Anne Frew is the charge nurse at Auckland District Health Board’s 58-bed acute adult mental health unit. She’s been nursing for 42 years, but still believes in learning.

In 2010, while working as a nurse educator, Anne completed some postgraduate physical health and clinical leadership papers under the Skills Matter Clinical Leadership in Nursing funding programme.  In 2011 she completed her Masters of Nursing, also with Skills Matter Clinical Leadership funding. Her Masters topic was seclusion and restraint and training was provided by the University of Auckland.

Anne was encouraged by Anna Schofield, Auckland District Health Board’s nursing director for mental health throughout her studies and the clinical integration was supported in the unitl as part of the requirements of the Skills Matter funded programme.

The idea is to support our current nursing leaders so they become even better leaders. They can then help introduce and expose colleagues to new and more innovative models of care.”

The purpose of the training is to enhance the skills and knowledge of nurse leaders, like Anne, in priority areas.

“The idea is to support our current nursing leaders so they become even better leaders,” says Anna Schofield.

“They can then help introduce and expose colleagues to new and more innovative models of care – role-modelling them, strengthening current capabilities and leading positive changes in clinical practice.”  
 
Anne Frew says there has tended to be a disconnect between physical and mental health in the past and that change is needed, working towards a more holistic approach to peoples’ care and treatments (body, spirit and mind).

“People who access mental health and addiction services can have some significant physical health problems and we need to do what we can to support people to improve those problems as well. However, most mental health nurses have had little training in how to perform a proper physical health assessment. Gaining added skills so I’d be able to enhance awareness and knowledge around this (for service users and staff) was seen as really valuable to my role as nurse educator.”

I knew about seclusion and how I felt about it, but now, when someone says seclusion will do this or that, I can say, well, actually, no it won’t.”

Concern about using restraint and seclusion with people who are experiencing mental health problems is growing, both worldwide and in New Zealand. Anne says her Masters study has given her the knowledge and confidence to lead change in this challenging area of clinical practice.

“I knew about seclusion and how I felt about it, but now, when someone says seclusion will do this or that, I can say, well, actually, no it won’t,– and here are some alternatives.”

“There’s a lot of misinformation out there about the effectiveness of seclusion. How clinicians feel about it has been treated as more important than how people using services may feel. With my newly developed knowledge I’m able to have a more evidence-based, person-focused and empathetic view of seclusion. I feel I can transform that into greater awareness for staff and support them to become more engaged in the advantages of reducing its use.”

Anna Schofield agrees Anne’s enhanced knowledge and skills are invaluable as part of the unit’s long-term strategy towards change in priority areas.

“Fundamentally, we’re talking about how we manage change to values and attitudes and practices that have been in place for a very long time. This sort of change is very challenging, especially in a very complex and busy work environment.

You have to be quite dedicated and plan carefully… You need to make sure your work-life balance doesn’t suffer and that you take personal time for yourself.”

“Anne’s work and study make her an early adopter of the improvement and development work we are doing. Her ability to demonstrate the effectiveness of some of the innovations she has learned about is immensely helpful.”

Anne says there are a number of challenges involved with postgraduate study and many of them are of a personal nature.

“You have to be quite dedicated and plan carefully. Either you’re going to study in the evenings or during weekends, but not both. You need to make sure your work-life balance doesn’t suffer and that you take personal time for yourself, otherwise you get ill.

“I was fortunate in that I had the support of my colleagues and my manager who gave me time to do the required study days. For the Masters I was spending about 30 hours a week studying because of the research required.

“I don’t have kids to look after and I think that made things a little easier for me. Nevertheless, I was looking after my unwell father at the time and had to ask for a couple of extensions because of those demands. Things are going to happen in your life and you need to be prepared for that.”

Fortunately, the study wasn’t expensive for Anne because she didn’t have to travel and could freely use Auckland Hospital resources, such as computers and the University of Auckland library. The required paid days off were negotiated with her line manager as part of her agreement to do further study.

Nurses who can lead and who have progressed through advanced levels of practice bring flexibility around how we develop our workforce.”

Anna Schofield says the Skills Matter programme helps her keep professional development as a top priority and this make things happen that improve outcomes for service users.

“For me it’s about having those conversations with the nurses who will be completing the study to find out what sort of individual support they will need, each person is unique and has their own personal roadblocks to overcome. It’s to our professional advantage because nurses who can lead and who have progressed through advanced levels of practice bring flexibility around how we develop our workforce.

“I also think the linkages formed between the nurse, the nursing director and the academic provider are invaluable in enabling success and ensuring we have nurses studying in areas that are the most important.”

Anne says she’s definitely a better nurse for having done the study.

“I have an evidence-based understanding now, which puts me in a better position to show leadership to staff and develop their awareness. I can also work with other nurses who are doing their own study as I know some of the challenges they will face. I can also encourage, support and enthuse them as a manager.”