Tag: post-qualification education

Specialist practice in the community

For many years I led a Nursing and Midwifery Council (NMC)-approved post-qualification degree course for mental health nurses working in, or wanting to work in, the community. I wrote about the curriculum we developed in Cardiff, and was involved in two surveys of course leaders of programmes of this type which went on to be published here and here. Our Cardiff course, like others of its type, was recognised by the NMC (and by the NMC’s predecessor, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting) as preparing qualified nurses for ‘specialist practice’. Linked to a set of UK-wide standards, specialist practice was designated as practice beyond that expected at initial registration.

Most programmes of this type have long since disappeared, ours in Cardiff included, but the regulatory standards against which they were validated remain. The specialist practice qualification (SPQ) was first introduced in the 1990s, with the standards for SPQ in community nursing (including community mental health nursing) not being updated since the early 2000s. In 2019 the NMC commissioned an independent review into SPQ, with the final report from this exercise making clear how poorly understood these long-outdated standards had become and how much a root-and-branch review was needed.

A debate can be had on the extent to which standards for practice beyond those linked to professional registration should be prescribed by a regulatory body such as the NMC. For the professions of nursing and midwifery, however, no UK-wide bodies able to definitively set standards of this type exist other than the NMC; this is partly because we have no equivalents to the royal colleges, which exist to set and maintain standards for doctors preparing for post-registration practice in the various fields of medicine.

The NMC’s ongoing programme of work developing its standards has so far included the publication of an education framework, the Future Nurse standards of proficiency for registered nurses and new standards for student supervision and assessment. Now, following receipt of its independent evaluation of SPQ the NMC is embarking on a post-registration review. In August, through my membership of the All Wales Senior Nurse Advisory Group for Mental Health I took part in an NMC webinar and discussion on specialist practice in the community, convened as part of this wider post-registration programme of work. With work already happening in parts of the UK to more closely specify ‘advanced’ practice, such as through Health Education England’s Advanced Practice Mental Health Curriculum and Capabilities Framework, the NMC is stepping into an already-crowded space. It is in this context that consistency and joined-up policy and standards will surely be needed: which is something members of Mental Health Nurse Academics UK (me included) will continue to say as this programme of activity continues to progress.

Review fever

Just what we need: another review of nurse education. Yesterday the Nursing Times carried this item reporting a joint Health Education England and Nursing and Midwifery Council plan to investigate standards. The NT says:

Health Education England and the Nursing and Midwifery Council will launch the review in May to specifically investigate the standard of education provided to around 60,000 nursing and midwifery students each year.

The Shape of Caring Review, which will be led by Lord Willis of Knaresborough, will also consider the standard of post-registration training for the NHS nurses once they have qualified. The review is due to produce a final report by early next year.

It follows concerns over the standard of nurse training raised by the Francis report into care failings at Mid Staffordshire Foundation Trust.

As part of its work, the review will examine the controversial pre-nursing experience pilots that have seen around 160 students work as healthcare assistants for a year before starting courses, and which were a key plank of the government’s initial response to the Francis report.

This is the same Lord Willis who chaired the RCN’s review of nursing education which reported in 2012, and about which I wrote a piece on this site here. As I wrote then, there was some scepticism on the timing given that universities and their partners in the NHS were in the throes of reshaping their pre-registration curricula following the publication in 2010 of new NMC standards for pre-registration education. This latest review is going to start before more than a handful of new, post-2010, nurses have registered and certainly before we know anything of the impact of these new regulatory standards on practice. This is exactly a point the NT goes on to make:

But Professor Ieuan Ellis, chair of the Council of Deans of Health, said he was concerned the review would duplicate work already underway by “multiple different projects and working groups”.

“This group needs to reflect on the reviews that have already happened, some quite recently – otherwise there will be a lot of duplication going on,” he added.

Jackie Kelly, head of nursing at the University of Hertfordshire, pointed out that the NMC had already imposed new standards for pre-registration courses in 2010, and stressed 50% of nursing students time was spent in a clinical setting away from the classroom.

She said: “We have already gone a long way and I wouldn’t want the review to move in a direction of travel before we have seen the output from the new standards agreed in 2010.”

Quite so.

Education for community mental health work

This week brought a COCAPP meet-up in Bristol, where we had the chance to plan our work for the immediate period ahead. The RiSC team also met, albeit in teleconference rather than face-to-face fashion. I’ve had pre-registration student nurses’ assignment work to begin marking, and this afternoon will be taking part in a joint Cardiff University/Local Health Board discussion on the future provision of post-qualification modules for community mental health practitioners.

This afternoon’s meeting has given me pause for thought, and a chance to reflect a little on my long involvement in post-registration mental health education. It was explicitly to lead a full-time, one-year, programme for actual or intending community mental health nurses (CMHNs) that I was recruited into what was then the University of Wales College of Medicine in 1997. Education, and my role, have changed considerably in the period following. In Wales there is no longer a fully funded, full-time, course of this type. Like pretty much everywhere else, here education for health care workers beyond registration has increasingly become part-time, and modularised.

I once wrote about the CMHN course we ran in Cardiff in the journal Nurse Education Today. The article was titled ‘Specialist practice in community mental health nursing‘, and had an abstract which went like this:

Community mental health nurses (CMHNs) work in an increasingly complex health and social care environment. Over recent years, the evolving direction of general health service and specific mental health policy has directed CMHNs towards: the provision of clinically-effective interventions; a closer attention to meeting the needs of people experiencing severe and long-term mental health problems; the simultaneous provision of services to meet the needs of people experiencing a wide range of mental health problems presenting in primary care settings; greater collaboration with workers representing other disciplines and agencies; and the development of active partnerships with mental health service users. This paper explores the context within which CMHNs practise, and within which education programmes preparing specialist practitioners in community mental health nursing have been developed. One recently-validated specialist practice course for CMHNs is described in detail, with the intention of stimulating discussion and debate surrounding the practice of, and the educational preparation for, community mental health nursing.

I can’t claim that this paper did actually trigger any particular debate, but at least I tried.

I also had the chance, during the time that I ran Cardiff’s full-time CMHN course, to survey the leaders of other programmes of this type offered elsewhere in the UK. A paper called, ‘Specialist practice for UK community mental health nurses: the 1998-99 survey of course leaders‘ appeared in the International Journal of Nursing Studies. This was co-written with Philip Burnard, Debs Edwards (who, I am delighted to say, is now project manager for the RiSC study already mentioned in this post) and Jackie Turnbull. In the paper’s abstract we said:

Surveys of the leaders of the UK’s post-qualifying education courses for community mental health nurses have taken place, on an annual basis, for over 10 years. In this paper, findings from the survey undertaken in the 1998–99 academic year are reported. These findings include: that most course leaders do not personally engage in clinical practice; that interprofessional education takes place at a minority of course centres, and that course philosophies and aims are characterised by an emphasis on both outcomes (in terms of, for example, skills acquisition, knowledge development and the ability to engage in reflective practice), and process (adult learning).

And then there was a paper called, ‘Education for community mental health nurses: a summary of the key debates‘ which Steve Trenchard, Philip Burnard, Michael Coffey and I wrote for Nurse Education Today. Here we said:

A wide range of post-qualifying education courses exist for community mental health nurses (CMHNs) working in the UK. ‘Specialist practitioner’ courses emphasize shared learning between CMHNs and members of other community nursing branches. These programmes typically include course content drawing on the social and behavioural sciences, as well as on material more tailored to the clinical needs of practitioners. Such courses and their predecessors have been subject to criticism, however. Courses have been described as anachronistic, and failing to take account of recent advances in treatment modalities. In addition concerns about the generic focus of some programmes have also been raised. Educational alternatives, such as programmes preparing nurses and other mental health workers to provide ‘psycho-social interventions’ have, correspondingly, become increasingly popular. In this paper we explore some of the debates surrounding the education of CMHNs, and explore the context in which CMHNs work and in which educational programmes are devised. We consider the multidisciplinary environment in which CMHNs practise, the differing client groups with which CMHNs work, the developing policy framework in which mental health care is provided, demands for more user-responsive education, and the relationship between higher educational institutions and health care providers. We conclude the paper with a series of questions for CMHN educators and education commissioners.

And there are other papers and book chapters, too, which I won’t refer to now. But I am reminded that I once spent large parts of my working life running programmes for community mental health workers, and managed to research and write a fair bit about the same. Perhaps today’s meeting will lead to a modest rekindling.