Patients, nurses exposed to greater risk

The NSWNMA has called on the Ministry of Health to intervene to stop local health districts employing assistants in nursing in mental health intensive care units.

Employing AiNs in mental health intensive care units (MHICUs) is “an ill considered approach” that will leave patients, visitors and nurses “exposed to an increased risk of significant and probable harm” said NSWNMA General Secretary Brett Holmes.

He made the comment in a letter to the ministry’s acting executive director of mental health, drug and alcohol programs, Dr Karin Lines.

Brett noted there was an increasing trend for LHD mental health services to try to cut costs by employing unregulated health workers.

He said AiNs were valuable members of the nursing team with a distinct role.

However their qualifications and knowledge in specialised acute areas such as acute mental health was “quite restricted” in comparison to the RN or EN with mental health qualifications and/or experience.

“Highly educated and experienced nursing clinicians are required to provide optimum care managing clients who have been detained under the Mental Health Act, due to being unwell and a high possibility of being a danger to themselves and/or others.”

These patients needed the most skilled and highly qualified nursing care “to ensure the best possible outcomes for all involved.”

“The limited training an AiN undergoes is not the appropriate level of training required to protect them and others from the very real risk of violence.

“Clients are often highly agitated, volatile and unpredictable.”

He said putting AiNs into MHICUs would breach various laws, regulations and policies set out by the NSW Work Health and Safety Act, the Australian Health Practitioners Regulatory Agency, NSW Health and the National Mental Health Standards.

Violence is an ongoing hazard

National Mental Health Standards required nurses to have an in-depth knowledge of mental illness, its management and treatments.

“MHICUs are highly volatile working environments where workplace violence is an ongoing hazard (where) qualified and experienced RNs and ENs are required to make informed clinical decisions based on their education, experience and competency level.

“Introducing AiNs in such a critical and specialised area will increase the risks of violence against staff and patients.

“The AiN is unable to perform mental state observation and risk assessment, the core mental health nursing skills requirement” for MHICU nurses.

“This type of assessment needs to be conducted at every interaction with clients on an ongoing basis to monitor and assess their level of risk.”

Brett said the introduction of AiNs would significantly increase the workload of RNs who would have to oversee and manage an AiN while trying to manage their own patient allocation.

Having to oversee an AiN would expose both to increased risk from aggression as well as greater risk to the RN’s registration, given that the RN would be legally and professionally accountable for the work of the AiN.

Introduction of AiNs would also foster a task-oriented model of care leading to more use of seclusion and consequent higher risk from aggression.

Patients would be “deprived of the opportunity of receiving the highest quality of care they need from highly qualified and competent nursing staff.”

“The intensive structure and the potentially volatile nature of a MHICU require a high nurse to patient ratio.

“It must follow that clients who require intensive observation due to a high level of acuity and complexity require the most skilled and highly qualified staff not the least qualified.”


“Anywhere else in the world the MHICU is the last place you would put an AiN”

Gabi Pearson (pictured top), Hornsby Branch Secretary, says it is “outrageous” to entertain the idea of putting AiNs to work in a Mental Health ICU.

She says it is unfair to AiNs to expose them to the dynamics that occur in such a tough environment.

“I think some patients – those that understand the system – would just play the AiNs. They would manipulate them and play them how they can. It’s unfair to the patients as well because they don’t get the appropriate care or the appropriate structure they need in order to be safe.

“I have trained in Germany in a big mental health facility with over 800 beds. There, they wouldn’t even think about using untrained AiNs in an acute mental health environment. You can’t imagine that happening there. Not even remotely. Even student nurses would not be able to work in the forensic part of a mental health facility,” she said.

Gabi says it is hard to understand where the idea even came from and the Hornsby branch feels strongly that it should be opposed.

“Absolutely everybody in the branch and the hospital believes that this proposal should not be allowed to happen.”