How the NESP programme helped me pursue my passion - Fiona's story

Fiona Armon's journey into the healthcare sector started in a support worker role. Now Fiona is a New Entry to Specialist (NESP) clinical coordinator and an MHAID registered nurse. Skills Matter project lead Jacqui Hampton spoke to Fiona about her experience in the NESP programme and how it helped to shape her career. Here is Fiona's story.

Ko wai au - What is important to me

Kia ora, I am Fiona Armon, I am a New Zealander of English, Scottish, Afican, Irish and German descent and in recent years have discovered that I whakapapa back to Ngāti Kahungunu. Connecting back to my Māori culture is a journey I am on currently. I am an MHAID registered nurse and reside in the incredible area of Dunedin.

I moved to the South Island 19 years ago and for the past 14 years have lived in the Otago region and absolutely love it. There is so much on offer in Otago. In three hours you can be on the mountain playing in snow, in ten minutes I can be in the ocean to surf and dive or get into the many options for biking and tramping. Dunedin itself is a great little city, with everything you need from a bigger centre but without the woes!

My main role in Dunedin is the New Entry to Specialist Practice(NESP) clinical coordinator for Te Whatu Ora – Southern. I also have a clinical role in Balclutha as a community mental health nurse, engaging with people who have been referred to our service. I enjoy both my roles and like to keep my clinical practice current, which I feel supports the work I do with nurses new to mental health and addiction nursing. It is rewarding to work with tāngata whaiora and their whānau and seeing the difference that our support can make in their lives. It can be so small but makes such a positive impact. A part of my clinical role is to ensure people have access to the right services and support them to build their family and community connection. Mental health, addiction and disability nursing certainly comes with challenges, but I love working with people in partnership to assist them to problem solve and support them to find what may help. Often times it is tāngata whaiora and the families holding the solutions with our role being to facilitate recovery.

Similarly, as the NESP clinical coordinator, my passion is to ensure the nurse graduates and nurses new to mental health and addiction are supported and to guide them through the first year of their mental health and addiction nursing practice. I enjoy the collaboration that this role affords me, I feel I am able to support nurses clinically when working on the floor as well as having the opportunity to develop and improve the programme to better support the needs of the wider service.

Working within rural communities

Working within a rural community is a unique experience in that they are truly invested in strengthening and using resources from within. Unlike main centres, rural communities do not have the same level of health services available to them, so as a community there is a resilience and from this comes the ability to problem solve and to find solutions for the community designed and resourced by the community. Like all other parts of Aotearoa, we do have gaps in what resources we have and need more services that look at reducing violence, the rainbow community, gender diversity and young people. Currently we do not have access to specific Māori or Pacific Mental health services that are needed.

My journey into mental health and addiction nursing

When my husband and I first arrived in Dunedin in 2008, we began working in a bike shop, I am pretty good at fixing punctures now. I knew I loved working with people, so when I was made redundant, this was something I wanted to continue. I began in a support worker role in the community with people who experience physical disabilities. I found I really enjoyed working with people to live their best lives. After this role, I decided to look for a part-time health care role and applied for a job with the DHB as a mental health assistant in the intellectual disability services. There was a new transition unit for tāngata whaiora who were moving from long term inpatient living to supported community living. I worked in this role for seven years, it was during this time I had a sense of coming home and felt it was an area I could make a positive impact on peoples lives. I wanted to learn more and really deepen my capabilities and knowledge to better support people. This led to me completing a certificate in human services, specialising in mental health through Otago Polytechnic. I learnt as much about myself as I did about working with people with mental health challenges and so this was the beginning of my academic learning journey. My manager Lynn Noye (nee Hall) at the time saw a strength and potential in me that I couldn’t see in myself, and they encouraged me to consider a nursing degree.

Southern DHB (SDHB), particually Heather Casey our Director of Nursing, was really supportive both with bonding, flexibility and being an encouraging cheerleader. I was able to work part-time in my role as a mental health assistant and this gave me the flexibility I needed, such as increasing hours during the academic breaks. This commitment made me feel valued and I personally felt this was a key reason for my ongoing commitment to SDHB. I moved into the NESP programme as a new graduate while working in an acute adult mental health unit.

NESP – what went well and what was helpful

I went through NESP with the University of Auckland in 2019. I felt well supported by the university and programme coordinator, Shirley McKewen. They anticipated all of the challenging areas and had structures in place to support us. Some of the challenges I faced were improving my time management and working and transitioning from student to being a nurse is a big step. I had an excellent preceptor, Lil Pugh, who I worked with me most shifts for the first three months. I feel lucky to have had this as this is not always an option these days. She and Kirsteen Heaven my other preceptor really guided me in this transition into the role and helped me develop as a nurse. Although I had a lot of experience working as a support worker and mental health assistant, there were far more complexities and responsibilities to consider around ethics, advocacy, understanding whaiora perspectives and needs, working with whānau and working within a wider multidisciplinary environment and much more. Having these preceptor relationships really built my confidence and voice, they helped me connect to the team and our enjoyment of our work. My NESP supervisor, James Caley, worked outside of my unit so I really benefitted from his wise words and wider mental health and addiction and disability experience.

I think its essential to plan the work, life, study balance and develop time management skills. It's also really important not to pick up too many extra shifts when asked at the start. Having boundaries around this, enabled me enough capacity to do the academic work and maintain my own wellbeing. I know, as nurses, we want to help out when we can, particularly in this workforce climate, but in order to get through the programme start practicing the boundary of saying ‘no’. This is really important in terms of self care and long term sustainability as a nurse.

The other helpful and important part of NESP is your peer group. You are in this journey together, and when we met for the in-person university block courses, this was really beneficial. We worked together on assignments, had group supervision, shared lunches and support and became friends. We heard about people's challenges and good news stories. We all learnt from each other.

Throughout the year, I did an alternative placement of my choosing in an early intervention in psychosis team. The variation in your NESP year is crucial, to have that exposure to a really different context solidified my desire to work in the community.

The journey after NESP

After NESP, a job became available in the rural community team in Balclutha in 2020. This was a part time community mental health nurse role. I felt passionate about community nursing as I could see there was an opportunity to really do some good mahi and hopefully prevent admissions by supporting people to remain well in the community. I settled in that job over the year, we have a great team and I was really well supported as a new clinician. I suddenly had this autonomy, and responsibility, I liked working in this way. Covid19 arrived and made things even more challenging, however we soon realised that our whaiora are a resilient bunch and they managed it far greater than we feared. We had more new referrals, new presentations and lots of anxiety in the community.

My passion for education and improving outcomes for the people I supported remained, so I completed another Skills Matter-funded post graduate certificate in Cognitive Behavioural Therapy at Otago University (out of Wellington campus). This added to my kete of skills and knowledge for supporting the people I work with and is integral to my everyday work. I’m also on my Masters pathway which will have a particular focus on understanding diagnostic overshadowing. As my knowledge and experience grows, I started to consider the importance of supporting my colleagues and other new nurses. Our team enjoys working with students, especially when we can show them how awesome being a mental health nurse is. It’s great when you can convert them!

I then applied for the NESP coordinator position that became available. Looking at the job description, I realised I got a lot from working and mentoring students through their NESP year. I was also able to retain the part time position in my rural community team, something that is important to me. I think having that clinical role supports the work I do as a NESP clinical coordinator nicely and keeps my feet on the ground.

In the climate of Covid19 and the current challenges of workforce shortages, we have tried to create a realistic, pragmatic and connecting NESP programme to meet the nurses needs while balancing this with a post graduate academic progamme that is very contemporary and consumer focused. I am continually impressed with the NESP nurses, who even though we are no longer in lockdowns, its still a covid world in health and are managing these challenges beautifully. We have shifted to a more blended delivery of academic learning. We encourage Facebook groups and social interactions, such as sharing kai to build peer support and connection. I provide pastoral support to navigate through and thrive, that’s what is important to me, I really want them to succeed and feel valued.