Starting as an NQN in the Community

“You should go to the ward first? Shouldn’t you get some experience before you go into the community? Oooh, are you sure about doing that?”

These are some of the common statements I heard from fellow students, nurses, and lecturers when telling them my Newly Qualified Nurse (NQN) role was a Mental Health Nurse, also known as a Care Coordinator, in the community. Why are we still questioning and doubting our student nurses’ decision to go to the community or a slightly different path to the ward as an NQN?

Nursing is varied. That’s why we have numerous placements. So that we learn how to nurse in a variety of settings. I’m now a year into working in community mental health, 10 months of that as a Registered Mental Health Nurse. Of course, being a community nurse is different from being a ward nurse. Like being a ward nurse is different from being an A&E nurse. And being an A&E nurse is different from being a research nurse, which is different from being a nursing home nurse. None of these roles requires fewer skills. But all these roles require different skills, which as an NQN, you can learn and develop.

Over the past 10 months as a newly qualified Mental Health Nurse in the community, I’ve learnt so much. Some of which, I would like to share. So, whether you’re thinking about heading out into the community, have a job in the community lined up, are currently working in the community, or are just interested, I hope these help.

1) Supervision is not all about your patients, but it’s also about how you are emotionally, academically and personally doing. You need to be open to receive constructive criticism. Open to receive support. And honestly admit when you are struggling or if you don’t know something. For me, supervision has been so helpful and a vital part of my first year as a Registered Mental Health Nurse.

2)The to-do list never ends. But that’s okay. In the wards, you hand things over to the next nurse. In the community, this is a little harder. My to-do list seems to go “one thing done; three things added”. You have to learn to accept that you can only do as much as you can that day and prioritise. I personally like to highlight my to-do list in different colours, so I can visually see what need to be done when. 

3) Teamwork. Although you’re care-coordinator for your patients, it’s mega important to work as part of a multidisciplinary team. Seek advice from Occupational Therapists, Support Workers, Social Workers, everyone, as they will all give you a different perspective. Before my role in the community, I had no idea how to apply for social care funding (we don’t learn that as a nurse in my area). But thank goodness the Social Workers in my team who were there to talk me through it!

4) Team dynamics can be challenging. Some people don’t get along with others, some people may not get along with you, some people may gossip & try to draw you in. Be professional at all times.

5) Every day is so different. But that’s why I love it. One day I’m in depot clinic, the next I’m having a meeting with a cleaning company, the next I’m doing risk assessments and care plans. Embrace the difference.

6) Not all patients will take your advice. And because they are in the community, you have to respect that, even if it means that the patient’s mental state may deteriorate. This can be frustrating, sad and difficult to manage. Use your colleagues to discuss cases and gain emotional support yourself.

7) Positive risk-taking is necessary but can be scary as NQN in the community when you don’t have the protection of a ward environment. Gain support and advice from colleagues and remember to document and risk assess.

8) You get to know your caseload of patients and their families over time as you build that therapeutic relationship and also get to know yourself. I’ve learnt so much about myself these past 10 months.

9) Switch off. As I explained above – that to-do list can be never-ending. But it’s so important to switch your phone, laptop & mind off at 5 p.m. Because you can’t pour from an empty glass!

10) Paperwork. Tribunal reports take half a day at least. Social care funding forms take another day or so. Case notes are a must. Then there are plans, risk assessments, letters, housing forms, emails, etc. etc. Being good at organisation and timekeeping is very important in the community, so find a routine to your day and week that suits you and the team you work with.

I loved the past 10 months in the community. Sure, at times, there are some not so great days, but we all have those. Working in the community as an NQN, for me, has been amazing. It’s taught me so many skills, strengthened me both as a professional and person, given me many opportunities to develop. And I feel so privileged to have started my registered nurse journey there. If community nursing is something that you have a passion for then go for it and embrace that passion.

Abby (www.twitter.com/MHnurseabby)

Published by RCN Newly Qualified Nurses

The voice of newly qualified nurses within the Royal College of Nursing. Providing support from six months pre-registration throughout preceptorship.

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