Monique Lammers is the Director of Nursing and Allied Health at the Ashburn Clinic in Dunedin. Established in 1882, Ashburn is New Zealand’s oldest psychiatric facility. It uses a therapeutic community model of treatment, and has 34 beds in its inpatient unit and 10 more in its self-care hostel.
Ashburn provides treatment for people with enduring mental health issues such as personality disorders, eating disorders, depression, anxiety and addictions. Altogether 35 full- and part-time nurses are employed.
Benefits of NESP to NGOs
Monique says there are many benefits when NGOS like Ashburn encourage their nurses to study under the NESP programme.
“It’s always good to have people on staff with new and up-to-date education and practice. Often the nurses who start the programme are newer, so it means we end up with a good mix of skills and experience across our older, middle-aged and younger nurses."
“One of the biggest advantages is being able to grow our own staff. It’s difficult to find qualified mental health nurses and the NESP programme is a way we can improve the skills of the nurses we already have. I also think the nurses who successfully negotiate work and study to complete the programme are admired and appreciated by other staff."
“Another thing is that they bring questions to the other nursing staff that have arisen from their study. These get us thinking because we have to articulate our practice and why we do what we do.”
She says there are a lot of benefits to service users as well, and not just because NESP nurses bring back with them the latest thinking around issues like trauma informed care, strengths-based models, pharmacology and de-escalation.
“I think one of the greatest benefits to service users is that our NESP nurses are so much more confident and relaxed in their work. This makes them much less intimidating to the patient group. They’re calmer and that often makes things easier all around.”
Demands on employers
In most cases nurses at Ashburn studying under the NESP programme are employed as extras to the staffing roster. They may be employed full-time at the end of their training. Nurses who have started the NESP programme will have their hours reduced by a day each week to allow time for study so there aren’t too many significant demands on staffing.
“The demand is mostly on the preceptor,” Monique says.
“Our preceptors work really hard with our NESP people alongside working with a patient population who can sometimes be very challenging.”
Preceptors act like mentors. They make sure new graduate nurses are working within their scope of practice; helping them to learn and rise to challenges. They also make judgements about which nursing groups or areas of work at Ashburn the new graduates are ready to move to.
All registered nurses at Ashburn put themselves forward as preceptors but it’s always limited to a one-on-one arrangement. No preceptor has more than one student and each new graduate will have a single preceptor. The preceptor is separate to the supervisor which each NESP student must meet with at least 10 times per semester. Ashburn also arranges supervisors for its NESP students.
Choosing and supporting nurses
In choosing which nurses to encourage onto the NESP programme Ashburn looks for those they think are open to learning and who will be able to manage the study demands. Monique says most of the new graduate nurses doing the programme talk about the stress of work, life and study balance.
But there’s also the challenge of stepping up in the work environment.
“When you’re working with people with personality difficulties you really must use yourself as a tool and there’s some hard work involved with that,” Monique says.
“We need good boundaries and to set good limits, but we also need to have compassion and empathy. There needs to be a level of maturity to manage all this.
“We also think it’s really important we don’t put our beginner practitioners in positions or situations that are outside of their ability, both psychologically and physically in terms of nursing practice. We work in teams and our teams are very mindful about supporting them when they face difficulties.”
One new graduate nurse Ashburn has encouraged onto the NESP programme is Laura Smith. Read her profile here.
Monique says Laura’s practice has definitely been enhanced by doing NESP.
“I’ve seen her understanding and self-assurance really growing throughout the year, and she’s talking about how things are starting to make sense as she applies her new learning to her practice. She’s become more articulate and a better critical thinker.
“Laura is naturally non-confrontational and has a friendly kindness about her that has a beneficial effect upon service users. They miss her when she’s not here. She is gracious with them but knows and maintains her boundaries. People respect her for that.”
Though these are personal traits Laura already possessed, Monique says they have been enhanced by doing the NESP programme, mainly because she is more confident about being herself.
“NESP has helped her see that it’s okay to be the nurse she is – that she has the knowledge and skills to use herself as the best possible tool when dealing with our service users.
“Some effects of the learning have been subtle, but they’re there.”