Mental health unit's nurses consider action over triage

SIPTU shop steward Des McSweeney

Nurses working in the acute mental health unit (AMHU) at Cork University Hospital (CUH) are considering industrial action in protest at being asked to triage patients who present out-of-hours.

SIPTU shop steward Des McSweeney said the HSE is “trying to force through this change in our working conditions without due process and engagement with trade unions”.

Mr McSweeney said the industrial agreement reached prior to the opening of the unit in 2015 made no reference to an out-of-hours triage service.

He said it would create unnecessary workplace stress for staff in a busy ward where they were caring for vulnerable clients.

The unit’s incident log for the first nine months of 2018 shows 189 incidents of violence and aggression, 96 incidents of deliberate self-harm and 56 incidents of people going AWOL.

Mr McSweeney said if anyone presenting to the unit out-of-hours became aggressive or violent as a result of mental illness, or as a result of being under the influence of drugs or alcohol, this would place staff - and potentially other patients - at risk.

He said if out-of-hours triage is to be introduced, the unit would need to provide a dedicated assessment space as well as hiring assessment nurses so that the staff complement on the ward is maintained.

“At the moment, we don’t have the proper infrastructure in place. In the Mercy University Hospital, which also has an AMHU, they have assessment nurses,” Mr McSweeney said. He said currently, just one trainee doctor provides an on-call out-of-hours psychiatric service covering the entire CUH campus. 

Last month, SIPTU industrial organiser Sharon Cregan wrote to Ned Kelly, area director of nursing, HSE mental health services, to warn: “The issue of individuals presenting for assessment at the AMHU, outside of the agreed pathways of referral, remains contentious and of major concern to our members."

She asked for management to confirm no unagreed policy would be implemented pending the outcome of a Joint Review Group (JRG) which is due to meet on March 12.

In response on February 20, Maria Daly, HSE employee relations manager, said the purpose of the JRG was “ to identify an agreed referral’s pathway”.

Ms Daly said current practice at the unit is for nursing staff to come from the ward to main reception when people present for emergency assessment and that this “ is to be maintained pending the finalisation of the JRG process”.

Yesterday a spokesperson for the HSE said they had "a duty of care to anyone who presents at any acute mental health unit, regardless of whether or not they have come through the correct referral pathways".

Last Friday, Ms Cregan applied to SIPTU for approval to ballot members for industrial action at the AMHU.

A spokesperson for the Psychiatric Nurses Association (PNA) said the union “is currently in a process around this issue which has been running on for several months”.

“We will be having further engagement with the HSE on the issue,” the spokesperson said.

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