A comparison of the work and values of community mental health nurses in two mental health NHS Trusts

Abstract

With the reconfiguration of health services in both the primary and secondary sectors, the role of community mental health nurses (CMHNs) has become a highly contested one within mental health care. There would be great variability in the skills that CMHNs possess, the contexts in which they work and the nature of the work they do. This study sought to explore aspects of the work of those nurses who provide services at the interface between policy and practice. Two groups of CMHNs were compared, one working in an urban setting (Trust A) and the other in a rural (Trust B), focusing particularly on caseloads and client mix, the values held by CMHNs, the models of care they utilize and what they consider would improve care in the future. A specially designed 39-item questionnaire was employed, with a mix of open and closed questions, and statements to which participants were asked to respond on a three-point Likert scale. The findings raised interesting issues around collaborative working, whether CMHNs are happy to take on clients previously on their caseload, bureaucratization, autonomy, role definition within a culture of working with primary care, lack of specific models utilized by CMHNs, and the demand for greater training and educational support. The implications of the study are discussed with the aim of assisting mental health nurses determine their future roles.

Valuing Autonomy, Struggling for an Identity and a Collective Voice, and Seeking Role Recognition: Community Mental Health Nurses' Perceptions of their Roles

“…However, only one publication was identified that investigated CMHNs' job satisfaction. Nolan et al (2004) found, in a study of nurses who worked on multidisciplinary teams, that autonomy and participation in decision making was positively related to CMHNs' satisfaction, as was direct patient care. In many reports reviewed on nurses working in other specialties, satisfaction was related to perceived autonomy in the nurse's role, and often defined or measured as decision-making.…”

“…For example, Hrykas (2005) and Allen and Vitale-Nolan (2005) cited autonomy as an intrinsic factor more likely to influence satisfaction than other more extrinsic factors such as salary. Nolan et al (2004) looked at multidisciplinary teams and found that autonomy and participation in decisionmaking was positively related to CMHNs satisfaction. Participants saw autonomy related to the decisions they made regarding practice and consumer care.…”

“…This theme emerged because the NPs expanded functions intruded into areas that were traditionally considered the domain of the medical profession Other researchers reported that CMHNs claimed that barriers such as administrative functions, not being appreciated or valued, and working with constant obstacles such as third party payors, were factors in their dissatisfaction (Nolan, Haque, Bourke, & Dyke, 2004).…”

Talking about mental health nursing: a qualitative analysis of nurses’ and service users’ accounts

“…For example a service user may judge success quite differently from a nurse in terms of role expectations. Research into properties associated with mental health nurses' role performance reported that nurses' dissatisfaction related to overly bureaucratic systems with too much paperwork, resulting in a neglect of the nursepatient relationship (Nolan, Haque, Bourke & Dyke, 2004). Similarly a study by Wilson and Crowe (2008) explored what Community Mental Health Nurses (CMHNs) found satisfying about their role by studying 12 individuals over a 12 month period and identified that therapeutic relationships were the primary source of satisfaction for…”

“…Academic and policy literatures have debated what constitutes the role of a mental health nurse (Nolan et al, 2004;Department of Health, 2006;Crawford et al, 2008).…”