Joint working between health and social care is all the rage but the field of learning difficulties has been pioneering a joint practitioner role since the 1980s. Dave Sims looks at new research on the success of the role
Joint training in learning disability nursing and social work first emerged in the 1980s when the closure of long-stay hospitals for people with learning difficulties was at its height.
The training councils for nursing and social work decided to experiment with a course that would combine learning disability nursing and social work. They were looking for a new practitioner role to work in the community, who would combine the clinical skills of the nurse with the networking and communication skills of the social worker. Someone to work across the health and social care divide.
In the 1990s, the idea of joint training took hold and was established in six universities, spurred on by the growing integration agenda that over the years has led from joint commissioning of learning difficulty services to the emergence of care trusts and the breakdown and stretching of traditional boundaries in learning difficulties. This could only benefit people with learning difficulties.
Five universities currently offer the training, one of which also offers joint training in mental health nursing and social work. In three years, students achieve full qualification as both a nurse and a social worker. But what has become of the practitioners? What makes these people useful to services and why have they been hidden for so long? And can you really practise two professions at once?
The Nursing and Midwifery Council and the General Social Care Council do not hold records of how many of these practitioners have qualified, so a survey was sent to the universities in question who circulated it to as many former students as they could. We received 47 questionnaires and carried out a further 25 interviews.
Of those who responded, 25 held posts in social work, 17 in learning disability nursing and five were in other posts including two people working as mental health workers in child and adolescent mental health teams. Five people had switched between jobs in nursing and social work since completing their course. Almost all the respondents had maintained their focus on disability.
In the interviews, practitioners said they felt they had been well prepared by their courses, although some believed that when they went into their first job they had to get up to speed with the particular requirements of the role. Most were disappointed that they could not practise as a joint practitioner because no roles existed which allowed them to use all their skills at the same time. One said he felt a sense of "divided loyalty", and many were concerned that in having to choose one profession the skills of the other would be lost.
Those who worked as social workers were clearly using their health knowledge and talked a great deal about how this was part of their practice. One person described how on her community care assessments she crammed the health box full of information.
Those employed as nurses found they had a "bigger picture" of the service user's situation. They believed they were good networkers and were strongly influenced by the social model of disability. Respondents consistently used the term holistic to describe their practice.
Having a broad knowledge base was seen as one of the biggest benefits of joint training. One person working as a learning disability nurse said: "I have a holistic approach and a rounded understanding of issues from both a social and health perspective. I am also aware of which professionals to refer on to, therefore preventing people enduring pillar-to-post situations."
But practitioners believed that the real benefits of the training were being missed. Combining the roles of nurse and social worker could avoid delays in referral and assessment and streamline services for people with learning difficulties.
But no combined roles existed, and being forced into singular roles led to some anomalies for the practitioners. For example, some of those working as social workers had to refer clients needing a health assessment to a learning disability nurse in the same multidisciplinary team, despite being qualified nurses themselves. This could lead to the service user having to wait longer for their assessment than necessary.
Most interviewees reported a positive reaction from other professionals when they heard they were jointly trained. People were interested to hear about it. Some singly trained practitioners were critical and questioned how you could get two professional qualifications in only three years.
Overall, awareness about joint training was not very high, except perhaps in services close to the universities, which offered it. Practitioners were frustrated by a lack of training and support to maintain the dual skills.
Contrary to what might be expected from a course which combines two professions, the practitioners were not confused about their professional identity. "I call myself whatever I am doing at the time," said a social worker who had practised as a nurse for several years. "I am a 'social work enhanced nurse'," said another.
Joint training is an example of what happens when we rethink professional futures as it helps create a new identity based on broader knowledge, bringing together learning disability nursing and social work.
The research revealed that these practitioners felt adept at working along the boundaries of health and social care. A number referred to their ability to build bridges and cross boundaries. They were able to speak and understand the language of two cultures and could empathise with other professionals and sometimes mediate between them.
Respondents felt they brought the influence of their alternate discipline into play on whichever side of the health and social care divide they were obliged to make camp. Their broad insight benefited service users.
But most felt they were held back from achieving the real value of joint training -Êthe opportunity to practise as a nurse and a social worker at the same time, with all its potential benefits to the holistic care of people with learning difficulties.
Dave Sims is professional lead for social work at the University of Greenwich. He was course director of a joint training course in learning disability nursing and social work for four years. He has published a number of articles on the subject and maintains a strong interest in inter-professional education.
Training and learningJ Davis, P Rendell, D Sims, "The Joint Practitioner: A New Concept in Professional Training", The Journal of Interprofessional Care, Vol 4, No 13, 1999 D Sims, "Joint Training for Integrated Care", in T Leiba, S Glen, Multi-professional Learning for Nurses, Palgrave, 2002
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals' learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.
This article looks at the findings of a research study on the experiences of practitioners who jointly trained in learning disability nursing and social work. The research found that the training gave them a broad knowledge of the two disciplines, an ability to work across professional boundaries and to provide a holistic service. The article explores whether their full potential is being realised.
About the research
Dave Sims' research is being carried out as his thesis for a doctorate in education at the Institute of Education, London. The title of the study is The Influence of Joint Training on the Professional Identity, Skills and Working Practices of Graduates.
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