1. EXERCISE 1 & 2 ON OPEN CODING
Focus group MHS: February 15, 2000
<WRITE C ODES IN THIS C O LUMN>
MHS personnel issues are many
Threre is more than one institution
with this issue.
Focus group MHS: February 15, 2000
MODERATOR: If we continue now, the session will be finished at about
ten o’clock. There is one issue that is important for my client and that is
the issue of employment. Is there enough employment? Are there enough
nurses? Are there enough carers? This is a very broad question but in the
workplace, you are confronted with that problem and I want to know your
experience with this? What are the problems of personnel management?
GUI: There is way too much personnel (laughs). One of the tricky issue in all Mental
Health Services (MHS), that is one, the shortage of personnel. More specifically, I
think there is a primary shortage in the T-services. Especially in the intramural
services, the biggest problem, we talked about it earlier. In the Centres for Mental
Health Services (CMS) it is the same story. But in CMS, it has to do with initiatives
being too little. In CMS, they will have to double the number of people working
there. They need to triple them in order to start accommodating the requests for
help. Besides the shortage in numbers, there is a huge shortage in qualifications. I
think there are fights today to attract graduating A1-psuchiatric nurses in the
institutions. In my institution for example, there are job interviews during the Easter
Holiday for people who will graduate in June and September. You also have some
people … I will give you an example. In earlier times, people who resigned and
asked permission to stop earlier because they wanted to go to another institution
were always given permission to do so. Today, we are very difficult in granting such
questions. People can only leave when their entire notice period has ended. Why?
We are constantly beneath our staff norm. We are exactly on our norm but we had
budgeted to be always about twenty or thirty people above our norm. Today,
because we can’t find the people, we are constantly twenty full time equivalents
below the budgeted norm, which is the norm we have set up ourselves. We also see
the ratio between the nurses and the other carers with different qualifications. This
ratio changes every year and evolves towards less nurses and more and more other
qualifications.
2. MODERATOR: Who are these other qualifications?
GUI: They have different backgrounds: occupational therapists, psychological
assistants, educators, psychologists, exercise therapists, people with lower
qualifications. Everybody of whom we can estimate that their personality will fit a
little bit in our institution and who has interest in a little retraining. But most of all,
we prefer trained nurses because that is a group of which there are huge shortages
today. You cannot solve all problems in a department by hiring – so to speak – an
additional occupational therapist. A limited degree of division of labour is possible,
but some tasks are better done by nurses.
HUN: Indeed, there is a tension between the need to hire more people and the
shortages of good people on the labour market. For our institution, we are 12 full
time equivalents under the norms. I talk about the situation one year ago and each
year it gets worse. In January, we were even 12 additional full times under the
norm, while the management says ‘we want to be ten full time equivalents above
the norm’. That is a shortage of more than twenty full time equivalents on a group
of two hundred something. Given the care needs, this is actually catastrophic. At
certain moments, I think of holidays, you can hardly deliver the minimum care. They
are constantly talking about quality and quality decrees and you name it but I find
this very alarming.
GUI: You end up in a vicious circle. For example, people come to you and ask for a
reduction in working hours to work part time. You cannot phase down any more
because you need these people. You cannot afford this … you put them on waiting
lists and because they are on waiting lists they do not receive their part time
contract immediately and they leave for another institution. And this is a continuing
process; it always goes further like a screw motion. They place you with your back
against the wall. People enter the institution with certain expectations ‘I would love
to start with you, but I want to work on the mother-child department’, just to say
something, the favourite department at our campus. Yes, we never have staff
shortages on our mother-child department, but we do have some departments with
severely psychotic patients where we need to expand our personnel staff. But they
do not want to work there. This gives additional difficulties if they find an institution
where they can work in a department on which the perception lives that it is a
pleasant one to work in. Yes, those are the first people want to go to.
MYR: I also see a decrease in the level of education. They always tell me that my
expectations are rising and that this give me a blurred vision, but I can’t stop
thinking that it goes in the wrong direction.
3. GUI: This is certainly the case.
LIC: I think that on this moment, there is a real danger in a loss of educational level.
When saying this, I think about the psychiatric nurses. I think of the withering of our
profession. What I mean is, we have hired people through the European Migration
Fund (EMF). I can’t tell how many of them do not have a qualification of psychiatric
nurse. Sometimes, they do not have a diploma at all. Logistic assistants are
massively employed as carers in psychiatric institutions. It is said that an
occupational therapist can take on several tasks. We are hollowing our specific
profession. In the end, the few specific psychiatric nurses left will evolve in the
direction of technical actions and it is not the technical actions that have made us
choose for this profession. We also have the issue of the twenty-four hours care that
an institution needs to guarantee. You cannot schedule an occupational therapist
during the night. But I do see in our institution, but also in other hospitals, that
therapeutic norm personnel is used for other things than they are meant to. I’ll
explain this: the “quality manager”. We are obliged to have such a position but we
do not get money to hire one. Ok, what we do is using somebody and taking that
person away from working with patients. There is less and less time to care for
patients because the government obliges us to do more other stuff without giving us
the necessary funds for these new tasks. Another issue is the new staff functions
like the Minimal Psychiatric Data (MPD). Again, this is obliged by the government
but no funds are given to implement them what results in taking away these
resources from the patients. That is a dangerous tendency in my opinion. On the
other hand, we have shortages of psychiatric nurses on the labour market. This
year, there is a decrease of ten percent in the registration of new students for the
psychiatric nurse school.
LIS: If they all get their diploma, there will be only 60 new psychiatric nurses next
year in the whole of Flanders.
MODERATOR: So the need for graduated psychiatric nurses is bigger than
for other qualifications?
LIC: At this moment, we are reduced to supervising staff. I know this is rather crude
to say. We are the ones that fill in the Psychiatric Registration System (MPD) and
carry around the medicine.
HUN: I have read a recent article in which Walter Serneus says there are too many
psychiatric nurses and that – in the future - nurses should only be the coordinator of
4. the care and nothing else. He said there were thousand nurses too many, I do not
remember the exact number any more. The title of the article said that we ought to
do something at the job description of nurses and carers. Nurses will probably no
longer do exclusively the care they love to do. They will do the coordination and in
that case we have too many nurses.
LIC: Aside from that, it is important, returning to the nurses, that we think about the
working conditions of nurses. For example, I think about the scheduling. In Belgium,
they do not follow the European guidelines on scheduling. The end of the career
issue is getting urgent as well. Of all fifty plus, we do not have so many full time
working carers. But also among the part time carers, I hear voices like ‘will I make it
until my pension?’.
MYR: I think that the work pressure, on whatever level, has increased a lot. I do not
only talk about working conditions but also of the content of the labour.
The patient population, but also all the other tasks that are added next to the direct
care for the patients.
LIC: For which they do not give any additional means.
