In the staffing shell game it’s patients who lose

With hospitals shuffling workforce to keep administrators, budgets and unions happy, somebody gets left out.

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When the Nine press published a story last week about St Vincent’s Hospital Sydney deciding that “close observation nurses” would no longer be used on morning shifts from Monday to Friday, it touched a chord with me. 

Close observation nurses are also called “specials”. They’re usually an enrolled nurse or an assistant in nursing. When they’re working a special shift, it’s their job to give constant one-on-one care to a high-needs patient – usually someone with dementia, with behavioural issues, or high falls risk. 

Largely it’s about patient safety.  

A St Vincent’s spokesperson said it wasn’t their intention to reduce the number of close observation shifts, rather they were changing who worked them. Instead of expensive agency nurses, the hospital’s own nursing staff would be doing them.  

“All patients who need a special, will get a special,” said the spokesperson. 

It struck a chord with me because my mother has dementia with behavioural issues. At midnight on Boxing Day she broke her hip. 

Despite being fully insured, and despite a family member being with her at all times, the local private hospital refused to accept her as a patient in emergency, because they didn’t have a “dementia bed” available. 

A dementia bed, by the way, isn’t a new-fangled hospital bed with special doohickies. A dementia bed is a hospital bed with a close observation nurse assigned to it. In other words, the private hospital didn’t have the staff available to provide my mother with one-on-one care. 

So, my old mum ended up at the local public hospital where she received superb care in a four-bed orthopaedic ward filled with patients with dementia. They didn’t all get a special, mind you. But there was a special in the room. Most of the time. 

I was talking with a friend of mine who happens to be a senior nurse who has done her time in both private and public systems over the years. 

“Mate,” she said. “I would rather close a dementia bed than have it under-resourced.” 

Sounds good in one way, and terrifying in another. 

Because of course that is one of the alternatives to having agency nurses filling special shifts. If the union for the St Vincent’s Hospital Sydney nurses decides that doing special shifts will stretch the frontline staff too far, then what are the alternatives? 

Bring back the agency nurses? Expensive, particularly for a hospital with well-publicised financial troubles.  

Or reduce the number of beds available for high-need, complex patients like my mum? 

St Vinnie’s spokesperson said that won’t happen at the Darlinghurst facility, because patients like my mum are their “core business”. In fact, St Vinnie’s Sydney has a higher rate of complex and vulnerable patients coming through its doors than the majority of big hospitals in the country, simply because of where it is and the demographic that surrounds it. 

I’m inclined to think they will work out a way of giving the care that needs to be given. 

Still, hospital administrators and spokespeople across the country and across the systems talk routinely about the nil-sum game of shuffling nursing skillsets around on the magnetic board. No net loss in workforce numbers, they’ll say. 

But someone loses. And that’s the patient and their families. It’s terrifying how quickly the poor old patient gets forgotten about.