Professionalism and community psychiatric nursing: a case study of four mental health teams

In this paper I report on a 2-year study of the professional status of 10 psychiatric nurses, working in four community mental health teams. The focus of the research was directed towards identifying the levels of clinical autonomy experienced by psychiatric nurses working in these teams. Diary-interview schedules were used to record how new clients were processed by the psychiatric nurse. The other members of the teams were interviewed (as were the managers to whom the nurses were accountable), using focused-interview schedules. The quantitative data from the diary-interview schedules were analysed using the Statistical Package for the Social Sciences. An adapted form of the technique advocated by Burnard was used to analyse qualitative data extracted from the diary-interview schedules and the focused-interviews. Conclusions from the research indicated that the nurses experienced a high degree of de facto clinical autonomy, which was characterized by unsupervized and arbitrary decision-making processes. In order to protect the user of mental health services, it is recommended that the espoused occupational strategy of professionalization for community psychiatric nurses is reconsidered.