Friday 20 September 2019

'Patients who are at a low point are left languishing on chairs in a chaotic ward' - Psychiatric nurses take action over crisis in services

Waterford Regional Hospital
Waterford Regional Hospital

Sasha Brady

The HSE has been accused of ignoring pleas to solve an overcrowding crisis at two of the country's psychiatric care units which nurses say is putting patients at risk.

On Tuesday members of the Psychiatric Nurses Association (PNA) commenced industrial action while their colleagues in Kilkenny escalated their current industrial action in protest at overcrowding and under staffing issues at mental health facilities in the counties.

A nurse at Waterford Regional Hospital told that conditions in their mental health wards have deteriorated over the past two years.

She said they regularly suffer from chronic overcrowding issues but pleas to the HSE to resolve the issue have "fallen on deaf ears".

The psychiatric department at Waterford Regional Hospital has two areas: a sub-acute area with 30 beds and an acute area with 14 beds.

The nurse said that both wards are operating above capacity on a regular basis and some patients admitted to the facility often have to spend nights on chairs in corridors.

"At times over the past two years we could have up to 18 patients in the 14-bed unit and and about 40 patients in the 30-bed unit," she said.

"The ones without beds are left on chairs. We try to make them comfortable as possible by pulling two chairs together and placing a blanket on them but it is completely unacceptable.

"We are trying to provide a place of safety and a therapeutic environment for our patients but it's impossible when we have patients with mental health issues languishing on chairs in corridors"

The nurse explained that PNA members are taking industrial action to advocate for the patients and families who have "been dealt a raw deal".

"It's actually so embarrassing when patients come in with their families and you're saying 'I'm the nurse, I'll help you,' and you turn around and show them a chair. They're shown a complete lack of dignity and respect.

"At the very least we should be able to provide patients with beds. It's heartbreaking to see someone so grateful to get a bed after two nights on a chair."

The nurse said that families of psychiatric patients rarely complain, despite being aware that their loved ones are sleeping in corridors.

"A lot of the time they're just so desperate to get the help that they feel once their foot is in the door, they're on the path to recovery.

"They don't want to complain and rock the boat. They put up with it but they shouldn't have to.

"To accept these circumstances would be wrong. That's why we're taking a stand. There comes a time when you have to say 'enough is enough'."

The nurse said that "managing the unmanageable" has taken an emotional toll on staff. Overcrowded wards and staff shortages have made working conditions extremely difficult.

"We're trying to balance comfort and care but it's tough in these conditions.

"We have people coming in who are in a depressed and in a very low and hopeless situation that is ingrained into their psyche. They're sitting in a chair in an open space where people are mentally unwell and going through psychotic episodes. They're witnessing aggression and violence and it's delaying their recovery.

"You need to provide a safe environment for them but there's too much going on. The wards can be chaotic and patients can become violent."

The nurse expressed frustration that there have been no realistic proposals from management to address the issues facing mental health services in the region.

She claimed that staff highlight the issues daily and the problem will resolve "for a day or two" before the same issues arise again.

The Waterford nurse said that there are currently 26 open positions for psychiatric nurses in the hospital but they are struggling to fill them.

"The hospital has a recruitment and retention problem," she said. "We are training graduates to leave for better opportunities elsewhere. We have seven graduates working with us at the moment and only one of them is staying on, the rest are leaving."

Meanwhile, psychiatric nurses at St Luke's General Hospital in Kilkenny said that overcrowding has become a common occurrence in their mental health ward in the last couple of months.

The facility operates at a 19-bed capacity but at times they have had an additional seven patients being admitted to their unit.

Patients are often nursed in recreational rooms due to a lack of beds in the ward. This has a knock-on effect on other patients.

"If some people are being nursed in the television room, that means that other patients can't use that room to relax and unwind. They're stuck in their wards.

"People are coming in and you're saying 'here's a chair'. You didn't get into nursing to say that to people. You got into nursing to care for people."

Another nurse in Kilkenny said the environment changes when the hospital is operating above capacity. She said that nurses are constantly worried about the risks involved in treating patients in an overcrowded ward.

"If there was a fire how would you evacuate that many people? Staff are fearful that there will be a major incident one day," she said.

"At the end of a shift, we're just relieved that we've avoided an incident. It's only because staff are working above and beyond."

The nurse said staff can't attend to patients in the way that they would like. There is more paperwork involved with extra people on the ward. Staff get caught up in administration tasks and it leaves them with less time to spend on therapeutic treatments and activities with their patients.

She explained that PNA members are taking industrial action to in an appeal to enhance the lives of the patients in their care.

"We're not looking for a raise or anything like that. We're looking for better treatment for our patients. It's for their benefit.

"It's not ideal when you see an older or vulnerable person sleeping on a couch for three or four nights."

A PNA spokesperson said the build up of recent problems in Waterford and Kilkenny can be attributed to the growing level of acute patients in the region.

The number of long-stay patients has also been building up in acute units. There is nowhere for these patients to move on to.

Figures show that 18pc of those in psychiatric units are now there for six months or more and this figure is growing.

PNA industrial relations officer, Michael Hayes said: "This  action to commence in Waterford mental health services is a direct result of continuing instances of  overcrowding in the admission unit at the Department of Psychiatry, University Hospital Waterford, where lack of facilities and ongoing staff shortages and vacancies within our nursing numbers are compromising both patient care and staff safety."

"Nurses cannot continue to provide services that rely on redeployment of staff, agency staff, overtime and sheer goodwill on an almost continuous basis. They cannot ensure a level of safety for clients and staff where there is consistent and unacceptable overcrowding."

PNA has repeatedly brought to management’s attention the ongoing overcrowding, nursing shortages, failure to fill identified vacancies and the resulting health and safety ramifications within the Waterford mental health services.’

In a statement to, the HSE said it wants to "reassure the public that all of the staff within the South East Community Healthcare mental health services are committed to the provision of a quality and safe mental health service to the population it serves.

"The 44 bed Dept. of Psychiatry (DoP) acute mental health unit in Waterford is located on the grounds of University Hospital Waterford and serves the Waterford/Wexford catchment area.

"An excellent team is in place at the DoP in Waterford to serve the needs of all those who require treatment and support. There are 45 Whole Time Equivalent (WTE) nursing posts in place there, in addition to other medical, specialist and support staff.

"The HSE continues to work with staff representatives in the development of mental health services at acute and community level across the South East. Meetings, as part of ongoing engagement with the Psychiatric Nurses Association (PNA), will be taking place in that respect."

The HSE said that patients should continue to present to services as normal.

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