and HEE is working closely with providers and key stakeholders to ensure the workforce is equipped to respond, available in the right numbers and has the right skill mix,” said Lisa Bayliss-Pratt, director of nursing and deputy director of education and quality at HEE.

 

  • 23 Comments

Readers' comments (23)

  • there is a lot in the article about how mental health will loose out but it makes no mention of learning disability nursing which is already much smaller and poorly resourced part of the service

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  • I have always felt nursing should include both mental and general.
    We hear so many stories of mental health patients being stigmatised in general hospitals and in mental health, patients having their problems assumed to be all mental health related, when they are in fact physical.

    A body is a body and anything can go wrong. Perhaps nurse training need to be extended to include all areas of nursing including LD, that is the only way you can treat a whole person, not just treat patients from the neck up or the neck down!

    For me this is great news .... and about time too!

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  • It is a good idea that nurses train in general nursing before persuing to do a speciality such as psychiatry, intensive care, paediatrics, midwifery as such kind of nurses are equipped with vast amount of knowledge to deal with any incident. I have seen so many Mental Nurses that have no knowledge in doing dressing, catheterisations. Mental clients can have skin tears etc should these all be referred to A&E?

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  • Rosemary Gondwe Mazhandu

    It is a good idea that nurses train in general nursing before persuing to do a speciality such as psychiatry, intensive care, paediatrics, midwifery as such kind of nurses are equipped with vast amount of knowledge to deal with any incident. I have seen so many Mental Nurses that have no knowledge in doing dressing, catheterisations. Mental clients can have skin tears etc should these all be referred to A&E?

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  • I feel that mental health nurse training does already have many elements of general nursing within it. And with it totally. However, as with all specialisms, you need to have time in that area to be competent to practice effectively. What about bringing back the ability to do an extra year's training to become dual qualified, ie 3 years training in the mix as it is now for mental health, and a year training in general nursing? Would that not help the situation? Just a personal view.

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  • I feel strongly having qualified over ten years ago that it is about time we did something like this. I believe that there are not many countries alike ours were we train as MH, LD, Children or Adult from the very start of their career.
    We should move to a model were we all start of in the three year course training as RN (Generic) before specialism.
    You do not see medical students finishing their five years and qualified as psychiatrists, surgeons et cetera. It would seem that there is more respect for their professional acumen and ability that comes from specialism after qualification and further training.
    If we are to call ourselves nurses then it would be wise to have a common platform of ability and understanding.
    The issue me and my peers faced when we qualified was that we felt that we were grossly under prepared. To a certain extent we have to learn to be nurses only since the point of qualification. We have also had to continue to learn skills that should have been taught in the first three years to which many percieved this as a wasted opportunity to learn a good template of skills.
    Perhaps the current specialism so early on that we have now is a means of saving money whilst not investing in our professional care giving nurses, skills that could give them and their patients confidence and avoid the "silos of learning" often talked about

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  • I agree with the comments made regarding the need for a general base before specialising; and that mental health patients often have the physical needs unmet within a MH setting, and vice versa with MH patients within a medical/surgical/similar ward have only their physical needs met but not their MH needs.

    II should add the further point that, after general nursing, adult nursing ought to be a specialism and not assumed to be general nursing.

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  • This article almost purports ignorance in my opinion. There are 1.3 million children and young people with learning disabilities in England; do their needs not to be covered/filtered into nursing training, no matter the model adopted? Moreover, what about children and young people more generally? They also need nurses with a specialist skillset. Mental and physical health should not dominate nursing education in any way shape or form yet this article hints at this by not even acknowledging that learning disabilities and children's nursing even exist as separate fields!

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  • michael stone

    I think J Taylor has already written my comment for me.

    'The proposed new model also includes a year-long preceptorship with an employer in a student’s chosen field.

    “Preceptorship is a good idea but what concerns us is that many services – particularly mental health services – are so overstretched and under-resourced at the moment,” said Professor Duxbury.'

    I am forever reading that nursing is becoming increasingly complex - so it seems logical to suggest that a training model closer to that of doctors might, therefore, be necessary. But there seems to be neither the time, the money, or the 'political will' to do that ?

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  • many parts make the whole. thus stating the not so obvious to some. nursing is a complex profession and humans are complex so we need to rise to the challenge. I think mental and general sit well together but specialised care should be an add on after graduation

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