COVID-19 Rostering and Re-deployment

COVID-19 Omicron outbreak planning

With Aotearoa NZ having now moved to ‘Red’ on the alert level framework, the increasing daily case numbers of Omicron means that preparedness plans are now being put into action.

STONZ along with all the other Healthcare unions continue to meet regularly with DHBs and Ministry to work together at a national level to develop policies, procedures and principles which can be applied locally.

Services and departments should now have plans in place and be prepared; if you have not been communicated with or involved in planning or discussions then we encourage you to reach out to your colleagues, SMOs and Service Managers. 

While we are working at a national level, we do not have oversight of every service and department so please get in touch with our support team, the executive or our delegates if you have any concerns about how planning is being undertaken, and/or rosters or staffing are being managed now or in the future.

Rostering in response to a COVID-19 outbreak

When Hospitals or communities are significantly impacted, then it is probable that we will need to adjust rosters, and if we look to our colleagues overseas there is a likelihood that RMOs and other healthcare workers will need to be re-deployed in order to continue to provide care for our patients and the community. (See next section on re-deployment)

As part of the preparedness planning, this should include reviewing current rosters and preparing for increased pressure on the healthcare system. This may include new roster patterns, hours worked, duties and we encourage everyone to work together and be innovative while remaining safe. 

From STONZ perspective, the main principle around crisis rosters is that they should be safe, while maintaining flexibility to meet the needs of the situation & department.

As part of planning, here are a few practical things that should be considered when putting together or reviewing a new roster:

  • Work with your local department (Clinical lead, Service Manager, SMO’s) include everyone who is affected and don’t forget to include your RMO Unit.
  • Rosters need to be reflective of the workload in the department (i.e., RMOs not picking up all the work). It needs to include each level and be balanced across House Officers, Registrars & SMOs.
  • While possible, stick to the upper limits of the MECA e.g., no more than 12 days in a row, 72 hours a week etc and consider the requirements around safe working hours.
  • If 72 hours in 7 days is breached, then the 140 hours in 14 days must not be breached.
  • If there are rosters that exceed the limits on hours, penalty payments should be paid without question.
  • Try and restrict quick turnaround after leave. Support rosters where there is a window that allows RMOs to stand-down between frontline shifts. In 2020 for example we saw some services moved to rosters on a 3-week rotation.
  • When there is an outbreak, there is no need to have excessive amounts of people at work; this will only put health staff at risk, and we need to ensure there is opportunity for RMOs to rest when they can.
  • Support rosters that protect vulnerable workers.
  • There is no need to have face to face handovers, this can be done over the phone, at the opposite ends of a meeting room or via teleconference, zoom, facetime.
  • Crisis rosters should be reviewed regularly to meet the needs of the situation and assist with fatigue management.
  • Reasonable notice should be given to RMOs wherever possible if there is to be a change. Now is the time to plan, noting that even with the best laid plans there may still be the need for flexibility.
  • When there are only low levels of COVID-19 in the community, we would expect business as semi normal rosters (i.e., 4-day RMOs, 1 long day RMO, 1-night RMO). These patterns will be less fatiguing and need to be maintained as long as possible.
  • With the predicted absence of healthcare workers across all specialties due to exposure or sickness we do not expect there to be enough capacity to implement pod rosters if there is an outbreak of Omicron.
  • Timing is everything, we do not support the early introduction of any crisis rosters that are going to be high fatiguing and not sustainable long term.


QUESTIONS TO ASK WHEN REVIEWING/DEVELOPING CRISIS ROSTERS

  • Does your service/department have a plan? Has this been appropriately communicated with you?
  • Is it above the limits on hours outlined in the MECA?
  • Is it significantly more hours than you were doing before? If so, has your category been amended.
  • Have these changes been communicated and discussed with you and your colleagues?
  • Are there plans to regularly review the roster? And is there the ability for team members to provide feedback if the situation changes?

RMO Re-deployment

As part of the response to Omicron, it is likely that there will need to be some level of redeployment amongst the RMO workforce.

Outlined below is a broad set of principles which have been developed as part of the planning and our hope is that these principles will be applied nationally, acknowledging that circumstances will ultimately dictate the full extent of movement.

The ethos is to retain as much normality as possible in regards to rosters, but as cases volumes and pressure on hospital services rise, we must be prepared to add additional resource in a logical and safe way:

  • The most inexperienced RMOs (all our PGY-1s) should face the least disruption where possible
  • Support for PGY-1s at this time of the year is crucial so minimise losing PGY-2s from each service if possible
  • The more senior the RMO is in a training programme the less flexible they are regarding scope of practice – in other words a senior registrar in General Surgery should stay in General Surgery and work to maximise efficient care within that speciality.  But this is variable specialty by specialty so for example an Advanced Trainee in a medical subspecialty is in fact very well trained in General Medicine via their first three years of the RACP programme so is likely of considerable clinical value to a General Medicine roster if such a move is desirable for patient and staff safety.  Such decisions will be left to the HODs and CDs in each Division 
  • PGY-3 and above are considered the most flexible until we get to the senior registrar ranks as per previous point
  • Maximise keeping TIs with their teams to support the House Surgeons as much as possible. DHBs have agreed nationally that we will maintain Yr4 and 5 medical student clinical attachments until such time as adequate supervision and education cannot occur.


Note:
The Medical Council has reintroduced its 2020-21 policy to allow PGY-1 & 2 movement at “no threat” to completing each nominal attachment. We will also strongly advocate for recognition of any time spent in “pandemic work” being recognised by each college. 

In addition to this, STONZ view is that it is still important to consider training programmes i.e., protecting those pre-requisites to training and trainees minimum training requirements.

Other COVID-19 Rostering and Re-deployment questions

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E: support@stonz.co.nz
P: +64 03 745 9258

PO Box 7050
Newton, Wellington 6242

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