My Mental Health Nursing 'Patchwork' Career From Clinician To Leader
[Author] Simon Arday, Lead Nurse for Mental Health at Imperial College Healthcare NHS Trust
My route into nursing began before I ever sat down in a lecture or stepped onto a ward. It began when I was 13 and curious.
I was curious about the work that my mum (now a retired mental health nurse and social worker) did in supporting people with mental health needs. Over a number of months, she explained how mental health and wellbeing was as important as the physical. She detailed the biological, psychological and social factors that can enable us to flourish, or cause us to languish.
She emphasised how she or I could experience the challenges experienced by the people she helped, and how they were a part of being human. I didn’t decide then and there that I wanted to be a nurse, in fact; I held a number of roles in mental health before I eventually went on to train as a nurse. However, I did know that I wanted to spend my time helping people, because that felt like the right thing to do.
As many others who came before, have, and will come after me, my first nursing role was on an inpatient acute ward. It’s considered something of a rite of passage for newly qualified staff and I saw this as central to my nursing identity. A strong clinical foundation built on working with multiple people, with different needs, potentially at a time most challenging for them.
The clinical dexterity gained here has never left me and cannot be overstated. I often find myself returning to these early clinical experiences, as a compass, or guide. I don’t know if I have ever had or found a ‘true north’ as a nurse - but reminding myself that I am a clinician first, comes close. It’s been a ‘safe space’ where I know I belong and has allowed me to explore other aspects of nursing.
I’ve come back to this ‘safe space’ that clinical practice offers over and over. At times, I’ve found it hard to leave, and have fought to not have to do so. Clinical practice has been a golden thread that has tethered me to what I believe to be important, and it has helped me stay grounded in the understanding that all the choices I make and influence have a consequence for a person who has the right to receive good care.
There is strength in diversity. I have recognised this as a person, and now realise it as a nurse. The same curiosity that guided me as a teenager has steered me towards novel opportunities - curious to learn ways to not only do things better, but to do better things. To understand what the ‘right’ work is.
Because of this, I’ve had what some have described as a ‘patchwork’ career. I’ve grown fond of this term as it speaks to the richness that can be gained from piecing the lessons together from diverse experiences.
In a relatively short space of time, I’ve had many roles - often because I have held more than one at the same time. This occurred for the first time just over a year from qualifying. I hadn’t long since been promoted to deputy ward manager, when I saw an advertisement for a part-time secondment.
It was for a newly established role to support pre-registration student development and experience. I was interested in education, and didn't know how or where to start, so I threw my hat into the ring, and hoped for a good outcome. I started the secondment in October of that year.
Around this time, I was considering my career options. Clinical, managerial or academic? The choices and opportunities were limited for mental health nurses. More so if you wanted to remain in the clinical space. My sights had been set on Liaison Psychiatry since my student days. But I wasn’t there yet.
And what would happen once I did arrive in that ‘lane’? Would I have to stay there as many are told to do? I was committed to trying to find the career that fitted me best and this meant opening myself to different experiences.
I decided to trust in the process, and make decisions about my career when they had meaning for me. In doing this, I soon came to realise that there were no lanes, or if there were, I needed to create my own.
Looking back, I didn’t set out with the intention of taking this path. Whether through choice or circumstance, this is my story. It’s been unconventional, varied and often laced with uncertainty. In spite of this, I’ve stuck with the choices I made for myself.
My formula for discovery has, and will always place clinical care at the centre - whether through the values I hold, or in actual roles. And this formula has led me on an amazing journey over the years.
I did make it as a psychiatric liaison nurse, where I learned the importance of holding mental and physical health needs in the same space. I developed a rotational nursing programme for RMNs and RGNs as part of a London-wide pilot. We aimed to improve holistic care for people with mental health needs who came to the attention of services in a crisis.
I was a clinical advisor to a national unit established to meet workforce challenges in healthcare, and a senior lecturer in parity of esteem. At one point, I was even the only Specialist Renal Mental Health Nurse in the country!
Each and every role has made a difference professionally, and personally. However, I highlight my year spent as a Darzi Fellow as truly transformative. The Darzi Fellowship was designed to develop leaders who could achieve complex change within the healthcare system. It’s fair to say that the fellowship found me.
It wasn’t something that I went looking for or, if I’m honest, even knew existed at the time. I only applied for it because it allowed me to continue the pilot I had started. I believed in that work and it felt right to focus my energy there. I welcomed the opportunity to continue to pour my passion into it. But it ended up expanding my world and my perception of my ability to change it.
Transformative Learning Theory, as I understand it, speaks to how we expand our consciousness, enabling us to challenge our sense of self, what we believe, and how we choose to act. From this we are able to take on new perspectives which enhance our ability to self-motivate and self-govern, to collaborate and empathise. This is how I have made sense of what happened to me during that year.
I became focused on ‘finding my voice’ - or learning how to amplify the one I had in influential spaces. I explored what type of leader I aspired to be, and realised how important authenticity was to me. I widened my gaze; stripped away aspects of any imposter syndrome; and changed my perspective on how I could have a positive impact on the people I cared for.
I realised that empathy wasn’t just about increasing my capacity to understand another’s feelings, it was also about increasing my capacity to respond appropriately to it - and that meant working, influencing, and agitating at a systems-level.
Ambition is a strange thing. When I started on this path over a decade ago, I didn’t aspire to the career I’ve had. I wouldn’t have dreamt about occupying the roles I have, and the role I currently do. I wouldn’t have said that I was ambitious then. But I am now.
I’m driven to be in the room where it happens (to borrow a line from one of my favourite musicals), doing my best to steer the work that feels ‘right’. I’m firm in my position that I have much to contribute, and the ability to impact change at scale.
I’m aware of my aspiration to be a positive example for others, in the realisation that I am still in the minority - a black, male senior leader in the NHS. I truly believe that I belong in this space, and above all, I intend to occupy it in no other guise than that of my authentic self, so that when others, like me, claim their space, they can do so as they are.
Further reading by the same author:
Top Career Tips for Black and Ethnic Minority Mental Health Professionals
Resources:
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Health Education England: Mental Health Nursing - Competence and Career Framework
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NHS Confederation Podcast. BME leadership in the mental health sector: How can the NHS foster an environment that welcomes more people from diverse backgrounds into senior positions? 5 September 2018
