covid-19: 12 hour roster implementation

COVID-19: 12 Hour Roster Implementation

SUMMARY OF ISSUE / POSITION: As a response to the COVID-19 Pandemic, Western Health proposes to implement a 12 hour shift roster for nursing & midwifery staff. This roster endeavours to alleviate staffing shortfalls as a result of the potential rise in personal leave of greater than 10%, in our current workforce due to the COVID-19.

ANALYSIS & DISCUSSION

Background COVID-19 is a respiratory illness caused by a new virus with symptoms ranging from a mild cough to pneumonia. Most people recover easily, whilst others will get sick very quickly. COVID-19 has officially been declared a pandemic by the World Health Organisation (WHO) and is now a Public Health emergency of International Concern.

The growing risk of an increased burden of patients with COVID 19 in the Health System in Australia requires planning. There is a need to establish workforce models that will be able to respond to the potential increase in the number of patients requiring inpatient beds or critical care services, some of which may be in disparate locations. It is also anticipated that the increase in patient acuity and presentation will be combined with potential workforce shortages.

General principles Staff shortages may be the primary challenge. Due to demand and potential workforce shortages it is likely that nursing staff without currency of skills, as well as nursing/midwifery students and Patient Care Assistant’s (PCA’s) will have to assist with care (COVID19 support role). This will require the utilisation of a team model that is under the delegation and supervision of the Registered Nurse/Midwife or Specialist Nurse. Staff duties will need to be carefully considered and adjusted to meet demand. To help facilitate this, clinical staff in administrative roles will need to return to clinical practice as much as possible.

Registered & specialist staff should practice ‘at the top of their scope of practice’ and eliminate most other responsibilities.

Model The model requires urgent identification of staff capability to work across diverse areas and their capacity to work additional hours. The introduction of the model may not be a whole of health service determination, but potentially needs to be dependent on urgency and area need.

The model comprises 3 surges:

• Surge 1 - personal leave rate of <10%, and additional beds open are within available resources• Surge 2 - personal leave rate of 10%- 20% and/or clinical demand/activity dictates that

additional beds are needed beyond what can be achieved through business as usualprocesses.

• Surge 3 - personal leave rates of >20%, and/or clinical demand/activity dictates that additionalbeds are needed substantially beyond what can be achieved through business as usualprocesses.

Western Health intends to ensure that all reasonable efforts are made prior to adjusting a ward/department’s status to an elevated surge level. The possible implications and strategy for the surge levels are:

COVID - 19 | Date: 09.04.2020 | Version: 1 | Author: Wendy Watson | Approved by: Shane Crowe Western Health


• Surge 1 - Maintenance of Safe Patient Care Act staffing requirements through business asusual processes. Personal leave is less than 10%, acuity is manageable and replacement ofpersonal leave is achievable with either bank, pool or agency staff.

• Surge 2 - Personal leave is greater than 10%. The level of personal leave, together withincreased demand and clinical acuity may mean that very limited nurses/midwives are availableto meet demand. Western Health may be forced to implement measures to ensure that patientscontinue to receive care. Shift times may alter to 12 hour shifts where possible to maximisenursing coverage of shifts. We do understand that 12 hour shifts will not be possible for somestaff, and managers will work with their teams to ensure individual requirements are taken intoconsideration. However many staff may elect to do the 12 hour shifts as it may suit them.

The proposed change to 12 hour shifts decreases the overlap time for double staffing therefore maximises staff social-distancing, increases the hours of direct care reducing pressure on night duty staff and maintains nursing/midwifery ratios for day and nights as long as possible. The changes also increase ‘downtime’ for staff to assist with well-being and rest between blocks of shifts.

• Surge 3 - Personal leave of >20%, together with increased demand and clinical acuity maymean that no nurses/midwives are available to meet demand or cover vacancies. In thisinstance non-clinical nurses/midwives would be reassigned to clinical roles where possible.Additionally Western Health would be forced to implement measures to ensure that patientscontinue to receive care. Western Health would use additional COVID-19 Support Staff andassign them to our clinical wards/departments to fill vacant nursing/midwifery shifts (where anurse/midwife is not available). This would including RUSON, RUSOM and PCA roles in wards,and ward nurses in ICU and ED.

Staff would be working to top of scope, and delegating any aspects of their role that can be safely assigned to other roles (including members of the COVID-19 Support Staff). Any delegated task would be undertaken under the supervision of the Registered Nurse/Midwife.

No role would be asked to work outside of their scope of practice or educational preparation.

Implementation of the 12 hour roster Aim - To implement a 12-hour roster pattern across WH in conjunction with the current roster pattern over the period whilst the COVID 19 pandemic occurring (notionally 6 months).

The 12-hour roster patterns are already well established at Western Health in the Intensive Care Unit and Newborn Services at Sunshine Campus and have been successfully running in conjunction with 8/8/10 roster patterns. The 12-hour roster pattern will assist in addressing workforce shortages due to the predicted rise in personal leave due to COVID 19 pandemic. The 12 hours roster trial in conjunction with the current roster pattern for a 6 month period commencing May 2020 dependent upon predicted movement to surge two conditions.

Potential Advantages

There are many advantages to trialling a 12-hour roster pattern which include but are not limited to:

Employee • Maintain nurse to patient ratios for a longer period if personal leave increases• Increase social distancing in clinical area by decreasing periods of double staffing• Fewer consecutive days worked

- Employees would only work a maximum of 3 shifts in row compared to that of 4 or 6day stretches

• Increased number of days off- Allows for more time with family, less days of childcare needed

• Increased number of weekends off- Allows for increased participation in family



• Increased ‘rest’ days between shifts- More days off between work allows for employees to mentally recuperate (Bloodworth,

Lea, Lane, & Gin, 2001; Sullivan, 2002; Stone, et al. 2006).• Fewer shift turnovers and rotations

- Employees have a minimum 11.5 hours off between each shift creating fewer shortchangeovers compared to that of an 8/18/10 hour roster where it can be as little at 9.25hours

• Increased social and family time, whilst adhering to social distancing requirements- More entire days to spend with family instead of short periods or half days (Smith,

Folkard, Tucker, & Macdonald, 1998; Wootten, 2000; Richardson, Turnock, Harris,Finley & Carson, 2007).

• Increased utilisation of personal time- More consecutive days off allows for more time to undertake home duties and

participate in family activities (Smith, Folkard, Tucker, & Macdonald, 1998; Wootten,2000; Richardson, Turnock, Harris, Finley & Carson, 2007).

• Reduced commuting and decreased associated financial burden- Employees would not be required to commute to work as often thus reducing the risk

of road accidents as the percentage of time driving would be less.- A reduction in both car parking and running cost could also be achieved.

Potential Disadvantages

Employee • Longer days/hours

- Including commuting, days can be up to 14 hours long leading to fatigue (HEASConsultant and Clinical Psychologists. 2007; Moore-Ede, Davis, & Sirois, 2007). Thismay be offset by working fewer days and longer time off between rostered shifts.

• Less personal time on working days- Fewer hours off before and after work, which could lead to an increase in fatigue.

• Reduced flexibility due to less available shifts- There is a decrease in the variation of shifts available to employees under a 12-hour

roster. In some circumstances this may decrease the flexibility that some employeeshave at present (Richardson, Turnock, Harris, Finley, & Carson, 2007). This may beoffset by the increased number of days not required at work.

• Longer shifts in one departmental area- Longer shifts in one departmental area can be physical and mentally tiring which could

increase fatigue/burnout

Roster ImplementationWestern Health will implement a 12-hour roster in conjunction with the current 8/8/10 hour roster for a 6 month period. It will include six shifts per day. Six shifts have been selected so not to disadvantage those remaining on the 8/8/10 hour roster by taking the majority of early shifts. The introduction of 12 hour shifts require a direct matching of a 07:00 to 19:30 shift with a 19:00 to 07:30

12 Hour Shift Times: Morning Shift:

0700-1930 hours - Up to a maximum of night duty staffing for that area per day (receiving the afternoon penalty) Night Shift:

1900-0730 hours - up to a maximum of night duty staffing for that area (receiving the night penalty)

The minimum requirements to partake in the 12-hour roster trial are that the employee must work a minimum of 0.4 EFT during this period;



Eight hour shifts • The commencement times of eight hour shifts will change in order to provide greater coverage

of nurses and midwives over the 24 hour period.• Early shifts will commence at 06:00 and cease at 14:30 hours, late shifts will commence at

14:00 hours and cease at 22:30.

Advantages • This will increase the morning and afternoon coverage at full ratios by one hour on each shift,

reducing the strain on night duty staff• Prevent short changes between shifts reducing stress on staff• Increase personal time between shifts reducing stress on staff• Decrease handover time

Roster Guidelines Similar to that of the current 8/8/10 roster, the 12-hour roster will be built 4 weeks in length and will be built concurrently with the 8/8/10 hour roster. See Appendix 1 for an example The 12-hour roster must provide for the following:

• No more than three consecutive shifts in a row;• A minimum rest break of 11.5 hours shall not occur more than twice in a row;• No extension of work beyond 12 hours (i.e. no overtime following a 12-hour shift).• 12 hour day shifts shall not commence before 0700 hours;• Shifts shall not be compacted to produce long breaks;• The roster cycle shall be planned over a period of 8 weeks, and• The roster cycle shall include an allocated 8/24 or 12/24 ADO for full time employees and will

be confirmed via the EA introduction of 12 Hour Shift Trial provisions at clause 42 and 44.• Opportunity for meal and tea breaks in accordance with clause 44.1

Selection Process All eligible employees will be afforded the opportunity to nominate to participate in the 12 hr. shifts across the 24 hour period, refer to Appendix 2. To ensure selection process, the names of all eligible employees who have nominated should express their interest to their Unit Manager. At any point the individual can withdraw from the trial in conjunction with the Unit Manager.

Backfilling Any 12- hour roster absences will be replaced by part time employees where possible, and then bank employees or agency, in accordance with the Enterprise Agreement.

Part-time employees participating in the 12-hour trial may work additional 8, 10 and/or 12-hour shifts provided always that the roster guidelines are not breached and that the employee does not work in excess of 76 hours in one fortnight.

In exceptional circumstances only, a part-time or full-time employee who has worked 76 hours may, by agreement between management and the employee, work up to one additional 8, 10, or 12-hour shift in any 4-week period to cover for unplanned employee absences. Any such shift shall be regarded as overtime with all of the overtime provisions of the Enterprise Agreement observed.

Change in Contracted Hours Employees may choose to increase their contracted hours during the trial period in order to accommodate a 12-hour roster for themselves. This will be achieved through negotiation and agreement with the Unit Manager. As this option is being offered to increase nursing/midwifery capacity during the pandemic, employees will not be able to decrease contracted hours to accommodate a 12 hour roster.

All employees shall have their hours of work protected and must be given the opportunity to work their contracted hours.



Fulltime employees wishing to maintain their contracted hours will continue to accrue ADO’s. Through negotiation with the Nurse Unit Manager, an employee may choose to take this as a 12-hour ADO each 6 week period or 8 hour ADO per 4 week period. Depending on which the employee chooses, they would also be required to work a shift of the same length as their ADO in that period to meet their fulltime contracted hours.

Handover Handover will occur at the commencement of each shift. A 3-5 min ‘Team Huddle’ handover will be undertaken at 0600, 1400, 1900 and 2130 led by the AUM or Nurse/Midwife in Charge of shift, after which staff will attend to bedside handover between nurse/midwife. AUM/Nurse/Midwife in Charge handover will occur after the team huddles at 0600, 1400, 1900 and 2130.

Plan 1. Unit Manager to engage with staff regarding the 12 hr. shifts proposal - week beginning 13

April2. Unit Manager to encourage willing staff to complete the nomination form if interested in doing

the 12 hr. roster – see appendix 1 and return to the Unit Manager by 20 April3. Compile ward roster ready to go4. Commence trial 12 hour roster from 18 May.

PAPER WRITTEN BY: Wendy Watson, Director of Nursing and Midwifery, Sunshine Hospital

Hours 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5Shift length

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1900-0730

1 1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

Staff No’s 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 4 4 4 4 4 4 4 256

Proposed 12 hour roster with all night duty at 12 hours 32 & 30 bed ward

Appendix 1: COVID-19: 12 Hour Roster Implementation

Hours 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3 4 5Shiftlength

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 12

0600-1430

1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 12

1400-2230

1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

2100-0730

1 1 1 1 1 1 1 1 1

2100-0730

1 1 1 1 1 1 1 1 1

Staff No’s 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 11 11 4 4 4 4 4 4 4 256

Proposed 12 hour roster with mix of 10 and 12 hour night duty 32 & 30 bed ward



0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1900-0730

1 1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

Staff No’s 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 4 4 4 4 4 4 4 256

Proposed 12 hour roster with all night duty at 12 hours 28 & 25 bed ward



0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1900-0730

1 1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

2100-0730

1 1 1 1 1 1 1 1 1 10

2100-0730

1 1 1 1 1 1 1 1 1 10

Staff No’s 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 10 10 4 4 4 4 4 4 4 256

Proposed 12 hour roster with mix of 10 and 12 hour night duty 28 & 25 bed ward



0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1900-0730

1 1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

Staff No’s 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 3 3 3 3 3 3 3 256

Proposed 12 hour roster with all night duty at 12 hours 20 bed ward



0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0600-1430

1 1 1 1 1 1 1 1 8

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

0700-1900

1 1 1 1 1 1 1 1 1 1 1 1 1 1 12

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1400-2230

1 1 1 1 1 1 1 1 1 8

1900-0730

1 1 1 1 1 1 1 1 1 1 12

1900-0730

1 1 1 1 1 1 1 1 1 1 12

2100-0730

1 1 1 1 1 1 1 1 1 10

Staff No’s 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 7 7 3 3 3 3 3 3 3 256

Proposed 12 hour roster with mix of 10 and 12 hour night duty 20 bed ward




NOMINATION FORM

Dear Employee,

A 12-hour roster in conjunction with the current roster is being proposed for Ward __________

If you intend to nominate for this 6-month trial, then please complete the details below and return to your Unit Manager by 20 April, 2020

If you have any questions in regard to the trial, please contact me.

Regards,

Unit Manager

I, _______________________, nominate for the 12-hour roster trial in _______________ commencing May 18 2020.

Current EFT: _______ EFT

Requested trial EFT: _______ EFT

(N.b. any change to EFT will need to be discussed and negotiated with your Unit Manager)

Signature:

Date:

covid-19: 12 hour roster implementation

Documents