By Steve Riley, Consultant Nurse, Child & Adolescent Mental Health Service, Betsi Cadwadr Univeristy Health Board
Reading through Richard’s blog, ‘A Day in the Life of a Mental Health Consultant Nurse’, made me think of the similarities and differences in the day of a Child & Adolescent Mental Health Service (CAHMS) Consultant Nurse - that’s me - Steve Riley, Consultant Nurse in North Wales. I thought it might be helpful for enthusiastic and ambitious nursing colleagues out there to hear a bit about the journey that shaped my career.
Let me take you back to 2002-2003 when the Welsh Assembly was the ‘Welsh Office’ and I was a Senior Nurse in CAMHS. I got a letter from the then Lead for Mental Health:
We are looking to develop Consultant Nurses in Wales within the specialist field on CAMHS Nursing – can you help?”
My first thoughts, were – what is one of them?
Having done my research and read up on the history, I understood that this was an exciting opportunity for the profession. I busied myself putting together a business case for a Consultant Nurse to work alongside me as a Senior Nurse. At this stage I had not even considered myself. The idea of me taking up this formidable role, especially the academic bit passed me by. The panel approved the proposal and we got on with recruitment. Unfortunately, we did not appoint. It was then my inspirational Head of Nursing asked me why I had not thought of applying. After some consideration I applied, with the caveat ‘get your academia under your belt’.
And guess what?...I got the job!
My first discussions with the then Welsh Office related to how to influence the training available for nurses working in CAMHS, something identified as significantly lacking at the time. The ENB (603) over the border in England had come to an end, emphasising the need further. Back in the early days, my role as a Consultant Nurse was seen very much from the lens of ‘strategic development’, however, with the emergence of Everybody’s Business (2010), the landscape for the speciality was ready for an overhaul.
The change in role from a Senior Nurse to Consultant enabled me to put my managerial hat away, albeit, not forgetting how the experiences and skills managing people would help me in my next challenge.
Working clinically in CAMHS has always required a systemic consideration. Working with children and young people mostly means working with their families. Even earlier in my career (1992) as a nurse, I had been introduced to Family Therapy and although this had been put on the back burner, I had always wanted to legitimise and extend my knowledge of how to work systemically. The role of a Consultant Nurse with expert knowledge and clinical skills re-opened this opportunity, allowing me to qualify and register as a Systemic and Family Psychotherapist. Being a nurse prepared me well for this addition to my toolkit.
In the intervening years, the role required me to focus on the development of the Tier 4 aspect of the service - inpatient provision.
With service development a key aspect of the role, we worked with a team of planners, builders and policy developers to achieve our goal of a new build, something, as a nurse, I had never thought I would be involved in. The development of primary mental health services followed, as did health working in the Youth Justice Service – just some of the areas you can influence as a Consultant Nurse.
For the keen observer, you will note I have steered away from commenting on further academia and the research aspects of my job. With two MSc under my belt (something Mrs Thomas, my year head in my O level years would have never imagined) I needed to put the academic route to bed, however, the clinical and strategic influence re-emerged with a research slant. I have been working with a Professor of Psychiatry in Reading University and colleagues to develop a framework for understanding moment-by-moment interactional processes in families [have a look at our chapter in Evans, N. (Ed.). (2019). Family work in mental health: A skills approach. M&K Publishing].
This exciting work has enabled the emergence of several new pillars within the role. This is one of the most exciting parts to being a Consultant Nurse, the ever merging and diverging aspects of the role.
So, what does a day in the role of a Consultant Nurse look like?
Well, today, I didn’t have as early a start as Richard, but I was at my desk checking any overnight emails by 08:45. This was followed by a handover of both the clinical activity of our Intensive Care Team and an update of how the young people on the ward had been. My first task following handover was a systemic consultation/clinical supervision with the Unit Family Psychotherapist on a complex case. That took me to my first cuppa, after which I took a walk on the ward, catching up with the young people. ‘Hey Steveo’ one of them shouted, ‘can you charge my iPhone?’.
Charger located, I moved on to meet with the Charge Nurse to receive an update on the condition of another of our young patients before a gentle reminder from the Ward Manager that I had agreed to contribute to the shift on an early tomorrow.
My next meeting saw me undertake a clinical family therapy session. It went well – I think!
I eventually had time to get back to my desk where I reviewed the new proposed service specification. It hit me that this was likely to be the last service specifications I would be involved in – retirement is on the horizon.
Finally on my list for the day was a review of the documentation for the developing of the next generation of Advanced Nurse Practitioners (ANP) – something I forgot to comment on earlier. The role has afforded the space to influence the career development of so many nurses and I feel pride in thinking about those who are now in senior posts as a result.
As my day neared its end, I thought about a student nurse I had bumped into a little earlier (a rare sighting in this new world we are in). They wanted to know exactly what the role of a Consultant Nurse involved. I hope the insight Richard and I have offered in these blogs answers some of those questions and opens the door to others thinking about where they want their wonderful mental health nursing career to take them.
Other blogs in the series:
If you are interested in talking about the mental health workforce in Wales, take a look at our online conference ‘Informing the future of the Mental Health Workforce in Wales'. The content is available until the end of October and we welcome your views.
You can also join us in a series of online Q&A events led by experts in the mental health workforce field.