Psychiatric Nursing Workforce Survey: Results and Implications

OBJECTIVE

The last national survey of psychiatric-mental health (PMH) nurses was conducted in 2016 and was limited to advanced practice registered nurses (APRNs). Data on the demographic and employment characteristics of the PMH workforce could inform how to optimize the PMH nursing workforce to address increasing demands for mental health services. The objective was to conduct a national survey of PMH registered nurses (RNs) and PMH-APRNs to gather data on their demographic, educational, and practice characteristics.

METHODS

An email survey was administered between October 2020 and February 2021 to all members of the American Psychiatric Nurses Association and to all PMH-APRNs certified by the American Nurses Credentialing Center. Separate surveys included 51 questions (RN) and 52 questions (APRN). Survey questions were informed by several sources including the Minimum Data Set for the Behavioral Health Workforce.

RESULTS

Surveys were completed by 4,088 PMH-RNs and 5,158 PMH-APRNs, with a combined response rate of 12.1%. Findings suggest that the workforce is aging but has increased slightly in diversity. In all, 62.4% of RNs reported a hospital as their primary employment setting, while the majority of APRNs (70.4%) practice in outpatient settings. Forty-four percent of the PMH-APRN respondents indicated that most of their patients receive federal insurance.

CONCLUSIONS

Nursing must plan for significant retirements in the PMH workforce in next 5 years. Hospital-based practice continues to dominate PMH-RN roles but might be expanded to community-based settings teaming with PMH-APRNs in outpatient sites. Increasing the diversity of the workforce should be prioritized.

How relational leadership can enhance nurses' well-being and productivity

Leadership is an essential skill in nursing and has a fundamental role in ensuring high-quality patient care and the effective functioning of healthcare systems. Effective nursing leadership is vital to support nursing teams as they negotiate the challenges confronting the profession, such as ageing populations and the increased use of healthcare technology. This article discusses various relational leadership styles that can be used to promote nurses' health and well-being and enhance productivity. The author also explores the benefits and challenges of implementing relational leadership in nursing.

Enhancing communication within nursing and multiprofessional healthcare teams

Effective communication within nursing and multiprofessional healthcare teams is essential to promote patient safety. However, communication is a complex concept comprising various elements and variables that affect how messages are delivered, received and interpreted. In this article, the author explores communication within healthcare teams and provides some insight into the factors that affect team communication, such as interpersonal relationships. The author also explores organisational culture and cultural sensitivity, and discusses some evidence-based approaches to enhancing communication within healthcare teams.

Supporting nurses in acute and emergency care settings to speak up

Nurses' competence and confidence in raising concerns with senior clinicians is integral to patient safety and the quality of patient care. If nurses do not speak up when needed it can contribute to incidences of failure to rescue. There are many barriers to nurses speaking up in busy emergency departments and complex major trauma patient cases. Assessment and communication tools such as the SBAR (situation, background, assessment, recommendation) approach and communication techniques such as graded assertiveness can help to overcome some of these barriers. This article uses a case study to discuss how nurses can respectfully but efficiently escalate their concerns to the trauma team leader. It describes barriers to nurses speaking up and tools that can support nurses to speak up, with a focus on graded assertiveness.

Sickle cell disease: healthcare professionals' views of patients in the emergency department

Most patients with sickle cell disease (SCD) need support from healthcare services to manage their condition, including painful vaso-occlusive crises. Vaso-occlusive crises should be treated as a medical emergency, but the quality of the care patients receive when they present to the emergency department (ED) is often suboptimal. This article reports the findings of a literature review on the views of ED nurses and doctors about patients with SCD. The review included four studies, all of which had been conducted in the US, demonstrating that research on the topic is limited. The review found mostly negative views, including the belief that patients misuse pain medicines and demonstrate drug-seeking behaviours. Racial bias, widely recognised as a negative influence on the care of patients with SCD, was not mentioned in any of the studies. Staff education regarding SCD is required to ensure patients receive the care they need when they present to the ED.

Strategies to attract school-leavers to nurse education programmes: an integrative literature review

The shortfall of nurses in the UK has led to concerns that there are insufficient staff to ensure safe and high-quality care. To address this shortfall, one group to focus on for recruiting nursing students is school-leavers. This article reports on an integrative literature review that was conducted to explore the educational strategies used to attract school-leavers to undergraduate nurse education programmes. The review identified that a variety of educational strategies were used, and all of the included studies reported positive effects on school pupils' intention to undertake nursing studies. These strategies often included interactions with nursing staff and/or nursing students, as well as observing and practising clinical skills, for example via simulation. However, most participants likely had a pre-existing interest in healthcare or nursing, the interventions were delivered predominantly to young women, and the included studies lacked longer-term follow-up. This highlights a need to conduct further research to assess the longitudinal impact of recruitment strategies aimed at broader audiences.

Exploring the effects of the COVID-19 pandemic on nurse managers

BACKGROUND

Research shows that front-line nurses' workload and stress levels increased during the coronavirus disease 2019 (COVID-19) pandemic, however, there is little research of these factors in relation to nurse managers. Previous research undertaken in Austria found that some nurse managers working in nursing homes undertook clinical as well as managerial functions during the pandemic, a double burden that could have increased their stress levels and have had adverse psychological, physical and social consequences.

AIM

To investigate the effects of the COVID-19 pandemic on nurse managers' workload, perceptions of teamwork and stress levels, and the physical, psychological and social consequences of working during the pandemic.

METHOD

A cross-sectional design was used. Respondents (n=238) were sent an online questionnaire during the second wave of the pandemic (which in Austria was November 2020 to March 2021) containing questions on demographics and fear of infection, their current workload compared with pre-pandemic workload, their perceptions of the influence of the pandemic on teamwork, their levels of stress measured using the Perceived Stress Scale (PSS), and the physical, psychological and social consequences of working during the pandemic.

RESULTS

Most respondents (95%) had to undertake more or much more work than usual during the pandemic, while just over half (52%) perceived that the influence of the pandemic on teamwork had been positive throughout or partially positive. Overall, the respondents' level of stress was moderate, as measured by the PSS. Around 28% of respondents were afraid of infecting someone other than themselves, notably their families, employees and patients. Fear for themselves, their families and their patients or residents were commonly reported psychological consequences of working during the pandemic, while confusion due to information overload was the second most commonly reported psychological consequence.

CONCLUSION

Comparing results with previous research is difficult due to the lack of research of nurse managers' experiences of the pandemic. Fear appears to have been a major issue for nurse managers during the pandemic, particularly in relation to infection and information overload. This emphasises the need for healthcare organisations to focus on the mental health and well-being of nurse managers, as well as front-line staff, during and after crisis situations such as a pandemic. Organisations may consider reworking and adopting already-established COVID-19 regulations, schedules and local guidelines, particularly in terms of communication and infection control, which could help to reduce nurse managers' fear in future crisis situations.

After COVID-19: preparing staff for future surges in respiratory illness in children and improving well-being

The coronavirus disease 2019 (COVID-19) pandemic was a challenging experience for children and young people's services, and the workforce. The Valuing All Staff Together programme was a one-year project hosted by the North West Paediatric Critical Care, Surgery in Children, Long Term Ventilation Operational Delivery Network to support teams caring for children and young people to reflect on their experiences of the COVID-19 pandemic. Using an online survey, focus groups and interviews, it gave staff the opportunity to explore and understand the effects of the pandemic and the subsequent surge in demand, including how these affected services and the emotional health and well-being of staff. This would enable better preparation for future surges in respiratory illness in terms of learning, training and development. This article describes the programme's aim, method and findings, and the main recommendations for practice.

Factors influencing early career nurses to adopt leadership roles: a literature review

Effective nursing leadership has been shown to improve patient outcomes, but there has been little exploration of the factors that influence early career nurses to develop their leadership skills and adopt leadership roles. This article presents a rapid review of the literature on these factors, integrating data from 25 articles. Findings suggest that improving leadership confidence and self-efficacy, particularly in relation to system leadership, can increase nurses' motivation for adopting leadership roles. Supportive organisations that value leadership and give nurses opportunities to exercise it are equally important. Training and education, preceptorship, peer-to-peer shadowing, modelling and mentoring can all be useful in improving leadership skills and inspiring the next generation of nurse leaders.

Understanding and investigating potential problematic behaviour towards colleagues

Behaviour towards colleagues within the nursing team that undermines teamwork and conflicts with standards and policies can be described as problematic. It is important that nurse managers understand and investigate potential problematic behaviour towards colleagues, particularly in today's healthcare environment where team cohesion and morale are constantly under threat. In this article, the author highlights the challenges for nurse managers and describes the sensitive and respectful exploratory process they need to undertake. Nurses' behaviours are underpinned by beliefs, values and attitudes so investigating potential problematic behaviour warrants an exploration of these aspects with individual nurses and with the nursing team. Therefore, the author also suggests a way for nurse managers to conduct a collective exploration of the team's values.

Effects of climate change on the health of children and young people

The effects of climate change, such as air pollution and extreme heat events, can adversely affect the physical and mental health of children and young people at all ages. This article explores the effects of climate change on children and young people's development and explains the effects of air pollution and heatwaves on their health. The article also discusses how children and young people are knowledgeable and concerned about the effects of climate change and can offer new perspectives on addressing these effects. Finally, the authors consider the role of nurses in raising awareness of the adverse effects of climate change on children's health, incorporating climate change in their practice and promoting opportunities for children's involvement in healthcare decision-making, strategies and policy development.

Exploring the professional nurse advocate role and restorative clinical supervision

The professional nurse advocate (PNA) role is the key enabler of delivery of the NHS England Advocating and Educating for Quality Improvement (A-EQUIP) model of professional nursing leadership and clinical supervision. The aim of the PNA role is to provide clinical, educational and well-being support to nurses through restorative clinical supervision. This article describes the PNA role and the A-EQUIP model and discusses some of the challenges experienced by nurses in relation to delivering care to older people and current workforce pressures. The author suggests that restorative clinical supervision may support nurses to manage these challenges and enhance their practice in the care of older people, and describes part of a workforce improvement project to illustrate this in practice. Finally, the author considers some of the barriers to implementation of restorative clinical supervision.

Care of an infant born with a cleft palate: a case study

Orofacial clefts are the most common facial congenital abnormalities in humans. Their management is complex due to a range of immediate and ongoing challenges. These include breathing, feeding, speech, hearing and dental issues. This article uses a case study approach to outline these challenges for a patient who was born with a cleft palate. The case is followed by a discussion of contemporary evidence-based care. The article focuses on family-centred care and multidisciplinary teamwork, and the author also details the central role of the children's nurse.

A novel research competency framework for clinical research nurses and midwives

BACKGROUND

Clinical research nurses and midwives (CRN/Ms) are highly specialised registered nurses. They combine their clinical nursing expertise with research knowledge and skills to aid in the delivery of rigorous, high-quality clinical research to improve health outcomes, the research participant's experience and treatment pathways ( Beer et al 2022 ). However, there is evidence that the transition into a CRN/M role is challenging for registered nurses.

AIM

To discuss the development of a competency framework for CRN/Ms.

DISCUSSION

The authors identified a gap in their organisation for standards that would support the development of CRN/Ms new to the role. The standards needed to be clear and accessible to use while encompassing the breadth of scope of CRN/Ms' practice. The authors used a systematic and inclusive process drawing on Benner's ( 1984 ) theory of competence development to develop a suitable framework. Stakeholders engaged in its development included research participants, inclusion agents and CRN/Ms.

CONCLUSION

The project identified 15 elements that are core to the CRN/M role and the knowledge, skills and behaviours associated with it.

IMPLICATIONS FOR PRACTICE

A large NHS trust has implemented the framework. It is also being shown to national and regional networks. Evaluation is under way.

Further defining the roles and impact of genetic counselors in the biotechnology and pharmaceutical industry

As personalized medicine has gained traction, drug development models in the biotechnology and pharmaceutical industry (BPI) have increasingly sought to address medical conditions with a genetic component, creating an opportunity for genetic counselors (GCs) to fill new roles and utilize their unique training to contribute to drug development. Despite the potential for GCs in BPI, literature around the role of GCs in this industry has been limited. Our mixed methods study aimed to assess how the roles of GCs in BPI have evolved since 2016, investigate the value of and opportunity for GCs in this industry, and further characterize their motivation and job satisfaction. Participants were recruited via social media advertising, snowball sampling, and email listservs from the National Society of Genetic Counseling (NSGC), the Canadian Association of Genetic Counselors (CAGC), and the American Board of Genetic Counseling (ABGC). Survey (n = 20) and interview (n = 6) data indicates many aspects of GC roles in BPI are consistent with the 2016 study. However, there is evidence of roles becoming more varied and with increasing recognition of the value of GCs, opportunities for involvement in BPI are growing. Furthermore, combined study data found that GCs are motivated by the flexibility of BPI roles as well as the opportunity to contribute to rare disease treatment development and that they are overall satisfied with most aspects of their jobs. Interview data also found that genetic counseling training has the potential to improve clinical trial design and outcomes by making drug development more patient-centric. Finally, combined study data found that while GCs continue to utilize Accreditation Council of Genetic Counseling (ACGC) practice-based competencies (PBCs), business-related training may benefit GCs seeking to enter BPI. Together, these findings are critical for informing genetic counseling training programs, employers within BPI, and GCs interested in entering these positions.

Evaluating a competency framework for rheumatology nurses

The Royal College of Nursing (RCN) competency framework for rheumatology nurses was developed in 2020. As part of the framework proposal, a service evaluation was planned following the framework's roll-out to determine its usefulness and acceptability. The aim of this evaluation was to explore rheumatology nurse specialists' answers to the research question: 'What was your experience of using the RCN's rheumatology competency framework?' A total of 14 rheumatology nurse specialists were interviewed and shared their opinions regarding the competency framework. Five themes were identified: personal usage; benefits to managers; inequalities and inequity in nursing; ideas for improvement; and general properties. The findings of this evaluation demonstrated the value of the framework, which enabled rheumatology nurse specialists to document the competency level they were working at and to identify their future training needs.

Maximising nurse-patient communication in the emergency department

Effective communication in the emergency department (ED) is vital for ensuring safe patient care and supporting optimal patient outcomes and satisfaction. However, such settings are often noisy, fast paced and unpredictable, which can make nurse-patient communication challenging. Effective communication requires the appropriate knowledge and skills underpinned by clarity, mutual understanding, respect and empathy. However, maximising nurse-patient communication requires various practical and strategic measures, ranging from addressing the environmental challenges of the ED and meeting patients' individual communication needs, to implementing quality control measures and supporting mentorship, reflection and education in practice. This article offers an overview of some of the practical and strategic measures nurses of all levels and experience can apply to maximise nurse-patient communication in the ED.

Speech-language pathologist, physical therapist, and occupational therapist experiences of interprofessional collaborations

Interprofessional collaboration among speech-language pathology, physical therapy, and occupational therapy is considered to promote best practice in rehabilitation as it can enhance efficiency, patient outcomes, and clinician and patient satisfaction. Although clinician experiences with interprofessional collaboration have been studied in each of the rehabilitation professions separately, limited research has been conducted on the shared attitudes or experiences across speech-language pathology, physical therapy, and occupational therapy. The purpose of this study was to understand speech-language pathologist, physical therapist, and occupational therapist experiences of interprofessional collaborations. We conducted an exploratory cross-sectional online survey study. The survey included Likert-scale questions and open-ended questions that probed clinicians' general experiences with interprofessional practice and views and beliefs regarding barriers and facilitators to interprofessional collaboration. Responses from 213 clinician respondents were analyzed using descriptive quantitative methods and a qualitative content analysis. The results revealed overlap in attitudes and experiences across speech-language pathology, physical therapy, and occupational therapy about barriers and benefits to interprofessional collaboration. Perceived respect differed among the professions, with speech-language pathologists more frequently reporting that their role is often misunderstood or undervalued by other rehabilitation professionals. These results may guide future research focused upon the predictors of successful interprofessional collaborations and interactions.

Developing and evaluating a major trauma course and coaching programme for ward nurses

Nurses working with major trauma patients in ward environments in the UK are expected to evidence their knowledge and skills in a set of national competencies. This article describes a bespoke major trauma course and a coaching and portfolio development programme designed to enhance ward nurses' knowledge and skills, help them evidence their competence and support their professional development. Evaluation of the course showed an overall improvement in nurses' self-rated competence and confidence in a range of relevant major trauma topics and clinical skills. Evaluation of the coaching and portfolio development programme showed that nurses believed their knowledge and skills had improved after taking part and that they valued the opportunity for professional development.

Developing a web-based app for non-mental health nurses to assess the mental health needs and risks of children and young people

There is high demand for specialist mental health services for children and young people in the UK. Non-mental health nurses are well-placed to assess the mental health needs and risks of children and young people to maximise opportunities for early intervention and relieve the pressure on child and adolescent mental health services. This article provides an overview of a service development project to develop a web-based application (app) to support non-mental health nurses when assessing the mental health needs and risks of children and young people. The article describes the development, testing and evaluation process, which involved consultation with children and young people as well as interviews, focus groups and an online survey with a range of professionals working with children and young people. Overall, the findings suggest that the app is appropriate for use by non-mental health nurses in terms of quality, functionality and acceptability.

Exploring perceptions of digital technology and digital skills among newly registered nurses and clinical managers

BACKGROUND

Digital technology has an increasing role in healthcare, but staff lack opportunities to develop their digital skills and there is a lack of research on education and training in digital technology for staff.

AIM

To explore nurses' perceptions of the use of digital technology in their practice and to identify the digital skills required by newly registered nurses to work in a digitally enabled environment.

METHOD

Individual semi-structured interviews were conducted on an online communication platform with nine participants - four newly registered nurses and five senior nurses working in clinical and/or management roles. Inductive thematic analysis was used to analyse the data.

FINDINGS

Several barriers and facilitators to the use of digital technology were identified, including around infrastructure, time, skills, training, support, leadership, familiarity and confidence. The use of digital technology may enhance care consistency and increase patient autonomy, but it may also erode nurse-patient relationships.

CONCLUSION

Digital technology can enhance patient care but organisational barriers, notably in relation to digital literacy training, need to be addressed for nurses to fully adopt it.

How to design and deliver a small group teaching session

RATIONALE AND KEY POINTS

Small group teaching sessions are commonly used in healthcare to deliver education, provide practice updates and support continuing professional development. Such sessions can provide opportunities for participants to acquire new knowledge, foster peer relationships, consolidate learning and develop skills. This article provides a step-by-step guide for nurses and other healthcare professionals on designing and delivering a small group teaching session. • A small group teaching session requires considered, detailed and methodical preparation. • When designing a small group teaching session, it is important to determine its aims, learning outcomes, group characteristics, location and timeframe. • A well-planned small teaching session includes learning activities that are constructively aligned to the aims and intended learning outcomes. • Assessing participant learning and addressing gaps in their understanding is essential during the delivery of small group teaching. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article could improve your practice when designing and delivering a small group teaching session. • How you could use this information to educate your colleagues on small group teaching methods.

How to design and deliver a small group teaching session

RATIONALE AND KEY POINTS

Small group teaching sessions are commonly used in healthcare to deliver education, provide practice updates and support continuing professional development. Such sessions can provide opportunities for participants to acquire new knowledge, foster peer relationships, consolidate learning and develop skills. This article provides a step-by-step guide for nurses and other healthcare professionals on designing and delivering a small group teaching session. • A small group teaching session requires considered, detailed and methodical preparation. • When designing a small group teaching session, it is important to determine its aims, learning outcomes, group characteristics, location and timeframe. • A well-planned small teaching session includes learning activities that are constructively aligned to the aims and intended learning outcomes. • Assessing participant learning and addressing gaps in their understanding is essential during the delivery of small group teaching. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article could improve your practice when designing and delivering a small group teaching session. • How you could use this information to educate your colleagues on small group teaching methods.

Preventing and recognising skin tears using a standardised approach

Skin tears, defined as traumatic wounds caused by mechanical forces, can be debilitating for individuals, causing pain and reduced mobility. Although skin tears can develop throughout the lifespan, older age can make the skin increasingly susceptible to this type of injury. Studies have found wide variation in the incidence and prevalence of skin tears, in part because of suboptimal recognition and reporting practices among healthcare professionals. Effective prevention of skin tears requires a standardised approach to risk assessment, prevention, recognition and classification, such as that offered by the International Skin Tear Advisory Panel (ISTAP) best practice recommendations. This article examines the literature on the incidence, prevalence, prevention and recognition of skin tears, and outlines some of the ISTAP best practice recommendations on risk assessment, prevention and recognition. The authors also consider the need for patient and healthcare professional education to optimise the prevention of skin tears.

Psychedelics in Psychiatry, the Nursing Influence, and the Future of Psychedelic Therapies

OBJECTIVE

Psychedelics and psychedelic-assisted therapies (PATs) are on the cusp of becoming medicalized treatment modalities within the United States, both as potential U.S. Food and Drug Administration (FDA)-approved treatment and therapeutic options outside the medical model, through decriminalization efforts within individual states. Bringing with it a paradigm shift in the delivery of health care for both physical and mental health treatment. A workforce of highly trained facilitators will be needed to meet the anticipated demand for this type of treatment and nurses can play a key role in meeting this demand. This article serves to introduce psychedelic-assisted therapies to psychiatric-mental health nurses as we start to see this new field emerge.

METHOD

Review of published literature and other media.

RESULTS

Results based on historical data, modern applications, and future considerations.

CONCLUSIONS

Nurses have been involved with psychedelic-assisted therapies in the past and are fully capable of providing a wide range of roles upon the anticipated approval as a treatment modality.