clinical practice a somewhat static environment to a much more flexible one .
Teaching nursing in Australia also moved from a hospital-based model to education at colleges and universities . That transformed the nature of nursing education from attaining a psychiatric nursing qualification and working in a psychiatric hospital ward to a comprehensive education where mental health has a postgraduate approach , and someone can obtain a master ’ s degree in mental health nursing .
These changes were essential but also created an enormous amount of disruption , with the focus of nursing care moving to an unfamiliar and much more dynamic environment , and a lag in developing accessible postgraduate mental health nursing to replace the previous system .
It wasn ’ t unique to the mental health sector because there were many other times in health care that change occurred . However , it was significant in mental health nurses ’ experience because it resulted in a loss of their perceived identity in their role .
It actually took us a long time to realise how that change impacted mental health nursing and what we could do about it . For example , there were a lot of nurses doing fantastic work in setting up community services and establishing mainstream mental health services , but at the same time , those nurses were struggling to adapt .
Sometimes , they couldn ’ t adjust simply because of the magnitude of the change . So , it significantly impacted the way people worked and lived their lives .
While there was a perceived loss of role and identity , it also resulted in significant growth in other professions , such as psychology and social work groups , which altered how some teams work and collaborate .
Although it was disruptive and confusing , it also had major benefits . Probably the best thing of all was that the voice of people with experience in mental health was getting heard , which became even stronger as it progressed . Plus , services started to consider personal recovery , not necessarily only the alleviation of the symptoms , but to the extent that the patient was satisfied and felt the service was productive .
There was also a shift in philosophy . Where nursing used to have a very biomedical approach , which is still the case sometimes , there became an emphasis on services with a personal focus . And that meant that in addition to the structural change , the care focus changed to a personal recovery service .
So rather than saying ‘ we are providing care to you ’, it changed to ‘ we are working with you towards your personal recovery ’.
Those things inspired and changed the role and the identity of mental health nurses . It took a long time for those processes to become established – to get a universal and consistent view of mental health services across the country .
And we ’ re still facing challenges ; this is not a done deal . And as we learn and move further down the track , we must continue that cycle of learning to work with people .
So , while change is ongoing , are most processes now well established ? If we had the opportunity to study every mental health service in this country , we would find wonderful services , nurses and other professionals providing care in Australia . I ’ ve worked with many of those nurses and mental health professionals , and it ’ s evident that people have gained experience , are fully engaged in this service and have partners and support in their care delivery .
But I ’ m sure there are also services out there that are not operating in their business model and are still making that transition , which is unfortunate .
But I don ’ t want to paint too bleak a picture . We must simply move into this and look at the best way to approach these challenges in the future . Change has to be ongoing , and we have to learn from evidence .
One of the most pressing issues at the moment is how to address the workforce shortages in healthcare . How do you suggest we work on retaining and attracting mental health nurses ? Well , it ’ s a broad basket issue with a long history . First , we need to grow the mental health workforce in nursing and across psychiatry , psychology , social work and occupational therapy in the country . We ’ ve had a long COVID tail , so there will be an ongoing need for all mental health professionals across Australia .
To do that , we need to enhance the pathway to grow the number of nurses entering mental health nursing . We need to sustain – and I use the term sustain rather than retain – those nurses in the profession . But we also need to sustain nurses already working in the occupation .
“ We ’ re still facing challenges ; this is not a done deal .
The average age of mental health nursing in Australia is slightly older than other nurses , who are a few years shy of their mid-40s . Therefore , a high proportion of the older age groups are closer to retirement . So , many nurses in this area can ’ t stay in the workforce unless we properly sustain them .
At the moment , we ’ re not providing them with the skills and opportunities to look after themselves adequately , and that ’ s organisational rather than personal .
There are several techniques we can apply to sustain nurses . Not just in the way of retention – retaining people who are not working to their optimum is not ideal , and we want people to work at their best level . We need to sustain them , so they ’ re psychologically well and supported , at their optimum , and provide the proper health care .
Recently , the Fair Work Commission lifted minimum hourly wages . Do you think this increase will help retain nurses in any way ? There are different schedules for salary changes across other jurisdictions in the mental health sector . Unfortunately , mental health nurses happen to be at the wrong end of the curve . It ’ s a minimal increase . And to be honest , I ’ m also not sure whether it ’ s entirely about salary for them . Yes , I think there ’ s a valid justification for well-paid health workers across the board and to hold onto many of those salaries for many years . But I think it ’ s more about the work environment and , most importantly , health professionals ’ ability to conduct the care they ’ re trying to deliver .
That means it ’ s about better and more flexible staffing so they can perform their work to the highest possible standard . There ’ s ample evidence to suggest that if we give people the opportunity to practise at a higher standard , they will . That ’ s what drives health professionals and mental health nurses .
We need to develop a system so people can deliver better care to keep people in the profession and ensure they practise to a higher standard . Those are the key things that need to change aside from the appropriate salary . ■
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