Nurses with Cred

Last week, after a fair bit of a nudge, Australia’s federal government made the National Review of Mental Health Programs and Services available. This infographic from the report caught my eye:

Source: http://www.mentalhealthcommission.gov.au/media/119868/Fact%20Sheet%2012%20-%20What%20this%20means%20for%20workforce%20and%20research%20capacity.pdf

That nursing is the largest single component of Australia’s mental health workforce isn’t a surprise. What is a bit unsettling is that the big bubble with 19,048 in it is mislabeled as “Total mental health nurses”.

That’s not true.

Working in mental health does not make you a mental health nurse, in the same way as driving through Bathurst does not make you a racing car driver. Just because you have a basic licence and you are in the right setting, it doesn’t mean you have the skills to perform safely at a high standard. It doesn’t mean you have cred.

As per AHPRA’s Nursing and Midwifery Board there is no registration category for a specialist mental health nurse, there are only these types of registration:

1. Registered nurse
2. Enrolled nurse
3. Midwife

Compare this with types of registration listed by AHPRA’s Medical Board (sub-speciality fields and full range of speciality titles not included):

1. Addiction medicine
2. Anaesthesia
3. Dermatology
4. Emergency medicine
5. General practice
6. Intensive care medicine
7. Medical administration
8. Obstetrics and gynaecology
9. Occupational and environmental medicine
10. Ophthalmology
11. Paediatrics and child health
12. Pain medicine
13. Palliative medicine
14. Pathology
15. Physician
16. Psychiatry
17. Public health medicine
18. Radiation oncology
19. Radiology
20. Rehabilitation medicine
21. Sexual health medicine
22. Sport and exercise medicine
23. Surgery

Medicine and nursing do not correlate on every detail of specialisation, but still… why such a big disparity between the two in terms of registration? Australians have rated Nurses as the most ethical and honest profession each year for 21 years in a row (1994-2015) [source], but I wonder if the public is aware of a problem with nursing specialities not being given the similar recognition as medical specialities.

Midwives have made their speciality distinctly different in the eyes of the public and other health professionals. I am sure it is a comfort for many expectant parents to know that the person guiding you through pregnancy, labour, childbirth and early parenthood is a qualified specialist and is acknowledged and registered as such.

However, people receiving support/treatment for a mental health condition will not necessarily have a specialist mental health nurse providing that service. It’s quite the opposite of midwifery – the nurse providing care may have no specialised qualifications in mental health. I wonder how service users and the people who love them feel about that.

I’ve been a medical, surgical and high-dependency/ICU nurse, and have worked closely with Midwives. I can tell you with confidence that mental health nursing is as different from general nursing as midwifery is. There are some transferable skills, of course, but midwifery, general nursing and mental health nursing each have a completely different model of care, and a very different way of working with people.

Source: http://www.acmhn.org/credentialing/what-is-credentialing

It’s not all doom and gloom though: the Australian College of Mental Health Nurses (ACMHN) have a process to credential suitably qualified and experienced mental health nurses.  In the absence of AHPRA being able to discriminate the difference between a general nurse and a mental health nurse, ACMHN are essentially saying, “Leave it to us. We will tell you who is a mental health nurse and who is not.” To be credentialed by the ACMHN, applicants must demonstrate that they:

1. Hold a current licence to practice as a registered nurse within Australia
2. Hold a recognised specialist / post-graduate mental health nursing qualification
3. Have had at least 12 months experience since completing specialist / postgraduate qualification OR have three years experience as a registered nurse working in mental health
4. Have been practicing within the last three years
5. Have acquired minimum continuing professional development points for education and practice
6. Are supported by two professional referees
7. Have completed a professional declaration agreeing to uphold the standards of the profession. [source]

There’s more good news: Queensland Health has set targets to work towards a fully qualified, fully credentialed mental health nursing workforce. I wonder if other state health departments are thinking about implementing a similar strategy. It might be important: a program staffed entirely by Credentialed Mental Health Nurses was described as “one of the most innovative services ever funded” [source].

Credentialing + Ability = Credibility.

Credentialed Mental Health Nurses have Cred.

One last thing. It is encouraging that mental health is not the only nursing speciality in Australia that is setting the standard, for saying, “We the specialist nurses will tell you who is a specialist nurse and who is not”.  Under the Credentialing for Nurses initiative, currently there are six specialty nursing organisations working collaboratively to develop consistent, evidence based, recognition for specialist nurses:

1. Australian College of Operating Room Nurses
2. Australian College of Children and Young People’s Nurses
3. Australian College of Mental Health Nurses
4. College of Emergency Nursing Australasia
5. Gastroenterological Nurses College of Australia
6. Palliative Care Nurses Australia

Every speciality area of nursing,  every healthcare organisation, and every patient needs the same thing: Nurses with Cred.

End

That’s it, as always your comments are welcome.

Paul McNamara, 28th April 2015

Short URL: http://meta4RN.com/cred

References

Australian College of Mental Health Nurses, 2015: Credentialing for Practice Program

Corderoy, Amy. (2015, 25th April). Innovative mental health program falling victim to funding freeze. Sydney Morning Herald

Credentialing for Nurses

National Mental Health Commission, 2014: The National Review of Mental Health Programmes and Services. Sydney: NMHC

Roy Morgan Research. (2015, 28th April). Roy Morgan Image of Professions Survey 2015: Nurses still easily most highly regarded. Finding No. 6188