Neil Brimblecombe

Nurse prescribing in mental health: national survey

Mental health nurses can now train to become independent prescribers as well as supplementary prescribers. Independent nurse prescribing can potentially help to reorganize mental health services, increase access to medicines and improve service user information, satisfaction and concordance. However, mental health nursing has been slow to undertake prescribing roles, and there has been little work conducted to look at where nurse prescribing is proving successful, and those areas where it is less so. This survey was designed to collect information from directors of nursing in mental health trusts about the numbers of mental health prescribers in England, gather views about prescribing in practice, and elicit intentions with regards to the development of nurse prescribing. In some Trusts, the number of mental health nurse prescribers has increased to the point where wider impacts on workforce, the configuration of teams and services are inevitable. Currently, the way that prescribing is used within different organizations, services and teams varies and it is unclear which setting is most appropriate for the different modes of prescribing. Future work should focus on the impact of mental health nurse prescribing on service delivery, as well as on service users, colleagues and nurses themselves.

Using workload measurement tools in diverse care contexts: the experience of staff in mental health and learning disability inpatient settings

ACCESSIBLE SUMMARY What is known on the subject? Difficulties with the recruitment and retention of qualified nursing staff have resulted in nursing shortages worldwide with a consequential impact on the quality of care. It is increasingly recommended that evidence-based staffing levels are central to the development of workforce plans. Due to a paucity of empirical research in mental health and learning disability services the staffing needs and requirements for these settings are undefined and the availability of tools to aid staffing decisions is limited. What this paper adds to existing knowledge? This paper provides a valuable insight into the practical uses of these tools as perceived by staff members with day-to-day experience of the requirements of mental health and learning disability wards. It reveals that while workload measurement tools are considered a valuable aid for the development of workforce plans, they are limited in their ability to capture all aspects of care provision in these settings. It further emphasizes the inapplicability of a one-shoe-fits-all approach for determining nurse staffing levels and the need for individual and customized workforce plans. What are the implications for practice? This study demonstrates that the development of tools for use in mental health and learning disability services is in its infancy, yet no tool that has been validated as such. It highlights the potential for workload measurement tools to aid staffing decisions; however, a more holistic approach that considers additional factors is needed to ensure robust workforce planning models are developed for these services. ABSTRACT INTRODUCTION The critical challenge of determining the correct level and skill mix of nursing staff required to deliver safe and effective health care has become an international concern. It is recommended that evidence-based staffing decisions are central to the development of future workforce plans. Workforce planning in mental health and learning disability nursing is largely under-researched with few tools available to aid the development of evidence-based staffing levels in these environments. AIM It was the aim of this study to explore the experience of staff using the Safer Nursing Care Tool and the Mental Health and Learning Disability Workload Tool in mental health and learning disability environments. METHOD Following a 4-week trial period of both tools, a survey was distributed via Qualtrics online survey software to staff members who used the tools during this time. RESULTS The results of the survey revealed that the tools were considered a useful resource to aid staffing decisions; however, specific criticisms were highlighted regarding their suitability to psychiatric intensive care units and learning disability wards. DISCUSSION This study highlights that further development of workload measurement tools is required to support the implementation of effective workforce planning strategies within mental health and learning disability services. IMPLICATIONS FOR PRACTICE With increasing fiscal pressures, the need to provide cost-effective care is paramount within the services of the National Health Service. Evidence-based workforce planning is therefore necessary to ensure that appropriate levels of staff are determined. This is of particular importance within mental health and learning disability services due to the reduction in the number of available beds and an increasing focus on purposeful admission and discharge.

Service users' beliefs about acute in-patient admission

Purpose – As the beliefs people hold exert more influence over their behaviour than any other single factor, the purpose of this paper is to elicit those held by service users about being cared for in acute mental health settings.Design/methodology/approach – Data were collected by means of a semi‐structured, non‐standardised, 17‐item interview schedule from an opportunistic sample of 44 respondents (18 men and 26 women) following their admission over a nine‐month period.Findings – Findings suggest that those admitted to acute care settings harbour very different beliefs about what to expect, what is being offered and how it will affect them. While some respondents saw admission as an event simply to be endured, others saw it as a means of gaining relief, accessing better care and treatment as well as providing respite for their families. Whereas previous knowledge and experience of acute care did influence their beliefs, this was largely due to how they interpreted experiences rather than the experiences...

New Ways of Working for nurses

An enormous amount of change has occurred in the last six years for the mental health system in England and the workforce within it. We have seen the 10‐year National Service Framework for Mental Health (Department of Health, 1999) gradually make its impact felt in the form, in particular, of new community mental health teams and structures for delivering care in the community. We have also, most recently, experienced the passing of the Mental Health Act 2007 (HM Government, 2007), after many turbulent years of controversy and argument, extending to nurses and non‐medical practitioners who have been given statutory powers to act as approved mental health practitioners and approved clinicians.Alongside these important developments has been a gradual revolution in traditional ways of working, in the form of the New Ways of Working initiative. This article considers the impact of New Ways of Working on mental health nursing ‐ the single largest professional group within the mental health workforce ‐ and the continuing implications for the profession. The development of nurse prescribing is used as an illustration of the challenges and opportunities that have commonly arisen when new roles and skill sets have been introduced in mental health settings.

Community Psychiatric/Mental Health Nursing: Contexts and Challenges—The Case of Nurse Prescribing and Recovery-Focused Interventions

This chapter focuses on the role of psychiatric/mental health (P/MH) nurses who work in community settings. The chapter retrospectively reviews the stated and implicit aims of mental health services and what has driven the changes that have taken place across Europe in the last 50 years, moving from a heavy reliance on institutionally based services to varying degrees of community-based care. The role of P/MH nurses within these changes is explored, using P/MH nursing in England as a ‘case study’, particularly the growth of the so-called ‘Advanced’ nurse prescribing role within England. Nurse prescribing has been adopted, to some extent and to a certain degree, some by countries across Europe. It is perceived by some as allowing P/MH nurses to practise with a more holistic, recovery and service user focus, conversely by others as replicating undesirable medically defined models of care. It is argued that all changes in mental health services are perceived through multiple perspectives, dependent on philosophy, profession and personal circumstance. The development of P/MH nurses as prescribers of medication is an example where different perspectives are starkly brought into focus. The emerging evidence is reviewed and tentative conclusions drawn.