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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.
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3 Comments
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Couldn't agree more but psychiatry is going backwards, it is even more mechanistic and biomedical to the exclusion of all else. It's also colluding with government recovery agenda's of what is supposed to be recovery. When I say this I mean commissioners, top level management, the professional bodies [RCP]. Nurses at the coalface have understandably given up because bucking the system means being disciplined or pushed out at the worst, working within the mental health system is as unhealthy as using them. It's about ruthless brutal cuts but it's also about culture and ideology. Unless Trusts take a stand against this push to put people [only in dire crisis] in/out of services in under 6 months with effectively no ongoing support I can't see how this will change. Trusts need to stand up to government but they won't because no one is.
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As an ex general nurse due to living with Bipolar Disorder I do have to agree that on some units indeed the culture is stuck in a time warp. My experience as a first time patient many years ago still reminds me of the prison like regime on the acute unit I was admitted to.
My long-term goal was to work in mental health which I now do but within the voluntary sector that does indeed focus on the holistic view and recovery principles. I would have liked to have trained as a CPN but could not negotiate the acute hospital units as a student for fear of becoming like the staff who 'looked after me' many years ago.
The health care assistants and students were unique on the ward I was on many times and were stars but the qualified staff seemed to have trained in the same prison. To this day my recovery would have come much quicker had it not been for this stay in the office all shift crowd. Staff such as this are in the wrong profession and I can only praise those who activly become involved in patient care.
It has changed over the years but some wards are run like the old 'back wards' - they are NOT theraputic environments and staff not up to the role should be re-trained to inspire and treat with dignity those who are kicked down. My first experience was frightning as staff only appeared at medication time or to 'pin some one down' in a totally uneccessary manner. There really are some fantastic nurses out there but please NHS trusts remove those who do not reach the standard. -
I have been a patient on an acute ward a couple of times. From what I saw and was a part of wheb I was ill these nurses have a very difficult job. I think the ones that try to hide in the staff room are kind of understandable in what they do. But obviuosly they can do a lot more good if they are brave. On my ward in Exeter I would say nearly all the nurses were good and very nice. I am so thankful to all of you as u do a job that most people couldn't or wouldn't want to do.
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