Our members have overwhelmingly voted in favour of industrial action up to and including strike in pursuit of an increase in measures to sufficiently address the recruitment and retention crisis in nursing. This is a clear indication of the frustration felt by our members.

The Public Service Pay Commission’s final report in May 2017 identified recruitment and retention difficulties in nursing. The Public Service Stability Agreement 2018-2020 addressed the recruitment and retention issue by recommending that the Commission would comprehensively examine the recruitment and retention issue. The Commission’s report Module 1, dealing with recruitment and retention of nurses and medical staff was published in September 2018.

The Pay Commission recommended a 20% increase in both the location and qualification allowances i.e.;€371.60 and €558.20 per annum respectively and a reduction in the eligibility criteria for senior staff nurse from 20 years to 17 years. The Commission also recommended that the post 2011 entrant salary scales would be addressed. This resulted in measures to bypass point 4 and point 8 of the incremental pay scales from the 1^st March 2019.  Full details available on the website, www.pna.ie

Our National Executive Committee (NEC) adopted a motion at their meeting on the 26^th September to ballot on the measures proposed and to reject same as the Executive did not believe they were sufficient to address the recruitment and retention crisis in nursing. The subsequent ballot endorsed this position with a 94% rejection of the measures proposed. The NEC reassembled on the 15^th November and adopted a motion to “ballot for industrial action up to and including strike action in pursuit of our claim for an increase in measures to sufficiently address the recruitment and retention crisis in nursing.

The PNA have signed up to the Public Service Stability Agreement 2018-2020, of which the Public Service Pay and Pensions Act 2017 gives legal effect to the Agreement. The following are a range of penalties in respect of public servants not covered by the Public Service Stability Agreement;

• The Pay Commission proposals and new entrant proposals may not be applied
• Increments may be suspended
• Pay increases may be delayed
• PRD (Pension Levy) adjustments may be delayed

The nursing crisis in the Mental Health Services is exacerbating month by month. There were 500 vacancies last November 2017 and at the end of August 2018 this had increased by 40% to 700 vacancies, this is totally unsustainable. A HSE analysis conducted in 2016 showed that over 34% of Psychiatric Nurses are eligible to retire in the next 5 years, we are now midway through that timeline. The filling of the 700 vacancies would only permit the service to standstill, however to fully implement Vision for Change would require up to another 2,000 nurses.

The reality is that there are ongoing nursing vacancies which are impacting daily on the delivery of Mental Health Services and service development. The expensive and inappropriate reliance on agency and overtime is masking the true scale of the staffing crisis and is impacting on the quality of service provided. It is time for Government to accept the reality that the only way to address this crisis is to pay a decent wage.

The outcome of the ballot sends a clear message to Government that the measures proposed fall far short of addressing the recruitment and retention crisis and we are calling for meaningful and constructive engagement with the relevant Departments to avert action. However, should this not happen we will be left with no option but to engage in action.

PNA Officer Board will convene on the 10^th January to decide on our course of action.

I would like to wish all the membership a happy and peaceful Christmas and every good wish for the new year.

The overoccupancy crisis in the acute mental health units in HSE CHO5 first began over 2 years ago.

 It began with a practice of admitting clients into “leave beds “in Kilkenny and Waterford, then when the acute unit was at its licensed numbers, after hours admissions were admitted to a tv room, day room, or if a service user was in seclusion their bed was utilised overnight.

What started as an occurrence became more common practice, all pleas and efforts by staff working in the Department of Psychiatry fell on deaf ears. The local branches in conjunction with head office organised a protest at lunchtime. This was held successfully in both areas which attracted the attention of the media and local politicians who were outraged to hear of the overoccupancy crisis, and that members of the public who use the mental health services were being admitted to a unit that had no bed for them to sleep in.

An over stretched workforce attempted to provide a therapeutic environment but sometimes in the course of a working day it was a reach too far due to over occupancy, reduced resources and an emphasis by staff to ensure the safety of staff and service users. 

Following several letters to Senior Nurse Management and HSE Management and meetings the branches were left with no alternative but to ballot for industrial action. They feared for the health and safety of all persons sharing the space of the Department of Psychiatry in Kilkenny and Waterford. This industrial action commenced in Kilkenny in late December and in Waterford in January. Similar issues presented in each area. Discussions were ongoing, correspondence going back and forth, but the overoccupancy continued. Sometimes 4 and 5 voluntary service users were admitted overnight. The units were full to capacity, staff were forced to work in a highly stressful environment with the ongoing degrading practice of admitting clients over the licensed numbers.

The assistance of the Workplace Relations Commission was sought by the HSE and PNA attended the process.  We have presented many proposals to assist in dealing with the health and safety ramifications, clinical risk issues, understaffing and out of hours admissions. Whilst our (PNA) engagement has been meaningful, “in some respects”, at the time of writing we have failed to agree on the principle where “no bed no admission” exists.

Q. I have applied for parental leave and I have received a letter from my employer to say that I’ve been refused and that I can reapply in 6 months’ time. Is this correct?

A. This is incorrect. The Parental Leave Act 1988 is very clear in terms of the rights and entitlements of parents. Parental leave differs from flexible working in that your employer is obligated to approve your request in some format - hours, days, weeks, fortnights or in a larger block. Every applicant is entitled to 18 weeks parental leave per child up until they reach 13 or 16 with a child with special needs. When the application is being considered it must be approved in some format, but the start date can be postponed by your employer by up to 6 months. 
Points to note:

Parental Leave and flexible working are different.

There can only be one six-month postponement.

Your entitlement is 18 weeks per child. 

If both parents work for the HSE there can be a transfer of weeks from one parent to another.

What Paperwork Needs to Be Done Following an Assault at Work By A Patient?

Incident needs to be recorded in the patients file, incident form completed, incident to be recorded in the daily or nightly report and submitted to management. The records above will be completed by the Nurse in Charge in the Unit.  

If the Nurse is out on sick leave following the assault-

1. The nurse needs to attend A & E or own GP. Review by SHO in own area is not acceptable.
2. Following treatment, a letter or certificate should be sought including nature of injury, treatment given, and initial time given on sick leave. This letter should include that the nurse “was assaulted at work”.
3. At first opportunity complete Form 108 for Serious Physical Assault and return to ADON office with sickness certificate. (This form has to be processed by managers as soon as possible so that no interruption to premium pay is necessary.)

Nurses who pay “A “stamp there is requirement to obtain a social welfare certificate

Public Servants who are Members of pre-2013 Pension Schemes with Standard Accrual Terms 

1 January 2019

Band Rate

Up to €32,000 Exempt

€32,000 to €60,000 10%

€60,000 plus 10.5%

1 January 2020

Band Rate

Up to €34,500 Exempt

€34,500 to €60,000 10%

€60,000 plus 10.5%

 __________________________________________________________

All Public Servants who are Members of the Single Public Service Pension Scheme

1 January 2019

Band Rate

Up to €32,000 Exempt

€32,000 to €60,000 6.66%

€60,000 plus 7%

1 January 2020

Band Rate

Up to €34,500 Exempt

€34,500 to €60,000 3.33%

€60,000 plus 3.5%

 ____________________________________________________________

Public Servants who are Members of pre-2013 Pension Schemes with Fast Accrual Terms 

(Unchanged)

Band Rate

Up to €28,750 Exempt

€28,750 to €60,000 10%

€60,000 plus 10.5%

https://www.workplacerelations.ie/en/Publications_Forms/Forms/Public_Service_Stability_Agreement_2018-2020.pdf

The position of the PNA following endorsement of the NEC on 15th November 2018 is;

‘That no PNA member will engage in the training, supervision and assessment of non-nursing staff in the area of administration of medication’

The Following is the advice from the Nursing and Midwifery Board of Ireland (NMBI)

Delegation takes places where the nurse (the delegator) who has the authority for the delivery of healthcare, transfers to another person the responsibility of a particular role or activity that is normally within the scope of practice of the delegator.

When delegating a particular role or activity, the nurse must take account of several principles. The individual nurse must:

1. Ensure that the primary motivation for delegation is to service the interests and needs of the patient; 2. Assess the degree of risk involved in the delegation; 3. Ensure that the delegation is appropriate with reference to the definitions and philosophies of nursing; 4. Take into account the level of experience, competence, role and scope of practice of the person taking on the delegated task; 5. Do not delegate to junior colleagues or other HCW tasks and responsibilities that are beyond their colleagues’ competence to perform. 6. Ensure appropriate assessment, planning, implementation, monitoring and evaluation of the delegated role or activity; 7. Communicate the details of the role or activity in a clear, understandable way; 8. Decide on the level of supervision and feedback required; 9. Ensure that the practice setting supports the delegation of the role or activity. Delegation of the task should be consistent with organisational PPPGs. 10. The nurse or midwife who is delegating a particular role or activity (the delegator) is accountable for the decision to delegate. This means that the delegator is accountable for ensuring that the delegated role or activity is appropriate and that resources and supervision, where required, are available. They are also accountable for appropriate assessment, planning, implementation, monitoring and evaluation of the delegated role or activity (Scope of Practice Framework, NMBI, 2015)

In making decisions about their individual scope of practice, nurses should keep to the fore the rights, needs and overall benefit to the patient and the importance of promoting and maintaining the highest standards of quality in the health services. They must adhere to the principles, values and standards as outlined in the Code of Professional Conduct and Ethics (NMBI, 2014), paying particular attention to Principle 2 and 5 regarding professional responsibility and accountability and collaboration with others.

Guidance to Nurses and Midwives on Medication Management (ABA, 2007) describe the responsibilities and conduct expected of nurses and midwives in their involvement in medicines management, which provides a standard of care expected by patients. In the interest of patient safety, utilising a skill mix for the purposes of administration of medicines should not lower this standard.

Synopsis of Horatio Congress 2018 at Torshavn, Faroe Islands

 Babu Lal Yadav RGN, RPN, B Sc N, M Sc N (Psychiatric Nursing), M Sc N by Research The National Forensic Mental Health Services, Central Mental Hospital, Dundrum, Dublin 14, 

Introduction

It was a great opportunity and experience for me as a Psychiatric Nurses Association (PNA) sponsored delegate in Horatio congress which held from 10^th to 12^th May 2018 at Nordic House, Torshavn, Faroe Islands organised by the Horatio: European Association for Psychiatric Nurses in conjunction with Faroe Psychiatric Nurses Society. The congress was part of Horatio annual routine. It was attended by a number of other local, national and international delegates and experts in the field of mental health and psychiatric-mental health nursing. 

I knew it was going to be an amazing experience but it went above and beyond my expectations, and I most certainly admired the whole theme of this year congress, “safe settings” that was a huge success. The keynote speeches, symposium and workshop such as ‘Psychological safety’ and ‘Safewards model’ were knowledgeable and gave a new insight to me. There was a very constructive debate on a number of emerging issues relevant to psychiatric-mental health nursing in Europe. The importance of ‘a safe settings’ has been emphasized by a number of eminent presenter in various ways. I feel it needs to be emphasised in Irish Forensic mental health service as well. In my opinion, emerging role of forensic psychiatric nurses must be considered as a theme in the future Horatio Congress.

I think many keynote speeches and scientific plenary sessions by national and international delegates were knowledge based and useful to guide my practice. Most of all, the concurrent oral presentations and interactive poster presentations were exceptionally good. Moreover, it was a great opportunity for me to networking with a number of congress delegates. I enjoyed the inter-disciplinarity and sodality among all.

It was a great entertainment for me to watch the music and band performance by local mental health service users and concert by the well known Faroese Singers in both the opening and ending ceremonies.  

I enjoyed the relax atmosphere of the venue, the Nordic House and the excursion of Torshavn harbor and the PNA night dinner. I was really taken aback by the beauty of the location, especially as viewed from Nordic House. I never knew before how beautiful Faroe Islands is? I hope everyone had good time at the congress.

Action to be taken

1. I will always think of ‘Psychological safety’ at my workplace particularly in my managerial role and usefulness of ‘the Safe settings’ in my role as psychiatric nurse based on reflective knowledge and insight gained from attending this congress. 

2. I will share my positive experience with my colleagues and also motivate them to participate in such a superb professional conference.

3. I will try to do further research in area i.e. role of psychiatric nurse in creating safe setting at the national forensic mental health services.

Acknowledgement

I'd like to add my thanks to PNA of Ireland for providing me bursary for attending this superb - Horatio Congress and I feel hugely in debt.

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Synopsis of Horatio Congress 2018 at Torshavn, Faroe Islands

Neil Crowhurst  Waterford Mental Health Services

Background

I was very fortunate to be able to attend the above conference as a Horatio Bursary winner. I submitted a poster presentation on the conference theme of ‘Safe Settings’ and was able to fully participate in the conference proceedings at both presenter and delegate levels.

Research

I currently work in clinical, research and teaching roles. My postgraduate research project aims to examine contributory factors relating to serious incidents in mental health services. As such my poster presentation was a review of the antecedents associated with violence/aggression and suicide within inpatient mental health areas. Many of the presentations I attended also dealt with this type of research area – another reason why I found the conference so invaluable.

Experience

From a professional perspective, being able to attend the conference was extremely productive. Not only was I able to develop my poster presentation skills (something I had not attempted before) but I was able to add the presentation to my list of publications and to my CV. The feedback I received during the conference was very helpful in terms of developing my research/presentation skills. Similarly, I was proud to be able to represent both the Health Service Executive (HSE) in Ireland and Waterford Institute of Technology (WIT) who are jointly overseeing my research project.   The links and contacts I made with various delegate group members, from all across the world, would not have occurred without the opportunity afforded by the Psychiatric Nurses Association of Ireland (PNA).  

From a personal viewpoint, I really enjoyed the conference, particularly the range and scope of presentations and the level of interest and commitment amongst delegates. The setting was perfect and the hosts of both the conference and my accommodation were extremely accommodating and friendly. I would really liked to have stayed in the Faroe Islands for a longer period – I only really got to see the capital Torshavn, which in itself was a lovely city, but I would certainly venture further beyond if the opportunity arose again. It is very unlikely that I would have made it to such a stunning place at any time in my life had I not been given the chance and resources to present.  

I would recommend the opportunities offered by Horatio and the PNA to all nursing and healthcare colleagues. Indeed I have already brought the 2019 conference in Copenhagen to the attention of friends and colleagues in Waterford.     

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Synopsis of Horatio Congress 2018 at Torshavn, Faroe Islands

Gerry Maguire Cavan / Monaghan Mental Health Services

Well, the landing in the Faroe Islands was ‘interesting’!! Atlantic Airlines, owned by the Faroese Government, provide an exceptional service between Copenhagen and Faroe, as well as from Edinburgh. As was the journey to Torshavn, the Capital ‘city’ of about 10,000 people!! The landscape, while breath-taking, seemed quite inhospitable with huge mountains and deep ravines…and water everywhere…including overhead! Dwellings in the countryside were sparse and it was about 45mins drive to Torshavn. Every so often, we would come along a small village nestled between the mountains and invariably close to the sea. Idyllic in good weather! The roads network was top class with bridges and tunnels connecting some of the various islands. The Faroe’s highest temperature in the Summer months ranges between 10-13 degrees! However, their winters are relatively mild (3-4 degrees min), though they do get a sprinkling of snow now and then.

Torshavn, the Capital, is beautiful. There were limited hotels and many of us stayed in B&B’s that were functional. It is a bit more expensive then Ireland, but not as bad as we had feared. There is a good bus service around the town and some folks stayed an extra few days to take advantage of available sight-seeing trips around one or more of the islands that make up the Faroes.

The Conference itself was very well organised and every possible detail was attended to. The venue ‘The Nordic Centre’ was first class; a fabulous new build convention centre, covered in grass, not unlike many of the traditional buildings in the Old Town. The food was class…and plenty of it! There was a great international flavour to the conference and we had the opportunity to learn about the differences as well as similarities in service delivery in mental health care across Europe, primarily, though there were a few presenters from as far away as Australia and Canada. There were smooth transitions between the Key note and plenary sessions and the various rooms were comfortable and the attendees interested, engaged and interactive – I believe it’s this last piece where much of that deeper learning takes place, where we tend to compare and contrast, thinking of how, and which bits, we can take from the session to our own areas of practice.  

I’ve been to Horatio a few times now but this is the first time I was facilitated by the PNA. Many thanks to Peter and the PNA Executive for making this wonderful trip possible, and for their continued support for the annual bursary scheme. Sincere thanks also to the Local as well as International Organising Committee for the Conference, that includes our very own Aisling Culhane!

It’s not so easy, nor cheap, to get to the Faroes! I guess it’s one of those places one wouldn’t think to visit….unless you had a reason! But it’s well worth a visit. And of course, Horatio is always a well organised, high calibre international Conference. Go for it!!

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Synopsis of Horatio Congress 2018 at Torshavn, Faroe Islands

Ciara Healy The National Forensic Mental Health Services, Central Mental Hospital, Dundrum, Dublin 14,

May of this year I was lucky enough to be selected for the Horatio congress which was held in the Faroe Islands, alongside five other of my nursing colleagues. As this was my first year attending, I was unsure of what was ahead of me in the coming days however I was egger as well as excited for the conference. I was also really looking forward t exploring a new part of the world for me. From the moment we landed I felt a great welcome from the other PNA delegates as well as the hosts of this year’s conference. We had the pleasure of being entertained by local musicians, dancers and poets throughout.

The conference was held over a couple of days which gave you a chance to attend several presentations from different nursing professionals from around the world. Two presentations which stood out for me were, one from a nurse that attended from Australia who spoke about palliative care for patients in the mental health settings and another from a fellow PNA member Tracey, who gave an engaging presentation about giving responsibility to the patient for their physical health in a community setting as well as introducing apps to help communication between all MDT members and the patient. I loved hearing presentations, having discussions and bouncing ideas off different nurses from other countries to develop and broaden my nursing ideas.

Overall, I had an amazing experience at this year’s conference and I would highly recommend nursing professionals of all grades to attend as well as present in future years. Once I returned to Ireland, I was already planning to attend next years conference and maybe even presenting! I am extremely grateful to the PNA for giving me the chance to attend and will have fond memories of our trip together.

Patient safety and quality are at the heart of the delivery of health care. For every patient, client, carer, family member and health care professional, safety is pivotal throughout the care journey. For all who work in the health system there is a commitment to the values of care, compassion, trust and learning (HSE, 2017) that contributes to enhancing and enabling excellence in the standard of care provision. A sustained commitment to continuous improvement is required from everyone involved in the health and personal social care system.

Across the world it is well recognised that measurement and monitoring of the quality of care delivery is integral to raising and maintaining care standards.  In June 2018, the HSE Office of Nursing & Midwifery Services (ONMSD) completed pioneering work, entitled Quality Care-Metrics that consists of a robust framework of care process metrics and indicators to support nurses and midwives to engage in measurement and monitoring that leads to safer care. A robust suite of care process metrics and indicators, sensitive to the influences of nurses and midwives working in the areas of mental health, intellectual disability, older persons, children's, public health nursing, midwifery and acute care are available for use. These metrics and indicators when measured and monitored in clinical practice, provide an indication of the quality of care delivery aligned to evidenced based standards, procedures and guidelines, enabling the development of action planning for improvement.

To further support nurses and midwives and to ensure a standardised approach to Quality Care-Metrics implementation in clinical practice, seven guideline documents were approved in December 2018 and are available on the ONMSD website: www.hse.ie/eng/about/who/onmsd/safecare/qcm/qcm-pppgs.html

Additional information and learning resources can also be accessed on the Quality Care-Metrics hub on HSELanD: http://qcmhub.hseland.ie/

Most health care systems would agree that the destination to higher quality safer care is to deliver been outcomes for service users. The route to this destination is to have the right metrics and indicators. The ONMSD have ensured that the voice of both service users and the consensus of nurses and midwives were central to determining the Quality Care-Metrics that truly matter.

Should you wish to roll out Quality Care-Metrics in your practice area support is available through the regional Nursing and Midwifery Planning and Development Units. 

NMPDU QCM Contact Persons

Health Service Executive (2017) HSE Corporate Plan 2015-2017. Available at: https://www.hse.ie/eng/about/our-health-service/values-in-action/

On 19^th November 2018, Mary Wynne, Office of the Nursing and Midwifery Planning Director in the HSE launched the National Professional Development Planning (PDP) Framework for Nurses and Midwives. A Professional Development Plan (PDP) is a tool that supports the nurse or midwife to identify professional goals, both short and long term for the benefit of themselves, their service users and the organisations in which they work. Professional development planning is a continuous development process that enables nurses and midwives to make the best use of their skills, to identify their professional goals and the supports required to achieve their goals, and helps advance both their individual plans and the strategic goals of the organisation. The PDP can be used only for professional development planning and is shared only with the nurse’s line manager. The PDP will support nurses in maintaining a record of professional competence as will be required with enactment of Part II Maintenance of Professional Competence of the Nurses and Midwives Act, 2011. The digital PDP, on the Nursing and Midwifery Hub on HSELanD provides an easy way to maintain a professional development plan online, available at www.hseland.ie

The PDP framework includes a template, an information guide, a workbook and a brief awareness video. The launch included testimonials from staff nurses and clinical nurse managers of their experiences in testing the PDP Framework. Each brought a different perspective and all endorsed the personal benefits in realising their continuous professional development requirements, improving communications and increasing job satisfaction.

The PDP framework has been developed under the governance of a national steering group involving Directors of Nursing, HSE Human Resources and the nursing and midwifery staff associations including Aisling Culhane, Research & Development Advisor, PNA. Mary Wynne, Nursing and Midwifery Services Director of the Office of Nursing and Midwifery Services HSE, chaired the steering committee and the project was lead and managed by Deirdre Mulligan, Interim Area Director of Nursing and Midwifery Office of the Nursing and Midwifery Services Directorate of the HSE

The PDP Framework was tested by nurses and midwives across all disciplines and sectors in the HSE, include mental health / psychiatric nurses in Dublin North Central and Cavan Monaghan Mental Health Services. Nurses and midwives were involved in the design, development and testing of the PDP Framework, hence the slogan PDP By Me for Me 

Access the digital PDP and supports on the Nursing and Midwifery Hub at www.hseland.ie

The PDP Framework documents are also available on the Office of Nursing and Midwifery Services website https://www.hse.ie/eng/about/who/onmsd/res/professional-development-planning-framework-for-nurses-and-midwives.html

The PDP awareness video can be accessed on http://auriondemo.com/Digital_PDP_Explainer/Digital%20PDP%20Explainer-03.mp4