6.4 Challenges Experienced by PNs
6.4.1 Shortage of Staff
162 admission of patients, meeting attendance, dispensing of medication and communication with patients and / or relatives. These administrative roles are often time-consuming and tiring for nurses. Lastly, on a daily basis, the PNs who participated in this study are expected to do administrative duties. PNs highlighted that they have to do a variety of administrative tasks in the ward. These administrative tasks are both nursing related and non-nursing related tasks. Nursing-related administrative tasks include writing reports, ordering medication, attending meeting, complying statistics, ordering drugs, writing patient reports and leave of absence reports, and many more.
Calling and tracing the relatives of the patients, and buying stuff for patients are some of the non-nursing related administrative tasks that these PNs do.
163 on the delivery of high-quality medical care (Jack-Ide et al., 2018). The current research highlighted 95 percent of PNs experienced a shortage of personnel in the three mental health institutions. The ratio between patients and nurses is not proportional, which makes the caring duties very strenuous and overwhelming. In some instances, some nurses are unable to take vacation and overtime leave owing to the personnel shortage.
According to Sobekwa and Arumachallam (2015), who concur, an inadequate number of professional nurses are required to manage and provide treatment for large numbers of mental health care consumers as a result of a rise in admission volumes. As a result, nurses end up with an unacceptable burden.
High workloads and stress associated with work were expressed as a huge problem to professional nurses who are available. Due to a lack of professional nurses, professional nurses working in these mental health institutions are overworked, according to the nurses, who added that they were unable to take vacation or overtime leave. Owing to the personnel shortage, nurses are forced to do over-and-above tasks, and experience backache. Out of sympathy for patients and their colleagues (enrolled and auxiliary nurses), PNs end up bathing patients, feeding them, and carrying some of the bedridden patients and those who are unable take care of their basic needs. Others must come to work early in order to cover and assist the other nurses. Moreover, limited male staff has been found to be a serious challenge for these PNs.
As highlighted in Chapter 4, the population of nurses in the three MHIs is predominantly female. Consequently, male PNs are fewer and in high demand. Joyner et al. (2014) agree, saying that South African nursing remains a predominately feminised profession.
According to female participants, male nurses are needed and play a vital role in assuring their safety. This is supported by Mulaudzi et al. (2020). The following behaviour has been observed by female nurses when a male nurse is present in the ward: patients are cooperative, less aggressive and violent, and behave well. Even though it is the policy of some psychiatric wards for female nurses to work with female patients and males with males, the majority of the nurses do not agree with this policy in that they see the need to have both female and male nurses in one ward. This policy was established after a few cases of sexual assault, where male nurses were accused
164 of sexually assaulting female patients. Considering the shortage of personnel, this policy can only be theoretical but not practical in that, in the three MHIs, female nurses were more in number than male nurses. For safety and security reasons, female PNs in male wards prefer to work with male nurses. Other nursing specialties, including staff nurses and auxiliary nurses, are also suffering from a lack of workers.
PNs who care for patients with chronic mental illness at the three mental health institutions not only experience a shortage of nurses but also a shortage of other multidisciplinary staff members. Like in any other hospital setting, multi-professional team members play a significant part in ensuring patients’ holistic treatment. However, it is often not so in many public and rural hospitals. Participants in the present study revealed that a multidisciplinary team plays a vital role when caring for patients with mental illness. From the feedback given by the professional nurses, the different expertise of a professional multidisciplinary team inclusive of social workers, counsellors, psychologists, medical practitioners, and psychiatrists would be helpful in creating a mentally stable society. A study by Jack-Ide et al (2012) is in support of this notion. In his study, participants outlined the essence of having professionals such as psychologists, social workers, doctors, psychiatrists, and nurses working together in rendering appropriate services to patients with mental conditions. Makgato (2020) concurs by indicating that a multidisciplinary team is imperative in dealing with mentally ill people. In one of these MHIs, multidisciplinary staff members that are not available or are insufficient are psychiatrists and psychologists.
In this study, nurses described how the lack of essential personnel, such as psychiatrists, hinders the delivery of mental health care. The same thoughts are expressed in a research by de Kock and Pillay (2017), which alludes to a serious dearth of psychiatrists in South African rural mental health facilities. Additionally, a different study conducted in South African public hospitals revealed that there are incredibly few psychiatrists in rural healthcare facilities—only 0.03 per 100,000 people (de Kock &
Pillay, 2017). De Kock and Pillay (2017) claim that South Africa faces a problem with the lack of human resources for mental health care due to the fact that many psychiatrists work in private facilities. The lack of psychiatrists has a direct impact on
165 mentally ill patients and stalls their recovery process. General staff members such as cleaners are also a challenge in Hayani and Evuxakani MHIs.