nurse understaffing

Cumberland mental health nurses knew COVID-19 would eventually reach their understaffed and ill-prepared hospital, but their warnings went unheeded.

When the Delta outbreak took the life of a Cumberland Hospital mental health patient in August, nurses and medical staff took up a collection for their family.

“We were very upset by their death,” said Nick Howson, the hospital’s NSWNMA delegate and branch president.

“In mental health, you can have years-long relationships with some of your patients, and this patient was extremely well known to us.

“We felt we had let them and their family down because we failed to stop the infection getting into the unit, despite taking every precaution provided to us.”

Staff suspect the initial patient contracted the virus in the emergency department, where they returned a negative COVID-19 test result in the ED prior to coming to the unit.

“Our patient developed symptoms a couple of days after admission and by then it was too late to stop the infection spreading through the closed environment of the unit,” Nick said.

“We were policing distances between patients and doing our utmost to get them to wear masks, and it still wasn’t enough to stop the infection spreading.”

A total of 11 patients were reported to have been infected in that outbreak at Cumberland Hospital, which is Western Sydney’s main psychiatric hospital.

Delta also spread through Nepean, Campbelltown, and other Sydney mental health units.

A struggle to get PPE and staff

Nick, who is also the health and safety representative for his work group, said nurses knew that COVID-19 would eventually reach the hospital, which was understaffed and ill-prepared.

“There were COVID-19 plans on paper, but no-one really knew what to do in a practical sense and we hadn’t had any drills. It was all based on prevention – not what to do when the virus got in.

“Our PPE stocks were locked away apart from a few kits and very few of our patients were vaccinated.

“We were understaffed, and we knew it would be an absolute nightmare when Delta got here, but management ignored our warnings.

“We have always had to fight to get staff shortages covered.

“In the first week of the outbreak in August, there was an endless struggle to get the PPE we needed and the staff we needed. We were told there was enough, yet we constantly had to chase up supplies.

“On the first day there were only five of us on shift to start with and seven after staff deployments. We should have had ten.”

Nick points out that mental health patients are less likely than most to follow guidelines and requests.

“Before Delta got here, only about 20 per cent of patients would wear masks regularly and some would flat out refuse to wear them.

“We get people who spit and become violent if you try to tell them what to do. Even if it’s in the interest of their own safety.

“On the first day of the outbreak I called all patients into the lounge before breakfast and told them a patient had COVID-19 and every-one had to wear masks. Anyone who refused would be kept in their room with a staff member stationed outside.

“Most patients immediately got a mask and went outdoors to put a bit of space between them and others.”

Higher rates of burnout

Getting enough staff in mental health has always been difficult and COVID-19 has added to the strain on nurses.

Nurses who escort patients to outside appointments face the challenge of ensuring the patient wears a mask and takes other precautions against contracting the virus.

Mental health nurses are also required to do more medical work now than they did before COVID-19.

“Having to learn how to do more advanced observations for respiratory, cardiac and other issues related to COVID-19 was a stressful experience for everyone in our unit – nursing and allied health as well as the consultant psychiatrists,” Nick said.

“The extra time and effort involved in donning and doffing PPE makes you more uncomfortable and tired than normal and erodes a lot of break time.

“It takes an extra 10 minutes to get in and out of your gear every time you need to change. By the time everybody has had their breaks, that is the equivalent of taking one person off the floor for six of the eight hours.

“People were postponing toilet breaks because they were approaching the end of the shift and didn’t want to waste time dealing with PPE.

“At the start we had 14 permanent staff put in isolation, which obviously made the workload even more horrific for the rest of us.

“On top of all that, we had to swab every patient every day of the first week.”

Under these circumstances, nurses were only able to do perfunctory mental health assessments.

“The quality of mental health care we were able to provide was well below any anything that any of us were comfortable with,” Nick said.

“COVID-19 has led to a higher rate of burnout among staff who need a break from the acute environment.

“People are resigning, taking maternity leave and long service leave earlier than planned, or shifting to rehab work.

“I’ll be very surprised if the profession as a whole doesn’t come out with some sort of collective PTSD from this.”