How Australia Is Expanding Advanced Practice Psychiatric Nursing with Nathan Dart

A psychiatric nursing system can add staff, add clinics, even add prescribing rights and still feel broken if the care stays fragmented. We sit down with Australian nurse leader Nathan Dart to get a grounded look at what is changing in mental health services across Australia, what still isn’t working, and why Peplau’s interpersonal focus keeps showing up as the missing ingredient when reforms get too task-heavy.

We talk advanced practice nursing and the nurse practitioner model in a largely publicly funded mental health system, including how prescribing works now and what new registered nurse prescribing legislation could mean on the ground. Nathan shares what it looks like to trial nurse-led clozapine clinics designed to be less fragmented by combining therapeutic relationship, physical health monitoring, metabolic requirements, and medication management under clearer clinical continuity.

From there, we zoom out to the day-to-day reality: big systems, high demand, and services that have historically leaned hard on risk assessment and repeated questioning. Nathan describes the push toward more therapeutic interventions, suicide prevention work like Zero Suicide, and growing access to evidence-based psychotherapy such as DBT. We also dig into the “therapeutic use of self,” reflective practice, and one patient story that captures why not everything that counts can be counted.

Finally, we look ahead 10 years. With rapid workforce expansion and many senior clinicians retiring, what “traditional” psychiatric nursing skills are at risk, and what innovations can protect quality and professional identity? If you care about psychiatric mental health nursing, nurse-led care, and practical system reform that doesn’t lose the human being, this conversation is for you. Subscribe, share the episode with a colleague, and leave a review with the change you most want to see next.

Let’s Connect

Dr Dan Wesemann

Email: daniel-wesemann@uiowa.edu

Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner

LinkedIn: www.linkedin.com/in/daniel-wesemann

 Dr Kate Melino

Email: Katerina.Melino@ucsf.edu

 Dr Sean Convoy

Email: sc585@duke.edu

 Dr Melissa Chapman

Email: mchapman@pdastats.com

Transcript

Welcome And Meet Nathan Dart

SPEAKER_03 0:31

Welcome back, everybody, to another episode of Pep Lao's Ghosts. I am Dan Leesman. I am joined by the ever-present Dr. Sean Convoy and Dr. Kate Molino. And we are thrilled to have another international guest on our podcast. I'm super excited to introduce Mr. Nathan Dart, soon to be Dr. Nathan Dart, as I hear. So congratulations early on that. He serves as the director of nursing at the Metro North Mental Health and the board director. We're just talking the second year as the Australian College of Mental Health Nurses, as you will hear soon with the accents. Although he tells me I have an accent, I don't hear it, but but I hear his accent. You'll hear his accent as well. You'll understand that he does practice and is an established and senior nurse leader down from Australia. So I'm really excited to get to know his perspective on mental health nursing, psychiatric mental health nursing, and how advanced practice nurses operate down in Australia. So maybe that's where I'll start off with a little bit, you know, is I think one of the passions that we've had for this podcast in Peplow's Ghost is to really kind of pay homage to the ghost of Hildegard Peplow. And I should ask Nathan, do you know who Hildegard Pepplau is? And I apologize if that's a very offensive question. I don't know if she's just UX US centric or not.

SPEAKER_00 1:49

No, it's not US US centric. It's um, you know, it's a part of our our curriculum and you know it's foundational in in a lot of the work or or you know in our education system here for mental health nursing.

Advanced Practice Nursing In Australia

SPEAKER_03 2:02

Wonderful. Good. I know she's in Europe as well. People kind of know, but but thank you again. I didn't mean to be offensive, but but again, with Hildegard and kind of her idea of really kind of keeping the interpersonal and relationship part of the work that we do very integral. Do you mind sharing kind of how advanced practice nurses are utilized or you know, what's on the, you know, how they're currently being seen and maybe utilized within the healthcare system in Australia?

SPEAKER_00 2:29

So within the within our context here in Australia, I think you know, advanced practice nursing is is really starting to take off. I guess, you know, nurse practitioner models are really something that the the government is investing in. I guess one of the biggest differences the majority of our mental health services here in Australia are publicly funded. So a lot of services, you know, people access, you know, via government funding. I guess nurse practitioner models is something that is really probably in the last three to five years are really starting to grow legs. And, you know, I think with the international shortage of medical staff, it's been an opportune time for us to look at nurse-led models of care. So a lot of community services are moving to including nurse practitioners. That doesn't mean that mental health nurses that aren't nurse practitioners don't play a pivotal role. But yeah, that's probably one of the biggest differences in how services are provided.

Prescribing Rights And Clozapine Clinics

SPEAKER_03 3:34

Super. So it sounds like the the federal government is kind of having a real push on and getting nurses more involved in kind of those advanced practice roles. So in the United States, you know, there's like I said, this podcast has been kind of, I think, a passion project for us as far as you know, the over dependence on prescribing medication. In Australia, uh, do advanced practice like mental health nurses, do they prescribe medications? Is there have to be a relationship with a physician, or or how does that all look, Nathan?

SPEAKER_00 4:02

I think there's a combination of both. So nurse practitioners have prescribing rights, so they can prescribe medication. I guess if you're not a nurse practitioner, Australia has just passed legislation which will see registered nurse prescribing. It's very early in that game, so we we just don't know how that's gonna how that will play out from a practical point on the ground. I guess we use a very multidisciplinary team model, which is, you know, usually medically led, but we are seeing uh a shift into more autonomous NES-led models of care. I mean, an example of that is in my service, you know, we're trialing nest-led Cozapen clinics so that it's therapeutic, it's looking after physical health, it's doing the you know the metabolic requirements and the prescribing. Now that that is early days, so there is still some you know medical governance, but we might see a shift in that as you know we prove that that that model really really works. But I guess the the model is underpinned by that that relational well-being, not just the medication prescribing itself. And we see that as you know less fragmented. So you know, we used to have care coordination, or we still have coordinate care coordination, but now we're trialing, you know, the clinician-led relationship with the patient, and and you know, that's ongoing. Early indications are that's really beneficial, and and more from the relational side, you know, uh and increased adherence to a medication that's high risk, but does work in in a population that that need it.

What Peplau Would Praise Or Fix

SPEAKER_03 5:46

Yeah, thanks for sharing. That's awesome. I yeah, I I love that kind of wraparound type of thing. So that's awesome. Sean, I'll turn it over to you.

SPEAKER_04 5:54

Yeah, Nathan, question for you. Imagine the ghost of Hildegar Peplow is hovering over your shoulder as you execute your daily duties as both a nurse clinician and nurse leader. What do you suspect she would say you're doing well in Australia? And what do you suspect she would suggest you need to improve upon? That's a tough question.

SPEAKER_01 6:15

Yeah.

SPEAKER_00 6:17

What we're doing well is really trying to make mental health nurses, you know, more therapeutic. So trying to reduce the fragmentation in our system. So our systems are big, they're complex, patients move between different parts of the system. So we're really trying to move from case management and task-oriented to care coordination, which would see, you know, mental health nurses and our allied health colleagues being central into providing care, not just providing case management. I guess we're investing a lot in a therapeutic model. We've just appointed a director of therapies so that we move from being risk-adverse assessment-based services to actually providing an intervention, and that those interventions are therapeutic in nature. So investing quite heavily in you know, suicide prevention models, uh, we use zero suicide uh where I work, so that it's assessment, it's you know, formulation, it's safety planning that's you know very practical and interventional. So I think we're we're moving in the right direction in trying to be, you know, as I said, you know, more therapeutic. I guess the negative or what we're not doing well is we haven't got that right yet. You know, the the system is so big, it's stretched, you know, demand is is high, and we're working hard on getting that more coordinated, but you know, there are challenges with that as well. You know, uh we're moving to increase access to DBT clinics or DBT-like services. So again, so it's more evidence-based rather than just you know I don't know what the word is, but so so so so so it's more meaning for buck. I think as services we've been very risk adverse, and we we, you know, I remember sitting with a family and and talking about them, talking to them about their experience with our service, and it was, you know, you know, the acute care team came around three times in the week and you know, it was just assessment and questions. So moving from assessment and questions to, you know, what can we practically do to move move things forward and reduce reliance on on mental health services and empower patients to you know get better.

Growing Therapeutic Use Of Self

SPEAKER_04 9:01

Nathan, it sounds like we have some similar challenges, and I'll I'll tell you, you know, one thing a mentor of mine once said is Sean, you have to take an appetite suppressant for change that more often than not, these big systems issues are like turning around an aircraft carrier. So thank you. Go ahead, Kate. Yeah.

SPEAKER_05 9:18

Thank you. And I'd like to build on something you said, Nathan, which is about you know creating opportunities for nurses to be more therapeutic. And so I'm curious to know a little bit about you. How has your understanding of therapeutic use of self evolved from your early days in training to today as a leader in the field?

SPEAKER_01 9:41

Some questions.

SPEAKER_00 9:43

I think, as you know, I'm I'm I'm 25 years in into my career. I think every interaction you have with a patient, you learn something about them, but you also learn something about yourself. And when I say that, you learn something about that that interaction or how you've crafted the conversation to make that assessment or offer you know some sort of insight for them. And I think you know, that's how you get your experience. So it's more about that reflective practice around how you manage different conversations with different patients, and and everyone comes from a different angle or a different socioeconomic background, and that really has to guide your practice and how you engage with that particular individual. I remember, you know, a patient who was really quite unwell and a lot of self-induroused behaviors, and the emotion that that can can rise in a clinician, and you know, 10 years later to see the same patient doing you know advocacy work with you know a real change in lifestyle and life and and and a better life. And you know, she talks about that one interaction. So she's probably had thousands of interactions with a with a mental health nurse, a psychiatrist, but she talks about the one interaction that that made change. So I think when I I talk to patients and I do that less these days, but but when I do, it's about this could be that interaction for that person. So there's always got to be holding their hope, and and it might transfer.

Beyond Diagnosis Toward Recovery Goals

SPEAKER_03 11:33

Yeah, that's great. I mean, this is this is good because you know it's it's it's getting more to kind of understanding because I I know my next question kind of goes into that a little bit more about you know, like a medical diagnosis, you know, when we we look at a patient, we have to kind of you know be with them for a certain amount of time, and then we have to make a an assessment and a diagnosis very quickly. Can you kind of share a little bit about what you do as far as maybe you know looking past any you know biological data and trying to find the human being within that person that maybe Peplau was talking about, keeping that the center of our work? You know, how do you kind of you know get to know that person and know what's important to them?

SPEAKER_01 12:18

I think we are.

SPEAKER_00 12:22

Our system here in Australia is a little bit biological in sense. So funding is you know based on getting, you know, certain diagnosis, interactions, you know, service provision, and that all goes into an algorithm and and spits out the funding at the end of the day. I think that's the task-oriented stuff we do as clinicians because it's required. But you know anyone can have a diagnosis, but their their personal circumstances, their you know, where they're at, what they're thinking can be is very individualized to them. So that needs to be at the core of discussion. And I think you know, when you when you're looking after people, you you want to understand, you know, what's going on for them right now and what we can do to help regardless of diagnosis, but also you know, what is their future goals and how can we develop a plan to sort of get to that endpoint. And that may not necessarily be diagnosis-driven. So in the back of the mind, you know, you've got the diagnosis and how we can get them as well as possible. That may or may not include medication, but I think the interaction needs to be centered about what where they're at, where they want to go, and what's the journey, and how can we break that into pieces so that they've got achievable goals until you you sort of catch up next time. So, you know, uh you've got to balance your knowledge as a clinician with you know what their recovery goals are, I guess. And you know, sometimes that may not align with your own values, but it's where where they want to be or where they want to get to, and you know, we we sort of hold their hope and get on the on the journey with them. And sometimes that's easy and sometimes that's very difficult.

SPEAKER_03 14:22

Yeah, it reminds me, you know, I had a professor that I looked up to quite significantly, and um he would he was you know applying for federal big you know grants funding and things, and he would always be looking at these outcomes, and he always felt like he had to put some biological thing in there. So he's always he was measuring cortisol levels, so kind of you know, saliva-based cortisol levels, and and he always thought that was kind of always a bit kind of an add-on part of his research, but but he knew he could get funded kind of at a federal and kind of the bigger grants that were looking at some sort of biological data. But it's always been, you know, and that's been the struggle. Some of the reading I've been doing lately, too, is just you know, are we looking at the right thing? You know, when we treat someone with depression or schizophrenia or whatever diagnosis we want to say, you know, are we looking at the right outcomes? Is this, you know, is you know, shouldn't we look at the person more than than just you know getting a pH q nine that's been you know decreased or something like that? So yeah, thanks, Nathan. I appreciate your perspective.

SPEAKER_00 15:20

Yeah, I think um yeah, it it can be a combination of both. Yeah.

SPEAKER_04 15:27

Nathan, I'm gonna I'm gonna shift gears and kind of bring this more closer to your actual clinical practice. You said you've been in practicing as a psychiatric nurse for 25 years. That's incredible. Can you reflect on a specific psychotherapeutic experience you've had over the years with a patient that crystallized to you the inherent value of the therapeutic relationship?

SPEAKER_01 15:48

De-identify it and tell us the story.

SPEAKER_00 15:58

I can remember being a new graduate nurse uh on a ward and a patient with, you know, quite a complex severe eating disorder and self-harm. And I can remember or you know, recall as a junior clinician how frustrating and how disturbing that was to be a part of, and you know, sort of the the pain and the anguish and the trauma background that this young person had, and not knowing at times what to say, what to do, and you know, sort of just being an onlooker as a as a clinician or a very inexperienced clinician, and then sort of fast forward a few years, the same patient was still uh a real part of the system. And you know, we talk about revolving doors coming in and out. And then I moved from inpatient setting and was working in the community where this young lady was a patient, and having to look after her with a little bit more experience and trying to really understand her history, her trauma, and you know, we did some good work, and you know, she she went about eight to twelve months before having another relapse and requiring inpatient care. And then after that inpatient setting moved away, and I I didn't see her again. And then I saw her in a social setting about five years after that, and to have a conversation with an ex-patient in a social setting that hadn't been to hospital for four years and had really, you know, taken charge of her own life and got employment, and you know, there were still struggles, but hadn't been in hospital that linked that long. And, you know, you don't at that particular juncture think that you've offered much, but to see someone in a social setting and for them to say thank you, you were a part of their their recovery, I think that's probably one of the most rewarding feedback loops that you don't expect. And someone that you know you had a long interaction with, and starting as a junior clinician, and you know, you know, that you know, that transference, that frustration, that, you know, why are you doing this, and not really understanding that as a junior clinician, and then working through some of that as a more experienced clinician in a community setting, and then losing touch, but that feedback loop, I think that's probably you know one of the situations I really reflect on.

SPEAKER_04 18:42

Thank you for that, Nathan. I um I'm I'm thinking about what you just said, and I'm thinking about what Dan previously talked about in terms of how we relatively value unit our role. And it it's reminding me of a quote from uh William Cameron. I think he said something to the effect of not everything that counts can be counted, and not everything that counts should be counted. You know, what you did there that needs to be counted. Thanks. Kate?

Skills At Risk And Workforce Innovation

SPEAKER_05 19:08

Thank you. What a what an incredible example. Nathan, my question for you is you've talked a lot about how advanced practice psychiatric nursing in Australia is is changing and growing and so on. And looking at the landscape of psychiatric nursing over the next 10 years, what is one quote unquote traditional skill that you fear we might be losing as psych nurses? And what is one modern innovation that you're excited to embrace in the Australian context?

SPEAKER_00 19:49

We are growing rapidly. So, you know, in Victoria, we've had, you know, a few years ago a Royal Commission into Mental Health. Here in Queensland, closer to home, we've had a parliamentary inquiry into public mental health services. And I guess the purpose of both of those reviews were to try and fix what's broken in a very large and complex system. So what that has resulted in is huge funding reform. And, you know, as a director of nursing, we are growing rapidly, but the pipeline is is very junior clinicians coming into our service. So, you know, that's challenging because you know, with the the aging population of nurses or mental health nurses, they're exiting the system because they're they're old and they they're retiring. So that that ability for more experienced nurses to pass on their skill set to our more junior clinicians, you know, so I fear we're we're we're losing that transfer of skills rapidly and then you know that therapeutic use of self. And you know, it's challenging to support and grow and educate because a lot of the work we do, I believe, you know, you you look at skilled nurses around you and you take the best of what they do and you put it in your toolkit, and that's how you develop your you know, your your clinical skills moving forward. So I do do fear that the rapid growth is is really challenging our our system. But I remain optimistic as we you know in Australia that the the the work the college is doing, you know, our credentialing uh for mental health nurses to sort of retain that specialist skill and you know that professional identity. You know, I I do have hope, but I I do balance that with the reality of of what we're we're dealing with in services. You know, one of the biggest innovations for us is. you know our our transition support program you know and you know we're really developing a a pathway to practice which is you know embedding that postgraduate mental health nursing into to our expectations as clinicians you know grow and and progress through their career so again I think it's the same the the challenge is is our rapid growth and the investments very needed but you know with that rapid growth how do we make sure that the mental health nursing product that we're developing is of of a high quality you know that is a challenge and a risk but it's also an opportunity and I guess it's how we use that opportunity to to make sure that that we're at the core of you know system reform.

SPEAKER_05 22:46

It sounds like such an exciting time and and like you said it's a real opportunity to be very intentional about how to build this out too and I also am imagining that this might be a focus of conversation that is related to the background on your Zoom screen right now that our listeners can't see but wondering if you wanted to speak about that a little bit so a very proud board director of the Australian College of Mental Health nurses.

SPEAKER_00 23:15

I guess that in Australia is our professional organization. So being a part of that is an absolute honour for me. And we are celebrating 50 years as an organization this year and our conference is going to celebrate that 50 years in in Adelaide between the 7th and the 9th of October and for those that don't know Australia well Adelaide is extremely renowned as you know the best wine growing country so hopefully it'll be a good exchange of professional ideas and innovations with a nice Barossa Valley Love it.

Building A Global Voice For Nurses

SPEAKER_03 24:00

That's great. I mean that's I mean you should have that on a t-shirt for sure I mean that's going to draw lots of registrants for your conference. So yeah thank you and maybe just to kind of wrap up this uh podcast which again thank you Nathan for your time I know it's really early in Australia while we're recording this so thank you for that and sacrificing a little bit of your Saturday but you know talking about organizations I know one of the things one of the places where we first met was with the International Council of Mental Health Nurses in uh Barcelona we talked a little bit about this with Rhonda and Oliver that we had on a previous podcast but what are your what are your hopes and excitements about that organization and and you know if if you could like you know as we sometimes say you know your crystal ball of looking to the future of that organization what do you what do you hope you know develops from this and yeah what are your dreams and aspirations related to the International Council on mental health nurses yeah my hopes and dreams is that the International Council grows legs early indications from around the globe and Dan you were a pivotal part of this is that it will slowly but surely over time form and we can have a voice and an identity that will see mental health and nursing that's our term here in Australia but psychiatric nursing is is what you guys use.

SPEAKER_00 25:20

But you know being a powerful recognized discipline within its own right that is a part of the broader international system and and and and not just watching from the sidelines.

SPEAKER_03 25:37

Yeah having a seat at the table has always been something that I think nurses have done and and have done very well and so this is just another opportunity for that. So Nathan thank you for your time and yeah thank you so much and in you've really inspired me your passion you know comes across very clearly and so thank you very much uh thank you for all who's listening appreciate it please drop in like share subscribe to the podcast we'll have new episodes coming out shortly but thank you again to Soon to be Dr. Nathan darts and uh see us next on a new episode.

SPEAKER_02 26:11

We have darkness the world