The recently released Strategic Review on Healthcare Manpower Planning & Professional Development report claimed that there is a surplus of psychiatric nurses in Hong Kong. The report estimates an existing surplus of 3%, and the number is forecasted to grow to 16% given the increasing supply. With regards to the manpower surplus, the review suggested the Hospital Authority (HA) and social welfare institutions to take the opportunity to plan ahead and make greater provision of existing and new healthcare services.

Is a forecast that is built on the existing service level reflecting what is needed?

However, the forecast is based upon the assumptions that “the existing service level and model will remain unchanged throughout the projection period and no new services will be provided”.

Under existing service levels, the nurse to patient ratio in Hong Kong often reaches 1:10 – 12, much lower than the international standard of 1:4 – 6. Although the nurse-to-patient ratio for psychiatric tends to be the lowest when compared to other types of units such as paediatrics and medical/surgical – it still has a long road to close the gap.

Moreover, with Hong Kong’s growing population, there is an increased need for psychiatric outreach programmes which see the workforce spread even thinner. Even with the supposed excess in psychiatric nurses, many have to frequently work overtime which, in return, severely affects their quality of service and morale.

Outreach programmes are especially tricky given the situation of community psychiatric nurses in Hong Kong. On an average, each nurse takes care of up to 60 to 80 patients at any given time. Even though there are cases of severe mental illnesses – due to the insufficient manpower – a community psychiatric nurse can only offer each patient approximately 30 minutes for care.

“Patients with depression could be talking a lot. We need to build up relationships with patients through chit-chat, before they speak their mind to us,” said a community psychiatric nurse, Keith.

Additionally, when the report establishes its forecast simply based on the existing service level, it somehow encourages the current nurse-to-patient to become the norm. “People consider community psychiatric nurses as all-powerful and capable of taking care (of almost everything),” he added.

Increasing manpower and reducing the nurse-to-patient ratio

Meanwhile, the growing ageing population is putting a strain on the existing medical psychiatric medical workforce. Aside from carrying out follow-up on patient medical needs – psychiatric nurses also have to assess if patients are able to care for themselves, carry out basic activities of daily living and ensure that anyone under their care is properly taken care of. On top of that, psychiatric nurses are also required to complete visit reports and modify patient’s care plans when required. That, in combination with the fact that psychiatric nurses have to take care of up to 60 patients, makes for an extreme workload that is only getting worse.

In response to the report, the Association of Hong Kong Nursing Staff issued a statement on 15 June, claiming that the government should not take reference of the report as its indicator when formulating long-term healthcare policies. Although there is a constant supply of psychiatric nurses, the total number of psychiatric nurses does not necessarily equate to the number of psychiatric nurses working within the public sector. In view of this, the Association suggested the government to increase the manpower supply and reduce the nurse-to-patient ratio to 1:20 – 30 for community case managers.

At present, even “sufficiently” staffed medical workforces such as psychiatric nurses are in fact facing very heavy workloads. The government needs to recognise the fact that the city is currently facing a shortage of doctors and nurses – and it is a dire problem that needs to be addressed immediately, before the problem gets out of hand. MIMS

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