From the Sydney Morning Herald: Nurses fear bedlam in jail hospital
NURSES at the state’s highest security psychiatric prison hospital fear for their safety, and say they are left defenceless against violent patients.
The NSW Nurses Association and the government confirmed a male nurse at Long Bay Forensic Hospital had his skull fractured this year by a patient, and was put in a taxi to get to hospital.
Nurses have also been bitten and punched by patients, many of whom are accused of rape and murder….
This is, obviously, much more than just an issue of ethics. Clearly, it’s an issue of workplace safety and one in which both the needs of the patients and the needs of the nurses are not being met. Acting as a full-time security guard, as the article describes most nurses’ roles, is not conducive to any kind of nurse-patient relationship. The reality is that nurses are, as many say, “on the front line” and with inpatients, in almost every institutional setting, for 24 hours a day. Issues of workplace safety, dangerous or harmful situations, insecure or injurious environments tend to have the greatest impact upon nurses and, logically, upon the perceived and real quality of nursing care. And that is one reason that this becomes not only a workplace or practice issue (a very critical one) but also an ethical issue.
Situations like this but less serious are echoed by nurses in many settings. Overwhelming workloads, unsafe ratios of nurses to patients, staffing based on numbers of beds rather than patient acuity — these kinds of workplace concerns are frequently voiced in cafeterias, nurses’ lounges and classrooms.
Despite this, it’s difficult to get nurses to organize and take action, such as approaching management in order to voice concerns, to note the kinds of serious problems that may be affecting patient care and to suggest change. Further compounding this difficulty, as the article notes, it’s often perceived as very difficult to get management to “pay attention” to the problems, according to many nurses. In this article, one forensic nurse notes that ”The general feeling is that it will probably take a very serious assault for them to bring in security.” Like many situations in clinical practice, the worst-case scenarios tend to attract attention and induce changes in practice or force management to come up with concrete strategies to address problems. This, however, shouldn’t be one of those situations.
The Canadian Nurses Association’s Code of Ethics , revised in 2008, offers a discussion on “quality work environments” and the link to ethical practice of nurses. The inclusion of this section, as I recall, was seen as somewhat controversial when it was introduced for discussion as the revisions were taking place. Quality work environments are, according to the Code, essential for ethical nursing practice, but not enough just on their own. The Code goes on to say that nurses have a responsibility to reflect on the kinds of interactions they have and the resources required to help create and sustain a workplace in which “safe, compassionate, competent and ethical” care can be provided. Reflection is great and highly useful in a variety of contexts, but there is no doubt that this situation calls for, at this point, far less reflection and far more purposeful action. While it may be a health care provider’s (not only nurses!) responsibility to maintain a place and space in which compassionate, competent and ethical care can be delivered, safety of everyone involved needs to come first.