They have some of the most difficult jobs imaginable, but the public never hears from Milwaukee County’s Mental Health Complex employees, the unsung heroes who care for individuals who are hospitalized because of their serious mental health issues.
By law, health care professionals aren’t allowed to reveal personal information about their patients. Nor do the county’s Behavioral Health Division (BHD) employees want to speak out, for fear of being targeted at work and losing their jobs.
But more than one nurse was willing to talk to the Shepherd about what it’s like to care for the hospital’s patients. Those with the most intense psychiatric needs can be violent or threaten violence. Some need to be restrained occasionally for fear of hurting themselves or others. Some get into the heads of workers to manipulate them, causing incredible stress for these employees both on and off duty.
One nurse who spoke to the Shepherd had worked at another psychiatric facility, but BHD’s high acuity unit is “a whole other level. It’s street-level combat.”
The nurse said each day on the unit is different, since patients are cycling in and out of the hospital and their moods and behavior are in constant flux as they get treated. Patients in full-blown crisis are placed with patients who are nearing the end of their treatment, but the combustible mixture can stir up trouble and undermine patients’ recovery.
Staffing is often a problem. A nurse is usually responsible for five or six patients, one or more of whom could need one-on-one oversight. Certified nursing assistants (CNAs) provide assistance, but they’re underpaid and often under-trained for the demands of the job, the nurse said.
“You are running from the moment you get there,” the nurse said.
This nurse, like many BHD nurses and CNAs, has been physically and emotionally attacked by patients, some of whom try to play staff off of each other in an effort to manipulate them so the patient can gain the upper hand. It takes professional training to remain in control.
Patients are stabilized and then they’re released, but they often return when they aren’t able to take care of themselves in an unstructured environment, the nurse said.
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The nurse told the Shepherd they are concerned about the county’s efforts to privatize the hospital’s in-patient care via a request for proposals (RFP), since the winning vendor will likely feel pressure to do things cheaply while caring for difficult patients who private hospitals would normally reject.
“This is the safety net,” the nurse said of BHD. “This is the bottom. There is nothing after this.”
The nurse is concerned that future patients will be discharged without proper follow-up treatment—or, worse, not seek or be denied treatment—and will wind up in jail, become violent, support themselves in the drug trade, lose their homes or die prematurely.
That said, this nurse committed to providing excellent care at BHD even though one more hospital unit is closing this year and the entire system is being downsized and reorganized.
“It’s only going to get worse as this winds down,” the nurse warned.
The nurse wanted the public to know that BHD employees are well-meaning, caring professionals doing their best under very difficult conditions.
“I’m going to lose my job when this is over,” the nurse said. “But I want to make sure that people are getting the best possible care. So I’m torn.”
‘It Takes a Special Person to Work Here’
This nurse’s story is echoed by other BHD employees who spoke to the Shepherd, both on and off the record. Jeff Weber, a nurse with more than 20 years of experience at BHD and the president of the Wisconsin Federation of Nurses and Health Professionals (WFNHP) Local 5001, said morale among his union members is at an all-time low. He said his union members are concerned about providing safe and high-quality care during this period of rapid change at BHD.
“The turnover is incredible,” Weber said. “It’s a difficult population to work with and it takes a special person to work here. In my 20 years I have not seen the flight of employees that I have seen in the past two years.”
Weber said many of his union members feel they aren’t fully appreciated by the administration or the public at large for the difficulties they face on the job at the same time their jobs are threatened by privatization and downsizing.
Milwaukee County Executive Chris Abele’s administration and BHD managers had crafted a bonus plan in early 2014 to retain employees as the county downsizes its in-patient care, but that hasn’t materialized. The Milwaukee County Board of Supervisors rejected the plan before Act 203 took away their oversight of BHD in the summer of 2014. Abele’s Health and Human Services Director Hector Colon didn’t take it to the new Milwaukee County Mental Health Board, which took over the supervisors’ BHD duties. At any rate, the Mental Health Board voted this summer to not be involved in BHD employees’ salary or benefits issues, leaving it to the Abele administration to manage personnel.
“The board has given Abele carte blanche,” Weber said.
In the meantime, the BHD administration has been working on new salary pay ranges. It turns out that some nurses and CNAs were making less than they should and new hires were earning more than their colleagues with many years of experience.
“Through careful analysis and months of work, we are taking a few exciting steps now in terms of employee compensation,” Patricia Schroeder, BHD administrator, emailed the Shepherd. “We are implementing a 1% pay increase for all employees who meet performance evaluation criteria and we are implementing complete salary equity adjustments to get everyone to market rate.”
But Weber said that the administration hasn’t explained the new policy clearly and employees find out about it on a “need to know” basis. He said it would take his union members 50 years to reach the top of the new pay scale at 1% at a time.
Marion Chambers, a CNA and president of AFSCME Local 170, said she’s concerned about the employees who are losing their jobs due to downsizing as the hospital plans to close one unit by the end of the year.
Chambers said each day at the hospital is different, but that patient care and safety are of primary importance.
“You never know what you are going to walk into,” Chambers said.
This article is part of an ongoing series on Milwaukee County’s behavioral health services. For more, go to shepherdexpress.com.
