How good nursing leadership can champion holistic healthcare
A leading mental health researcher underlines the importance of investment in mental health nursing leadership on acute medical and surgical wards
King's College London researcher Una Foye explains why it is crucial to invest in mental health nursing leadership on acute medical and surgical wards
Research shows that people with mental health problems have significantly worse medical and surgical outcomes.
Compared with the general population, they:
- Have higher rates of readmission to acute, medical and surgical care (Hanrahan et al 2016).
- Are more likely to be admitted to acute care by ambulance as an emergency rather than receive planned care (Reeves et al 2018).
- Have significantly longer rates of stay during non-psychiatric hospital admissions (Buller et al 2015).
These stark figures underline the need to address the intersection between physical and mental health.
Good leadership improves outcomes for patients
A study I conducted with colleagues at King’s College London and City University of London, examining the challenges faced on medical and surgical wards when caring for patients with mental health problems, shows how important it is to consider leadership and its effect on overall hospital culture.
There is a wealth of literature that links leadership and quality of care (Thorne et al 2019), showing that good leadership improves outcomes for patients (Sfantou et al 2017) and staff (Cummings et al 2018).
Good leadership when considering the care of patients with mental health problems on medical or surgical wards will champion mental health so it is taken more seriously.
Leaders must drive this positive culture change in mental health
Unless organisational leaders drive this positive culture change, mental health will remain an issue delegated to psychiatric liaison teams or additional mental health nurses employed to provide enhanced care. This delegation of care sends a message to staff at ward level that mental health is someone else’s business.
Such disconnection is recognised as an issue we should address. The King’s Fund (Naylor et al 2012) recommends that collaboration between physical and mental health services needs to be a priority, while the Nursing and Midwifery Council (2019) recognises the need for all nurses to be more confident in managing mental health difficulties.
Our study findings, described in a paper titled Somebody else’s business: the challenge of caring for patients with mental health problems on medical and surgical wards, also raise serious concerns about the emotional effect of this challenge on the mental health and well-being of staff.
Staff we interviewed described feeling burnt out, shedding tears on their way to and from work, and in some cases feeling suicidal. This is in addition to the anxieties staff can feel when caring for patients with mental health problems.
Healthcare staff should be confident to practise without fear and anxiety
It may be easy to suggest additional training for all nurses around mental health, but in these difficult times of understaffing, lack of resources and increasing workloads, good leadership needs to support staff from the top down, for example by tackling the ‘blame culture’ around serious incidents, providing space to talk about the effects of working with issues such as suicide attempts and self-harm, and building effective collaboration across teams to allow the development of skills.
Leadership is not only about encouraging collaboration between physical and mental healthcare staff; it is also about motivating staff to see mental health as part of their job and providing more supportive environments in which they are confident to practise without fear and anxiety.
Una Foye @unafoye is a post-doctoral research associate at King’s College London working in mental health
- Buller L, Best M, Klika A et al (2015) The influence of psychiatric comorbidity on perioperative outcomes following primary total hip and knee arthroplasty; a 17-year analysis of the National Hospital Discharge Survey database. Journal of Arthroplasty. 30, 165-170
- Cummings G, Tate K, Lee S et al (2018) Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review. International Journal of Nursing Studies. 85, 19-60
- Hanrahan N, Bressi S, Marcus S et al (2016) Examining the impact of comorbid serious mental illness on rehospitalization among medical and surgical inpatients. General Hospital Psychiatry. 42, 36-40
- Naylor C, Parsonage M, McDaid D et al (2012) Long-term conditions and mental health: the cost of co-morbidities. King’s Fund, London
- Nursing and Midwifery Council (2019) The NMC Register
- Reeves E, Henshall C, Hutchinson M et al (2018) Safety of service users with severe mental illness receiving inpatient care on medical and surgical wards: a systematic review. International Journal of Mental Health Nursing. 27, 46-60
- Sfantou D, Laliotis A, Patelarou A et al (2017) Importance of leadership style towards quality of care measures in healthcare settings: a systematic review. Healthcare (Basel, Switzerland). 5, 4, 73. doi:10.3390/healthcare5040073
- Thorne I, Cox J, Baker E (2019) Sharing learning from hospital trusts on a journey of quality improvement. BMJ Leader. 3, 24-26