Standardised teamwork guidelines could ease NICU conflict

Multidisciplinary healthcare professionals representing collaboration and NICU teamwork guidelines. © Magnific

Conflict between different types of neonatal care providers can affect how consistently a neonatal intensive care unit (NICU) team functions. In turn, this can shape the quality of care infants receive. Clear guidelines and shared expectations can help create a more standardised, collaborative environment. They can also support greater consistency in care and teaching across a unit. A recent paper presents recommendations from a multidisciplinary workgroup of neonatal-perinatal medicine programme directors, fellows, and frontline providers in the United States. The recommendations also draw on a wider survey of neonatology programmes. The paper outlines how NICU teamwork guidelines, self-study frameworks, and structured communication can support more standardised teamwork.

Many neonatal intensive care units rely on different types of providers. These include neonatal-perinatal fellows and frontline providers such as neonatal nurse practitioners, physician assistants, and neonatal hospitalists. When teams do not clearly define expectations and responsibilities, this mix can lead to regular conflict between team members. A previous survey found that most neonatology programme directors reported this kind of conflict happening routinely. More standardised approaches to teamwork could help units address this gap and function more consistently.

A multidisciplinary workgroup developed recommendations to address these challenges. The group reviewed common sources of conflict and proposed practical tools for neonatal units. These include a self-study framework that units can use to identify their own specific pressure points.

Why NICU teamwork guidelines support neonatal teams

The workgroup recommends that units use a self-study framework to assess strengths, challenges, and opportunities within their own teams. This involves gathering input from both fellows and frontline providers. Methods such as anonymous surveys can encourage honest feedback.

The workgroup encourages teams to focus first on shared core values, such as excellent patient care and support for learning. Teams can then create specific action plans. These plans can follow the SMART approach, meaning goals should be specific, measurable, assignable, realistic, and timely.

The workgroup particularly highlights clear, standardised guidelines for procedure distribution and role expectations as tools for reducing conflict. Several institutions described in the paper have already developed written guidelines. These specify how team members divide procedures and patient care tasks.

The paper notes that guidelines for procedure distribution vary between institutions because local needs and staffing levels differ. Some programmes prioritise newer trainees for procedures early in training. Others adjust priority according to patient acuity or provider experience. Despite these differences, all examples share a common goal: making expectations clear and consistent for everyone involved. The workgroup also recommends simulation training and regular team meetings to support procedural skills and communication across the team.

What this means for parents and health professionals

For health professionals, the findings suggest that clearer guidelines around roles, procedures, and communication can help reduce conflict. They may also support a healthier learning environment in the NICU. For parents and families, a more collaborative and consistent care team may translate into steadier, more coordinated care for their infant.

The workgroup also identifies psychological safety as an important part of consistent, high-quality care. This means creating an environment where team members feel comfortable speaking up and asking questions.

These recommendations offer a starting point for units seeking greater consistency in how their teams work together. The authors encourage health professionals to discuss these approaches with their teams and consider how a self-study framework might apply to their unit.

Paper available at: Journal of Perinatology

Full list of authors: Marc-Aurele, K.; Branche, T.; Adams, A.; Feister, J.; Boyle, K.; Scala, M.; Fernández Dyess, N.; Keels, E.; Myers, P.; French, H.; Reber, K.; LaTuga, M.S.; Johnston, L.C.; Odumade, O.A.

DOI: 10.1038/s41372-023-01756-8