Neonatology Staffing Practices: An In-Depth Exploration of Leaders' Perspectives

Objective To describe neonatology leaders' perspectives on ideal staffing practices, including clinical work, nonclinical roles, shift characteristics, and flexibility. Although the current state of neonatology staffing issues is reported in the literature, a description of ideal, recommended staffing practices is lacking. Study design We performed a qualitative study, using purposive sampling to interview 26 neonatology leaders. Semi-structured interviews included open-ended questions on ideal staffing practices in 4 categories: clinical and nonclinical aspects of work, shift characteristics, and flexibility in the work environment. We conducted a directed content qualitative analysis of interview transcripts. Results Leaders described their perspectives of ideal staffing practices. All clinical hours should count toward total clinical time and clinical full-time equivalent, and many nonclinical efforts should be compensated with time or money. Most stated varying workloads reflective of team structures and patient factors should be considered. Maximum in-house shift length should be <= 24 hours and weekend assignments should be equitable, irrespective of career track. Most endorsed flexibility at the individual physician level with a clear plan for covering variable staffing acute and chronic needs. Conclusions Neonatology leaders recognize current staffing challenges and the need to evolve toward more ideal staffing practices. However, competing interests and complexities drive maintenance of the status quo and make change difficult for healthcare organizations and academic departments. Future work needs to create and measure optimal, standardized, and transparent staffing practices with appropriate adjustments for clinical, administrative, teaching, and scholarly obligations.