Good care needs good nurses
Posted Monday 21 November 2011
To mark the launch of our crisis care campaign, Zarathustra writes about the need for good nurses in acute care and the difference one personality can make to a ward.
When I was a student mental health nurse, I had a series of nurses inform me that I should spend my first year after qualifying on an acute psychiatric ward.
There I should 'gain experience' and 'earn my spurs' before going off to 'do something more interesting', such as becoming a Community Psychiatric Nurse. It quickly became clear that this was the expected thing for me to do.
Being the kind of person who pushes doors marked 'pull', this had the effect of making me want to work anywhere except on an acute ward.
When I did my acute placement, this didn't encourage me either. The ward culture was one where shifts of nurses and healthcare assistants gathered in the office for eight hours to avoid the patients.
Often I was the only member of staff actually out on the ward floor. That was okay by me because I was starting to develop a seething hatred for at least half of the nursing staff.
A final year student nurse tried to challenge the team culture, and was promptly bullied off the ward for his efforts.
When I did qualify, I didn't go to an acute ward but I occasionally work bank shifts in acute care. While working bank I've seen better care than during my negative experience as a student.
I've seen genuinely committed nurses on acute wards, showing real compassion often in very challenging situations. But the cultures on wards are very variable - not just from ward to ward but even from shift to shift.
All too often, the personality of the nurse in charge of the shift is what makes the difference.
Now I'm a grown-up, I get to mentor the new crop of student nurses. A surprising number of them don't want to go to acute wards either when they qualify.
Quite a few of them have had similar experiences to me, spending placements on wards with poor cultures. They've attended lots of high-minded university lectures stressing the importance of engagement and therapeutic relationships.
If they see the exact opposite on a ward, it's no surprise if it immediately gets crossed off the list of where they want to make their career.
But here's the paradox - how can the cultures of such wards be changed when the very people who would make the change simply don't want to work there?
As I've said, a passionate, therapeutically-minded nurse running the shift can be transformative, but it needs to become an attractive option for such nurses.
Perhaps something needs to change in the way such wards are perceived by mental health nurses.
They shouldn't be regarded as a training ground for the newly-qualified before heading off to a cushy number at the Community Mental Health Team.
Nor should they be untherapeutic holding tanks where the role of the staff is to give out the meds and digest a six-month old copy of Bella magazine.
Acute psychiatry needs to be seen as a vital and valued speciality, so that it can attract the kind of nurses who will provide good care.
Zarathustra is a mental health nurse, currently working in Child and Adolescent Mental Health Services (CAMHS). He blogs at The Not So Big Society.
All views expressed are in a personal capacity and not necessarily the views of his employer.
Excellent crisis care exists, but we need it everywhere, for everyone. Support our campaign, take action now.
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