Nursing staff in psychiatric care: satisfied, but overworked

The nursing crisis is on everyone’s lips, and creates additional challenges for healthcare staff. A report by the University of Basel shows how satisfied psychiatric nursing staff are with their daily working lives.

Irregular working hours, night shifts and overtime: it’s not news that nursing is a challenging profession. However, the focus is often on physical healthcare - the care of people with bodily complaints. Yet those working in inpatient psychiatric care are also affected by these issues.

A study conducted by a research team led by Professor Michael Simon from the Institute of Nursing Science at the University of Basel investigated the state of nursing in inpatient psychiatric treatment. They surveyed 1,185 registered and licensed practical nurses from a total of 114 departments in 13 psychiatric clinics. The results are summarized in their report, which appeared in early April: Pflege in der stationären Psychiatrie der Deutschschweiz (Match Psychiatrie) [Nursing in inpatient psychiatric care in German-speaking Switzerland (part of the Match Psychiatry study). The first investigation to be conducted on this scale, it took place between 2019 and 2021.

The conclusion: in general, most respondents were satisfied with their working environment. Four out of five of them would recommend their place of work to others. A good psychosocial environment - such as a strong team spirit or capable management - has a particularly positive effect on job satisfaction. Nurses who feel that their needs are taken into account as far as possible, for example during shift scheduling, are happier.

Concern over staff shortages

However, the effects of staff shortages are also being felt in psychiatric healthcare. If staffing levels are too low, then staff members end up taking on extra shifts or working overtime. "At the time of the survey, over 40 percent of respondents told us that they had worked overtime on their last shift," says Michael Ketzer, a doctoral candidate and lead author of the study.

Three quarters of those surveyed step in at short notice at least once a month - often on weekends and holidays, or for late shifts and night shifts - and their work-life balance suffers as a result.

However, the respondents were also concerned about the quality of patient care provided during understaffed shifts. "Psychiatric nursing staff identify strongly with their profession. They feel responsible for their patients, who are particularly vulnerable and are still highly stigmatized by society on top of that. These nurses want to protect them and support them in getting back on track in life," says Michael Simon.

The care of these patients is therefore their top priority. However, lack of time means that downstream tasks such as administrative duties tend to fall by the wayside. A significant issue is the correlation between neglected care and staffing levels: if there are fewer staff on hand, then more of the planned nursing tasks are left undone. This can, in turn, increase the likelihood of emotional stress and burnout among nursing staff.

Nurses need long-term prospects

Countering this will require input from management staff at these clinics, where the working environments need further improvement. The researchers found that far from all clinics have a plan for how this could be achieved.

"It’s worth investing in personnel and creating incentives for nursing staff to remain in the profession. These are capable, professional people who are also interested in developing further in their field," says Michael Simon. Continuing education that offers prospects keeps up their motivation to remain in their profession in the longer term.

Countering the accusation that this would lead to the nursing profession becoming overly academic, he responds: "Most people that work in nursing do so primarily because they like coming into contact with the patients. For them, it is about being there for these people, and they rightly aspire to ensuring high-quality care." For this they need development opportunities, such as clinical training courses, which will contribute to keeping nursing professionals "at the bedside".

Further development is also needed at management level, Simon has come to realize. "In order to master the various challenges in nursing, we need modern management concepts that are less hierarchical and that perhaps change the methods used in staff planning."

In a second survey in 2023, the researchers deepened their findings from the first, recently published report. Here, they focused on stigmatization of patients by nurses, as well as on the use of temporary workers, the atmosphere on the wards and aggressive incidents in everyday nursing life.

Original publication

Michael Ketzer et al.
Pflege in der stationären Psychiatrie der Deutschschweiz Gesamtbericht, April 2024
(available only in German), doi: 10.5281/zenodo.10884894