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Exclusive: Trust aiming to make nurses ‘dual competent’ in physical and mental health

  • 13 Comments

North East London NHS Foundation Trust’s chief nurse wants all her nurses to be “dual-competent” in both physical and mental health within the next five to 10 years.

Stephanie Dawe told Nursing Times she was determined to ensure all nursing staff were able to deliver truly holistic care, as part of wider efforts to create more integrated services.

“My vision is in five to 10 years all of our nurses will be dual-competent”

Stephanie Dawe

Her pledge follows a successful trial of rotational posts at the trust, which saw newly-qualified nurses develop both mental health and adult nursing skills by gaining practical experience working on wards and in the community.

The initiative – which launched with just three rotational roles – has since been expanded with the trust looking to recruit 26 “first destination rotational nurses” to start this September.

“My vision is that in five to 10 years all of our nurses will be dual-competent,” Ms Dawe told Nursing Times.

“This may seem like a courageous statement to make but if we are not courageous then we don’t make progress,” she said. “I’m in the process of developing a business case to enable us to do that.”

“The only experience they did have was what they’d read in the papers”

Paul Chesnaye

Two registered mental health nurses and one registered nurse trained in adult nursing took part in the 18-month trial.

All three completed preceptorships in the area they qualified in before moving on to work in several different services.

They also did “dip-in shifts” once a month to keep up their skills in their core areas of expertise.

Ms Dawe said the initiative had come out of a recognition that – more often than not – patients had both physical and mental health needs.

“In the main services are commissioned purely for either mental or physical health,” she said.

“This project was based on the simple premise that we needed to treat the whole individual and why would you want to do that by sending two people into somebody’s home when you could send one,” she said.

“It was about consistency, continuity of care but there was also a business sense there,” she added.

North East London and Essex Foundation Trust

Nursing director ‘reverse mentored’ by BME staff

Stephanie Dawe

Ms Dawe admitted she had also been spurred on by personal experience, as her mother had chronic obstructive pulmonary disease and her father Parkinson’s disease.

“I could see the gaps in services and that their psychological needs were not being addressed,” she said.

The pilot was led by practice facilitator Paul Chesnaye, who first carried out research among adult nursing students and found most had “no experience of mental health at all”.

“The only experience they did have was what they’d read in the papers,” he said. “On the other side our [registered mental health nurses] get six weeks’ physical health in their first year, so by the time they qualify that is a distant memory.”

Ms Dawe said the trust had used existing vacant nursing posts for the pilot. Getting it off the ground had been complicated, especially when it came to promoting the idea to other nursing staff and team leaders, she said.

“There was quite a lot of work we needed to do particularly with the ward managers and team leaders, because they are running very difficult or challenging wards or units, and were getting a nurse who wasn’t what they really wanted,” she noted.

“So, in a rehab ward they were getting a mental health nurse and they really struggled to see what the value could be. But by the end of the placement, they were desperate to keep people so there was a real turnaround,” she said.

The nurses on the placements were expected to achieve the standard competencies for both mental health nurses and adult nurses.

However, it was sometimes a challenge to get competencies signed off, given there were only in relevant settings for a limited period of time and some procedures or techniques did not come up that often, said Mr Chesnaye.

This is one issue that will be addressed in the second round, alongside more work on identifying the key competencies participants will be expected to achieve.

After each rotation, the nurses taking part answered a series of questions designed to test their knowledge – with half related to mental health and half to physical health.

Their results were compared with those of equivalent band 5s not involved in the scheme. Those on rotation “fared a lot better” on the tests because of their extra experience and exposure, said Mr Chesnaye.

Ms Dawe said one of the biggest benefits was increased confidence.

“General nurses who are treating somebody who has schizophrenia are quite often terrified,” she said. “Through this they gain a huge amount in terms of confidence, competence and ability to work across and develop themselves in different settings – it opens up their future.”

“As a nurse, I have become such a holistic practitioner”

Sally Barbrook

Other benefits from the programme included the fact that participants were able to teach new skills to fellow nurses and students, including initiating mental health assessments on adult wards and blood pressure checks on mental health wards.

Sally Barbrook was one of the three nurses who took part in the trial having qualified as a mental health nurse.

She said she had no doubt the experience had made her “a better nurse”. “I’ve always been passionate, not just about a patient’s mental health but their physical health,” she said.

“During my training the physical health side wasn’t quite up there as much as mental health, so I was very keen to join this pilot to further my skills but also for the patients – to give them a better well-rounded nurse to look after them.

“As a nurse, I have become such a holistic practitioner and I know my colleagues have too,” she told Nursing Times.

Her input, while on rotation with a district nursing team, has since led to anxiety and depression assessments being carried out in the community.

She is now working at a memory service where her increased knowledge of physical health is proving invaluable.

“I’m able to check for and rule out underlying physical health problems that could actually cause confusion or interfere with a possible diagnosis,” she said.

“I found one patient had a urine infection that was so severe she was taken to A&E and possible sepsis was prevented,” she added.

Fellow mental health nurse and pilot participant Joanna Jobson is now working in child development in the community in Barking and Dagenham. She said the rotational role had given her excellent transferrable skills.

“I have come out of it so much more rounded and confident and competent in my physical health skills,” she said.

“When I was a student I went on a placement where a patient had self-harmed and I had to do a wound dressing and I didn’t feel very comfortable doing it,” she said. “I knew why the service user had done it and how to handle that – I just didn’t know basic wound care.”

“I have come out of it so much more rounded and confident and competent”

Joanna Jobson

She said: “Now I would be able to do a risk assessment and a care plan, but I would also be able to know exactly what type of dressing to use, how often it should be changed so that service user wouldn’t need to go to another hospital to have it looked at.”

The third nurse on the pilot – Diane Blade – is working as a practice nurse at a GP surgery in Dagenham, where she has been assessing both patients’ mental and physical health.

The trust is also developing a number of other rotational posts spanning acute and community services, and in children’s nursing.

“We really see this as the future for our nurse development and for the organisation,” said Ms Dawe.

About nine or 10 nurses have already been recruited to the 26 new rotational posts. So far the pilot and second round of posts have attracted many more mental health nurses than adults nurses.

Ms Dawe, who urged more general nurses to apply, suggested said one reason for the disparity could be prejudice around mental health and mental health nursing.

“When you work in mental health you can absolutely see the value of developing your physical health skills,” she said.

“But there’s still very much a stigma attached to mental health – and a fear – so general nurses may not necessarily see the same value in developing and learning that skillset,” she added.

Anyone interested in applying for one of the rotational posts currently on offer can email Mr Chesnaye at paul.chesnaye@nelft.nhs.uk

  • 13 Comments

Readers' comments (13)

  • Sensible. Physical health is mental health and mental health is physical health; it is false to divide them.

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  • hotshiningsun

    What a good idea.... I would welcome the opportunity to be dual qualified

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  • michael stone

    'Ms Dawe admitted she had also been spurred on by personal experience ...'

    Yes - surprising how often 'personal experience' makes you think.

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  • I really liked this article because it is saying such a wonderful thing in that nurses need to have a lot of education and the more educated the nurses are, the better care the patients will receive. I believe that this is a great and positive thing. Please keep up the good work and thank you for helping to make patient care a priority. Purplespider, CNA

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  • the body and mind are extricably linked so why not do both to integrate the approach of the practitioner. it should be very effective and have a fantastic impact on our services.

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  • Thank you for doing this research on a new trend in the nursing profession. It is a very interesting aspect on holistic nursing and that means that nursing is in the care of the whole person. Thank you for having this article and for doing the research. It surely will be changing the future of the nursing profession.

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  • It is so nice to view nursing as "the whole picture" when it comes to patient healthcare. When I am on the floor doing my nursing duties and when I am looking at a medical chart and examining a patient, I look at the whole holistic approach to their care. The medical chart and the health assessment should compare very well. Thank you for doing this survey. It has opened my eyes as a nurse and it will keep my eyes open forever.

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  • Understanding the physical aspects of medicine is very important, but when a nurse understands that there is a mental component to that physical aspect, then it becomes even more meaningful. When a person is sick or hurt and is in the hospital, it is up to the them to have the will to live and that mental state of living and feeling better in order to get out of the hospital and feel good. My mom is in rehab right now and she does have dementia as well. When she started therapy, she did not want to walk or do it. Now, she mentally realizes that she needs to do more therapy and get walking again in order to gain strength and get out of rehab. Physical and mental health go hand in hand for every patient.

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  • I really enjoyed reading this article. I agree with what this article is saying in that more and more practitioners need to be more and more dual accurate in health and mental of the client. Not only does a practitioner have to have knowledge on how to take care of a client health wise, but also mental health too. They are both important and they both go hand in hand.

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  • More and more nurses need to be more involved in mental health; not just the physical health. Mental health is growing and growing and more and more nurses need to have both physical and mental understandings on health. Being healthy in the physical sense is so good because that means that the mental aspect is also beneficial. When the physical and mental health are impacted, then it is up to the nurse to assess why that impact is occurring and how to improve it.

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