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Making it fit-for-purpose: the nursing and midwifery rostering project

Making it fit-for-purpose: the nursing and midwifery rostering project

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‘It is no secret that we have a workforce issue,’ says Victoria’s Acting Chief Nurse and Midwifery Officer Jac Mathieson.

‘Our workforce is tired. We don’t have enough workers. We’ve got a lot of vacancy. We can look at pipeline, we can look at recruitment – those are important – but retention is a big barrier here. And the number one frustration that ANMF hears through its members, and that we hear from our EDONMs, our unit managers and from our nurses and midwives on the ground, is that the rosters aren’t working for anyone.’

Jac and others at Safer Care Victoria (SCV) are currently working with ANMF (Vic Branch) and a representative group of health services to look at changing the way we roster across Victoria. The project will build on the workforce retention survey of public sector members that the Branch conducted earlier this year.

‘This is a really big, and important project,’ says Branch Secretary Lisa Fitzpatrick. ‘It will look at the current state of play, but it’s also going to look at where we want to be with rostering and what workforce benefits we would see from improving rostering processes.

‘It’s bigger than Ben Hur, but if we achieve good outcomes we can then embed those outcomes in the 2024 public sector EBA and health service operations.’

The project’s aim is to build rostering that:

  • maximises the availability of nurses and midwives
  • reduces absenteeism, fatigue-related illness and casualisation
  • meets an individual’s work, family/social and health situation
  • meets the professional needs and desires of nurses and midwives.

The project’s steering committee recognises that typically the roster is the responsibility of the most experienced nurses and midwives on a unit. A large ward might need to fill thousands of shifts each week, and it’s estimated that it can take up to 1.2 EFT of  time to create – and recreate – a roster per ward, each week.

‘We want to be able to free up some of our most experienced nurses and midwives who are charged with spending hours and hours doing the roster,’ says Ms Fitzpatrick.

Flexibility and fatigue

Another big issue to be addressed is flexibility within employment and in the roster, especially for nurses and midwives trying to juggle work and caring roles.

The proportion of nurses and midwives under 40 is increasing as a proportion of our workforce, and our workforce is almost 90 per cent female. Women under 40 are more likely to have multiple caring responsibilities that can affect the times in which they can work.

For example, with childcare typically opening at 7am and day shifts often commencing at 7am, it’s a challenge and sometimes not possible to manage both.

Fatigue is another major issue that needs to be addressed. Currently, rosters are often established with little consideration for fatigue-management principles. Adding to the issue, last-minute unplanned shift changes and calls/texts to pick up additional shifts are leading to increased stress and burn out.

‘We want to build rosters that facilitate the needs of nurses and midwives, including the possibility of set shifts/set days and being responsive to flexible work arrangement requests,’ says Ms Fitzpatrick. ‘We want to build rosters that prevent fatigue and adhere to best-practice fatigue-management principles. We also want to look at the ability to accommodate any EFT fraction for a permanent employee.’

This means looking at shift lengths also. Protecting the 26-hour roster will be critical. ‘We’re very mindful about the implications around adding short shifts as far as multiple handovers and continuity of care,’ Ms Fitzpatrick says. ‘That is going to be a really challenging balance for us, but we have to examine it, we have to respond to what our members are able to work and how individual needs can be met.’

What does success look like:

  1. Recognised as professions that offer choice, capitalising on availability of nurses and midwives as well as being able to meet the needs of those in our care across our public health system.
  2. Technology available to us is maximised to reduce the impact on those undertaking the responsibility of rostering.
  3. Rosters are built ensuring set shifts/set days that the employee requests enable flexible work arrangements to be met (subject to ‘built in’ and agreed periodic review).
  4. Where applicable, the preference of employee in terms of location and shift preferences within a ward/unit or multi ward service (e.g. birthing suite, oncology) are considered.
  5. Fatigue management and best-practice shift work principles (e.g. day to evening to night) are utilised.
  6. The requirement behind the need for flexibility – including childcare starting and finishing times, alternate childcare options, other shift options around childcare availability, partner work requirements and other care requirements – are understood.
  7. Understanding how far in advance is optimal for staff to have the roster released.
  8. Understand and clearly articulate the time and further support for the skills required to be undertaking and completing a roster for a ward/unit.
  9. Any EFT fraction for the purposes of being a permanent employee is recognised and considered.
  10. The 26-hour roster to enable CPD time is retained.

‘If we can get this right,’ Ms Mathieson says, ‘it will not only positively impact our current nurses and midwives but hopefully it’ll also help those now entering our professions to stay in it for longer, and to stay working at the bedside, the place where our nurses and midwives make the most impact.’

The project has commenced. A communication strategy is being finalised and will include information regularly distributed as the work progresses. Consultation with nurses and midwives at the local level will occur and be a critical element of the project.