An evaluation of working from home practices and experiences on a tertiary NICU during the COVID-19 pandemic

ABSTRACT

Background During the Covid-19 pandemic, remote 'working from home' (WFH) practices were developed on a tertiary neonatal unit to ensure compliance with Covid-19 recommendations around shielding, self-isolating and social distancing, and mitigate anticipated junior doctor staff shortages. Objectives . Establish a remote working service for junior doctors unable to attend in person due to Covid-19 restrictions then develop a remote working rota and guideline. . Enable remote staff to contribute to clinical and non-clinical tasks securely. . Conduct a mixed-methods evaluation of remote working by practices and identify facilitators and barriers. Methods A remote working rota allocated shielded and selfisolating staff to contribute to intensive care, postnatal duties, outpatients clinic or community calls. Staff used an electronic patient notes system that was securely accessible from home and communicated using digital technology. A guideline formalised practice. Quantitative and qualitative data was collected as part of a mixed methods evaluation. Quantitative data was collective retrospectively from remote working rotas between March- August 2020 to analyse time worked by staff role. Data was collected prospectively via online questionnaires sent to remote working staff between 28th July -15th August 2020 to record activities undertaken on shift. Qualitative evaluation was conducted using focus group discussions (FGDs) with staff according to whether they were working remotely intermittently or permanently. Thematic analysis of focus groups was undertaken. Results Between 23rd March-15th August 506 hours were WFH over 274 shifts equating to a mean of 119 hrs/week (equivalent to 12 shifts). (66% ST6-8, 25% ST1-3, 8% Advanced Neonatal Nurse Practitioners (ANNPs)). 20 questionnaires were sent with 14 responses (70% response rate) covering 126 hours of WFH activities. The largest proportion of time was spent on audit/management roles, followed by ward-based work. The table reports on thematic analysis of FGDs. Conclusions The remote workforce contributed substantially to the neonatal unit service and was broadly valued with positive impacts on junior doctors' experience. Hierarchy and communication were recognized barriers posing a risk to effective teamwork. Promoting an inclusive handover and utilising digital technology further may mitigate this. Remote working has positive and negative impacts on training and wellbeing. It is important to recognize this and ensure staff and training remains supported.