Shrink got me thinking. His post on “Understanding” speaks to the role of the Consultant Psychiatrist in Aged Care.
“What kind of proportion of your work is made up of patients with dementia and related conditions?”
Probably about a third to a half of my work is dementia related.
“What can you do for them if (as in this case) medications won’t help?”
Ah, now that’s what is of interest.
[...snip snip...]
My stab at the simple answer of what’s done could be that, “appropriate patient centred health care and social welfare is provided with dignity and respect.”
And he eloquently goes on to describe the typical process of behavioural analysis and intervention planning for those folk under his care.
One example in his post:
She often (twice a day or so) would get upset and sometimes cry but with frustration and anger rather than sorrow. She’d shout repetitively, she’d rail against carers and repeatedly slap furniture and walls. This would last anything up to an hour and a half, with her shouting and tap tap tapping the wall.
And he continues to provide details on the reductionist analysis of her needs and the resulting care plan. It’s all good stuff. Until I get all ‘super nursey’ and ask – Why does it take a consultant psychiatrist to get such (simple) things done in the name of ‘care’?
His answer is honest and true. I’m not pasting everything – so go read it yourself.
But I ask ya – since most of the work involved in this process is not medical but more a lot of knowledge on aging processes, normal human behaviour and common sense – who needs a Consultant?
Wiki defines a Consultant as:
an expert or a professional in a specific field and has a wide knowledge of the subject matter
This is how Shrink deomonstrated his process – taking a wide knowledge of how to treat someone with a little understanding to make all the difference. Well, actually, and with all respect to the good man – it wouldn’t take a rocket scientist – or even a Consultant Psychiatrist – to have worked it out; given patience and objectivity and a little common sense. But as he says -
If they ask (or get) the formal direction of a Consultant Psychiatrist, in their minds that’s the final answer on the matter. Right or wrong, Consultant Psychiatrists are in a better position to direct or effect change where others find obstacles or inertia.
At the end of last century when Ms Bairbre de Brún, Minister for Health, Social Services and Public Safety, announced the arrival of the Nurse Consultant they were quickly re-annointed “Super Nurse“.
The DoH release “Making a Difference” suggested the competency level of a nurse consultant to be able to:
provide expert care, to provide clinical or public health leadership and consultancy to senior registered practitioners and others and initiate and lead significant practice, education and service development.
..and that those nurses should be trained to masters or doctorate level. That’s pretty serious business (for a nurse). So, nearly ten years later; where are they?
[For a really objective unbiased review on Dr Nurses and Nurse Practitioner please go to the NHSBlogDoctor website - but I think he's dead - again]
In a 2004 speech, Rosie Winterton, Minister of State claimed:
I know that there are more Nurse Consultants in Forensic Care than in any other mental health speciality
But what of the elderly? Where are their nurse consultants?
Well one is working here in the Livingstone community hospital; in fact – the nurse consultant runs it. In 2007 they were
leading the way in providing older patients with specialist care tailored to their specific needs.
They were highly praised in a 2007 DoH report: “A Recipe for Care: Not a single ingredient” for providing a service to the people of the local community that gave choice to elderly patients to receive treatment nearer their home; which is why in June 2007 the Dartford PCT…
..announced last month that it is “likely to recommend the relocation of existing services” provided by the Livingstone in view of the cost of refurbishing its facilities.
Yes. Well. Hmm.
In 2004 Deborah Sturdy wrote in the Age & Ageing editorial:
Currently there are 54 Consultant Nurse for Older People Posts in England: 23 posts in Acute Hospital Trusts, 21 posts in Primary Care Trusts, 8 posts in Mental Health Trusts and 2 posts which span both Mental Health and Acute Trusts. There are 2 Consultant Nurse posts in Wales, 1 post in Northern Ireland and 2 in Scotland. In addition there are 11 Consultant Nurses in stroke services across England.
It was heralded as the way of the future for nursing; how to progress your career without leaving the patient care.
I couldn’t find anything else relating to any other Mental Health Nurse Consultants.
So, and remembering I haven’t been UK for a few years now – this is my question -
Why is it still up to the likes of The Shrink to demonstrate to people that holding hands and not getting in their face can calm people?
Where are the Nurse Consultants in your area and what are they doing?
Mr George Normal RMN, Nurse Consultant, is alive and well and working for PoshPrivate ASD hospital. Fearless of consequences of stepping on NHS toes, he’s single-handedly done the job, that 2 and a half years of OldPoshshire’s NHS “best practice care and services” have been unable to do.
Our Nurse Consultant doesn’t see patients . . .
I’m not entirely sure what our nurse consultant does. I know he’s done some staff training on personality disorders, but I don’t know if he has a clinical caseload. We don’t see him much…
There isn’t a nurse consultant in CAMHS for our area. I’ve met one for another area. He seemed to be doing a lot of teaching at the local university, and also seemed to be doing a lot of research on the transition of patients from CAMHS to adult services, and trying to improve services with regard to that.
The NC role as practised here does not involve seeing patients directly, or having any kind of direct say in any individual’s care. The role appears to involve pointing things in the right direction only in organisational terms, (presumably, pointing with policy-stained fingers).
Nurse consultant posts were meant to be 50% patient care but many have ended up as practice development/research roles.
The new advanced practitioner roles are suspiciously similar, the NMC has a definition of a mostly clinical role (70%-80%) and a skills and competency bit which I’ve seen somewhere but can’t find this morning on their website.
The other change which might have an implication for nurse consultant roles is the responsible clinician role under the amendments to the mental health act.
That’s my point quacktitioner.
The whole NC was sold on the premise that it wasn’t another level of nurse management and it was to include around 50% direct patient care.
They were meant to ‘lead’ nurses into a higher level of professionalism.
But it seems to have basically pooled the resources of management, research and policy maker and created exactly that. Now even our super duper consultant psychiatrists remain clinically involved in decision making with/for/on/at/to their patients. They don’t disappear off altogether into a haze of academia and manageria.
I posted a comment here about Risk Management and how some nurses had made a career for themselves out of it – I think I’m talking about the same kind of person who became a Nurse Consultant and (re)wrote their own job description.
Where are the ones that still get their hands “dirty” dealing with patients and their complex issues? Or even spending time on the ward demonstrating to junior staff better ways of working?
We have them here in Oz – under the term Clinical Nurse Consultant. But they’re just Charge Nurses who work outside the numbers who have progressed. Academic clinical knowledge (ie masters or doctorate) is not necessarily necessary. Tho I must admit – my CNC isn’t afraid to get his hands dirty still and I see him more than regularly mixing it up with the patients and staff.
Why do NCs have to be on the ward to demonstrate new ways of working to junior staff? Why do nurses always mercilessly cut down their tall poppies with claims that they somehow aren’t “proper” nurses any more?
“Why do NCs have to be on the ward to demonstrate new ways of working to junior staff? ”
Clinical credibility.
If it’s 8 years since you last saw a patient, or worked in that environment, or balanced competing demands and tensions (Trust protocols you disagree with, patient advocacy that’s ignored, team working where you’re expected to go with the flow, interpretations of legislation that give different answers, team roles which are unclear, the interface with organisations like social care providers who don’t deliver what your patient needs when they need it) especially when roles and work and organisations evolve and change, how can you then with any credibility tell a colleague how they should nurse a patient they’re struggling with in a world you’re now disconnected from with a patient you’ve never seen?
A nurse who doesn’t see patients may be able to remain a credible clinician. But I’ve yet to see it. All, all evolved in to managers (despite what title or role they notionally have).
@beakie – To be pedantic – I said “better” not “new” – but both are equally acceptable reasons for having an experienced clinical expert work hands on with the staff – or even to present educational sessions on working practices; clinical skills; advances in treatment; new evidence…. etc…
I am not cutting down any tall poppy – I’m asking the tall poppies who’ve runaway to hide – to come play with the not so tall poppies and quit acting so elitist and precious about themselves.
NC’s quickly forgot the purpose of a Nurse Consultant when they got the opportunity to gain administrative and managerial authority. What happened to the 50% clinical patient contact – and to advance the patient care at the point of delivery by staying in touch with the coal face?
As Shrink says – clinical credibility is undermined – and as exampled by some of the comments here – nurses don’t even know who their nurse consultant is – if they have one – or what they do – or are meant to do.
A Nurse Consultant is to consult with – to ask for guidance support and to use that wide knowledge of subject matter in dealing with the presenting issues of a clinical nursing nature – just as we expect of a consultant psychiatrist in dealing with psychiatric issues.
But what I believe we have seen develop is a group of Nurse Advisors who sit on policy boards; strategic management groups and develop and publish “research” that most the staff on the unit it was performed in don’t even know it was their unit or recognise it from the published report.
Today my Nurse Consultant spoke with me about an issue I raised in regard patient safety. He replied with problem solving answers. He also dug out some recent culturally relevant material on Aboriginal Suicidology. He spoke with me about it and we debated ways of dealing with the individual and client sub-group issues – all whilst we were dealing together with the management of a patient who had just attempted to stab another patient through the heart at the dinner table – and then discussing guidance on matters of staff acquiring some rather good native paintings from an aboriginal patient currently residing with us as being a matter of professional conduct breach – then following it all up with incident debrief and clinical supervision.
That was just my input from him in an 8 hour day and I was the least of his demands.
That’s the kind of tall poppy I expect a Nurse Consultant to be.
Not one confined to a plant pot.
@beakie –
“Why do nurses always mercilessly cut down their tall poppies with claims that they somehow aren’t “proper” nurses any more?”
That is without some kind of direct patient care they are not ‘proper’ nurses. They are another kind of nurse with a different perspective and role.
Nurse lecturers who do do not spend time providing direct patient care somewhere are not proper nurses either.
In all fairness, not all nurse consultants have abandoned clinical duties.
While I was training I had occasional lectures from two nurse consultants. Both had an active caseload of patients.
Shrink – yes, I hear what you’re saying but presumably your own clinical credibility as a consultant doesn’t require you to clerk in the odd patient in A&E at four in the morning, even though you supervise junior medics who do that very thing.
Mr Ian – my experience of nurse consultants is not that they “hide away” anywhere but are involved in a whole range of activities all of which are either direct patient care or concerned with direct patient care.
@beakie – Then that’s 2 with good experience. 3 including myself. And 3 or 4 without.
The experience of others varies and the context of the discussion is why there isn’t one doing the likes of Shrink’s behavioural analysis who he states doesn’t even see patients – and so many doing Forensics.
Seems that NCs are – by and large – just cherry picking which jobs and/or which parts of the job.
If anyone has any more info on the NHS roles and remit of NCs or job description I’d love to see it.
Why so many in forensics? Because that’s where the money is, Mr Ian. The funding for forensic units comes out of the MDO budget, which is decidedly more generous than that available to your bog-standard acute unit. Hence the ability to appoint more NCs.
NCs are expected to work 50% of their time with patients, but that doesn’t necessarily mean on the wards. They could have their own caseload in the community, say, or work with patients using specific therapies. I worked with one NC whose speciality was substance misuse and dual diagnosis. She had her own patients, usually the most complex cases, to work with. The NC for violence prevention took on a real consultative role in that people would call her in when presented with difficult cases, and she would work with those patients to develop behavioural plans and other interventions. So effectively, her caseload was anyone the wards and other units wanted to refer to her.
Just because they aren’t eternally visible to every band 5 staff nurse doesn’t mean they’re hiding away.
@beakie, I might be reading this wrong but no-one is saying they should be working 50% of time on the wards but they should be working 50% of the time with patients. The NC you worked with had a clinical component to the role and was clearly working in a consultative role. Sounds like you have a NC working as a NC, joy!! I bet the band 5 nurses on the ward knew who she was too and had an idea of what she did.
What seems to happen for some individuals is the clinical side of the role is the first thing they discard (or are pressured into abandoning, because the trust management have a different expectation of the role) and the shame then is that these posts where designed to keep very skilled clinical nurses in nursing and that is not necessarily happening.
Agenda for change and the skills escalator and new ways of working for nurses etc etc etc were meant to reward nurses who stayed in clinical practice and who still wanted to advance their careers. However it just never seems to work, as evidenced by nc’s, lecturer practitioners, modern matrons, etc.
The shame is that if you are a nurse who enjoys clinical practice and wants to further their career, gain new skills and earn more once you are at the top of a band 6 there is nowhere to go and one of those aspirations has to give, so generally these nurses go onto management or teaching.
I’m just wondering if people are starting to violently agree in this thread.
Personally I’ve no problem with the concept of consultant nurses so long as they’re involved with patients in whatever capacity (whether that be on the ward floor, conducting individual therapy, doing troubleshooting with complex cases). If they’re not doing that, then they’re probably in reality carrying out a different role (manager, academician, policy wonk) than the one envisaged for consultant nurses.
I don’t think there’s anything in the above view that contradicts any opinion expressed by either Beakie, Mr Ian or Quacktitioner.
Agreed, so just a quick career question, whats the compentency framework for a policy wonk?!
Yes I do violently agree with beakie et al. as to the nature and purpose of a NC.
beakie – your descript is such as I would envisage an NC to be performing and have no umbridge with such a pictorial.
[That line was something I learnt on policy wonk training where they also teach you how to properly use butchers apostrophe's].
.. but you gotta admit there are those that just milk it for what it’s worth – or those who are PCT reassigned an “improved” role of NC that is much less direct patient care.
Re Forensics and money – also violently agreed.
There must be no money at all coming into CAMHS, because we’ve got hardly any NCs round our way.
Our Nurse Consultant does not generate information or attend meetings with police, when vulnerable adults are at risk or support protection of vulnerable adult proceedings or manage patients (and has never ever been a Care Coordinator for even one patient, ever) or input in to the wards (and wasn’t recognised when on a ward a couple months ago) or support staff or carers or patients in care homes or support, undertake, give advice or in any way contribute to liaison work or work with younger adults or support developments band 7 colleagues have proposed and implemented or undertake or participate in or contribute to MCA 2005 Best Interest meetings or undertake clinical audit or contribute to CMHT meetings or case discussions and has not written or developed any useful policy documents.
Our Nurse Consultant does spend a lot of time in their office. When not in their office, our Nurse Consultant does spend a lot of time in meetings.
Which is why you’re writing care plans about holding patients hands I guess.
Sorry for exposing your achilles heel of the service… I feel bad now for disturbing the tranquil calm waters of the Lake now….
Here… have a hob nob.
Some people better at their job than others shocker! More news at 11.
The attitude of those who leave the shop floor for their own safe haven is like those who abandon ship and take all the lifeboats for their sake of their own good leaving those behind to sink or swim.
The rule was always women and children first – and you seem no exception to this rule.
Mediocre people move to a mediocre job with mediocre values and mediocre motivation to help others.
Why are you personalising this Mr Ian?
I mean, you want a row, you can have one, but it seems to me you are just stirring things up for no good reason. Some people are better at their jobs than others and you can’t extrapolate something about ALL people who do a job based on the poor performance of one or two of them.
On that basis, I might conclude that all staff nurses were lazy, ineffectual, uncaring and lacking even the most basic knowledge, based on the one or two I met when my mum was in hospital. But that would be grossly unfair and of course, stupid.
Ditto nurse consultants.
Guys, let’s not make this personal.
Whether one agrees with Beakie’s views or not, I happen to know that he’s a dually qualified RGN and RMN who’s spent considerably more of his career as a staff nurse on the wards than he has in academentia. I don’t think it would accurate or fair to dismiss him as either a failed nurse or an ivory-tower academic just because he’s now taken a lecturing job.
Play the ball, not the player.
To suggest that some people do their job better than others as being the bottom line here is wrong. It is also myopic. The issue originates in how those roles are utilised and promoted and it relies in part on NCs and those managers who ordain their duties to either keep the raison d’etre alive or simply fade into manageridum as another failed attempt at promoting professional nursing.
To dismiss and ridicule the debate by suggesting it is an acceptable ‘norm’ for people in such (potentially) positively influential positions to be sub standard does not exemplify the professional mores of nursing. So I can only presume comments of mediocrity are either made by someone who believes the status quo of sub standard is acceptable to them – or that these are not professional values and merely personal views on ‘life’.
I’m also annoyed at insignificant and pointless throw away lines being used to undermine otherwise worthwhile discussions.
If anyone thinks there is little point in debating the issues – then why get involved for no other reason than to throw spitballs from the back of the classroom?
I choose to avoid getting into mediocre jobs for these very reasons.
Next month I start my District MH Team Leader position and then the Nurse Consultant will be answering to me for their performance. But I’m glad to know I can settle for one who isn’t very good at their job and doesn’t see any patients… cos that’s just how it is.
That some people are better than others at their jobs is a fact of life. Get over it. That does not make it right that some people are lazy and incompetent, nor does it mean you have to accept poor performance – that is totally your own spin on what I have said, a straw man if you like.
This blog is off-duty time for me, as it is for many other people; if we start having some sort of quality threshold on posts, it will soon become a very tedious place to be.
I have never, not once, impugned your job or your ability to do it. I would thank you to extend the same courtesy to me. If you are unable to do so, then perhaps you could make your comments to me via email rather than publicly as it seems evident that public arguments are a turn off for many visitors to this site.
Anyone who says poor performance is no shocker – is obviously content to accept mediocre.
You impune my ideology and my progressive wont.
If you have no positive contribution then simply don’t comment.
Better to keep your mouth shut and be considered a fool than to open it and remove all doubt.
Once again, violently agreeing breaks out…
And Mr Ian constructs another straw man. Take your own advice. I’m done here.
Much appreciated beakie.
So getting back to the point of the post matter – as beakie succinctly reminded us before the interlude:
NCs come in good and bad form.
Having some replies – which barely constitutes a straw poll for this straw man – what are the processes for audit and evaluation of these positions?
One would hope the service measures the efficacy of these positions in terms of:
Do nurses have an easy method to access these NCs?
Are the responses of the NC found to be useful in practical terms?
How much direct patient contact does the NC have?
A 2005 document by Colin Hughes suggested some ways to evaluate the NC for older people (mental health)
http://www.leeds.ac.uk/lpop/documents/DLS1.doc
I admire Colin for at least attempting the evaluation – but it’s his own job he’s evaluating.
An RCN paper
http://www.rcn.org.uk/__data/a.....roject.pdf
The key issues that CNs, in this project, struggled with in their day-to-day practice included:
• Role ambiguity
• Developing skills in strategic, political and clinical leadership
• Developing the researcher role in practice and consultancy roles
• Working with the contextual factors that inhibited them in optimising the role for patients/clients.
One site I was impressed with was the CNC Forum; Consultant Nurse Cymru is a Welsh forum for CNs (which seems to be the preferred term to NCs) and presents a number of CNs in various specialist areas including mental health
http://www.cncforum.me.uk/
But after nearly 10 years of development of this role I’m still unable to find anything substantial that demonstrates an active evaluation of the usefulness, clarity of role, proposed or ongoing development and especially uniformity of the role of the Consultant Nurse/Nurse Consultant.
And I thought I was done but it turns out I wasnt!
Because before gobbing off you might like to consider where you should be looking. I found 222 articles on Scopus with “nurse consultant” in the title, several of which are evaluations of the role. Not bad for a mediocre person such as me.
Dawson, D., Coombs, M.
The current role of the consultant nurse in critical care: Consolidation or consternation?
(2008) Intensive and Critical Care Nursing, 24 (3), pp. 187-196.
Avery, L., Butler, J.
An evaluation of the role of diabetes nurse consultants in the UK
(2008) Journal of Diabetes Nursing, 12 (2), pp. 58-63.
McSherry, R., Mudd, D., Campbell, S.
Evaluating the perceived role of the nurse consultant through the lived experience of healthcare professionals
(2007) Journal of Clinical Nursing, 16 (11), pp. 2066-2080.
Humphreys, A., Johnson, S., Richardson, J., Stenhouse, E., Watkins, M.
A systematic review and meta-synthesis: Evaluating the effectiveness of nurse, midwife/allied health professional consultants
(2007) Journal of Clinical Nursing, 16 (10), pp. 1792-1808.
Stephen, A.
Leadership across boundaries: A qualitative study of the nurse consultant role in English primary care
(2007) Journal of Nursing Management, 15 (7), pp. 703-710
Jinks, A.M., Chalder, G.
Consensus and diversity: An action research study designed to analyse the roles of a group of mental health consultant nurses
(2007) Journal of Clinical Nursing, 16 (7), pp. 1323-1332.
Fox, C., McMaster, B.
Nurse consultants in A&E.
(2001) Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association, 9 (1), pp. 12-14.
Jones, P.
Consultant nurses and their potential impact upon health care delivery
(2002) Clinical Medicine, 2 (1), pp. 39-40
Happell, B., Summers, M., Pinikahana, J.
The triage of psychiatric patients in the hospital emergency department: A comparison between emergency department nurses and psychiatric nurse consultants
(2002) Accident and Emergency Nursing, 10 (2), pp. 65-71
Bullock, I., Pottle, A.
The Nurse Consultant: Rhetoric and reality! Personal reflections from one NHS Trust
(2003) Care of the Critically Ill, 19 (1), pp. 18-22
Booth, J., Hutchison, C., Beech, C., Robertson, K.
New nursing roles: The experience of Scotland’s consultant nurse/midwives
(2006) Journal of Nursing Management, 14 (2), pp. 83-89
Coster, S., Redfern, S., Wilson-Barnett, J., Evans, A., Peccei, R., Guest, D.
Impact of the role of nurse, midwife and health visitor consultant
(2006) Journal of Advanced Nursing, 55 (3), pp. 352-363
Ryan, S., Hassell, A., Thwaites, C., Manley, K., Home, D.
Exploring the perceived role and impact of the nurse consultant.
(2006) Musculoskeletal care, 4 (3), pp. 167-173
Fairley, D., Closs, S.J.
Evaluation of a nurse consultant’s clinical activities and the search for patient outcomes in critical care
(2006) Journal of Clinical Nursing, 15 (9), pp. 1106-1114
For you to be going on with Mr Ian.
I’m not sure from that list tho other than where clearly stated (n=1) which ones relate to mental health consultant nursing. Can you enhance your search string to eliminate those not MH related?
The one article – and seriously thanks for at least finding one – by Jinks & Chandler suggests:
There is a growing body of literature that addresses advanced nursing practice roles. There is, however, no international agreement on what constitutes an advanced practice role. A few countries have addressed the statutory requirements governing such roles. Consultant nurses’ roles in the UK are relatively new innovations that aim to enhance care. However, only a few investigations have evaluated the dimensions and impact of these roles.
The study demonstrated complexity and variety in how the consultant nurses’ roles in the UK are being developed.
Which kinda supports my argument that, where they exist, there is little uniformity and still no meaningful evaluation.
However, what I was more getting at was – govt introduced this 10 years ago – and it seems that the role has become an unregulated extension of practice that individuals have been permitted to develop at their own discretion or that of the organisations perceived need. Since it was introduced for a number of reasons – shouldn’t those reasons know be evaluated and perhaps identify which models are doing what was intended, which are exceeding and which are failing?
[This post has been scanned and verified by anti-straw man software(TM)]
The word I ‘m not using that perhaps I should is “governance”.
However, what I was more getting at was – govt introduced this 10 years ago – and it seems that the role has become an unregulated extension of practice that individuals have been permitted to develop at their own discretion or that of the organisations perceived need.
And the problem with this is…?
I mean, seriously? Why would/should there be uniformity given the wide range of different nurse consultants, working in a wide variety of specialisms? What’s wrong with a role developing “organically”? What is the problem with a role being allowed to develop without interference from central government, but in response to local needs? I don’t get what you’re griping about.
Did you not read the post? I’ll cut n paste for you…
It was heralded as the way of the future for nursing; how to progress your career without leaving the patient care.
I couldn’t find anything else relating to any other Mental Health Nurse Consultants.
So, and remembering I haven’t been UK for a few years now – this is my question -
Why is it still up to the likes of The Shrink to demonstrate to people that holding hands and not getting in their face can calm people?
Where are the Nurse Consultants in your area and what are they doing?
I was actually only asking, not griping – and specifically on MH NCs – not all nursing specialties. Forensics has lots – elderly a few – even enduring or ‘serious’ mental illness – generic adult MH seems to have but a few. But what do they deliver?
You defend the status quo as being adequate and not requiring change – I debate that the status quo is what we accept right before we say ‘My, my, it seems to have got stagnant and stale in nursing again’.
NCs should no more choose locally than nurse educators get to pick and choose locally what nurses need to know. Sure everyone has constraints, geographical considerations and logistical issues to deal with but these are not so idiosyncratic that each CN delivers a different model altogether.
The whole CN was about research, education, service development and clinical leadership – but about bringing together best practice under these remits.
I can tolerate the local need influencing delivery but it seems that CNs have done a lot of research about how the service can develop by educating people about what CNs are all about. But…
I’m still not seeing the clinical input.
I’m still not reading about how a NC changed the way we did things
I’ve not heard about a NC making a super duper difference to a group of people
It seems that NCs have become an added alternative optional nomenclature for the likes who were already doing research, policy and education and have brought very little in terms of practical hands-on clinical leadership to MH.
A NC for me is someone who makes all those things work for clinical benefit – and doesn’t just shout about it but delivers that benefit personally.
All I wanted, on the back of Shrink’s story of doing the job of an NC, was examples that this was happening elsewhere.
vis “governance” – central government is one option you suggested – but I’d think NMC was more the way to go and the determining and evaluation of ‘principles’ of NCs.
Anything that doesn’t deliver the NC in full is no more than a policy wonk management wolf in sheep’s clothing.
You defend the status quo as being adequate and not requiring change
And here’s where I stop reading as yet another falsehood comes slithering into view. As with other discussions with you, this could be interesting, were it not for your intensely irritating habit of ascribing views to people based on what you find easiest to counter rather than on what they have actually said.
I’m not ascribing anything more than I am reading. If I’m reading wrong then please correct me:
I’m reading that you’re promoting we continue to allow the NC in MH to develop as they have done – organically – and that review is not necessary – or that sufficient review is available in the 222 documents to evidence the value and worth of the role.
As this is the current process of NC development and has been for 10 years it would be fair to call it the status quo.
Correct me if I’m still wrong.
My anecdotal evidence is that by this organic process we seem to be ending up with lots of people working in one area in different ways and not many in another not doing much at all.
I am suggesting, at 10 years of randomly, uncontrolled and unregulated development of the role nationally, shouldn’t the current status be evaluated and, if found wanting, perhaps the approach of planned change through governance should be considered for such a significant role in MH – even if only for an interim period to keep/bring things back on track – or move the track to where it needs to be if necessary?
NCs started at a uniform platform and off they went. Now there is no knowing who is doing what where and how and surely it would be in the interest of the role development, nursing profession, health care delivery and social policy to at least have some idea where it got to by now?
Many of those who jumped onto the NC bandwagon seized an opportunity to write their own job descriptions and seem to be bettering themselves more than the organisation or the patient group.
The process of organic change is simply an evolutionary process – and there’s nothing wrong with it to the right degree and under the right motivational conditions. One could argue that if we didn’t interfere with evolution we wouldn’t be “carbon off-setting” – but we are the change makers and have already made the change by introducing the role of NC. Now we need to review the story so far.
I don’t suggest the NCs don’t have the ability skills or knowledge to do their job – but are they doing the job *we all* wanted?
If not – why?
Is it better ‘this’ way or ‘that’ way?
In what way?
Who says so?
Who’s way is cheaper?
Who’s way is of greater clinical beneficence?
Why is this so?
You seem to be arguing that evaluation of change is not necessary when it’s organic yet I believe it ought be done more so?
How far would you expect change be allowed to go on for without review?
I’m not ascribing anything more than I am reading
Nope, yet again, as you have done before and as you seem wont to do in every single discussion, you extrapolate what my views are on the basis of my disagreement with YOU.
And that’s all I have to say here, because I’ve discovered discussing anything with you to be an exercise in futility. You don’t want a debate, you want an audience.
That’s an odd way to concede. But I accept.