Dozens of violent assaults on nurses forced work refusal at city psychiatric unit

An unprecedented number of assaults on nurses at University Hospital Galway’s acute psychiatric unit in the past four months was at the centre of their decision to refuse to go on duty yesterday (Wednesday ) morning at 7.30am. At the time of going to press night staff had remained on duty to run the service in the interim.

Nurses at the facility were subjected to 36 assaults since January, a figure which is “unprecedented in an acute mental health facility anywhere in Ireland”, according to Peter Hughes, the general secretary designate of the Psychiatric Nurses Association.

Speaking to this newspaper on his arrival in Galway to meet members, he said the normal level of assaults on staff is “nothing near” this figure. While assaults have been ongoing, the number of incidents escalated over the past few months, he said.

“Our members are taking a stand on health and safety grounds, this is not industrial action,” said Mr Hughes. “There were insufficient staff to run the unit this morning. This situation has been happening over a period of time. Staff could not tolerate working there, it was just intolerable.

“The HSE is not providing a safe environment for staff to work in. They reported for duty on Wednesday morning but under health and safety grounds they would not take up duty until they could work in a safe environment. There are 45 patients in the unit, five of whom require one-to-one special nursing care.

This morning 10 nurses were assigned to the service - five of those to run the unit and look after 40 patients and the remaining five to provide one-to-one nursing care. You could have a situation where five nurses are providing this type of care and then there are just two nurses on the ward. What happens if one of those wants to go for an appointment or have their break?”

Continuing staff shortages coupled with the lack of a high observation and intensive care rehabilitation unit is at the root of the problem, according to the nursing union official.

“The acute facility in Galway does not have a six bed high observation unit which is recommended in the mental health document ‘Vision for Change’. If that was the case the number of ‘specials’[clients requiring one-to-one care] would be reduced and it would take pressure off admission beds. In addition, clients would be treated in a safer and more therapeutic environment. We have been calling for that unit for quite a while. When the Ballinasloe unit [22 acute psychiatric beds] was closed we believed a lot of community services would be set up but that did not materialise. There are no proper resourced community teams. There is supposed to be an intensive care rehabilitation unit for clients with more challenging behaviour but that has not been provided on the west coast. That would again take pressure off the one-to-one special care nursing service.”

Mr Hughes alleges the acute unit in Galway has been “unsafe” for a number of weeks due to insufficient staffing. “There have been 36 assaults since January, this is unprecedented in an acute mental health facility anywhere in Ireland. You don’t expect to go to work and be assaulted. Some of the assaults have been serious, staff have had to go on sick leave because of this violent behaviour. Some have been out for a few days, I believe one staff member may be still out.

“The fact that we don’t have a high observation unit, one-to-one care has to be provided. This takes a lot of staff and is also quite intrusive for the patient as a nurse is with them all the time. If there was a six bed unit they would be confined but there would not be a nurse at their side all the time. It would also be more therapeutic.”

He stated the ongoing issue came to an head on Wednesday morning when the day staff decided not to go on duty. “The HSE had a number of hours to resource four to five staff. Our staff would have no issue with that. We are hoping the HSE will provide extra nurses as soon as possible.”

He described the health authority’s response to the nurses’ health and safety concerns as “tardy”. “It has been very poor to date. We want the issue resolved, we want engagement with the HSE.”

In a statement the HSE West said it condemned what it claimed was the “arbitrary refusal of staff to turn up to work” on Wednesday morning.

“This is unannounced and unofficial action. Ten staff have not turned up to work which is placing severe pressure on other staff; has the potential to affect patient safety and will affect the level of service to patients undergoing treatment.

“No notice was given, which contravenes industrial relations standards, the HSE is calling on the staff to return to work immediately.”

Fianna Fáil spokesperson on mental health, Deputy Colm Keaveney called on the Minister for Health, Leo Varadkar, to intervene directly to resolve the staff safety issues at the psychiatric unit.

“These safety issues, arising from staff shortages, have been ongoing from the start of the year and have now resulted in staff refusing to work until HSE management resolve the safety issues. At the time of the closure of the state-of-the-art psychiatric in-patient unit in Ballinasloe, I and others, including medical professionals working in the mental health services, warned the Minister and local HSE management that the closure would have negative consequences for patient care as the unit in Galway lacked capacity to deal with service level demands. Sadly, we have been proved right with staff suffering from assault and no longer feeling safe in their work environment. The assurances that we received at the time, from Minister Lynch and the local HSE management, now ring hollow.

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