G201(P) Exploring new ways of working in the neonatal unit

Abstract

Aim This project has been commissioned by the London School of Paediatrics/Health Education England to explore new ways of working within neonatal units across London with an aim to provide collaborative recommendations on ways to reduce the dependence of service delivery on the paediatric medical workforce by providing a more stable, mixed, neonatal workforce. Workforce issues are not limited to medical rotas; review of national and local data has found that there is a considerable vacancy across the different professional groups nationally and within London. There is a paucity of qualified in speciality (QIS) nurses and a wide variability in the availability of enhanced and advanced roles in neonatal nursing. Method Common workforce and service delivery issues already acknowledged by professional bodies were identified during site visits and semi-structured interviews with over half of the London neonatal teams. Results Units spoke of developing different roles which may support the workforce and these have been explored further. It was clear to see a variance in how units have developed operationally to deliver care. Factors have been identified which have a direct impact on the workforce such as: medical and nursing vacancies, culture, transitional care, admission prevention, support for junior nursing staff and the development of the non-registered workforce. Increasing the support for lower dependency care can potentially relieve pressures upstream. Solutions for workforce transformation cannot be considered in isolation. It has become apparent that organisation and service delivery of care has to be considered in tandem for workforce transformation. Results To further explore: Nursing Associates Role definition for Enhanced Neonatal Nurse Practitioners Development of Non–Medical Supporting Roles Development of Associate Specialist/MTIp roles Awareness of impact of culture and morale on the workforce Investment in clinical supervision, education and training Development of networked preceptorship nursing programmes Development of Transitional Care Implementation of ATAIN programme Implementation of Integrated Family Development Care However, despite all best intentions, these roles and service developments may not have a sustainable effect on vacancies in middle grade doctors or nurses achieving QIS. It is important to recognise this as a limitation.