The professional status of the community psychiatric nurse

Many psychiatric nurses working in the community are changing their occupational base. They are working increasingly as members of a mental health multi-disciplinary team. This is a report on aspects of the role of the psychiatric nurse working in such teams. Freidson's professional-dominance thesis is used as a theoretical framework to assess the occupational status of psychiatric nurses working in the community mental health team. In particular, the levels of clinical autonomy experienced by the nurse are explored. Four community mental health teams are examined, using Diary-interview Schedules to record how new clients are 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. Furthermore, Field-notes were made of substantive, methodological, and pre-analytical observations made during visits to the team centres. The report concludes that although there is an occupational hierarchy and inter-disciplinary rivalry in the teams, the psychiatric nurse enjoys a large amount of de facto clinical autonomy. The psychiatric nurse has also a dynamic and invariably unsupervised influence on the creation and pathway of psychiatric careers for those who are referred to her or him. Recommendations include the need to affirm authoritative leadership in the team, and for formal supervisory procedures to be installed. It is also recommended that psychiatric nurses in the community should re-assess their occupational strategy of professionalisation, with a view to a re-alignment with medical practitioners.