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