Conclusions

As noted above, in the United States, the United Kingdom, and now in Australasia, nurse education and training has become firmly located in universities; nursing in the United Kingdom will become an all-graduate profession within a few years. In turn, following developments in the United States, nurses in the United Kingdom and other countries of the developed world are increasingly taking masters degrees and doctorates. On the one hand, such developments must be welcomed, as skilled and well-educated nurses can offer a great deal of support and, in some cases, replace a relatively small medically qualified workforce. Indeed, it is now recognized that nurses are able to perform, with great competence, tasks previously undertaken only by doctors in fields as diverse as diabetes, proctology, anaesthetics, and accident and emergency medicine. Those nurses who have been trained in mental health care, for example in the Thorn and nurse therapy programmes, are now obviously carrying out specialized treatments in a very independent fashion, with both clinical and economic benefits and with excellent levels of patient satisfaction. However, many nursing tasks concern very basic care, such as washing, feeding, and bathing. In psychiatric nursing, many patients with schizophrenia have, until now, relied on nurses for simple support and help with activities of daily living. With an increased emphasis on technical and specialist skills, it seems obvious that graduate nurses will not be best placed to fulfil these everyday, but nevertheless essential, roles. It seems clear that nurses in many countries, including the United Kingdom, will follow the pattern seen in most North American states. In the United States, most community services employ very few nurses in the roles now occupied by CPNs in the United Kingdom—such case-management roles are carried out by generic mental health workers with variable levels of training. Thus it is probable that the future of nursing in psychiatry is one which will see a great deal of change, and perhaps the emergence of a new non-nursing workforce who will carry out the day-to-day duties.

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