Bans win bed guarantee: relief for overcrowded mental health unit

Lamp, The, July, 2008

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Nurses at Prince of Wales Hospital's mental health unit have won extra beds for psychiatric patients after deciding to impose work bans.

Nurses also got a guarantee that the 50-bed Kiloh unit will not go 'over census' (patient numbers will not exceed bed numbers) and one bed will be kept free at night for police presentations.

During the unusually busy month of April, up to five patients at a time were forced to sleep on couches in interview rooms, along corridors and on mattresses in the seclusion room. Interview rooms are not monitored by nurses.

'It's disgraceful that our psychiatric patients are considered so second class that they have to sleep on couches in public areas,' said Sophia van der Wal, secretary of the NSWNA POW mental health branch.

Sophia said nurses had been asking management to take steps to prevent overcrowding for at least four years.

'It's not been happening every night--it comes in surges. It is unfair on patients and limits our ability to provide care and manage difficult behaviour,' she said.

'We were getting frustrated by management's lack of action so we started a NSWNA mental health branch less than a year ago. We felt that with union support we might have more chance of negotiating a solution.'

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The mental health branch chose Sophia and colleagues Anne McKenzie and Michael Kennedy, backed by NSWNA officials, to represent members at meetings with management.

'One of the ways management tried to placate us was to offer more staff when we went over numbers. That would have addressed some acuity and safety issues but would not necessarily have ensured therapeutic interaction between staff and patients.

'Management also suggested opening four more beds in Kiloh's gymnasium, but that is the only area where Kiloh patients can do anything health oriented. Most of our patients are scheduled and can't leave the hospital grounds.

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'If we turned the gym into an overflow area it could not have been used as a gym and would have caused more overcrowding problems.'

The nurses voted to impose Kiloh's first-ever work bans--including refusing to accept police presentations if the ward was at capacity--from midday on 14 May.

'This had never happened before and it was quite a dramatic step for us,' Sophia said.

'We are the only hospital in the eastern suburbs that accepts police presentations to the ward, without patients first being triaged in the emergency department.

'Bans would have meant the police having to take people around to ED and we were nervous about doing that, knowing that it was just moving the problem elsewhere.

'We were mindful also of the recent union action by ED staff in response to assaults on their staff by psychiatric patients. But we felt we could no longer deal with the situation and management had left us with no choice.'

Hours before the bans were due to take effect, management offered to provide four extra 'surge' beds and came up with a 'disaster escalation plan' to quickly find alternative accommodation at other hospitals if all beds at POW were occupied.

On the advice of NSWNA officials, nurses accepted the offer and suspended the bans.

'We certainly have our reservations about the success of these proposals but we are more than willing to try them,' Sophia said.

She said the four extra beds are outside Kiloh in the psychiatric emergency care centre, which is part of the general hospital.

'This changes the purpose of the PECC area and we are concerned also that there are not enough doctors and allied staff to cater for these extra patients.

'The hospital executive in conjunction with the bed manager now have the responsibility to make sure we have one bed free for police presentations going into night duty.

'May has been a much quieter month. The plan has worked so far and we hope there will not be bed shortages in the future.' As this edition of The Lamp went to press, Kiloh nurses were due to meet to discuss the effectiveness of the new arrangements.