Nurses at Canberra's mental health unit continue to face physical and verbal abuse from patients, with their union responding to 19 critical incidents lodged by members since October.
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Australian Nursing and Midwifery Federation secretary Jenny Miragaya said assaults remained a key challenge for staff in the mental health unit, with many reportedly weary and stressed by the nature of their work.
"We have had a couple of people who have been punched or kicked so they are very serious assaults, although some of the incidents last year resulted in people taking time off work [for treatment]," she said.
"These are just the incidents which were reported to us by members and there may be many more."
ACT Health data revealed staff at the mental health unit filed 57 reports about attacks on workers and 37 over physical or verbal threats last year, with more than 17 staff taking time off due to a workplace injury.
But Ms Miragaya said assault and abuse in the mental health unit had declined in recent months and she was satisfied ACT Health were taking the safety of staff seriously.
"The assaults are ongoing but they are not as frequent as they were during 2013-14 as there has been an increase in staffing levels," she said.
"We were at a stage last year when our staff were so worn out as they'd didn't have the appropriate skills for this type of work."
Reports that staff had been working in an aggressive and violent environment culminated in a provisional improvement notice (PIN) being issued at the unit in July, just one day after a nurse was believed to have been assaulted.
The notice required ACT Health to either close beds or increase staff numbers within the unit.
"ACT Health did increase the staff by one additional nurse per shift and despite the PIN ending in October they have maintained that staffing level," Ms Miragaya said.
"I really do have to give the directorate [recognition] for recognising there is a problem and for trying to address this."
An ACT Health spokeswoman said management were developing an "aggression and violence framework" that would provide staff with a list of key actions and responses.
"There can be incidents of violence and aggression within mental health units in Canberra and other hospitals, as there can be in other parts of the hospital," she said.
In an effort to upskill their workforce, ACT Health now provides a fully-funded graduate diploma in mental health nursing through the University of Canberra.
"This year 18 staff have enrolled [and] this will give us a solid base for more highly trained staff," she said.
"We recognise this takes time but are committed to developing these skills, which will also help improve safety of staff by providing them with the skills to manage difficult behaviours."
The union is currently in the process of confirming a new nurse-patient ratio with both parties agreeing to an interim ratio of nine staff on each shift during day and evening shifts.
"The risk needs to be minimised […] which means having means appropriately skilled staff in sufficient numbers," she said.
"That would mean when something escalates it can be mitigated early so the patient is not a danger to themselves or the staff."
But Ms Miragaya acknowledged there was an acute shortage of trained mental health nurses in the ACT and there was still work to be done to improve the unit.
"There may still be instances of verbal and physical assaults in the unit but I hope they would be the exception rather than the rule.
"We would like there to be a warden there for 24 hours a day. There is one there at night but we would like that during the day too."
