Scottish Mental Health Nursing Review

8. Theme 3: Mental Health Nursing Education and Development.

8.1 What we heard

Improved access to post-registration training, education and development was a strong theme that emerged through the National Mental Health Nursing

Conversations. Most participants identified it as a means of improving patient care, by being able to develop practice, deliver evidence-based interventions and improve outcomes. Some participants also linked better access to training and education with improved career progression and it aids staff retention and recruitment.

Mental health nurses also expressed a desire for additional training and development to better support people experiencing distressed behaviour, aggression, and violence, and to have a greater role in the leadership, design, and delivery of training. Having a consistent approach across Scotland was strongly expressed as a preference, as was ensuring a preventative focus.

The literature review also highlighted the need for more focused and targeted training and education on clinical and interpersonal skills. This included the importance of enhancing training and education programmes, to incorporate and enhance knowledge, skills and behaviours that address the clinical, psychological, and emotional demands of the profession. This will ensure mental health nurses are well prepared to effectively manage challenges and stresses they face in practice (Elsom et al 2008, Conlon et al, 2024, Hurley and Rankin, 2008, Hurley et al, 2022, Liu et al, 2023).

The evidence also highlighted the importance of covering topics such as legal knowledge, ethical reflection, the enhancement of resilience and emotional intelligence to support the psychological and emotional challenges of the work (Conlon et al, 2024, Demedts et al, 2018, McKenna and Lawson, 2022).

Another key theme across studies was the challenge of transitioning between roles, whether from practice to academia, or from hospital settings to community-based care. The findings also suggested that graduate mental health nurses face significant challenges when entering the workforce and often encounter a gap between their educational perceptions and the realities of practice. To address this, the evidence highlighted the importance of initiatives including transition to practice programs, mentorship, and support systems such as preceptors, to support the successful transition of newly qualified nurses into their professional roles. This was also highlighted as being important for improving recruitment and retention.

These findings were reflected in feedback obtained throughout the Review process. Many colleagues highlighted the success of Flying Start NHS and induction programmes and supports for newly qualified mental health nurses, such as NHS Ayrshire and Arran’s Transitions Development Programme for Newly Qualified Nurses. However, some people reported these opportunities were not consistently in place throughout Scotland.

Participants in the National Conversations also highlighted the critical importance of protected learning time, which was distinct from protected supervision time and noted that this was often not available due to workloads. For example, one participant stated training was “always first to go when there are staff shortages.” However, through our best practice and innovation submissions we have seen local solutions to supporting education and creating opportunities for protected learning time.

Protected Learning Time in a Mental Health Nursing Unscheduled Care Team

Learning and development is a key requirement to any health care practitioner’s role. Finding time across an unscheduled care team where there are 80+ practitioners working within the team, all with different core professions and different learning needs is a challenge.

This was recognised as a priority for the team and noting the challenges of accessing and engaging in learning and development, the first action was to reach out to mental health colleagues to enquire around learning needs and ideas of interest for learning. This was received positively by the team and local management as a development to establish a protected learning period, once a month, offered within a hybrid approach.

After analysing the responses, the Charge Nurse devised a local unscheduled care training programme that would be of interest across the team and offered the opportunities for practitioners to access the education sessions within a protected learning time session. This has been received positively, with interest for continuing the sessions across the team.

NHS Ayrshire and Arran

Another priority highlighted by participants was the need for clearer, structured career progression pathways, conversations, and opportunities. Additionally, some participants mentioned difficulties in understanding the training and career progression pathways available to them. Participants called for a nationally accessible resource that consolidates all training and learning development opportunities and linking them to structured career frameworks.

Throughout the Review process, we also heard the importance of ensuring mental health nurses and those with lived experience of receiving mental health support, were meaningfully involved in the development and delivery of mental health nursing training, from both a pre-registration and post-registration perspective.

The NMC Standards framework for nursing education states “ensure programmes are designed, developed, delivered, evaluated and co-produced with people who use services and other stakeholders.” Whilst we heard that this was in place for some areas, we also heard that at times people with lived experience of receiving mental health support, were approached in a last-minute request for participation and were asked to “tell their story” which could be difficult for the person and did not feel like meaningful engagement.

Stringer et al (2008) highlighted that increased service user involvement leads to better care, higher treatment compliance, improved health outcomes, and greater patient satisfaction. Therefore, it was felt important to ensure further exploration work is taking forward to build on examples of good practice and ensure meaningful and sustainable routes to lived and living input into education development.

Following considerations of the findings above from our Advisory Groups, it was also felt important to scope any gaps in the current learning offer for mental health nurses and to ensure clear mental health nursing career frameworks were available for all mental health nursing roles and sectors.

In addition, our Advisory Groups suggested developing an online platform, where all mental health nursing learning and development resources are consolidated and are accessible across sectors and clearly linked to structured career frameworks.

Therefore, we will:

15. ACTION: Working with NES, the Mental Health Nurse Leads, nurse leads from the independent and social care sectors and the Review Implementation Group we will scope potential gaps in the post-registration learning offer for mental health nurses, based on the Principles for Care and Practice, including considerations around physical health promotion and prevention.

16. ACTION: Working with NES, we will curate and improve access to relevant mental health nursing learning and development resources, which will be held on TURAS and accessible to mental health nurses across all sectors.

17. ACTION: Working with NES and the Mental Health Nurse Leads Group, we will review and refresh the existing mental health nursing community career pathways across the life span (incorporating CYP, Adult and Older Adult). Building on this work, we will develop broader mental health nursing career frameworks and will link this to the new online mental health nurse training platform, to support career conversations for both students and registered staff.

18. ACTION: Working with the Scottish Recovery Network, VOX Scotland, NES, HEIs, and local third sector mental health organisations, we will review existing examples of good practice of involvement of people with lived and living experience in mental health nursing education and development, and then codesign and test a framework for future meaningful and sustainable involvement for those with lived and living experience.