Working out solutions: branching out into private practice has been challenging but very rewarding for three mental health nurses.

Take three very experienced mental health nurses. Mix in a desire by each of them for a new challenge. Add in a growing need, under the Health Practitioners Competence Assurance Act, for nurses to prove their competence and to undertake supervision. Blend in an impressive range of personal, professional and academic skills, including a doctoral thesis. Stir together and Working Solutions is the result.

Early last year Christchurch-based mental health nurses Karen Moke, Ruth Cochrane and Bronwyn Dunnachie were talking about their desire for new challenges. Moke, with 25 years' mental health nursing experience in New Zealand and overseas, in the private and public sectors, in rural primary and youth and family mental health, and with formal supervision training, was becoming a little restless career-wise. "I kept thinking there must be things we could do. I had an interest in nurse-led practice and we all had unique skills. I thought if we combined them, we could offer supervision to a wide range of people, not just nurses in the public sector, but to nurses in other sectors and to other health professionals," she explained.

Canterbury District Health Board supervision trainer and long-time nurse/case manager in adult mental health, Ruth Cochrane, said the mental health sector had a very robust supervision programme but other nursing specialties and other health organisations did not. She has been involved in clinical supervision both as a supervisor and more recently as a trainer, for 17 years. "Nurse-led supervision is important because nurses understand what nursing is." The third member of the Working Solutions trio, Dunnachie-McNatty, has extensive experience in child, adolescent and family mental health and is senior adviser for the Werry Centre in Auckland, which recently released a policy document for the Ministry of Health on child and adolescent mental health workforce development. She is an experienced child and family therapist, as well as working with adults with other therapy needs.

So once these three women--"all of similar vintage"--recognised they had a range of marketable and complementary skills, they worked on a business plan, helped by the Canterbury Development Corporation, which assists small businesses, and with different business mentors. The genesis of Working Solutions was in March/April last year, followed by an intense few months of business meetings as they worked out the details of how their practice would operate. By August the three had found and begun working from rooms in Sydenham, with the official launch of the business last November. As well as professional supervision, they offer psychotherapy, mentoring, training and education on mental health issues and employment assistance programmes. They continue to work part-time in their other roles.

A year since they first began taking clients, the three women are delighted with the move into private practice and confident of a growing demand for their services. "In the last two months the business has started taking off and inquiries are coming from fight across the spectrum. I've just had a query from a palliative care service and other professional groups are making inquiries," Cochrane said.

Credibility in nursing

They believe their promotion and networking, the fact they work in three different services and their credibility in nursing are all factors in the growing demand.

For Moke the biggest challenge of Working Solutions is trying to do more private work on top of her other commitments, including part-time work at Lincoln University's student health and support. But she is relishing the variety and flexibility of working independently. "There is a real freedom from bureaucracy and it is very rewarding working with individuals and seeing their growth."

For Cochrane seeing someone develop through supervision and to see them feel refreshed and able to work in a different way is a great reward. She gets frustrated that some organisations don't understand the value of supervision. "They don't make the link between the fact that with supervision staff will feel valued and supported and that will flow on to clients. Employers will have to acknowledge the need for supervision. It will catch on. We are pioneers in this area of work." Dunnachie enjoys working with a team contact, working with other health professionals, and assisting other people's learning.

While working together means some peer supervision, they each have formal supervision.

So what individual professional and personal skills they bring to Working Solutions? Moke sees her wide experience across a range of settings, her nursing leadership roles, her ability to work across age groups and her role in helping establish NZNO's mental health nurses' section as important skills. "I've also got a sense of humour and that helps."

Cochrane's 12 years' working as a district nurse/ case manager in the community means she has a very good understanding of the needs of nongovernmental organisations and of nurses working in the community. And her personal skills--"I'm very good at putting people at ease. I've a lot of wisdom, humour, compassion and empathy"--are also very important professionally.

Donnachie brings to Working Solutions a strong academic background,--she has a masters in counseling and her doctoral thesis was on depression during adolescence--clinical management experience and an ability to strategise at national level. While hesitant to name her personal qualities, her partners have no such hesitation. "She is innovative, encouraging, supportive and intelligent," they say.

One of Dunnachie's challenges when establishing the business was whether people would consider the trio's experience expertise and skills were worth paying for out of their own pockets. "But I now have the confidence that we have a great product and we are worth every cent we charge."