Recommendations to improve neonatology staffing

Staffing challenges related to patient safety, physician well-being and workforce sustainability are a growing concern in the subspecialty of neonatology that call for reform. In a landmark work for the field of neonatology, a collaborative group of expert stakeholders developed consensus recommendations for best practices for neonatologist staffing using rigorous methodology. The process and 24 recommendations were published in Pediatrics.

The core team of investigators initially submitted a resolution to promote sustainable staffing models for pediatric physicians and their healthcare teams at the American Academy of Pediatrics (AAP) Leadership Conference that was voted into the top 10 priority areas for the academy’s advocacy. This resolution advocates for a repository of research and education and ongoing advocacy for innovative and humane staffing models, scheduling flexibility, development of best practices, and transparency to attract and retain the future workforce. Then, the investigators received the AAP Section on Neonatal-Perinatal Medicine Strategic Grant. The Improving Neonatology Staffing (INS) initiative’s goals are to achieve staffing practices that support:

1. Safe and optimal patient care.
2. Improved recruitment, retention, wellness and professional satisfaction of the neonatologist workforce.
3. Scholarly advancement in the field.

“Neonatology is a very rewarding field of work, in part due to its diverse range of work environments, yet significant concerns regarding workforce sustainability exist,” said Dr. Milenka Cuevas Guaman, principal investigator of the paper and associate professor of pediatrics in the Division of Neonatology at Baylor College of Medicine. 

They procured 60 initial potential recommendations for improved staffing from the literature and their two previous studies of physician leaders. They defined consensus as >80% agreement and strong consensus as >90% agreement. They omitted statements that did not achieve >80% consensus from the recommendations. Fifty-one individual statements reached consensus and were grouped into 24 final recommendations to improve neonatology staffing. See the list of recommendations here.

“Other organizations within and outside of medicine have recognized potential safety risks of prolonged shifts and adapted their work models accordingly. Reforming neonatology staffing may pose additional challenges but is overdue and necessary, with the goal of optimizing the health of our patients and the workforce,” Cuevas Guaman said.

The team aims to publish a toolkit later this year that includes these recommendations as well as a guide on how to implement the recommendations in the workplace.

“We really want to change how staffing is done. The toolkit will help with local implementation to assess and create goals and eventually reach a new and hopefully improved gold standard,” Cuevas Guaman said.

Other contributors to this work include Christine E. Bishop, Emily R. Miller, Christiane E.L. Dammann, Kaashif A. Ahmad, Eric Horowitz, Mark Hudak, Satyan Lakshminrusimha, Patrick J. McNamara, Mark R. Mercurio, Marielle Nguyen, De-Ann M. Pillers, Robin H. Steinhorn, Annemarie Stroustrup, and Kerri Z. Machut.

This work was supported by the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine (SoNPM) Strategic Grant. The AAP SoNPM had no role in the design and conduct of the study.