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Practice comment

Mental health professionals need to end tensions and work together


As roles in healthcare change, mental health nurses should put an end to conflicts with occupational therapists and take more responsibility for patient activities, says Pauline Cooper


Remember the days when nurses wore starched uniforms, called each other by their surname, and “did” things for patients? It was the time when occupational therapists visited patients and “gave them something to do”. Nursing and occupational therapy have now changed beyond recognition as the NHS rapidly moves away from being a service and evolves into a business.

Payment by Results is upon us and government directives offering patient choice and increased staff engagement are inflating expectations. Mental illnesses are being grouped into clusters and the focus is on the volume of face to face contacts and productivity, which is jeopardising quality of care.

Research shows that mental health service users’ needs are increasing in complexity and inpatients are complaining of being “bored”. The pressure to provide activity is gaining momentum and nursing staff are being asked to engage in protected engagement time and provide low key activities.

Understandably, nursing staff are looking for support from occupational therapists who, historically, have occupied patients.

OTs are expected to provide specific interventions, with outcome measures to prove effectiveness and promote discharge. Increasingly, generic group activities are becoming the role of activity coordinators, occupational therapy assistants or technicians - and nursing staff.

It is not surprising then that nurses are feeling jaded and conflict is arising between the disciplines. OTs are being asked to train nurses to facilitate activity groups, but nurses feel that activities are not part of their role - they are overstretched and understaffed.

We are all aware that we are working in an atmosphere of criticism as patients are encouraged to complain in the quest to deliver better patient experience. Those who sit about doing little but waiting - for medication, to see the doctor, to have meals, and to be spoken to - need encouragement to engage in conversation and promote social skills building and confidence, in low key activities such as reading or doing puzzles and games. By using these key activities, assessments can be made about patients’ mental health and day to day progress.

This is no time to be in conflict. It is up to us to promote more positive professional relationshops. Registered nurses have particular expertise: medication management, promoting healthy lifestyles, and smoking cessation, to name but a few. OTs also have particular expertise: the development of occupation, vocation and activities of daily living skills and so on.

Healthcare assistants and OT aides also have skills, in observation, conversation and interests they can share with service users.

If we work together, integrating these skills towards a varied and cohesive service in which all patients can participate and become involved, we could revolutionise our workplaces.

It has been said that nurses have the ability but lack confidence in running groups; OTs can support, train, and/or work alongside to build competence in group facilitation. Volunteers and students can assist with low key activities under supervision from nurses or OTs. Service users can be encouraged to share responsibility for highlighting good practice and complimenting innovation.

Payment by Results need not be an initiative to fear but a time when we can engage in multidisciplinary inclusive and collaborative team working, where each member plays a specific, interwoven, role. A united front can bring us all great satisfaction as we see our patients travel a pathway to recovery with our help at every stage of their journey. Together we can stand; divided we will fall.

PAULINE COOPER is head occupational therapist of an adult acute inpatient mental health unit, Oxleas Foundation Trust, Kent


Readers' comments (13)

  • when I trained many years ago as a registered mental helath nurse, it was seen as integral to developing quality rapport/therapeutic relationships with clients that we facilitated a range of large/small group/individual activities as part of person centred support. It has been a core feature of my practice ever since and in the practice base of all the different services/organisations I have worked in to date, across the country. Maybe my experience is unusual but based on my own experiences and the job specifications/services I have been involved with, I don't think so .....I think many mental health nurses are actively engaged in such endeavours, and whilst there is inevitably always room for improvement, I don't think it is the case that this is a 'new' concept.

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  • Whoops!... I did of course mean 'health' and not 'helath' in the above post...

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  • As a mental health nurse much of my work has been involved in facilitating groups for patients and encouraging them in activities. Much to the derision of occupational therapists I have to say who regarded some activities as 'too low key' for them to be involved in. They were into more didactic methods of 'teaching' patients. Ironically, the trust I work in disestablished the day hospital which provided valuable groups and activities for patients.

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  • I manage a 10 bedded Mental Health nursing home, and am a Qualified nurse by profession. The few residents that supposedly have "an occupational therapist" as part of their team, have not benefitted from them in any aspect of their care. It would appear that OT's now feel that as part of Community Mental Health Teams, their main job is to find unneccessary faults with care provided, and engage their management in costly and regrettably futile investigations. They display complete ignorance about issues that impact this client group, and nothing whatsoever with regard to "activities". It might be best to retrain OT's as advocates, at least they'll get the training to do the job they are attempting to do now. Anonymous.

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  • I dont understand why there is more job roles being dumped on Nurses, we have already taken on the receptionist job for Doctors by setting up meetings for family, we collate information for Doctors and work with the community teams we finalise discharge paper work or referrals, seek people who go AWOL calling family & friends,we do medication round along with the physical monitoring of patients illnesses, we act like security by escorting patients to examinations or restraining patients for seclusion, then after signing 15/60 ob sheets we have to attend interview meetings with Drs & family or staff meetings, then if we have time we have to finalise our documentation notes for the shift which can be detailed and lengthy and this article is telling us nurses not to be in conflict with OTs, why dont we(nurses) learn how to be Alcohol and Drug therapists as well because this is very important for the care of patients, dump more work on nurses for less pay is a great,I forgot to add more jobs in smoking cessation assessments,kitchen hand during meals,making beds assist people with ADLs, you wonder why we have shortages in Mental Health or Nursing full stop. OTs need to learn their roles properly and stop dumping more work on nurses.

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  • Yes, anyone in the same environment with equal (CN) responsibility placed on them can only truly agree and respect the points you make. Unfortunately, these 'extra/associated tasks' placed on us arrived at the cost of basic care to the patients we are trying to look after.
    My personal battle with patient boredom-(management) versus ticking all my CN duties in the shift is an ongoing juggling act, but one of which I can normally say the patient wins..(at the moment anyway)

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  • I am a third year student on my final placement on an acute my own back ive been delivering anxiety management, recovery, assertiveness, self-esteem etc groups on a daily basis.
    It only takes an hour out the day and is the only hour i truley enjoy being there!

    I have no time for OT's they seem to target the patients who are close to discharge to do abit of colouring in and painting...anyone who is acutley unwell often "dosent have OT potential" and is left by the OT until they are almost symptom free and then take all the credit for the person's recovery.

    nurses are giving far too much away to OT's, im going to claim it back in my first job!!!

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  • As an OT working alone across 3 busy acute mental health wards I am saddened by the comments I have read from the nurses above. In my place of work I like to think that I have a good relationship with the nursing staff and they frequently come to me for advice and support on how best to engage patients on the wards. I feel they understand my role and the pressures I am under just as much as I see how understaffed and overworked they are. My job description does not include running groups due to the time this would take away from me doing 1:1 work which my nursing colleagues appear to value. I am heavily involved in discharge planning because this is where decisions are made regarding support required for patients to reduce the risk of re-admission and therefore is a good use of my scarce time and resources. The information I gather from nursing colleagues when completing my assessments and reports is invaluable if we are to do the best for our patients.

    I would ask the the above respondents spend some time talking to their OTs rather than fighting with them - particularly the student who seems to have closed the door to being a multi-disciplinary worker before they have even begun.

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  • I enjoyed the comment from the OT...from the tone of what you have wrote it appears that the nurse works to serve you?
    exactley the same comment as before that you are there to take the praise and be in the thick of it at the end with discharge planning, but no mention of what you "do" whilst people are acutely unwell.
    take the semantics away from the conversation and i hope people agree that multi-disciplinary only works when a good "person" happens to be a nurse/an OT/ a psychologist etc and has the genuine values of being interested in the person they are looking after.
    The demarcation of who should do what and whose the more expert soley applied to job title is whats going wrong.
    I do find it strange that its only ever OT's who defend what they do so long as im useful to people who need help i couldn't give a monkeys about justifying myself! stop moaning and get doing!

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  • I'm a nursing student in my third year (Adult). I entered nursing, in the Mental Health branch. However, I found that the role of the Mental Health nurse seemed increasingly blurred and the hierarchy clearly apparent within the 'MDT'.

    Occupational Therapists I had spent time with, didn't waste a second in highlighting that, and I quote a clinical lead O.T, they 'have a higher position than the clinical lead nurse'. I also had another O.T tell me that she wanted her daughter to do nursing as it was 'easier'. Ofcourse, I couldn't help but take offence by the remarks made against the profession. O.T's study for three years and so do nurses. How is it any easier?? We qualify at the same academic level so how are O.T's any better??

    It was not only these comments but also the shear fact that in most ward rounds, I felt that the nurses opinions were under-valued if at all. It doesn't encourage MDT working. It instigates hostility and provokes questioning of your value within the 'team'. In turn, this decreases staff morale and therefore it comes as no surprise that nurses are upset by such an article. It's like saying, in a phrase, 'nurses are useless'.

    I completely agree with MH nurses engaging in therapeutic activities and building relationships but to my knowledge, this has always occured?! Our knowledge and skills set is unique and intrinsic to our profession and therefore it is often misunderstood. Our interventions are bound to differ from that of an Occupational Therapists. After all, we are trained differently and quite rightly so. We need a skills mix and a shared and valued contribution.

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