What is a mental health nurse again?

1 September 2013

New standards for mental health nursing were launched at this year’s inaugural Australasian Mental Health and Addiction Nursing Conference in Auckland. The standards set out what it is to be a mental health nurse, and in 2014, the College of Mental Health Nurses hopes to take the long awaited step and ‘certify’ its first mental health nurse. FIONA CASSIE reports on the New Zealand moves and what’s been happening across the Tasman.

So what is a mental health nurse? Many argue that a nurse is a nurse is a nurse…

Since the onset of comprehensive nursing training, all registered nurse education has included mental health components.

Mental health nursing leader, Heather Casey, says technically, there is no such thing as a mental health nurse. “RN (registered nurse) is our title.”

But for some years, the New Zealand College of Mental Health Nurses has been keen to draw a line in the sand about what are the requisite nursing skills and knowledge to work in the specialty of mental health nursing.

She says the college and profession now regard the New Entry to Specialist Practice (NESP) programme as the prerequisite for becoming a mental health nurse but there is no regulatory requirement for an RN to go through such a programme.

Casey, a former college president, has been in charge of a project to bring in a voluntary certification process so both consumers and employers can be clear who is and isn’t a mental health nurse and who is able to provide knowledgeable and skilled mental health nursing care. This is especially important now that mental health nurses not only work in district health board mental health specialist services but also in the relative isolation of NGO (non-governmental organisation) providers, and increasingly, primary health organisations.

Casey says the college knows of an example where a primary health provider employed a nurse into a mental health nursing position who had had no experience in mental health.

“You are setting them up to fail, as well as the patient.”

Current college president, Daryle Deering, says certification will not only set standards consumers and employers can expect of a mental health nurse but also provides professional recognition for the specialist skills of mental health nurses.

She says the stigma and discrimination that mental health and addiction consumers face is also sometimes extended to nurses working in the field, with some people regarding working in mental health as something “anyone can do”.

The project began with the college seeking government funding for its credentialing and certification framework. It did gain Health Workforce New Zealand funding to go ahead with a programme offering credentialing in mental health skills to nurses working in other specialties – in particular, primary health care – with the first primary health care nurse credentialed in mental health last year.

It was unsuccessful, though, in getting funding for the next plank of the programme – a certification process to recognise that a nurse meets the professional criteria required to work in the specialty of mental health nursing.

Despite the lack of funding, the college has continued to plug away at certification and the latest step has been the launching of the new Standards of Practice for Mental Health Nursing.

Evolving standards

Deering says since the standards were last revised in 2004, there has been a greater emphasis on community-based care and on concepts of recovery and wellbeing, which is reflected in the latest standards.

The then-Australia and New Zealand College of Mental Health Nurses issued the first standards of practice for mental health nurse jointly in 1995 before the New Zealand college went it alone in 2004 and released its own standards.

“Since then, there has been a greater emphasis on working in partnership with consumers and consumers’ physical needs,” says Deering.

The new standards reflect these changes and place more emphasis on health promotion.

Deering says the standards also set out what it is to be a mental health nurse (see below).

“They will certainly underpin the learning and outcomes expected from the New Entry to Specialist Practice (NESP) programmes in mental health and addiction nursing.”

The resulting standards are applicable to all mental health settings in New Zealand and are in synergy with the Australian college standards, the Drug and Alcohol Nurses Australasia specialty framework, and the generic framework for all mental health professionals along with the college’s own credentialing and certification framework.

The next step toward certification is now to build on the standards, and a working group will be consulting on and deciding how mental health nurses will go about seeking certification.

“This process should be as simple and straightforward as possible but also robust,” says Deering.

Casey says the process is likely to include the requirement for nurses to prove their mental health qualifications, peer and consumer review feedback, an attestation that they meet the college standards of practice, and participation in ongoing clinical supervision.

Then roll on 2014, and the first mental health nurse should be able to gain certification.

Definition of a mental health nurse

The mental health nurse is a registered nurse who is a graduate of a nursing education programme with a specialisation in mental health nursing and is registered by the Nursing Council of New Zealand to practice in the specialty of mental health.

This includes nurses who have completed a hospital-based specialist undergraduate programme or a tertiary education undergraduate programme followed by a postgraduate programme in the specialty of mental health nursing (note: RNs now only need a one-year post-registration mental health programme rather than the earlier requirements for two years mental health experience).

Standards of Practice for Mental Health Nursing *(summary)

A mental health nurse:

  • provides culturally responsive care
  • establishes collaborative and therapeutic relationships
  • provides care that reflects contemporary mental health standards
  • promotes mental health and wellbeing
  • is committed to professional development
  • and is professionally accountable for their care.

*See the full standards at the College’s website: www.nzcmhn.org.nz

Certification

A certified mental health nurse is a nurse that has gained formal recognition from the College of Mental Health Nursing/Te Ao Māramatanga for meeting the Standards of Practice for Mental Health Nursing.

Credentialing

A registered nurse working in primary health or other fields can also seek to be credentialed under the College’s overarching Accreditation, Certification, and Credentialing Framework.

Being credentialed means a nurse is recognised as having specific skills in basic mental health and addiction assessment and intervention but not to the specialist level required to be a mental health nurse. The first primary health nurse was credentialed last year and 8 more from a Far North PHO are expected to follow shortly. Corrections is also trialling mental health credentialing for its nursing staff.

NB Across the Tasman, credentialing is the term used for what the college calls certification in New Zealand. The different use of the term credentialing in New Zealand reflects the terminology used in the Ministry of Health’s credentialing framework for health professionals.

‘Perfect storm’ promotes Oz ‘certification’ process

It is nearly a decade since Australia’s mental health nursing introduced its professional recognition process.

But it was the “perfect storm” in 2009 of the Mental Health Nurse Incentive Programme (MHNIP) and the arrival of national registration, which saw it take off.

That is how Queensland chief nurse, Dr Frances Hughes, and her mental health director of nursing, Debra Nizette, describe the combination of circumstances that saw the Queensland Government backing the recognition and support of national standards for mental health nursing.

The national standards grew out of the same trans-Tasman 1995 standards developed when Hughes was president of the New Zealand committee of the then-Australasian-wide College of Mental Health Nurses.

Australia’s professional recognition process for mental health nurses (called credentialing there and to be called certification in New Zealand – see box*) was built on the standards and was launched in 2004 by the Australian College of Mental Health Nurses (ACMHN). But ACMHN chief executive, Kim Ryan, says it was the federal funding incentive provided by MHNIP in 2009 that was the push for more mental health nurses to apply for formal recognition.

MHNIP was part of the 2006 National Action Plan on Mental Health, which invested $191.6 million of federal government money over five years into incentives for general practice and private psychiatrist providers to employ mental health nurses to work with patients with severe and persistent metal disorders. At the end of 2009, the scheme required that mental health nurses had to be credentialed by the ACMHN to be eligible to receive MHNIP funding.

The result was that the number of nurses credentialed by ACMHN rose from 234 at the beginning of 2009 up to 1,153 by June 2012. Ryan says the numbers peaked at 1360 but some had not renewed and there were currently 1102 credentialed mental health nurses.

Queensland’s response

Hughes says another motivation for Queensland to be involved in supporting national mental health nursing standards was the move from state by state registration to national registration of nurses in 2009, which meant the end of the state’s own endorsing process for mental health nurses.

Nizette says there is nearly 3000 mental health nurses in Queensland and probably more than half had been endorsed as having the requisite qualifications to be formally recognised as a mental health nurse. She added that many other qualified nurses had joined the workforce since endorsing stopped becoming available in 2009.

Hughes says with there no longer being a state-regulated process for recognising mental health nurses, questions started to be asked by consumers and employers about who was or wasn’t a mental health nurse.

Only about 300 of the 3000 mental health nurses have been credentialed by the Australian college prompting the Queensland Government to work with ACMHN and heavily invest in supporting nurses to apply for credentialing, with the aim of more than doubling that number in the next year. This includes funding credentialing ‘ambassadors’ to run workshops on preparing applications, covering the application fee and funding education programmes to support more nurses meet the standards.

Nizette says with only about 100 mental health nurses currently employed under MHNIP in Queensland another big carrot for employers and the government is to get more nurses credentialed so federal MHNIP funding can be accessed. Evaluation of the federal scheme found the community-based nurse programme making a positive difference to the mental health and wellbeing of patients involved, and it has been rolled out making available millions of dollars for providers that employ credentialed nurses.