Co-designed Roster & Wellness Enhancement

Every Nurse and Midwife has a roster generated which identifies which shifts they will be working. These rosters are prepared using a set of roster rules which were developed by the senior managers at Western Health in 2007 which may no longer meet the needs of the organisation or the staff participating in the rosters. Roster rules are designed to ensure that the appropriate number and skill of nurses and midwives are rostered to every shift of every day, and meet the legislative and industrial requirements that nurses and midwives work under. These rules were based on the 2004 -2016 Nurses and Midwives enterprise agreement. There have been four subsequent agreements which detail changes to how nurses and midwives can be rostered. Examples of such changes are the number of shifts a nurse or midwife can work without two clear days off duty, the number of weeks in advance that a roster must be available to staff and the hours of duty or shift length that a nurse or midwife can work.

Some of these rules must remain in place as nursing and midwifery staffing levels are governed by two key documents:

• the Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Act 2015, which legislates how many nurses and midwives must be on shift at any time, which  is based on the number of available beds occupied and available to be occupied per shift.
• the Nurses and Midwives (Victorian Public Sector) (Single Interest Employers) Enterprise Agreement 2020-24, which is an industrial instrument which effectively determines the working conditions for nurses and midwives, inclusive of, as stated, shift lengths, hours of duty, need for days off together and the skill mix required.

Anecdotally nurses and midwives at Western Health report that the current rostering rules do not meet their needs, the needs of their area of work, are not transparent and equitable, are rarely adhered to and are applied inconsistently across the organisation, however this has not been investigated fully.

There are a number of studies which look at the effects of shift length or the rostering of specific shifts back to back and the effect on the staff members’ fatigue levels{1-20} however there are no specific articles on using co-design methodologies to improve rostering practices, and the resultant outcomes from involvement on staff satisfaction and participation in workplace attendance.

Traditionally, groups of managers, clinicians and service planners sit down and review or plan a new service based on their experience and expertise and, as planning progresses, patient groups and the sector may be consulted.

Experience-based co-design is a method for turning this around and partnering with patients, consumers and service users right from the beginning of service planning to ensure a closer alignment of service delivery with what will work best for service users.

Using a co-design approach to develop a new set of roster rules/guidelines will, as a minimum, result in agreement from all parties involved and meet the required needs of Western Health, Nurse and Midwife Unit Managers and the nurses and midwives who work the roster. Further benefits may include a greater understanding of the legislative and industrial requirements of a roster, greater transparency and equity in rostering, and increased staff satisfaction with their roster.

Aim:

To develop an agreed set of rostering guidelines which meet the need of the staff and the organisation through using an approach co-designed between nurses and midwives and their managers. To increase nurse and midwife satisfaction with their individual roster, and ultimately their wellness and sleep patterns.