An exploration of experience and perceptions; AIN working in Mental Health Drug and Alcohol Darrin Cowan Clinical Nurse Consultant Practice development Northern Sydney Local Health District

Background 2011 Northern Sydney Local Health District (NSLHD) implements an initiative strategy to employ AIN Mental Health/Drug and Alcohol (MHDA) settings. Modified Delphi Study (Cowan.D, Brunero.S et al. 2013) constructs AIN Scope of Practice for MHDA NSLHD establishes professional development framework for AIN working in MHDA. 2013 Recruitment and training of AIN into MHDA 2014 Current research into experience of AIN in MHDA in NSLHD Cowan.D, Brunero.S, Lamont.S and Joyce.M (2013). "Direct care activities for assistants in nursing in inpatient mental health settings in Australia: A modified Delphi study." Collegian: Journal of the Royal College of Nursing, Australia In Press.

Sample & Collection The study employed a purposive sampling method 11 AIN from NSLHD (7 Female / 4 male) All geographic sectors of the LHD represented Both undergraduate and Certificate III AIN represented Both Acute & Sub-acute settings represented Data collection Semi-structure 1:1 interviews Utilised 5 questions constructed to illicit AIN experience 1) Scope of Practice 2) role perception 3) education 4) inter-staff relationships & 5) role satisfaction

Method & Data Analysis Thematic Analysis utilised as outlined by Braun & Clarke (2006) used to generate themes and explore meaning 6 step process of data analysis 1) becoming familiar with the data 2) generating a system for coding data 3) searching for initial themes 4) *review of the themes against the (a) coded extracts and the (b) entire data set 5) deconstruction and thematic reconstruction of grouped codes, defining themes 6) Synthesis of the final report that conveys the experience of the participant * 4 researchers cross-referenced notes and themes to ensure and validity and consistency amounts themes

Role definition and clarity Dual perception of role I personally think if we do everything for them we rob them of their independence, it sort of makes them, I dont know what words can use, let me see These clients are fully fledged human beings just like myself -Participant 4 Misinterpretation/understanding of SOP by all staff I have been doing endless ECGs here. And, after five months of working here I realise Im not actually allowed to do that. -Participant 10 Scope and role malleable to suit ward construct/workload etc. .at new admissions, I can cover almost everything that the RNs do because sometimes they just dont have the time -Participant 1

Socialisation and Adaption AIN generally happy with integration/acceptance to MHDA the people you are working with, thats the best thing that makes the workplace enjoyable. Theres no more important thing than that. But I am very happy with this ward, theyre all nice -Participant 3 Active mentorship and being included are the greatest factors for positive socialisation you feel better about your role when the nurses come to you and be like oh, you can do ityou feel like you can do more and take on more responsibility, it feels good being, like, your role. -Participant 10 Role Satisfaction increase with familiarity to routine and environment. The job became more enjoyable as I started to learn what the real routine was -Participant 6

Education and Training Mixed response attendance at correlated with higher satisfaction Yes, it was helpful, yes. But it my case I already learnt about that from the school, so I could revise all the content, the mental health content -Participant 7 AIN identified both practical and theoretical areas for further education I only learnt about how to write the progress notes in general hospital, not the mental hospital. So, I do like to learn what is different what is different from mental hospitals progress note and general hospitals progress note -Participant 1 AIN wanted education to follow their practical experience

Recommendation Further and continuing education needed For both AIN and existing staff Appointment of ward-based Preceptor Further research and exploration into Needs of Undergraduate & Cert III AIN to be addressed Utilities of Undergraduate & Cert III AIN to be addressed Constructing an professional identity for MHDA AIN Retention Drawing undergraduates into MHDA Overarching governance of AIN AHPRA registration

Conclusion Numerous avenues for improvement Positive culture exists to cultivate AIN Likely that improvement in an of the identified themes will have a positive impact on AIN utility and efficacy.