Failure to provide extra staff for specials is an additional burden on the public health workforce.

Almost half of NSW public sector nurses say they are not provided with additional staff to look after patients who require one-on-one care, or ‘specials’ according to an NSWNMA survey.

When additional staff are provided for specials they are mostly assistants in nursing (AiNs) the survey shows.

NSWNMA General Secretary Brett Holmes said the union ran the survey to help campaign for improved workloads.

More than 73 per cent of respondents were RNs and more than 42 per cent of respondents worked in medical or surgical wards.

Brett said some survey respondents were asked to perform extra duties to cover the lack of additional qualified staff for specials.

Almost 61 per cent reported that patients required specials during the previous week but more than 48 per cent said additional staff were not provided, thereby adding to staff workloads.

Where extra staff were provided, more than 56 per cent said they were AiNs.

Experienced RNs were provided in only 16.33 per cent of cases and experienced enrolled nurses in 12.93 per cent of cases.

Compromised quality of care

“AiNs often do not meet the standards required of specials, which can compromise the quality of health care,” Brett said.

The areas of demand for specials were behavioural management (65.85%), mental health (42.16%), increased level of care for monitoring haemodynamic instability (21.41%), nursing care interventions (17.97%), and medical interventions (12.75%). Some patients needed specials from two or more fields.

There was no consistency across facilities in the methods of allocating additional nurses for specials.

In facilities where policies were implemented, they mostly covered mental health (69.92%), aged care (45.13%), medical (43.31%), surgical (31.48%), and emergency (26.04%).

“The survey suggests that other areas such as paediatric and maternity services are very poorly managed when it comes to use of specials,” Brett said.

‘Specials’ take a toll on understaffed wards

Winning the union’s claim for additional nursing hours to cover patient ‘specials’ would be a major advance in patient care, says John Hunter Hospital RN Brad Phillips.

Brad, a NSWNMA delegate, works on John Hunter’s gastro and cardiac ward.

“On average we have one special a week and at times we can have two specials at the same time,” he says.

“Patients who need specialling can be there for two to three weeks or even longer. This really does take a toll on the nursing staff who are on the clinical frontline.

“On some shifts we have had two nurses looking after 11 patients, which puts huge pressure on staff.

“You’re already looking after really acute patients and they expect you to pick up an extra load when specials are needed.

“The pressure can be horrendous, especially if you’re a senior nurse and you’ve got juniors and AiNs working with you.

“We need experienced and qualified staff to ensure safe care when specialling a patient.”

Specials need careful monitoring

Brad says patients needing specials may be disoriented, are likely to escape, at high risk of falling, and inclined to violence.

“On our ward, we sometimes have to ‘special’ anorexia patients who have complicated behavioural issues that need careful monitoring. Patients are inclined to pull out nasogastric tubes and that needs careful management.

“When we ask for extra staff to deal with these situations we are often told no staff are available because other wards are also short on numbers.

“It frustrates you to know you are not able to give the care you should be giving. A lot of experienced staff are leaving because they’ve had enough.”

Brad says staffing for patients deemed to require a ‘special’ should be in addition to ratios or rostered staffing.

If you knew the specials would be taken care of on every shift, it would take a lot of pressure off, especially when you’re team leader.”