Rostering guidelines under COVID

ROSTERING GUIDELINES UNDER COVID

The following was advice published during the March / April 2020 lockdown, but has been updated, mindful that the Delta variant is more virulent, spreads more rapidly and is nastier than that we faced in 2020.

Introductory comments

• We have our COVID streams in hospitals pretty well organised these days – the risk of covid infection of staff from this source is lessened as a result (assuming correct use of PPE etc). The main risk of spread is through community – and that includes health workers as part of our wider community as we saw with the ADHB nurse who contracted COVID in the community and then, unknowingly, went to work.

• So, we need to keep people (and that includes essential workers) as isolated as possible from each other to stop spread – hence all of NZ are at home in their bubble and (largely) must not leave their bubble. The same needs to be applied to those at work – this is where pod or bubble rostering comes in.

• Where we can, we stay isolated, so if there is no work to do, we should be at home, or if we can work from home likewise, because with every person who is isolated in their bubble the less chance of spread occurs.

• And where we do have to work, we have a bubble within which we work. If infection does occur, the risk of infection being transmitted outside that group of workers is limited, those in that pod can be stood down to isolate and another pod stood up to replace them. It also allows some down time for workers in preparation for working in what is a stressful environment – so all the better that we get a bit of rest!

Team, Pod or Bubble Rostering

A few pointers:

• This was originally proven to work in Singapore during the SARS outbreak and again during our last lockdown in early 2020.  A pod (or bubble or team, whatever you want to call it) includes members of the wider team being rostered within a series of discrete pods: so, for instance in radiology a radiologist, registrar, MITs and nurses.

• Think about what other staff should be in your pod – cleaners, clerical etc.

• Each pod stays together as a team but separate from other pods so if one pod member becomes unwell, that (entire) pod is stood down whilst being tested / cleared of infection and another pod takes up the roster gap.

• Think outside your immediate team for sources of additional staffing.

• Remember we need to be prepared for a marathon here, not a sprint so this needs to be sustainable.

• We need to have pods at home as spare capacity for this to work well – so any unnecessary work should be stopped, allowing as many workers as possible to be rested as well as rotated through a pod rostering system. If there is no work to do, workers should be at home and as much as possible workers should work from home.

• Regular breaks are essential to wellbeing and safety.

• • Shifts should be no longer than 8 hours. As humans we are efficient for about 5 hours of continuous work (hence rest break provisions) and with rest breaks good for 8, but even with rest breaks we exhibit decreased efficiency after 8 hours.  Whilst 10 or 12-hour shifts may be required in some circumstances, only where justified clinically and additional break periods will need to be rostered.

• • No more than 4 consecutive night shifts and then 3 days off etc is a minimum.  However, we suggest starting with 4 days on 4 days off type rosters as these might be collapsed (to 4:3) due to staff availability if we go on for a while.

• • Whilst noting the point above about 8/10-hour shifts, we have seen a few 12 hour rotating shift patterns.  Whilst we suggest 8 hours is more sustainable, appreciate the need for 12 will be affected by several factors for instance the numbers of people we have available.  If small numbers of staff, and to ensure some are always off duty to give us that spare capacity, 12 hours might be necessary.  Just two other thoughts:
    • If you do go for 12 hours, you might want to have a backup plan for 8 just in case.
    • Remember to roster at least 3 half hour rest breaks at 3, 6 and 9 hours as a minimum in this time.
    • See more discussion on 12 hour rostering below.

Some pod rostering templates are below:

Handover

It is critical that handover between shifts occur for clinical safety reasons.  These should be done by virtual means if that is at all possible, if not then strict adherence to infection control, hand hygiene and the wearing of full PPE should occur.

12-hour shift patters

A few final pointers about 12-hour shift patterns which are common in an ICU environment outside of COVID, so we might be able to learn something from them. This pattern comes with several significant caveats that cannot be minimized if we are to stay safe.   The following discussion relates to night shifts only but should be noted by all considering 12-hour night shifts in the face of COVID-19.

Recognition of fatigue. In ICU it is assumed that you will sleep (nap) on your shift and is actively encouraged. Making decisions after being at work for 10 hours and no break or sleep is tantamount to making clinician error. This risk will be further compounded by donning and doffing PPE.  So, nap when you can, better still roster a nap period (see buddy below).

And remember that fatigue accumulates which is why you must have sufficient days off between shifts.  When you return to duty it is preferably not to another set of nights. In many instances in ICU those who do a series of nights back-to-back often have 5-6 days between them.

Work as a team. You have a buddy that works with you, not on the other side of the hospital but someone who for the most part is right beside you. On a busy night you will be tired (even if you slept during the day) and you need to cognitively shift some of the load to your colleague. Particularly in light of Covid-19 you will need more people at night with you to do the work, doing it with the same numbers you had previously will not work.  When it comes to napping, one goes to sleep the other holds the fort unless absolutely necessary to wake you; and then you swap over.

Your sleep during the day is going to be noticeably worse. You will probably be getting up at 6pm to have dinner and then start work. Most folks only get one good session of sleep which can last anywhere between 4-6 hours (hence accumulated sleep debt), very few folks have more than this and you won’t get another opportunity until your nap.

You cannot work more than 4-night shifts at any time. That being said if doing 12-hour nights, work fewer consecutive night shifts if you can. 2-3 is a manageable number; the 4th shift is always really hard – don’t do 5.

And remember, the level of supervision offsets the impact of fatigue, so as part of the team, we need our more senior colleagues to be equal participants in the roster.

What you will be paid if the roster changes?  
Your various collective agreements (MECA or SECA) set out any limits on maximum length of shifts, under the hours of work clauses, as well as when overtime and penal rates apply and what the rates are.

In general, if you are required to work over your ordinary hours be that “re-rostered” or not, you must be paid overtime.   That may be longer days, it may be on days that should be RDOs etc.  ALL attract additional pay.   As a general rule of thumb: you should receive the payment the new roster attracts or your normal pay that you would have received if the roster did not change, whichever is the greater,

We recommend you keep a record of where you work and when for the duration of the Covid-19 response. We also recommend you continue to submit fortnightly claims for reimbursement of overtime / penal rates and other costs such as those associated with working from home as you normally would and keep a record. After Covid-19 emergency response we may need to ensure appropriate remuneration has been paid and records of hours worked will be important where follow up is required.