The Senior Mental Health Nurses’ Network of South Eastern Sydney Illawarra Area Health Service (SESIAHS) provides leadership in the development and evaluation of policy, clinical standards, supervision, training and development for mental health nursing within SESIAHS. This Network reports to the SESIAHS Mental Health Executive.

The Education Sub-Committee of the Network identified the need for a comprehensive Transition Skills Program (TSP) for nurses new to mental health.  The Committee conducted a needs analysis and a review of literature to establish a list of clinical skills considered necessary to enable nurses new to mental health to practice in a competent manner. The Committee and clinical nurse experts in each specialty setting compiled this information into an educational program and then developed clinical learning objectives. The program was designed to provide a theoretical framework supported by structured learning in the workplace, thereby facilitating the transfer of theoretical knowledge into clinical practice.

The aim of the program is to assist new graduate nurses and nurses new to mental health attain competence in a range of clinical skills necessary to work in mental health nursing, with a subsequent aim to increase retention rates.

The Area Mental Health Program (MHP) and Committee recognized that a standardised approach to the education and skill development of nurses new to mental health was required to ensure consistency in the professional development opportunities provided across MHP sites.

The Education Sub Committee members compromising senior mental health clinicians from across SESIHS and the Professorial Mental Health Nursing Unit, met to identify the level of inconsistency in education and skill development. This Committee also obtained feedback from preceptors and educators within the MHP. A needs analysis identified that nurses new to mental health were not gaining adequate knowledge or skills to work competently in an acute care mental health setting thus placing themselves and other staff at risk.

TSP relates directly to "Building A Sustainable Health Workforce" (NSW State Health Plan, 2007) by building the capacity of new nurses working in the mental health setting to work effectively and collaboratively within a team.

TSP also supports the Area MHP participation in the National Mental Health Seclusion and Restraint Project which aims to decrease and possibly eliminate the use of seclusion and restraint in mental health facilities. By educating and building clinical competency in staff, TSP may reduce the use of restraint, seclusion and PRN medication and improve patient outcomes and ensure the success of this project.

The Committee developed the content of the TSP after extensive consultation with senior nurses and clinical experts from each specialty setting in the Area. The content and clinical learning objectives were also based on information from clinical settings, expectations of new nurses along with preceptor feedback from previous New Graduate Mental Health Nursing Transition Programs.

The learning objectives were structured in three parts; orientation to the workplace, orientation to nursing and clinical skills. The draft program was circulated widely for comment and presented at the Mental Health Nurses’ Forum and the MH Networks prior to finalization and endorsement by the Area Mental Health Executive.

Due to the large geographical area covered by SESIAHS, the Area decided to convene two programs, one in the Southern Network (SN) and the other in the combined Central and Northern Networks (CN &NN).

The TSP consists of two parts; a course of nine study days for the Central and Northern Networks and eleven days for the Southern Network, along with a structured set of clinical learning objectives. These assist skill development, reflection on practice and facilitate the application of knowledge in the clinical setting.

Following endorsement by the Nurses Network, the learning objectives were distributed to preceptors and all new graduate nurses who participated in the previous Mental Health New Graduate Transition Programs throughout SESIAHS. Committee members were available as a resource at each hospital to support implementation of the package. The learning objectives were also given to nurses new to mental health who were not part of the Transition Program.

Prior to the commencement of the formal TSP, a workshop was conducted on Preceptorship in Mental Health Nursing to educate preceptors on their roles and responsibilities. This successful workshop continues to run at the start of each year for all mental health nurses across the Area.

The first comprehensive TSP commenced in 2004. The program has been divided into two steams, A and B. Stream A requires attendance at nine study days with subsequent clinical learning objectives and assessment of specific clinical skills, including comprehensive assessment, risk assessment and formulation of management plans. Stream B requires the same as stream A along with the completion of two academic assignments. At the conclusion of the Program, a certificate of attendance is given to all participants.  In addition, Stream B participants may apply for advanced standing for a postgraduate qualification at the University of Technology, Sydney, University of Wollongong and Charles Sturt University.

Clinical skills are assessed formally by the preceptor and each of the study days are evaluated for content, interest and relevance to clinical practice.

A survey was conducted at the end of the first year, new graduates indicated that the content of the theory was appropriate and preceptors wanted more specific learning outcomes in relation to clinical assessment. This has been incorporated into the revised learning outcomes.

The learning objectives are reviewed at the conclusion of each TSP year. Participants and preceptors are surveyed and revisions made as necessary in collaboration with the MH Training and Development Committee. Educators and Clinical Nurse Consultants seek feedback from managers, based on performance reviews, regarding the competence of new graduates at the conclusion of the Program each year.

At the beginning of each year the participants are given a written assessment which is repeated at the end of the year. Results are then compared to identify an improvement in clinical skills. Assessments include knowledge of the Mental Health Act, Therapeutic Interactions, Medications, Assessment and Management.

Results of these assessments for those who completed the TSP year in the Central and Northern Networks are as follows:

Results 2005

Results 2006

Results 2007

As demonstrated above, the scores are improving at a greater rate from pre to post test each year. In 2005 the average change was 8.6% compared to 28.9% in 2007.  As more feedback is received from evaluations of the program, the coordinators will continue to update the program to ensure it is contemporaneous and engaging.

Outcomes have also been measured by recruitment and retention rates as demonstrated below.

TSP Recruitment and Retention Rates 2005

TSP Recruitment and Retention Rates 2006

TSP Recruitment and Retention Rates 2007

Early stage trend analysis indicates that on average SESIMHS is retaining more of the new staff completing the program. The higher retention rates appear to be due to the support and encouragement the staff receive within the program. There are currently 13 and 10 participants enrolled in the Central/Northern Network and Southern Network programs respectively.

The TSP identifies the clinical skills necessary to practice as a mental health nurse in all MH settings and acts as a guide for program participants, preceptors and educators. A self-directed approach to learning was chosen in acknowledgment of the diversity of clinical settings, the varied learning needs of program participants, and the availability of senior clinicians to support participants. The TSP provides a structure to learning that identifies participants learning needs and a framework for the monitoring of the acquisition of clinical skills. The Professorial Unit for mental health nursing will continue to provide ongoing support to the new mental health nurses even once the TSP year is finished to ensure maintenance of their level of learning.

The next phase of the TSP evaluation will focus on demonstrating improvement in clinical competence of new graduates and new nurses who participate in the program. This will be done by establishing the skill level of nurses at the commencement of the TSP, during the program and on completion of the program to measure the change in clinical competence. 

The coordinators of both the Southern Network and Central/Northern Network programs along with the Training and Development Committee and the Senior Mental Health Nurses Network have commenced planning the merger of the two programs to ensure a more unified approach to training is taken for nurses new to mental health across the Area. 

There is scope for implementing TSP in other Area Health Services.

Quality Collaborative Manager, Clinical Governance Unit
South Eastern Sydney Illawarra Area Health Service
Phone: 02 4253 4936