Loss of experience must be reversed

A shortage of experienced nurses has led to the overuse of seclusion in some mental health units, says nurse practitioner Joanne Seymour

Joanne has been a mental health nurse for 23 years and a nurse practitioner (NP) for 14 years.

Joanne believes the use of seclusion could be reduced if more NP positions were created for in-patient units.

NPs would role model best practice to junior nurses, helping them to avoid the need for seclusion. Victoria is already moving in this direction, she says.

“Seclusion should only be used as a last resort in extreme circumstances, for the safety of other patients and staff,” says Joanne.

“It should only be used when patients are highly agitated and aggressive and do not respond to medication.

“Some inexperienced mental health nurses who don’t yet have the necessary skills tend to use it as a first option, because they are scared of patients or they don’t feel they can communicate with them.

“The lack of experienced mental health nurses means seclusion is not always being used therapeutically or as a last resort as it should be.”

As an NP Joanne not only assesses patients but can also order investigations for them, prescribe medication and admit and discharge patients without them having to see a doctor.

A lack of career opportunities

She says there needs to be a focus on retaining experienced staff.

“Young nurses have adequate theoretical training but in a practical sense they will learn what is role modelled to them. If you don’t have senior staff to learn from then you learn bad practices right from the start.

“If you had NPs assigned to in-patient units they would help junior nurses to identify when patients are becoming distressed or agitated, review the effectiveness of their medications and ensure that situations don’t escalate to a point where patients need seclusion.”

Joanne says that in the absence of an NP, nurses have to rely on doctors, who are often not on duty on the wards.

Nurses are left to manage difficult behaviour as best they can because no doctor is available to review a patient’s medication.

Practical mental health training is also hampered by constraints on nurse educators.

“Nurse educators are often tied up in statewide rollouts of training programs or are required to work on wards to alleviate staff shortages. They don’t have enough time for clinically focused one-on-one education.”

More ED mental health nurses reduces restraint

Joanne says the use of restraint could be reduced by rostering more mental health nurses to EDs.

“If you had a 24-hour mental health presence in the ED you would have someone capable of engaging with patients, which would significantly reduce the use of restraint.”

Joanne says the government’s review into seclusion, restraint and observations follows a number of adverse incidents related to lack of compliance with observation procedures.

She suspects those procedures were introduced because of a growing reliance on junior nurses.

“Before these observation policies were implemented, mental health nurses engaged with patients a lot more and knew if they were escalating or becoming distressed.

“I think that those policies have given nurses permission to tick a checklist every so often to say they have seen someone. It doesn’t necessarily mean they are engaged with them.

“There is sometimes more focus on completing paperwork than attending to the person in front of them.”

Joanne urges mental health nurses to take any opportunity to contribute their ideas to the government review