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”
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”
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.
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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”
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”
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 email@example.com