Stockport & District Mind
Information for people who use mental health services and their carers
Registered Nurses and Your Mental Health
What is a ‘Registered Nurse’?
A Registered Nurse is a person who has successfully completed a 3 year training course in which they have shown their competence and safety by passing both academic (theory) and clinical (practical) exams. Qualified Nurses are then registered with the Nursing & Midwifery Council (NMC) whose role is to safeguard the health and wellbeing of the public. The NMC does this by setting and monitoring professional nursing standards that all Registered Nurses have to meet to maintain their registration and license to practice.
Within nursing, people can choose to specialise in particular areas of health, such as working with children, with adults, with people with learning disabilities or with people with mental health problems. Registered Nurses involved in the care of people with mental health problems are called Registered Mental Health Nurses. Sometimes the now rather old fashioned term of RMN (Registered Mental Nurse) may be used.
Do I have a Registered Nurse?
Within Stockport Mental Health Services you can expect to meet Registered Mental Health Nurses who work with the Community Mental Health Team (CMHT), or branches of that which might be called the Community Treatment Team, Wellbeing & Recovery Team, Early Intervention Team or other.
The Registered Mental Health Nurses working in these teams are usually called Care Co-ordinators. You may know your nurse by the title CPN (Community Psychiatric Nurse) However not all Care Co-ordinators are nurses by profession, you may well find Social Workers, Occupational Therapists and other equally qualified health and social care professionals in this role.
Registered Mental Health Nurses work with other professionals in the Crisis Resolution & Home Treatment Team, who you may meet if they are providing extra support to you at home during a particularly difficult time, or if you attend the Accident & Emergency Department for urgent mental health problems.
Registered Mental Health Nurses work in the in-patient wards of the local hospital, where they may be called Staff Nurses or if they have overall responsibility for managing the ward they may be called the Ward Manager. However not all staff that you meet on the ward are qualified Registered Nurses, many will be Healthcare Assistants (also called Support Workers or Nursing Assistants or Assistant Practitioners) who should have received some training to ensure that they are competent to perform duties delegated to them by the Registered Nurse. In this situation the Registered Nurse is accountable for supervising and monitoring the work of the assistant staff. In the ward situation where there are many nurses you will be allocated a particular “Named Nurse” who will take overall responsibility for your care and will arrange to spend individual therapeutic time with you. This means that you will be able to develop a meaningful helpful relationship with this nurse who will be your main point of contact for help, support and information. Of course this “Named Nurse” will not always be on duty but he or she will make sure that other nurses are aware of your situation and needs and they will substitute for him or her in their absence.
Particularly in mental health settings where staff do not wear uniforms it can be confusing so if you are unsure of who is caring for you and want to know just ask.
What do Registered Mental Health Nurses actually do?
When you first meet a Registered Mental Health Nurse in whatever setting, he or she will want to get to know you as an individual and to learn about what has happened to you and what is important to you. An assessment of your health and social situation will help identify your needs so that an agreed care plan can be drawn up. Wherever possible you will be actively encouraged to give your feelings, ideas, views, and suggestions of what you want to happen and how you would like this to be done. Equally, if at this time you feel too unwell to be able to be so actively involved, then this will be respected and your Registered Mental Health Nurse will always act in your best interests in consultation with other staff involved in your care, and with your permission, with your family and other carers. The important thing is that you are listened to and given the opportunity to express your feelings and needs.
The first assessment that you have may be lengthier than at other times in your future care, but assessment will not be a ‘one-off’ thing, as further assessments will continue throughout your care as your health and situation changes. This is so that your care plan can be regularly updated to make sure that you get the help that you need. Information gained during your assessments will be written in your healthcare record so you will not need to be asked all the same questions each time you see a member of staff.
You will have a professional relationship with your Registered Mental Health Nurse and you can expect to always be treated with care and concern for your best interests. Your health and safety is always the first concern of your Nurse. Your feelings and views will always be respected even if there are times when your Registered Nurse does not always agree with you. In this case he or she will provide an explanation and will be prepared to justify any decisions that you do not agree with and these should be recorded. You may ask about things that you are not clear about at any time.
You can expect all information about you to be kept confidential and not disclosed to anyone else without asking for your permission. The only exception is if your Registered Nurse has reason to believe that you may harm yourself or they suspect that someone else may be harmed. Because Registered Nurses usually work as part of a wider mental healthcare team, they will ask you about sharing your information with other professionals who would need to know such information to be able to help with your care. Other professionals also have a duty to respect your right to confidentiality. Discussions with you about personal matters should take place in a private place and not in public areas where others might hear.
Registered Mental Health Nurses recognize the importance of your family or carer in your life and will do all that they can to help them to help you. With your prior permission, your nurse will talk with your family to help them understand your mental health needs and offer support to them. Carers will be offered an assessment of their own needs which might be for individual personal support, information or practical help.
Once you have participated in the assessment process a written Care Plan will be formed and you should be offered your own copy to keep. If this does not happen and you would like a copy just ask.
Your Registered Nurse will work with you to put into place the things agreed with you in your Care Plan. This should involve spending time with you to listen to you and help you explore how you are feeling, giving you the chance to make sense of what is going on for you. It is important that you feel comfortable to say what would be meaningful and helpful to you at that time.
If you are taking psychiatric medication your Registered Nurse will be able to help you understand why this has been prescribed and how it is thought that it might help you. He or she will also be able to give information about how to manage any side effects that might occur and any special precautions you need to take with certain medications. Your response to the medications will be monitored and you can expect to be asked about whether you feel they are helpful or otherwise. Feel free to raise any concerns or questions about medications with your nurse who will help where possible or arrange for further advice from the psychiatrist or pharmacist if needed. If you decide to stop taking prescribed psychiatric medication it would be best to have a full discussion of this with your psychiatrist first. It is not advisable to stop psychiatric medication suddenly as this can cause unpleasant withdrawal symptoms and sometimes even relapse. If it is your decision and choice to stop your medication, even if this is against medical advice you should still discuss your plans with your Registered Nurse who will help you understand how to do this safely and gradually. You may also wish to look at the Mind guidance booklet “Making Sense of Coming Off Psychiatric Drugs” which is freely available from the Mind website www.mind.org.uk.
An important part of helping you may be to understand what the process of “Recovery” would mean for you and how you feel you may best be helped to reach that. For some people this might be about how they would like to feel, relationships with others, understanding and making sense of things, feeling more in control or doing certain things in your life, e.g. sleeping better or working, or maybe something else entirely.
Registered Mental Health Nurses also help people to maintain their wellbeing and reduce the likelihood of further relapse into poor health. In helping you with this, together you may try to identify things that have commonly happened in the past that have led to poor health or relapse. Early recognition of ‘triggers’ can sometimes help prevent a ‘full blown’ relapse from occurring as pre-arranged actions and extra support can be planned in advance. You may also be helped to learn how to recognise and manage stress if this is an issue for you.
Although your mental health and wellbeing may be the main focus of your care, your Registered Mental Health Nurse will also help with aspects of your physical health which is equally important yet sometimes overlooked. Advice and support will be provided to help you improve areas such as getting enough exercise, managing weight problems, reducing smoking, safe alcohol use, sexual health matters, getting regular health check-ups, etc.
As well as being able to work with you directly, the Registered Mental Health Nurse can give you information about many other services that might be of interest to you, refer you to other services, and help you access advice e.g. benefits, local groups, supported social activities, voluntary agency services, and many more.
What if I am not happy with my Registered Nurse?
Misunderstandings can sometimes cause friction so it is important to arrange to talk to your Nurse to express how you feel and give him or her chance to explain and hopefully sort things out to your satisfaction. If you are worried about doing this you might find it helpful to have a relative or friend with you for support. If you are not happy with the outcome of this your discussion, you may wish to speak to the nurse’s supervisor or manager, so ask who this is and how you may contact them. At any point you may ask for help from the Trust Patient Advice and Liaison Service (PALS) or a voluntary agency such as Mind. You have the right to make a formal complaint if you wish and advice leaflets are available setting out the Trusts processes and procedures. You also have the right to make a complaint to the Nursing & Midwifery Council (NMC) if you feel that a Registered Nurse has not given you a high standard of care. For serious breaches of professional practice the NMC can suspend or even remove a nurse from the Register and prevent them from working as a nurse. Further information on the professional “Code of Standards of Conduct, Performance and Ethics” is available free from the NMC at Tel; 02073339333 or online at www.nmc-uk.org. Your local Mind office also can give you the leaflets and support you if you feel the need to make a complaint.