Pressure mounts on mental health services

Loss of senior staff worsens skill mix at Coffs Harbour hospital

Asevere staff shortage at Coffs Harbour Base Hospital’s mental health unit has been made worse because experienced senior nurses have been replaced by recent graduates.

‘We have lost a lot of senior staff in the mental health IPU (In-patient Psychiatry Unit) in recent years,’ said Scott Hanson, President of the Union’s mental health services Branch at the hospital.

‘Some staff have been recruited but they are mainly first and second-year post-graduate students with very little experience in mental health,’ he said.

‘It is up to the committed nurses working in the IPU to do double shifts, extra shifts, use security guards, or work with even shorter nursing numbers with higher patient loads to deliver the care that mental health patients are entitled to.’

Coffs Harbour is one of four North Coast Area hospitals that staged nurse and community rallies against budget and staff cuts last December.

‘We recently lost three staff members from the IPU with probably 50 years’ experience between them. They left to take up employment in the mental health rehab unit which has not been able to recruit enough staff despite being completed for almost 18 months,’ said Scott.

‘The three who recently left were replaced by graduate nurses for the most part, with minimal combined experience, as well as one experienced casual who was given permanent employment.

‘We have lost approximately eight experienced and senior staff who have applied to work in the rehab unit in the past 12 months, as well as numerous senior staff to the Acute Care Service since its inception.

‘Our casual pool employee numbers are miserable at best. The recruitment process has simply not recruited enough employees to allow our casual pool to increase from unsuccessful permanent candidates or from actual casual applicants.

‘The staffing shortage is exacerbated because we don’t have access to agency nursing staff,’ said Scott.

Coffs Harbour’s mental health unit has six high-dependency beds and 24 low-dependency beds and the occupancy rate is over 100% on average per annum.

Scott Hanson says about 20-25% of the unit’s nursing staff have minimal experience working within an acute in-patient unit. The unit has no nurse educators, no clinical nurse specialists and no clinical nurse consultants.

‘Our patient-to-staff ratio seems a lot worse than some other psychiatric wards in the North Coast area,’ he said.

‘We have asked the Reasonable Workloads Committee (RWC) to provide staffing numbers of comparable units within the health service to allow the RWC to address any inequalities that may exist.

‘We are running at 3:1 in the high-dependency unit unless the level of acuity increases or aggressive incidents are credible, then we can approach management and ask to put another nurse in the HDU. At times we have had to use hospital security guards to cover nursing shortages or to cover “specials” on the ward.

‘The low-dependency unit runs from 5/6:1. On day shift it is mostly 6:1 as the NUM’s workloads are already extensive and to take patient loads would not allow for appropriate therapeutic interactions with patients,’ said Scott.

The NSWNA mental health Branch at Coffs Harbour has asked the RWC to address a requirement that two nurses rather than one must go to the pharmacy to collect S4 and S8 medication for the mental health unit.

‘This rule was imposed several years ago from what we have been led to believe, after some drugs apparently went missing. This requirement takes two nurses away from the unit for the best part of an hour more than twice a day on some occasions,’ Scott said.

‘We want to be able to send one RN like every other ward in the hospital, and we are quite willing to count and sign medications into drug registers at the pharmacy and then recount and sign again with a co-signature on the pharmacy receipts when the medications are returned to the IPU.

‘As a group we feel we are being punished in some way for an event that occurred when the majority of staff were not even employed in the unit.

‘Also the majority, if not all other wards use air chutes for medication delivery, requisitions for work, keys etc but we don’t have the use of one on the IPU even though the system goes straight over the top of the nurses’ station.’

Scott said the Branch also wants the hospital to abolish a discriminatory rule banning psychiatric patients from picking up medicine when they are being discharged from hospital.