Nurses reject dangerous work practice 

Mental health nurses in Albury force authorities to shut down and remodel an unsafe facility.   

NSWNMA members have refused on safety grounds to work as directed in the high dependency unit (HDU) of Nolan House, part of the Albury Wodonga Health campus on the border of NSW and Victoria.

Their stand – including closing beds and refusing to admit patients – led to an occupational health and safety review, a meeting with a NSW minister and an agreement to reconfigure the HDU to make it safer.

Nolan House is a 24-bed acute unit including a seclusion room and the three-bed HDU with bedrooms, lounge and a courtyard. The HDU accommodates acutely mentally ill patients, who may be highly aggressive/homicidal or suicidal and/or drug induced.

Both states fund the service and though the nurses are employed by NSW Health they are seconded to Victoria, which manages the campus.

A lack of clear jurisdiction bet-ween the states has caused confusion about which policies and practices nurses should follow.

Nolan House staff were not permanently stationed inside the HDU, which had a single entrance/exit door that needed a key to be opened from the inside.

Instead, staff constantly mon-itored patients through large windows plus state-of-the-art CCTV to eliminate blind spots.

Victorian directive inconsistent with NSW

Gillian Rhodes, secretary of the NSWNMA’s Nolan House branch, said staff “constantly met patients’ needs by frequently entering the HDU in pairs in a safe environment.”

“However, the Victorian chief psychiatrist visited the facility and without consultation with nurses, directed that staff should stay inside the HDU at all times. If not, they were to record every episode as a seclusion.

“The directive may have been in line with Victorian policy, but it was inconsistent with NSW Health policy.

“With an exit by key only there were episodes when staff were trapped and unable to exit the HDU until they were safely extracted with the aid of police and/or hospital security and porters.

“Branch officials told the chief executive of Albury Wodonga Health (AWH), Leigh McJames, that members would not comply with the request of the chief psychiatrist.

“The union organised an OHS inspection, which confirmed the unit was unsafe and we presented the findings to the CEO.”

The branch decided to close the HDU beds and refuse to admit patients in the emergency department who were deemed to be high risk and requiring an HDU bed.

It also passed resolutions criticising the lack of consultation with nurses and attempts to intimidate staff to comply with the directive.

“After a lot of discussion AWH agreed to suspend the operation of Nolan House and refer patients needing HDU level of care to other facilities,” Gillian said.

“Despite this understanding there were subsequent attempts to transfer ED patients into the closed HDU and the seclusion area, which were rejected.

“We also sought a meeting with the NSW Minister for Mental Health, Tanya Davies, to outline problems arising from the confusion over which state legislation and policies we were supposed to be under.”

The minister met with a union delegation including branch president Catherine Winchester, and delegates Jason Pascoe and Gillian.

Ms Davies agreed the situation was complex and said nurses’ concerns would be addressed by a redrafting of the memorandum of understanding governing management of AWH, which was
due to be finished by December.