Revised education standards lack parity for mental health

A central tenet of Lord Willis’ Shape of Caring review of nurse education in 2015 was that the future registered nurse, regardless of field, would require in equal proportion a range of fundamental physical and mental health skills.

At the time Mental Health Nurse Academics UK (MHNAUK) expressed some anxieties that this entirely sensible principle was being misinterpreted by many as a call for “generic” nursing, a call which could threaten specialist pre-registration training in nursing’s four fields of mental health, adult, children’s and learning disability.

The draft education standards published for consultation this week by the Nursing and Midwifery Council suggest that, for now, generic nursing is off the agenda and that the NMC has been listening, at least in part, to the concerns of mental health nurses. “The NMC’s vision for the future of nursing continues to be driven by a long list of hospital-focussed, physical health tasks”

However, a further challenge has emerged: a list of nursing skills contained in an earlier draft of the new standards were largely adult and hospital-focused and thus unacceptable for mental health nursing. And while the final version of the standards – and accompanying skills and procedures annexes – out this week are an improvement from that earlier draft, they still lack parity.

MHNAUK fully accepts that all nurses need fundamental mental and physical health skills. But the NMC’s vision for the future of nursing – with a supposed focus on promotion, prevention and early intervention – continues to be driven by a long list of hospital-focused, physical health tasks and the putative mental health elements in the annexes are not articulated especially well.

At a recent MHNAUK meeting, we heard that financial difficulty is both a cause and complication of mental health problems. Yet a technical skill such as “signposting to debt advice” is nowhere to be seen in the NMC’s document, while the ability to “undertake chest auscultation and interpret findings” is. Ask a mental health service user which of these is more important.

Nonetheless, the draft standards do offer some real opportunities: the proposed changes to mentorship; the potential for increased simulation hours; and the possibility of a national practice assessment document.

Regarding mentorship, allowing any health and social care professional (which we believe would include social workers and psychologists) to be “practice supervisors” enhances multi-disciplinary learning and deals with those irritating occasions where suitable placements have been rejected because there is no appropriate mentor.

Meanwhile, freedom from the constraints of mentorship in the new practice and academic assessor roles gives universities some flexibility, though we need to take care that flexibility does not mean a race to the bottom.

Simulation can enhance confidence and competence among students by allowing them to test, in relatively safe environments, their responses to complex situations. However, simulation done properly is not cheap.

In addition, a standardised practice assessment document would help stave off complaints about variations in the quality of nursing graduates. This kind of document already exists in Wales and MHNAUK would support a UK-wide, field-specific practice document.

We also welcome the reference to safe staffing and skill mix in the standards but, given new roles like the nursing associate in England, it is essential that there is clarity over what a registered nurse is and what she/he is expected to do.

If, as claimed, nursing associates will take on a lot of the bread-and-butter tasks of nursing in order to release registered nurses for higher level activities then we might have expected one of two things in the new standards.

Either a smaller, discrete set of fundamental physical and mental health skills agreed by all fields that allows the concomitant expansion of field-specific higher level activities - like delivering therapy and prescribing – or, as in some other countries, the extension of pre-registration courses to four years. This would ensure our future students are protected from the burden of increasingly crowded three-year curricula .

(Article Author: Steven Pryjmachuk is professor of mental health nursing education at the University of Manchester and chair of Mental Health Nurse Academics UK.)