Handover | Issue 42 - July 2018

The standards of mental health nursing were first published in 1995, updated in 2004 and then again in 2012 by Te Ao Māramatanga – New Zealand College of Mental Health Nurses. 

Standards of Practice for Mental Health Nursing in Aotearoa New Zealand (Te Ao Māramatanga - NZCMHN, 2012)

The Standards of Practice for Mental Health Nursing in New Zealand (herein referred to as ‘Standards of Practice’) are applicable to all mental health nurses practising in mental health and addiction services, in any practice setting. New graduate nurses, with support of a preceptor, will be expected to meet the Standards of Practice on completion of a New Entry to Specialist Practice mental health and addiction programme, leading to the award of a postgraduate certificate in the specialty, in their first year of practice. 

The Standards of Practice are concerned with the performance of mental health nurses in Aotearoa New Zealand, and include practice outcomes and attributes of knowledge, skills and attitudes. The values, attitudes and seven Real Skills identified in Let’s get real (Ministry of Health, 2008) which underpin the provision of effective mental health and addiction services in Aotearoa New Zealand, are reflected in these standards. 

Standard One

The mental health nurse acknowledges Māori as tangata whenua of Aotearoa, New Zealand. The mental health nurse is knowledgeable of the place of Te Tiriti o Waitangi in nursing care and acknowledges the diversity of values, belief systems and practices of people and cultural groups within New Zealand society. 

Standard Two

The mental health nurse establishes collaborative partnerships as the basis for therapeutic relationships. This involves building on strengths, holding hope and enhancing resilience to promote recovery and wellbeing. 

Standard Three

The mental health nurse provides nursing care that reflects contemporary mental health care and standards. 

Standard Four

The mental health nurse promotes mental health and wellbeing in the context of their practice. 

Standard Five 

The mental health nurse is committed to their own professional development and to the development of the profession of mental health nursing. 

Standard Six 

The mental health nurse’s practice reflects relevant policies, legislation, ethical standards and codes of conduct. 

In 2006, the framework’s situational analysis on the state of mental health nursing standards of practice revealed the following: 

Currently, there is variability in the adoption of the New Zealand College of Mental Health Nursing Standards by DHBs and NGOs. This varies from ‘lip service’ through to the use of the standards and their associated competencies for assessing practice and being part of professional development recognition programmes. There is also variation in auditing of the standards. The variability in adoption of the standards has implications for clinical career pathways, professional development and retention of mental health nurses (MOH, 2006, p.45). 

The framework made three recommendations:  

  1. All employers of mental health nurses should adopt professional mental health nursing standards. 
  2. All mental health nursing job descriptions should incorporate professional mental health nursing standards. 
  3. All DHBs and NGOs should annually audit the application of the New Zealand College of Mental Health Nursing Standards to ensure they are implemented consistently. 

Stakeholders impression of current situation in summary were: 

  • The adoption of the Standards of Practice is inconsistent across the country. 
  • Some position descriptions for mental health nurses include the standards, however, the use of generic position descriptions for roles that nurses hold may not. 
  • There remains a confusion around the “competency/standard” issue. 
  • The issue of advanced standards/specialist area standards or competency frameworks needs to be considered. For example, for mental health nurses the Framework for Specialist Addiction Nursing is underpinned by the Standards of Practice. 
  • The standards are included in the Skills Matter programme specifications for the clinical leadership programme for mental health and addiction nurses and the New Entry to Specialist Practice for mental health and addiction nurses programme.  

Suggested solutions included:

  • A focused national approach to embed the standards into mental health nursing practice over the next five years is needed. 
  • The NZCMHN could update the standards and create an audit tool as an enabler. 
  • DoMHNs and the NZCMHN could lobby for the standards to be more overtly acknowledged by the Nursing Council of New Zealand. 
  • NZCMHN standards need to be socialised nationally. 
  • Apply a strategic lens on profiling the differences in mental health nursing work. 
  • Conduct a stock take about the use of the standards. 
  • Develop a certification process for mental health nurses based on standards. 
  • Develop an accreditation process for employers of nurses, about the use of the standards. 
  • Should we be embedding the Let’s get real skills across the whole workforce?

Where to from here?  

The impression is that the Standards of Practice originally published in 1995, are still not yet fully embedded into mental health and addiction services who employ nurses. The standards are due for a review by Te Ao Māramatanga - NZCMHN and this may provide an opportunity to develop a national plan to ensure that the standards are fully integrated into mental health and addiction nursing practice, and nursing education. The review of the standards will be informed by the refreshed Let’s get real framework which will be relevant for the whole health workforce.