Values and valuing mental health nursing in primary care: What is wrong with the 'before and on behalf of' model?

摘要

The present model of employment specified in the Mental Health Nurse Incentive Program (MHNIP) is closely aligned to a traditional practice nurse model whereby the nurse is employed to assist and extend medical practice. Mental health nurses working within MHNIP typically possess post graduate qualifications and a breadth of experience characteristic of a specialist and advanced practitioner in mental health. Mental health nurses ought to enjoy the same status, level of remuneration, professional esteem and accountability of other health professionals. The Mental Health Nurse Incentive Programme (MHNIP) provides funding to organizations to enable mental health nurses (MHNs) to provide care to people with complex needs in primary care settings in Australia. The programme is based on a 'for and on-behalf of' practice nursing model whereby the MHN is presumed to have no specialist knowledge, skills or professional autonomy, and rather extends the reach of medicine. This paper provides a profile of MHNs working in the MHNIP derived from an online survey. A content analysis of responses establishes that nurses who work within MHNIP are highly experienced, and have extensive postgraduate qualifications particularly in psychotherapy. Nurses have negotiated a range of complex employment and contractual arrangements with organizations and pushed the boundaries of the programme to realize good outcomes. The 'practice nurse model' of employment and the underpinning assumptions about MHNs and their skill set relative to other professions is critically examined. Changes to the programme funding mechanism and programme specifications are recommended.