Janet McAdam

Read about Jan’s experience as a Consultant Nurse/Approved Clinician to discover what it’s really like.

I am a Consultant Nurse and Approved Clinician (AC) currently working in secure inpatient services, as Responsible Clinician for two wards. 

I always knew I wanted to progress to this role when working with newly appointed Nurse Consultants over 20 years ago. 

Janet McAdam

Consultant Nurse and Approved Clinician

I have worked as a Nurse Consultant since 2014, gained AC approval in 2017 and have worked in both Adult Mental Health and Secure In-patient services in this role. I am Vice Chair for the Yorkshire and Humber Northeast Approval Panel and a member of the Trust wide Multi professional AC steering oversight group. I co-facilitate mentoring sessions for professionals in the trust who are completing AC portfolio training and I am currently evaluating the impact of the nurse AC role. 

My area of clinical interest has always been psychosocial interventions (PSI), and over the years I have led on service improvement initiatives to support this within practice. This includes working with the local university to deliver whole team training in PSI for staff on a P.I.C.U, training staff in Behavioural family therapy (BFT Meriden Programme), and subsequent development of a virtual family therapy service. I am equally passionate about clinical nurse development, and nurses’ ability to access and facilitate quality clinical supervision. I deliver Resilience Based Clinical Supervision within practice and am currently working with the Foundation of Nursing studies (FoNs) to evaluate the impact of this.

Where and when did you start your nursing journey / What field of nursing did you qualify in?

I started my journey working as a care assistant in a nursing home. I truly believe this put me in good stead, as I developed my knowledge and skills working with people who required support with their basic human needs, at the beginning of my career. I then applied for a nursing assistant role on an Adult Mental Health (AMH) ward in 1995, until 1998 when I commenced my training as a Registered Mental Health Nurse.

What came next?

I took up my first post as a staff nurse in a Medium Secure Unit then progressed to an Assistant Clinical Lead (Band 6). During this time, I completed my mentorship module and trained in Behavioural Family Therapy (BFT), which I delivered in practice. Several years later I moved back to AMH services working initially as a Band 6 on a Psychiatric Intensive Care Unit (P.I.C.U). During this time, I completed a degree in Psychological Therapies.

I then worked as a Specialist Nurse Practitioner (Band 7) for nearly six years across four AMH wards and one PICU. During this time, I completed a MSC in Cognitive Behavioural Therapy (CBT) for psychosis. I continued to work with patients and their families but was also involved in service improvement initiatives relevant to the additional training I had received.

This included:

• Co-development with the local university, in the delivery of the whole team training in Psychosocial Intervention (PSI) on a P.I.C.U unit and subsequent audit to monitor progress. Psychosocial workup sessions and supervision to support this.

• Coordination of a virtual family intervention service across AMH inpatient and community services, including monthly referral and supervision sessions for staff trained in Behavioural family Therapy (BFT) or undertaking training.

• Co-development of a Hearing Voices Group within AMH inpatient service.

In 2011 I went back to secure inpatient services as Advanced Practitioner (Band 8a). During this time, I completed non-medical prescribing course. I continued to work with patients and their families delivering CBT and BFT. I then trained as a trainer in BFT and facilitated training and supervision of a core number of staff within the service in the BFT model, with the aim of driving forward interventions cited in NICE guidance for psychosis. Part of my role also included coordinating and providing evidence of the service meeting the programme of the Commissioning for Quality and Innovation (CQUIN) framework. Some of the core CQUINs included carer involvement and reducing restrictive interventions. This involved working with service users, staff and carers promoting service initiatives to meet the quality standards set out by NHS England. This was achieved through active engagement with stakeholders, including wider services, and NHS England. With an emphasis on acting as a change agent involving role modelling and facilitating training and supervision.

In 2014 I was successfully appointed as Consultant Nurse within the same service. It was during this time I set out on my journey to complete Approved Clinician status. This was supported locally by the service, but unfortunately at the time the trust did not have the governance arrangements in place to support this.

In 2018 I returned to my original trust as Consultant Nurse with Approved Clinician status. I worked within AMH for five years and secure inpatient services over the last year. I am the Consultant for one low secure female ward and two long term segregation wards working in the capacity of Responsible Clinician. In essence I have overall responsibility for the care and treatment of patients the same as my Consultant Psychiatrist colleagues do and work within a legal framework in which a non-section 12 Responsible Clinician can operate. The exception being I am a nurse and as such I strongly believe that I bring a different perspective to the table. Other aspects of the role include leadership, education, training, and supervision, service improvement and contributing to national forums. I am passionate that nurse’s access and promote clinical supervision and I routinely facilitate Resilience Based Clinical Supervision (RBCS) as a model of choice.

What were the challenges?

The challenge for me was navigating progression to Consultant Nurse with Approved Clinician status in the absence of a clear direction at trust level. I knew I wanted to be a Consultant Nurse over 20 years ago, when working with the first appointed Consultant Nurses. Then came New Ways of Working in 2007 with the amendments to the Mental Health Act (1983) meaning nurses and other professionals could work towards AC status. Development of this role for nurses has been slow on the uptake, but despite the challenges to get there I remained focused in the sense that I knew I wanted to remain in a clinical role.

I truly believe nursing progression remains a challenge for many nurses who wish to remain in clinical positions with direct patient care. Unfortunately, there remains a void between Specialist Nurse Practitioner (Band 7) and Consultant Nurse Role with little progression opportunity. With more of a national emphasis of new roles, now is the time for NHS trusts to map out clinical roles so we can develop a modern nurse workforce within mental health services. I strongly believe this will go a long way to promoting the retention of staff, but also meet the need of the people who we provide care for and enhance the quality of care we provide.

What academic qualifications did you gain along the way?

• BA in Psychological Therapies

• MSC in CBT for psychosis

• Non-Medical prescribing

• Post grad in Law

What were the learning points / would you do anything differently?

Learning points evolved along the way and there were stages to this, rather like novice to expert. My learning style is rather eclectic, and I am someone who needs to understand the theory but also walk the process or demonstrate practical application before I can confirm I fully understand something. Embarking on new training to then promote in practice evokes anxiety. It is a humbling process as you move out of your comfort zone. For me this was very evident when developing my knowledge and skills in psychological therapies and then later as Approved Clinician. At one point I questioned not only my ability to do the former, but also questioned if I was even a good nurse. Over the years I have come to accept that this process, including experiencing self-doubt, is an essential uncomfortable part of development and growth.

What advice would you give to others?

My advice would be to always develop your knowledge and skills in every area you work. Look for opportunities to enhance services with essential input from stakeholders. Always include service users, family and friends in this process. Think about mapping your nursing pathway out and what you want to aspire to. Think about what you need to do to get there and who can support you with this. Always access quality clinical supervision and finally take care of yourself and those around you.