A comparison of the work and values of community mental health nurses in two mental health NHS Trusts

With the reconfiguration of health services in both the primary and secondary sectors, the role of community mental health nurses (CMHNs) has become a highly contested one within mental health care. There would be great variability in the skills that CMHNs possess, the contexts in which they work and the nature of the work they do. This study sought to explore aspects of the work of those nurses who provide services at the interface between policy and practice. Two groups of CMHNs were compared, one working in an urban setting (Trust A) and the other in a rural (Trust B), focusing particularly on caseloads and client mix, the values held by CMHNs, the models of care they utilize and what they consider would improve care in the future. A specially designed 39-item questionnaire was employed, with a mix of open and closed questions, and statements to which participants were asked to respond on a three-point Likert scale. The findings raised interesting issues around collaborative working, whether CMHNs are happy to take on clients previously on their caseload, bureaucratization, autonomy, role definition within a culture of working with primary care, lack of specific models utilized by CMHNs, and the demand for greater training and educational support. The implications of the study are discussed with the aim of assisting mental health nurses determine their future roles.

The work and values of mental health nurses observed

While there is agreement among stakeholders that change is required in mental healthcare, yet the precise nature of this change and how it should be brought about are relatively under-explored. Research has looked at developments taking place in primary mental health services, but relatively little has examined the work of community mental health nurses (CMHNs), especially those working at the interface between primary and secondary care. This study used a 39-item questionnaire to explore how CMHNs perceive their role and the degree to which they are able to carry it out. The findings suggests that while CMHNs are enthusiastic about their work and are keen to see mental health services develop in primary care, many are concerned about how they are perceived by other health personnel, deficiencies in their therapeutic skills and the level of support they currently receive. The study concludes by suggesting areas that managers, commissioners and educators should target to enable CMHNs to continue to play their part in a service that relies heavily upon them.

Mental health nurses' perceptions of nurse prescribing

AIMS

This study aimed to ascertain mental health nurses' perceptions of the advantages and disadvantages of nurse prescribing and to identify the educational needs of mental health nurse prescribers.

DESIGN

A questionnaire was designed and administered to a convenience sample in the UK of 73 mental health nurses in clinical practice, 14 working in in-patient settings and 59 in the community. Questions included both closed and open-ended items. Descriptive statistics were used for numerical data, and category analysis of the open-ended questions was undertaken by two of the researchers independently and then conjointly.

FINDINGS

The majority of respondents felt that mental health nurse prescribing would significantly improve clients' access to medication, improve compliance, prevent relapse and prove cost effective. However, many were anxious that they did not have sufficient knowledge and skills to assume responsibility for prescribing.

CONCLUSIONS

Although there would be benefits to clients and patients, further training, rigorous supervision and the co-operation of doctors will be required if mental health nurse prescribing is to yield the anticipated benefits.