Warning of mental health nurses substituted on inpatient wards
Posted 27 November 2023 - 14:15
RCN says nurses could be at risk of breaching Code, but NHS England denies any inappropriate staffing in mental health and learning disability services
Mental health and learning disability nurses are reportedly being unlawfully replaced with adult or children’s nurses due to staff shortages, prompting warnings of an NHS ‘on the cusp of a national crisis’.
A survey of more than 600 members of the RCN’s mental health forum found that some inpatient wards are being left without any appropriately qualified nursing staff during shifts, as units struggle to recruit amid rising vacancy rates.
Only 57% of respondents could confirm they had mental health and learning disability nurses on every shift over the past 12 months.
One third said they had witnessed at least one shift in the past 12 months where no registered mental health or learning disability nurses were present.
Such use of nurses is ‘categorically not happening’ says NHS England
However, NHS England told Nursing Standard it rejected the findings of the survey, saying it is ‘categorically not happening in our mental health and learning disability services’.
RCN interim head of nursing practice and UK lead on mental health Stephen Jones said that members – including nurses on the front line and some in high level strategic roles at trusts – have been raising concerns and their potential legal implications for more than a year.
It prompted the college to write to chief nursing officers and survey its membership.
Mr Jones said the situation could leave nurses at risk of breaching the Nursing and Midwifery Council (NMC) code as well as failing in legal duties outlined in the Mental Health Act (1983).
‘Not having a mental health nurse on shift is – according to our interpretation of the legislation – unlawful, putting patients at risk and the registration of nurses,’ Mr Jones told Nursing Standard.
If providers have to do this ‘we are on the cusp of a national crisis’ says RCN
‘Non-mental health or learning disability nurses cannot be used to close the workforce shortages. If providers are saying they “have to” then it would appear we are on the cusp of a national crisis.’
The Act states that only nurses of a ‘prescribed class’ – meaning registered with a mental health or learning disability qualification – have the power to hold or detain an involuntary patient on a ward for up to six hours until they can be assessed by a doctor.
One mental health nurse working in an inpatient unit for adult men in central Scotland told Nursing Standard his trust had recently hired a number of adult nurses to staff wards as they 'just do not have enough mental health nurses’.
Mental health and learning disability vacancy data
- England: 13, 652 mental health nurse vacancies as of June, but no data on learning disability nurse vacancies is available
- Scotland: 89 full time equivalent (FTE) vacancies for learning disability nurses and 907 for mental health nurses as of September
- Northern Ireland and Wales nursing vacancy data does not provide a breakdown by profession
According to the NHS Long Term Workforce Plan, the shortfall of mental health nurses in England will rise to 15,800 and that of learning disability nurses will increase to 1,200 by 2036 if no action is taken to boost recruitment and training.
Employers and managers must ensure right skill mix of teams on every shift, says NMC
Without an approved mental health professional on site, says Mr Jones, an adult nurse will not be able to hold a patient, compromising safety.
He said: ‘These environments are very restrictive, taking away people’s autonomy and freedom, so we need to make sure that anyone making those decisions has a full understanding of the context and legalities of how that is undertaken and done.
‘The lack of national investment in mental health nursing is why there is a recruitment and retention issue. If the true value of mental health nurses had been taken seriously over the past decade we would not be in this situation.’
NMC nursing education adviser Julie Dixon said that while nurses can work across different settings ‘employers and managers also need to ensure the right skill mix of their teams on every shift’.
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