Improvement Story Eight

Chelsea & Westminster Hospital, London

Contributors: Dr Evangelia Myttaraki, ST3 Paediatric Trainee, [email protected]; Dr Shu-ling Chuang, Consultant in Neonatology & Unit Manager, [email protected]

Brief description of initiative

The Neonatal Nurse Shadowing Programme (NNSP) is a project idea focusing on building successful perinatal teams by encouraging communication, teamwork and bi-directional learning opportunities. Junior doctors (SHO/SpR) would shadow a neonatal nurse (band 6, 7 and NIC) for a full day in a neonatal unit in order to get familiar with specific nursing skills, gain competencies and understand the importance of recognizing each other’s role and contribution to perinatal care. The NNSP ran over 6 months (from September 2022-March 2023) in Chelsea & Westminster hospital which is a tertiary neonatal centre with surgical capacity. Participants included the junior doctors rotating there during that period and the neonatal nurses that were on shift on that day. The day agenda, list of suggested competencies/skills, and questionnaires were created after discussion with the senior neonatal nurses and NNU matrons. A certificate of completion was provided to all participants. The project was presented to the team and gained excellent feedback.

What aspects of culture did you focus on and what changes did you make?

My idea to run the NNSP in Chelsea & Westminster hospital derived from my eagerness to understand the work that my colleagues do and spend a day in their shoes. As junior doctors, we rotate through hospitals too often, and by the time we meet new colleagues we have to rotate again. Nurses are the front runners of neonatal units and support junior doctors massively. The NNSP provided the opportunity for doctors to understand the work that nurses do, to learn specific nursing skills that are useful in emergencies, but also to get familiar with the logistics of a level 3 surgical neonatal unit. On the other hand, the NNSP gave nurses the chance to trust the new trainees through the process of teaching one another and build relationships that can last longer than the brief 6 monthly rotations. The NNSP focuses on organizational culture, and highlights the essence of teamwork, communication, equity, empathy, respect, and true understanding of each other’s role. All these are widely recognized key qualities in building successful teams that work better together and produce better outcomes. During the NSSP all participants expressed their absolute enthusiasm in this idea, they felt they better belonged in the neonatal unit, they got to know the nursing team (and vice versa) better than they imagined and felt comfortable working amongst them.

What effect this has had on your team culture?

Working in a neonatal unit can be a stressful time, especially for junior doctors who might be unfamiliar with the acuity of tertiary neonatal centres. Even worse, working with people you don’t know, makes the job more stressful. The NNSP managed to bridge these gaps and make both medical and nursing teams feel closer to one another. By improving communication and by encouraging learning opportunities, doctors became more confident in their skills, they understood their roles in neonatal care and respected the contribution of neonatal nurses further. Nurses also got the chance to understand the stresses of doctors and teach them valuable skills, tricks and tips, but also felt more included in clinical decision making. The NSSP was an excellent opportunity to strengthen teamwork and build-on an open, honest and respectful team culture. The NNSP’s effect was also reflected in practice. After completing the programme, participants felt more confident in their roles, and this improved their performance during resuscitation cases, new neonatal admissions to the unit, transfers in/out of the unit, and daily ward rounds. The participants commented on how perinatal care can be optimized further when team members are supporting and understanding of one another. The nursing team also commented on an excellent feedback idea which was to perform a Neonatal Doctors Shadowing Programme (NDSP) where the nurses can shadow a doctor throughout a day! This shows exactly how successful the NNSP was in team building and team culture.

What barriers have you had to overcome?

Introducing a new project idea that requires commitment and involvement from all, is challenging. The largest difficulty for NNSP was the allocation of slots to doctors whilst ensuring that the rota is safe, all shifts are covered, and patient safety is prioritized. Sickness, annual/study leave dates, but also Covid isolation rules made the coordination challenging. However, the Consultant body was very positive about the NNSP and supported all junior doctors’ participation. The rota coordinators helped me allocate slots safely, and well in advance. The nursing team was brilliant in welcoming the doctors on their shadowing day and supporting them throughout, even when they had gaps in their nursing rotas. In general, the NNSP was welcomed in the unit with open-mindedness and any minor hurdles were easily overcome.

Now that a new cohort of trainees has started their rotation through Chelsea & Westminster the goal is for the NNSP to run again, thus providing this unique experience to those who haven’t had the chance to participate in it yet.

What helped to make this successful?

I believe that the NNSP was so successful because everyone in the unit appreciated the fact that the provision of neonatal care is a team effort. To provide better care for others whilst working in a team, means really knowing who you work with, understanding their role and respecting their contribution. The NNSP highlighted the above and gave the participants equal opportunities to feel as invaluable and inseparable members of a strong perinatal team. I truly believe that the NNSP is an excellent way to build stronger perinatal teams and I fully support the dissemination of this programme to other neonatal units in the UK.