• 01 November 2018
  • 6 min read

Why are RMN numbers falling faster than other specialisations?

  • Abby Holland
    PICU Mental Health Nurse

Mental health services are under severe pressure due to deep issues with recruitment and retention. Listen to nurses, and we can learn what we need to do.

It is well known that the NHS is desperately short of nurses.

This due to various reasons such as dropping of the bursary and funding, high stress levels, pay and un-met promises from government of improved working conditions.

This is even more present within mental health services. Mental health services are under severe pressure due to deep issues with recruitment and retention.

This lack of staffing leads to beds shutting and the practical inability to provide the care nurses strive to give.

Though these issues burden the entire nursing profession, it is sharpest within mental health. Evidence suggests that mental health nursing has been hit most by the NHS nursing shortages - it is hard to find and attract new RMNs to jobs.

Fewer mature students entering mental health nursing

The recent drop in mature students entering mental health nursing courses in England has highlighted these concerns even more so. Previously mental health careers had traditionally attracted people with significant life experiences.

The removal of bursaries makes this later-career decision unaffordable to mature students, depriving the sector of a previously valuable source of new recruits.

There are many challenges to working in psychiatry, which could be impacting the declining numbers in nurses that we are seeing.

Here are a few reasons for falling staff numbers amongst mental health nurses:

• a stigma attached to mental health nursing

• fear of assault (staff assaults rose recently risen by 21%)

• nursing shortages leading to more hostile environments

• increased use of new recreational drugs compounds stresses on over-worked units

• sense of decreasing support

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The reality of staff shortages and agency nurses

There have been times on the ward where I have been working short staffed, either the only qualified nurse or with private agency nurses.

Agency nurses are, on the whole, great. But if the agency supplying them has failed in their job (not checked that they are trained in restraint) then it clearly raises problems, and an awkward co-working situation.

Permanent nursing staff are familiar with the patient group, and have the rapport that helps us all get through challenging shifts.

So, shifts with agency nurses are more unpredictable and, if placed incorrectly, stressful.

Keeping it on the level and in the team

Mental health nursing is stressful at times, yes. But the emotional impact can be as demanding.

The conversations an RMN will have with patients can be, at turns, disturbing, extremely upsetting, distressing or simply bizarre.

That’s a lot of baggage to carry around with you. I’ve had conversations with patients that have left me heartbroken. I’ve had chats with others that have left me feeling frightened.

You must check in with yourself and your colleagues after difficult shifts or situations.

It sounds cliché but to quote Helen Keller: “Alone we can do so little, together we can do so much”.

Your team is what will get you through the worst shifts, the most psychotic patients and challenging situations. They are your biggest support network, and your work family. I would not be the nurse I am today without them.

Psychiatric nursing is a marmite thing

For every negative about the job, there are 5 positives.

Working in psychiatry will often be described as a ‘marmite job’, especially working in intensive care; luckily I love marmite!

Yes the job is challenging, stressful, emotional and at times has the potential to be dangerous; but there is nothing more rewarding than being involved in someone’s darkest moments, at their crisis point, and being one of the people to help pull them out of it.

You develop a very unusual kind of relationship with your patients; you start to be able to pick up little signs that they may be relapsing or deteriorating, you get to know some of your patients inside out.

You get to see them at their worst, and then you get to see them become their best, knowing that you were a cog in that process.

The job satisfaction is incredible, and sometimes it is something as small as a patient coming out of their room and engaging in a group activity, or it is the patient that has been on the ward for months getting discharged.

How can we improve staff attraction for mental health nursing?

How can we make mental health more appealing to attract new mental health nurses to openings / jobs? I think we need to break the stigma around mental health that still exists.

This can only be done when the media change their story on mental illness, and how they present it. More positive media attention needs to published.

Of course, it’s essential that we are aware of the moments we got it wrong, or where mental health services maybe failing. But there seems to me to be a distinct lack of positive-outcome articles.

I see very few stories by people who have been saved by a mental health nurse, a patient reporting exceptional support and care and recovering successfully as a result.

Just like doctors and nurses in physical care, the thousands of us working in psychiatry help fix people too. I would like the media to find those stories and broadcast them. This would certainly help attract new mental health nurses to the NHS and private health care.

Retaining mental health nurses – listen and understand us better

So what must be done to try and prevent mental health nurses from leaving the service?

As much effort and change needs to be put in place to retain our current nurses – people who have spent their lives training and gaining experience that cannot be replaced (at least not easily).

We should be listening to our mental health nurses.

Listen to what we are asking for. More money for what we do is always going to be the first thing we request.

But as critical to us is that managers, health officials and the public build a better understanding of what we do.

We work in extremely demanding situations, we are not paid highly, we are often under stress and we’re expected to remain calm in emotionally charged confrontations.

We regularly work long hours. We give unpaid hours

We want better recognition for all the hard work and unpaid hours worked.

If we can start seeing recognition for this (no big bunch of flowers, just a nod) that would be a great start.

A little bit of attention and, yes, mild gratitude, would, I think, ensure many of the qualified staff attending our mental health nurses keep swinging their legs out of bed each morning, pulling on their scrubs and heading to work.

And, yes, of course, everyone is agreed that nurses need more support and funding. If we’re supported we can continuing supporting and caring for others.

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About the author

  • Abby Holland
    PICU Mental Health Nurse

I qualified in 2015 from Southampton University with a degree in Mental Health Nursing. I have worked in Psychiatric Intensive Care for the 3 years where I currently reside as a Charge Nurse. During these 3 years I also spent 3 - 4 months working on acute female ward. I am also a Makaton signer, and Learning Disabilities lead on my ward.

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  • Abby Holland
    PICU Mental Health Nurse

About the author

  • Abby Holland
    PICU Mental Health Nurse

I qualified in 2015 from Southampton University with a degree in Mental Health Nursing. I have worked in Psychiatric Intensive Care for the 3 years where I currently reside as a Charge Nurse. During these 3 years I also spent 3 - 4 months working on acute female ward. I am also a Makaton signer, and Learning Disabilities lead on my ward.