Why nurses should be dual-registered
Physical and mental ill health often go hand in hand, which is why nurses qualified in both areas of practice are perfectly placed to offer person-centred care
In 2022, I graduated with a dual registration master’s degree in adult and mental health nursing.
I worked as a mental health support worker for six years before starting my degree, and my goal was always to train as a mental health nurse. But while working in a variety of mental healthcare settings, including forensic, psychiatric intensive care and acute wards, I realised how patients with mental health issues are highly vulnerable to poor physical health.
The links between physical and mental health
Research shows that patients with mental health illnesses are at high risk of developing conditions such as obesity, diabetes and heart disease; and psychiatric medications come with many physical side effects, including headaches, sedation, increased appetite, weight gain, muscle spasms, nausea, indigestion and constipation.
I wanted to support patients to lower these health risks, so when researching nursing degree programmes, I looked for one that offered comprehensive physical health skills alongside mental health, choosing the four-year programme at Oxford Brookes University.
After qualifying, I decided to work in adult intensive care (ITU), where I have worked for seven months, as I felt general nursing could help develop my physical health skills. To ensure my mental health nursing skills are kept up to date, I do regular bank shifts with the local community child and adolescent mental health services (CAMHS) crisis team.
Meeting psychological needs in critical care
Initially, I wasn’t sure whether there would be a place for my mental health nursing skills in critical care, but many patients are admitted to ITU following a mental health crisis, such as a suicide attempt or overdose, or in relation to an eating disorder or addiction-related illness.
Knowing what to say to someone who wakes up in intensive care after a suicide attempt can be challenging, but I have experience in having difficult conversations through my mental health training and can help support colleagues who may have any concerns or want some advice.
Patients in critical care are also highly vulnerable to conditions such as trauma and delirium. Withdrawal from strong sedative medications, such as propofol and fentanyl, can put patients at high risk of developing delirium. Feedback from patients suggests the experience of delirium can include visual and auditory hallucinations, paranoia, extreme anxiety, thought disorders and unusual beliefs.
As a mental health nurse, I have experience in assessing, monitoring and supporting people with these conditions, along with knowledge of de-escalation and distraction techniques that can help support them.
Patients who develop delirium also have a much higher risk of post-traumatic stress disorder. My research proposal for my master's dissertation looked at developing an intervention to improve the psychological well-being of critical care patients. While exploring the literature, I found that guidelines for the provision of intensive care services recommend critical care teams have a psychologist as part of the team, but this is rarely the case.
How dual registration works in practice
In my proposal, I suggest having a mental health nurse as part of the team, who could offer crisis intervention to people experiencing delirium or trauma while in critical care.
Dual-registered nurses could take on this role by dedicating some of their time to focusing on the mental health, psychological and emotional needs of patients. As such, they could ensure prevention and management of delirium care plans are in place, paying special attention to pharmaceutical and non-pharmaceutical interventions, offering different approaches to treatment, such as trauma-informed care, and offering staff training.
As well as bringing my mental health skills to ITU, I have been able to use my physical health skills to support the young people I work with in CAMHS, providing education on issues such as the impact an overdose can have on your body and on the physical effects of eating disorders.
I also have a comprehensive understanding of the treatment needs of these young people if they are in hospital following a crisis event, such as requiring treatment for an eating disorder or an overdose. This can be useful when we need to complete a crisis assessment.
The benefits of dual registration
Dual registration gives you:
- A truly person-centred view of health, and understanding of the need for parity of esteem between physical and mental health
- The opportunity to take a proactive approach in physical and mental healthcare for patients
- A comprehensive insight into patients’ psychological and physical needs and a better understanding of why some patients demonstrate certain behaviours
- The opportunity to gain experience from vastly different care settings and develop your knowledge and skills in both areas
- The ability to contribute to continuity of care by understanding the delivery of both mental and physical healthcare, creating links between services
- The opportunity to ensure patient groups are not being disadvantaged in their care by holding all aspects of health as important and approaching different treatment needs equally
- An enhanced opportunity to advocate for patients – for example, ensuring patients in mental health settings are being supported for their physical health needs and ensuring patients in physical health settings are being supported with their mental health needs
Practical ways of working and roles for dual-registered nurses
There are many mental health nursing roles in which physical health skills can be used, and vice versa. Being dual-trained in physical and mental health gives you the flexibility to work in a variety of settings and use both your skill sets to develop your career.
Employers are interested in the skills you can bring to the team with a dual qualification, and my managers have given me the support and freedom to explore and develop these in both my roles.
Building networks across organisations and areas of care
My goal is to raise more awareness of mental health conditions in general nursing settings. Holding a passion for both fields contributes to parity of esteem for our patients, helping to improve continuity of care by potentially creating better networks across organisations so we can deliver the person-centred care we all strive for.
Anyone can develop a mental health illness, just as anyone can develop a physical health illness – yet there is still a big divide between physical and mental health, which we need to move away from.
I think all nurses should be dual-trained in physical and mental health – it makes sense for the nursing workforce to treat these two aspects of health as equally important, regardless of the area of nursing, and dual training more nurses is a step in the right direction.
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The author would like to thank her dissertation supervisor Marion Waite, who helped her develop the confidence to write this article