Not many managers in mental health nursing can claim to have worked in the Royal Engineers and as a healthcare assistant. For Andy Johnston, however, it was those early experiences that led him to start nurse training in 1988. He is now a hospital manager. Here, he charts his career's trajectory
While training as a nurse at St John's Hospital in Lincoln, I realised that just doing my regular shifts without understanding the bigger picture - and what I might be able to do to influence it - was never going to be enough.
That is one reason why I became a Royal College of Nursing student representative and, after I qualified, a steward and then branch chair. The conferences, courses and resources this opened up to me helped satisfy my interests in practice development and the politics of healthcare provision.
In 1992, after my first staff nurse job, I went to work for a group of GP fund-holders. I had done some anxiety and phobia management courses and they were looking for someone to do specialist one-to-one and group work rather than pay for a community psychiatric nurse to provide a generic service. Looking back, I think what I did was more about enthusiasm and commitment than skills, but it was an interesting time and gave me an insight into how things could be done differently.
From 1994 to 1996, I was a mental health nursing undergraduate at the University of Nottingham. Funding was not available, so I supported myself through agency work. As a result, I finished the course with an academic qualification and lots of experience and confidence.
Psychiatric intensive care
I first worked on a psychiatric intensive care unit in 1997, at the Diana, Princess of Wales Hospital in Grimsby. Around this time, Dr Dominic Beer's paper Hot Beds of General Psychiatry was published and the National Association of Psychiatric Intensive Care Units was formed.
Since then, the association has played an important part in developing national minimum standards for psychiatric intensive care and now publishes the Journal of Psychiatric Intensive Care. I was fortunate to have my first exposure to intensive care services on the cusp of all this activity.
In 1999, I took a secondment as an associate full-time officer with the RCN Yorkshire and Northern Region and in 2001 I moved to the then Buckinghamshire Mental Health trust, as a unit manager commissioning, developing and then running new intensive care services. The same year, I was elected executive secretary of the National Association of Psychiatric Intensive Care Units, a post to which I have since been re-elected twice.
I took up a senior nurse manager post in 2003 with the West London Mental Health trust's medium-security services in Ealing. While there, I was seconded part-time to the National Institute for Mental Health in England to co-ordinate an intensive care unit and low-security governance network.
I started in my current job, managing Huntercombe, in 2005. It is a small, low-security hospital, and one of the attractions of the post was the chance to have overall responsibility for the development of evidence-based practice. The trust has won several awards in the past few years because we can demonstrate quality of care, added value and cost-effectiveness. Trying to develop practice and monitor quality in bigger units is very hard. You never quite feel as if you are closing the loop.
One of the conditions of taking my current post was that my employers would support me to finish the MBA I started at Grimsby. However, I have since been advised that with my experience of overseeing the development and redesign of services and managing budgets I should instead consider concentrating on my special interests in managing violence and aggression and teams and leadership.
I might not always have had good managers, but I have benefited from some exceptional mentors. They have pointed me in the right direction, guiding my studies and practice. They have also taken time to help me reflect and shown an interest in what I have done, not just what I am going on to do.
As part of my work with the National Association of Psychiatric Intensive Care Units I have reviewed around 40 psychiatric intensive care services across England, Wales and the Republic of Ireland. Now, I would like to have the chance to start something from scratch myself - a large state-of-the-art secure hospital - designing and then managing it to deliver on all the national and local priorities.