Safety fears at mental health ICU

A Local Health District has proposed the introduction of Assistants in Nursing in one of the most dangerous workplaces in the state.

An industrial battle has erupted over a proposal by the Northern Sydney Local Health District for the possible introduction of Assistants in Nursing (AiNs) in the Mental Health Intensive Care Unit (MHICU) of Hornsby Ku-ring-gai Hospital.

At the time of the The Lamp going to press, the LHD had not put forward a concrete proposal – rather, it was seeking to engage a consultant to review the proposal’s efficacy within a consultative framework with the NSWNMA.

The MHICU has seen patients kick down doors, smash equipment and bash and strangle nurses.

NSWNMA Assistant General Secretary, Judith Kiejda, said AiNs were not qualified to work in such a dangerous environment often with highly agitated, volatile and unpredictable patients.

“While AiNs play an important role caring for patients in low-care settings, it would be negligent to place a minimally qualified worker in this environment,” Judith said.

“This is clearly a cost saving measure. There is no other reason to introduce an AiN into such a critical and specialised area where a high level of communication, observation and response is vital.”

Nurses were planning to hold a stop work meeting at the hospital to further highlight their concerns with the proposal, but this was withdrawn following the intervention of the Industrial Relations Commission. The Commission continues to have a watching brief over the dispute and is providing oversight to the consultation process being established.

This consultation process was continuing when The Lamp went to press.

A move backwards

The LHD move came only three months after health unions and the Ministry of Health agreed on a plan to tackle worsening hospital violence.

Hailed as a breakthrough after persistent campaigning by health unions the plan included a security audit of emergency departments, improved staff and management training, development of better ways of managing drug and alcohol-affected patients and examination of possible legal changes.

The January edition of The Lamp highlighted the unacceptable level of aggression and violence at the Yaralla MHICU at Cumberland Hospital.

Judith said the unpredictable nature of patients in the MHICU required “constant clinical assessment and technical, professional skills.”

An AiN could receive their qualification after a six week course, while an RN had completed an undergraduate degree and often gone on to do further study, such as a graduate diploma or Master of Mental Health Nursing at university to specialise in mental health.

“Workers need to have sufficient grounding or at least an understanding of the complexities of mental illness and an AiN does not have that kind of experience,” she said.

The LHD’s proposal has caused widespread concern throughout the hospital, said Peg Hibbert, a registered nurse, NSWNMA Councillor and vice president of the hospital’s NSWNMA Branch.

“Our members are extremely concerned with the proposal, which has such a potential impact on the safety of patients and staff” she said.

“When the proposal first appeared there was widespread concern so we involved the whole branch, not just members in mental health.

“The issue is widely and deeply felt by all branch members.”

Lives at stake

She said the branch feared for the lives of AiNs who may be sent to work in the MHICU without sufficient qualifications and mental health experience.

“We feel it’s just a money saving exercise though management deny that. They say things like it will ‘enhance the nursing perspective’ and the role of the AiNs and creates a better mix of people working in the unit.

“These are just wonder words. You don’t need a better personality mix you need qualified staff.

“We’re not saying we don’t want AiNs anywhere in mental health because they are employed in acute care units and step down or psychiatric geriatric units.

“We are simply saying AiNs have to be in a place where they are safe and able to deliver proper nursing care within their scope.

“We know that if someone gets hurt as a result of the introduction of an inexperienced and unqualified AiN, management will trot out every policy and procedure they can find to tell the nurses why it is their fault.

“Management won’t take any responsibility for anything that happens as a result of this policy.

“They might get their wrists slapped but some nurse will be badly injured or dead.”