Tag: Royal College of Nursing

Learning how to see: industrial action in universities and the nursing workforce

5ef34afb-e2b4-47ec-ad34-be229c7b135c
Photo by @sarawhittam

I take the view that ‘everything is connected to everything else’, to use a phrase I recently learn is attributed to Leonardo da Vinci. More on him later.

Over the past week I’ve been involved in industrial action as part of #UCUStrikesBack. What I’m not going to do in this post is to explain why university staff are currently on strike, largely because this has already been adequately covered elsewhere (for example, see here and here). Instead, I want to share some picket-line reflections linking what happens in universities with what happens in the health service. These are connections which are not being made frequently enough, including by some who should know better.

As a mental health nurse academic I am acutely aware of the perilous position occupied by my profession in the NHS, with reports from earlier in 2019 pointing to a loss of 6,000 mental health nurses in NHS England since 2009. Below is a graph, created using NHS Digital data, which starkly reveals the current situation:

MHN numbers 2019As an aside, data of this type are not published here in Wales. They should be. In any event, quite correctly much concern has been expressed about this startling decline in the workforce, with mental health nursing now singled out as a group needing particular help to improve both recruitment and retention.

Reflecting my position as a health professional academic I hold joint membership of the University and College Union (UCU) and the Royal College of Nursing (RCN). The RCN, along with other health service unions like Unite and Unison, is trying to reverse the crisis facing the nursing workforce. It is campaigning on safe staffing, has published a manifesto to assist nurses wanting to interrogate prospective parliamentary candidates ahead of the December 2019 general election, and through its Fund our Future campaign is lobbying government to reverse the removal of tuition fee and living cost support for students of nursing in England.

These campaigns are important. So far, however, in its public pronouncements the RCN has failed to make the necessary connections between working conditions in universities and the present and future education of student nurses. Put simply, an adequate supply of educated, evidence-minded, person-centred nurses demands an adequate supply of secure, well-supported, fairly paid nurse educators and researchers. Nurse academics typically have career trajectories which are significantly different from those in other fields, with implications for their recruitment, retention and development. The modern norm for historians, physicists and sociologists seems to involve years of precarious, post-doctoral, employment characterised by repeated short-term contracts before landing (if ever) much sought-after full-time academic posts. In contrast, with some exceptions nurses are generally recruited into higher education by dint of their practitioner expertise, their posts linked to the servicing of courses of professional study. This was certainly how it was for me: my academic career commenced with an initial series of short-term employment contracts associated with the leading of a post-qualification course for community mental health nurses. In all universities, nurse academics can soon find themselves carrying major teaching and course management responsibilities, often for programmes and modules of study which run more than once across a single year. Demanding education and education-related workloads can squeeze out time for research, scholarship and wider engagement, in workplaces which traditionally value productivity in these areas for the purposes of career progression.

Expanding the number of nurses to fill the gaps which now exist, for which the RCN and others are rightly campaigning, requires thought and careful planning. In the run-up to the general election both are in short supply as nursing numbers become reduced to political soundbites. More student nurses must mean more nurse academics, but in any future rounds of staff recruitment potential entrants will have their eyes wide open. The erosion of university pensions relative to pensions in the NHS does nothing to encourage those contemplating the leap from health care into higher education (or, at least, into that part of the sector in which the Universities Superannuation Scheme predominates). Very reasonably, those considering future careers as nurse academics will also want to weigh up the appeal of doing work which is undoubtedly creative and rewarding with what they will hear about workloads, developmental opportunities and work/life balance.

I also learn, this week, that Leonardo da Vinci saw the making of connections as necessary in order that we might see the world as it truly is. In my working world, education, research and practice are intimately intertwined. It is disappointing that these connections are being missed by organisations which campaign on the state of nursing and the NHS, but which do not (as a minimum) also openly acknowledge the concerns that nursing and other academics have regarding the state of universities. Right now, some words of solidarity and support would not go amiss.

Out of the Asylum

Belated happy new year. Visiting the Royal College of Nursing headquarters in London last Friday ahead of a meeting of the Network for Psychiatric Nursing Research (NPNR) conference committee (more on that below) gave me an opportunity to pop into the ‘Out of the Asylum’ exhibition. I’m glad I did. Texts, photographs and other artefacts illustrate the history of mental health nursing.

2016-01-08 11.25.57Here are some of the pictures I took. These include a photo of the RCN’s copy of a sixth edition of the Red Handbook, displayed alongside nurses’ badges, a Bethlem Royal Hospital pamphlet, a syringe and other items of interest. For more on the Red Handbook see this earlier post, along with this post which includes material from my copy of a fourth edition of the same. Another picture relates a set of regulations for the bathing of patients. 

One of the display boards makes the observation that ‘few mental health nurses now wear uniforms’. As an unfortunate aside, this may need some future updating. From what I’m hearing, the historic trend towards mental health nurses wearing everyday clothes at work is reversing, with numbers of NHS trusts and health boards contemplating a return to uniforms. I regret that. But sticking with the exhibition…

…a final photograph I’m reproducing here is the front sheet of an early 1930s examination paper. Look hard and you’ll see questions on bones, asphyxia and antiseptics (amongst other things).

The NPNR planning meeting, this being the purpose of my trip,  was a productive one. This year’s event (the 22nd) will be taking place in Nottingham on September 15th and 16th. I’ll add more on this when I can, and include some regular updates on this site.

 

 

Fees, theses and project updates

Last week brought the news that, in England, people beginning nursing degrees from the 2017-18 academic year will need to take out student loans to cover the cost of their tuition fees. The cap on student numbers will also be removed. The Council of Deans of Health broadly supports this move, having previously argued for change. One of the things it points out is that current funding for students (via the agreement of the benchmark price) does not cover the real costs of educating new nurses. The Royal College of Nursing, on the other hand, is concerned that last week’s announcement prepares to break the connection between the NHS and financial support for student nurses, and simultaneously risks making nursing a less attractive career option. This concern particularly relates to mature students and those contemplating a second degree, for some of whom the prospect of additional debt may be exceptionally unappealing. As a nurse academic in Wales I wait with interest to see what policy on fees will emerge from the Welsh Government.

In other news, I find myself engaged in a prolonged period of doctoral student activity. I’ve examined a number of theses in and out of Cardiff in recent months, and have sat with students during their vivas as either supervisor or independent chair. This term has been particularly packed. Plenty of writing has also been taking place: papers and reports are being written from COCAPP, RiSC and Plan4Recovery, and from completed theses I have helped to supervise. Data generation in COCAPP-A has almost concluded, and new research ideas are taking shape. Exciting times, if a little frenetic. 

RCN in Wales award, public engagement and research student symposium

Lots of interesting things to relate in this post. November 13th saw Nicola Evans and me join Hayley Reed, Ed Janes, fellow-researchers Rhiannon Evans, Nina Jacob, Rhys Bevan-Jones and (most importantly) members of the mightily impressive ALPHA group at an ESRC Festival of Social Science-funded public engagement event focusing on young people and mental health. Organised with the help of SciSCREEN, the evening was hosted at Cardiff University’s Hadyn Ellis Building and began with a viewing of The Perks of Being a Wallflower. Post-film and post-food saw groups of young people, ALPHA members and researchers disappearing into interactive workshops. Nicola and I facilitated a discussion on supporting young people returning to school following a period of care in mental health hospital. This is a theme very much arising from our RiSC study, and in our session ideas and energy were in abundance. Interested readers wanting more on the work of ALPHA can see their video here:

November 17th was the School of Healthcare Sciences’ annual postgraduate research student symposium. This was, as usual, an excellent showcase for the PhDs and Professional Doctorates ongoing in the School. Follow this link for information on individual students and their projects.

I’ll write more about this in a separate post, but on Thursday November 19th, in Cardiff City Hall I was pleased to receive the Research in Nursing Award for 2015 at the Royal College of Nursing in Wales Nurse of the Year event. I appreciated very much the kind messages from esteemed friends and colleagues received via Twitter, text and email. I am particularly happy to have won this award as a mental health nurse, again being reminded of the need for investment in both mental health services and in research to find out what helps.

NPNR 2015 review

About to commence: #NPNR2015
About to commence: #NPNR2015

The 21st Network for Psychiatric Nursing Research (NPNR) conference took place on Thursday and Friday, September 17th and 18th 2015, with the theme of ‘Building new relationships in mental health nursing: opportunities and challenges’. The occasion was a fine one, with just short of 200 people in attendance. For those not able to make it but wanting to know more, the programme can still be found here and the book of abstracts here.

I’ve been on the NPNR scientific and organising committee this year, courtesy of my membership of Mental Health Nurse Academics UK. This afforded me the chance to welcome delegates at the conference opening, and to draw attention to the just-breaking news of Professor Len Bowers’ planned retirement at the start of 2016. Len has been an inspirational mental health nurse researcher: more on this later.

2015-09-17 15.58.04
#NPNRselfie with Karina Lovell

Introduced by Professor Liz Hughes as day one conference chair, this year’s keynotes commenced with Professor Karina Lovell giving an overview of the current state of knowledge in remote psychological therapies. Karina is a world leader in research into interventions for people with commoner mental health problems such as depression and anxiety, as well as being actively involved in services and practice through her work with organisations like Anxiety UK and others. For an example of important new research in this area check out the REEACT trial into computerised CBT for people with depression. This is an important study which Karina both referenced in her talk, and is actively involved in.

Dr Geraldine Strathdee, NHS England’s National Clinical Director for Mental Health, delivered a second keynote on using mental health intelligence. She praised the work of nurses, and made a strong case for mental illness prevention. Geraldine also reminded delegates of the high rates of premature mortality of people living with mental health difficulties, and the continued exclusion of many from employment. As routes to improvement she pointed to leadership, and the value of data to benchmark and drive up standards.

Keeping up with the evidence: an impossibility?

Day one’s final keynote presentation was delivered by André Tomlin, founder of the Mental Elf website and author of this pre-conference blogpost. André is an information scientist, who illustrated the challenge of keeping up-to-date with the evidence using this slide. Podcasts, social media, tweetchats and other new technologies are all part of André’s solution to the challenge of information overload, and as strategies to help plug the leaky evidence pipeline. The National Elf Service, of which the Mental Elf is a part, plays a big part in this area; for an overview of what’s on offer, here’s one of André’s videos:

Therapeutic approach, or therapeutic alliance?

Chair for day two was Professor Doug MacInnes, one of whose duties was to introduce Professor Shôn Lewis from the Institute of Brain, Behaviour and Mental Health at the University of Manchester as the deliverer of the conference’s fourth keynote lecture. Shôn spoke about current approaches to the care and treatment of people with psychosis and schizophrenia, using findings from the non-commercial CATIE and CUtLASS trials to suggest that newer antipsychotics are generally no better than first generation antipsychotics. Shôn also referenced the SoCRATES trial to evidence the idea that outcomes are associated with the quality of the therapeutic alliance, rather than with the specific therapeutic approach used. SoCRATES, I have now discovered, compared the effectiveness of (1) CBT plus routine care, (2) supportive counselling plus routine care and (3) routine care alone for people with schizophrenia. Shôn devoted the last part of his presentation to ClinTouch (a mobile phone app to record and upload symptoms) and CareLoop (which is testing if ClinTouch can be connecteded to NHS IT systems and to everyday practice).

Mark Brown about to begin his talk
Mark Brown about to begin his talk

#NPNR2015’s final keynote was delivered by Mark Brown, and the full text of his talk can be read here. Mark edited One in Four magazine, and is now development director of Social Spider, runs the Day in the Life project and is part of the team behind the WeMHNurses Twitter meeting place. Drawing on personal experience of its usefulness he described digital technology as less of a possible future than an unfolding present. One example of tech in action, which Mark referred to in his talk, is his own Doc Ready website. This was designed to help people prepare for discussions with doctors about their mental health difficulties.

SUGAR does Dragons' Den
SUGAR does Dragons’ Den

That’s summary enough of the keynotes. From the concurrent sessions I participated in, chaired or observed I’ll first start with the SUGAR meets Dragons’ Den workshop. Three volunteers – Jason Hickey, Laoise Renwick and Cher Hallett – pitched their research ideas to SUGAR members. In the event, SUGAR offered their time and support to all three, but also voted Cher’s plans (on intramuscular injections) as the best of the batch. In the second concurrent I’m picking out, Julian Hunt, Alan Meudell and Michael Coffey presented reflections from Plan4Recovery. This project, which I’m also part of, is examining shared decision-making and social networks for people using secondary mental health services. And, finally, a word about our COCAPP symposium. This started with an overview paper from Alan Simpson, was followed by a presentation from Michael Coffey titled, ‘Ordinary risks and accepted fictions: how contrasting and competing priorities work in risk assessment care planning’ and concluded with a paper from Sally Barlow and me on participants’ views and experiences of recovery and personalisation.

The RCN's history of mental health nursing exhibition
The RCN’s history of mental health nursing exhibition

Organised by Laoise Renwick, this year for the first time the NPNR conference featured a poster trail. This worked well. Displayed posters were themed, and during lunchtime on day two guided delegates took opportunities to speak with those associated with them. Along the way I spotted some interesting posters from the RCN, drawing attention to an upcoming history of mental health nursing exhibition (organised with lots of help from Ian Hulatt) about to launch in London.

Elsewhere, the NPNR conference has become the place where the names of the following year’s Eileen Skellern Lecturer and the winner of the Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award are announced. Check out my tweet below for news for 2016. Many congratulations indeed to both Cheryl and Tony:

Len Bowers at #NPNR2015
Len Bowers at #NPNR2015

Finally, a word on Len Bowers. At Doug MacInnes’ invitation, Len took to the lectern during the afternoon of day two to confirm his upcoming retirement and his plans for the future. These include (we learned) playing the flute, travel, photography and electronic music-making. Very nice. Len is a generous, principled and humble man whose contribution to creating new knowledge for mental health nursing has been immense. Take Safewards as an example. This is Len’s NIHR-funded programme grant, findings from which are changing practice in the UK and around the world. That’s some achievement, in my book. We wish him well.

Turning back the clock?

Here’s a post to draw attention to the RCN‘s newly published Report on Mental Health Services in the UK. This looks to be the latest document from Frontline First, a campaign revealing the effects of funding cuts on NHS care and nursing.

Working with the charity Rethink Mental Illness, and drawing on publicly available data, the RCN shows how (since 2010) the number of staffed mental health hospital beds across all four countries of the UK has reduced. The number of nurses working in NHS mental health services has also fallen, those remaining being revealed as an ageing group. Year on year, an increasing proportion is shown to be over the age of 50.

Here’s a chart showing reductions in the mental health nursing workforce, which I’ve extracted from page 16 of the report:

And, right at the front of the document, I see a clear case for investment contained in these recommendations which I reproduce word-for-word:

1) Governments must ensure there is equal
access to mental health services and that
the right treatment is available for people
when they need it.

2) Governments and NHS providers must
ensure that the commitment to parity of
esteem is directly reflected in the funding,
commissioning of services, workforce
planning, and patient outcomes.

3) Local commissioners and health boards
must make available enough local beds
to meet demand.

4) The principle of least restriction must
be embedded across all mental health
services. Detention under mental health
legislation should always be based on
clinical opinion and never be a result
of local failures to provide appropriate
care. Due to the significant increase in
detentions under the Mental Health Act
there should be a national objective set
to reduce detention rates in England.

5) There must be a consistent shift across
the UK from inpatient acute care to
community-based services which
recognises that prevention and early
intervention results in better outcomes,
reduces the pressure on acute services,
and reduces the overall cost to the NHS
in the long term.

6) Urgent action must be taken to address
the workforce shortages. Resources must
be committed to training and recruiting
enough mental health nurses who are able
to deliver specialist care in the changing
health and social care landscape.

7) NHS providers must invest in the current
mental health nursing workforce.
Band 6, 7 and 8 mental health nurses
should be developed to become advance
practitioners to deliver effective
recovery-led care in mental health
services.

8) There must be a sustainable and
long-term workforce planning strategy
which acknowledges the current
challenges facing the mental health
nursing workforce.

Restrictive practices

Today is the closing date for responses to the RCN’s consultation on the use of restrictive practices in health and adult social care and special schools. Michael Coffey has solicited views from members of Mental Health Nurse Academics UK, and has used these to inform the group’s formal submission. You can see what MHNAUK has contributed by following this link.

20th International NPNR Conference: call for abstracts

Early news of this year’s International Network for Psychiatric Nursing Research conference, and a call for abstracts, have just appeared. The event takes place at Warwick University on September 18th and 19th, and more information can be found by following this link. With support once again from both the Royal College of Nursing and Mental Health Nurse Academics UK this promises to be a special occasion, this being the 20th running of this esteemed event.

Catching up post

Plenty going on in the last week or so. I had the chance to join pre-registration mental health nurses and occupational therapists for a second day as they made preparations for an interprofessional event scheduled for early December. Some of these students have also been giving me drafts of assessed work to comment on, but as the deadline for receipt of these is first thing next week I expect a deluge then. ’twas ever thus.

Elsewhere there has been RiSC reviewing to crack on with, assignment marking, and peer review reports to both consider and write. I’ve also put myself in the frame to act as a reviewer for another university’s proposed new MSc mental health programme, this being the kind of curriculum work I haven’t had the chance to do for a while.

I’m not normally one for formal, suit-and-boot, events, but made an exception last Wednesday (November 27th) to join a posse of colleagues from the School of Healthcare Sciences at the RCN Wales Nurse of the Year awards. These took place at Cardiff City Hall, and the overall winner was Cardiff and Vale UHB ward sister Ruth Owens. Congratulations, Ruth. Congratulations, too, to the individual category winners: including Andy Lodwick (also from Cardiff and Vale) for picking up the Mental Health and Learning Disabilities award and Dr Carolyn Middleton, doctoral graduate from what was the Cardiff School of Nursing and Midwifery Studies, for winning the Research in Nursing award.

This week also brought me to a meeting of the MHRNC Service User and Carer Partnership Research Development Group and, yesterday morning, to the Cardiff City Stadium for an open meeting to discuss NISCHR’s infrastructure and programme funding review. Both were lively events, and on the NISCHR front I see big changes ahead from 2015.

And to close this summary post: via the twitter grapevine I see that the RCN is now giving early notification of the Network for Psychiatric Nursing Research 2014 conference. This will take place at Warwick University on the 18th and 19th of September. I’ll post a link to the call for abstracts once this appears, but for now will reproduce this extract from the event website:

This year [2014] is the 20th international NPNR conference and it’s going to be a celebration.

We wish to celebrate and promote some of the outstanding mental health nursing research that shapes mental health policy and nursing practice across the world. We will also acknowledge some of the best psychiatric and mental health nursing research that helped create the strong foundation for our work today. And we will invite delegates to look ahead to map out the future for mental health nursing research, education and practice.

Nursing stress (2)

Further to my last post on nurses and stress: an email to the RCN has produced this link to the full Beyond breaking point report.

For those interested, here’s what the conclusion from the Executive Summary says:

The 2012 survey findings highlight the high levels of stress among the nursing workforce. Stress can be a causal factor for health problems, physical injuries, psychological effects and burnout. In addition to the high personal toll, stress is a major cause of both sickness absence and presenteeism and affects the ability of workers to be effective.
The survey reveals that the main causes of stress are high workloads, long hours, unrealistic expectations, lack of job control, conflicting roles, bullying and violence, poor working relationships and a lack of engagement in workplace change. Addressing these problems is an obvious way to improve nurses’ working experience, and in turn improve the safety and quality of care for patients.

Issues of workload, stress and working life are, however, often symptomatic of systemic organisational problems. Poor work environments and working relationships damage the ability of nursing staff to provide safe care and there is a direct correlation between job satisfaction and patient satisfaction.