Understaffed mental health units are deterring junior nurses from choosing a career in mental health nursing.
NSWNMA General Secretary Brett Holmes has warned a parliamentary inquiry of a “looming staffing crisis” in mental health units.
He was giving evidence to an inquiry into management of health care delivery in NSW.
“How do you encourage someone to take up mental health nursing if their experience is to walk into an acute mental health unit that is understaffed?” Brett asked.
“You have one or more psychotic patients bouncing around the walls, threatening people, being highly dangerous, and everyone is saying, ‘Our KPIs say we cannot use seclusion here and going near them for restraint requires six people and we only have five, so we have to wait for security to come from the other side of the hospital to help us.’
“That sort of experience is not impressive for a person who has not experienced mental health nursing nor has a mental health background.”
He said the nurse education program had to cover every speciality including mental health nursing and was inadequate preparation for a nurse assigned to a mental health unit.
“My own experience is that I had 18 months to undertake a mental health certificate in those days and even at the end I was just a beginning practitioner.
“This is a volatile workplace to walk into and your first impression can be a fairly stinging one if you get into a situation where you are seeing a person who is affected by methamphetamine and is not controllable by normal means. That is a pretty scary thing.”
Support and resources vital if seclusion is reduced
Brett told the MPs that the use of seclusion and restraint in NSW can be reduced but only with the right support and resources.
“Seclusion must remain an option and necessary last resort to ensure optimum safety in NSW mental health facilities.”
He said the Ministry of Health recently produced – without any consultation with nurses – a new state-wide policy directive requiring “very high levels of observation and recording of those observations” in mental health units.
This would have “severe consequences” for staff because current nursing hours per patient day were insufficient to implement the policy, he warned.
Any nurse who tried to implement the policy in an understaffed unit was “setting themselves up for failure” because of the additional time it would take.
“We truly wish to see a better outcome for mental health patients, but we also fear that the profession of mental health nursing is at a critical point where it becomes more and more difficult to stay in the profession.
“Those of us who were among the last to be trained in a psychiatric nursing certificate are now at the point of leaving as early as possible to access their superannuation, because of the level of risk and … inability to recognise the skills and advice of people with many decades of experience.
“I have not practised at the bedside for more than 27 years, but I know that … it is tougher for my members now than it ever was when I trained in 1984 to 1987.”
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