5.3 Themes and Sub-Themes
5.3.3 Theme 3: Challenges Experienced by Professional Nurses
5.3.3.1 Sub-Theme 1: Shortage of Staff
PNs interviewed in this study also reported shortage of staff. Of PNs, 95 per cent highlighted experiencing shortage of personnel in the three mental health institutions.
The ratio between patients and nurses is not proportional, which makes the caring burden very strenuous and overwhelming. In addition, some nurses have to be at work earlier in order to cover and assist the other nurses. The following excerpts exemplify this particular sub-theme:
Shortage of staff obviously. Like in our shifts, there is a day, ani we come back on Wednesday. Then from Wednesday to Saturday, each person has to go home by 11, normally we work 7 to 7. There is just that day where you have to knock off at 11. Because of shortage of staff, you find that some of us are not knocking off. They will go and we will remain. So, shortage is a problem. Myself I have to sacrifice almost every shift. (Participant 16, age 29, female).
Another challenge is, aah, shortage of staff, which is a national problem, I don’t even want to talk about it. For example, in this ward we have 5 nurses and 40 patients, so it’s hard. How are five nurses supposed to take care of 40 patients?
Is not possible, but it’s happening here. The government is not hiring nurses.
(Participant 3, age 37, male).
Our challenges is shortage. We don’t have enough staff and that’s our biggest challenge. Like now we are 7, i mean nurses and the patient are 27. Those numbers don’t match. (Participant 10, age 55, female).
125 Shortage of male staff has been found to be a continuing factor for these PNs. As indicated earlier, the population of nurses in the three MHIs is predominately female.
Consequently, male PNs are fewer and in high demand. According to female participants, male nurses are needed and play a vital role in assuring their safety. The following behaviours have been observed by female nurses when a male nurse is present: 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 in that they see the need to have both females and male nurses in one ward. This policy was established after a few cases of sexual assault, where male nurses were accused of sexually assaulting female patients. Considering the shortage of personnel, this policy can only be theoretical but not practical. For safety and security reasons, female PNs in male wards prefers to work with male nurses. This is supported by the following extracts:
Challenges is the time when they fight each other; sometimes as a woman you find that i…(laughs) it needs males and even manpower. Because I can’t go inside them and try to help. it’s difficult. They know that we ladies don’t have much power than them; even if he is trying to do something, maybe you are trying to speak with and say don’t do that, he can be harsh. (Participant 12, age 46, female).
So, if we have more males and few females, it will be better because males are needed in this ward because they are patients who did crime like murder, rape.
So, if there are more male, we are afraid as females. (Participant 13, age 47, female).
Our problems as nurses, but is a general problem, shortage of staff. Especially males’ staff. Because these people, they are mental health users, you can’t predict them. (Participant 15, age 34, female).
126 PNs caring for patients with chronic mental illness at the three mental health institutions are not only experiencing a shortage of nurses but also a shortage of other multidisciplinary staff members. Like in any other hospital setting, multidisciplinary professional team members play a significant part in ensuring patients’ holistic treatment. However, this often not so in many public and rural hospitals. In these MHIs, the multidisciplinary staff that are not available or that are insufficient are psychiatrists, social workers, and psychologists. And general staff members are also not enough. This is captured by the excerpts below:
We don’t have a psychiatrist also; we only have GPs. (Participant 4, age 36, male).
Another challenge, when we do doctor’s rounds, all MDT members are supposed to be there but is not like that here. Doctor’s rounds are for nurses and doctors.
(Participant 6, age 35, male).
Another challenge is for cleaners; here in the ward if you can see today the patients themselves, they only cleaned around the corrido. There is no cleaner;
the one that cleans she is sick. (Participant 13, age 47, female).
In addition, the results of this study indicated that shortage of PNs is a serious problem, which causes a lot of stress and strain on these PNs. Owing to personnel shortages, nurses are forced to do tasks over and above their duties. Out of sympathy for patients and their colleagues (staff 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. This is in line with the following excerpts:
And we also have shortage of staff, I mean nurse, we are not enough. As a professional nurse, I also bathe patients which I was not supposed to, but I do it because we don’t have enough staff. Normally a professional nurse does not bathe patients, but here we do. (Participant 1, age 38, female).
127 Another challenge is that one of shortage of staff. We also bathe patients as professional nurses because we don’t have enough nurses. We are not enough at all. Aniri, some of our patients are bedridden, we have to turn them time and again, so the other nurses cannot do it alone, we help them. (Participant 2, age 27, female).
The above extracts suggest that professional nurses encounter enormous challenges while providing care to patients with chronic mental illness. They provide care for patients. Nurses are expected to do more nursing, and non-related nursing duties because of the shortage of staff. They are expected to provide optimal care to patients with a low number of staff, which increases their stress levels and makes the caring duties not easy. Consequently, these nurses feel overwhelmed and tired, which ultimately has a negative impact on patient care. Based on the above extracts, it is clear that the shortage of staff is a massive problem in nursing practice.