RCN questions separation of mental health nurse training

Speaking at the Health and Social Care Committee on Wednesday, Professor Nicola Ranger, chief executive and general secretary of the RCN, said the current national focus on NHS reforms presented an “opportunity” to “relook” at the way nurses are trained.

“I think we need to relook at the nurses that we are educating to really put the person at the centre”

Nicola Ranger

She said: “The way that we train nurses is we separate physical health and mental health.

“The reality is, mental health and physical health [have] completely merged together in many settings. This is an opportunity.

“How do we really train and educate nurses for what the patient need is, at scale, with the right calibre of people?

“So, it’s things like that, looking at the population health. What kinds of clinician do we really need for modern-day medicine and nursing?”

At present, there are four main fields of nursing in which undergraduate nurses in the UK can choose to train: adult, children’s, learning disabilities and mental health.

Professor Ranger was later asked by committee member and public health doctor Dr Beccy Cooper for further reflections on, in her words, the “current bizarre training programmes for nurses, where mental and physical health is separated”.

Specifically, Dr Cooper asked whether, under the new “holistic” training model that the RCN was potentially envisaging, public health would be better served.

Professor Ranger agreed that this was something she would like to see and reiterated that this issue was something the RCN was “looking at”.

She added: “I think things are far too segmented.

“You’ve got one person in front of you with so many different needs. You need someone skilled who can assess what you need, both now and in the future.

“And I think we need to relook at the nurses that we are educating to really put the person at the centre.”

The comments from Professor Ranger came as part of an evidence session held by the Health and Social Care Committee on the upcoming abolition of NHS England.

Following the session, Nursing Times asked the RCN for further information about its position on mental health nurse education and the work that Professor Ranger was referring to.

“No nurse can be a one-stop shop”

Dan Warrender

In response, a spokesperson said the college had nothing further to add at this stage but to expect more later this year.

Professor Ranger’s comments appear to stand in contrast to the aims of the Mental Health Deserves Better campaign, which was born out of a concern that the mental health nursing curriculum is becoming too generic.

The group is made up of mental health nursing staff, academics and students, including Dr Dan Warrender, who takes a leading role in the campaign.

Responding to Professor Ranger’s evidence, Dr Warrender, a mental health nurse, researcher and lecturer, recognised the importance of treating patients holistically but said it was unrealistic to expect nurses to be a “one-stop shop”.

He told Nursing Times: “We know that people have holistic needs, though we need to consider what this means in terms of the responsibilities of nurses.

“Does this mean we are aiming to train nurses to be all things to all people all of the time?

“This is a glorious ideal but may be a fantasy and expect too much of an undergraduate programme and new graduates.”

“No nurse can be a one-stop shop,” he added.

“Rather, we may be wise to retain field specialism, with holism addressed through thorough assessment, and appropriate and timely referral. Or even better, more integrated services.”

He noted that there were “unique” issues that nurses working in mental health services needed to be confident and competent in dealing with.

For example, he cited ethical issues arising from the use of the Mental Health Act and navigating the issue of power dynamics and coercion.

“Whilst physical health should be addressed in education it needs to be contextualised, and it should not overshadow and sideline the complex concepts and ethics which need to be addressed for mental health nurses to do their jobs well,” added Dr Warrender.

“Whilst I don’t wish to see people separated into their ‘mental health’ and ‘physical health’, there just simply are issues for mental health nursing which are separate to physical health and need dedicated attention.”

The session this week was the second time that mental health nurse education has been raised at the Health and Social Care Committee this month.

During a hearing on 12 March, comments were made about the importance of mental health nurses being taught skills and knowledge in physical health as part of their education.

In claims later disputed by the nursing profession, the president of the Royal College of Psychiatrists said the Project 2000 nurse education reform programme had created a “generation of [mental health] nurses not so confident in looking after physical healthcare”.