Our project, NICU Empower, aims to improve care delivery, staff satisfaction and family experience as we prepare to move into a newly designed Neonatal Intensive Care Unit (NICU) at John Hunter Children’s Hospital in 2026.
By addressing potential challenges with team communication and processes now, we hope to create a sustainable and high-functioning model of care that improves safety, supports families and strengthens the capacity of the NICU to meet future healthcare needs.
We initiated this project in response to the challenges experienced during the last major transition of the NICU at John Hunter Children’s Hospital in 2016, when the unit moved from an open-plan layout to its current design of 4-bed and 8-bed rooms. While the intent was to improve patient care, the change unintentionally impacted nursing workflows, staff visibility and collaboration.
Staff reported feeling isolated and disconnected, with limited opportunities for peer support and real-time learning, factors that are critical in high-acuity environments like the NICU. These issues were compounded by a lack of preparation and engagement in the transition process, resulting in ongoing frustrations, inefficiencies and a risk to staff morale and patient safety.
Strengthening team connection and communication
The new unit will shift from multi-bed rooms to mostly single-family rooms, aiming to enhance privacy, parent involvement and developmental outcomes for babies. However, this change will once again impact how nurses work, communicate and support each other.
Drawing on staff feedback and lessons from previous moves, the project focuses on redesigning nursing workflows to enhance collaboration, improve situational awareness and foster on-the-job learning. By involving staff in planning and introducing strategies that strengthen team connection and communication, we aim to improve care delivery, staff satisfaction and family experience.
During diagnostics and consultation activities, we identified three key issues:
- lack of teamwork and collaboration
- lack of awareness of staff workloads and unit activity and acuity
- lack of access to educational opportunities.
To address these issues, we undertook a structured, collaborative approach involving diagnostic review, stakeholder engagement and prioritised action planning. Initial steps involved gathering staff feedback through informal discussions, staff experience surveys, focus groups and consultation with key team members across disciplines. This information guided a series of brainstorming and prioritisation sessions that included nurses, educators, medical staff and leadership. The aim was to co-design practical, sustainable solutions grounded in frontline experience.
Co-designed practical and sustainable solutions
Four targeted interventions emerged from our co-design sessions:
- Introduce a mid-shift safety huddle, including nursing, medical, allied health and HealthShare staff, to identify workload concerns in real time and promote shared situational awareness.
- Develop and submit a business case for a supernumerary ACCESS (Assistance, Coordination, Contingency, Education, Supervision and Support) nurse in the Special Care Unit to provide consistent support, escalation and coordination.
- Design an educational pathway to support nurses transitioning into the ACCESS role, including a dedicated study day to consolidate learning.
- Implement a rotating schedule for in-services to ensure both morning and afternoon shifts can participate in learning opportunities.
We have successfully implemented all four of these interventions. Staff feedback and evaluation is underway for the mid-shift safety huddle, in-service rotation and ACCESS nurse pathway, and will shape refinement and sustainability. We have submitted the business case for a Special Care Unit ACCESS nurse for consideration.
Initial results show strong support for initiatives
We will be using a combination of qualitative and quantitative tools to evaluate impact, including pre-and post-intervention staff experience surveys, participation audits and targeted feedback sessions. Initial indicators show improved team engagement, an increase in access to education and strong support for further embedding these initiatives. We will use ongoing evaluation to inform scalability across the new NICU build and guide future workforce innovation. Three key lessons have emerged that continue to shape our project’s refinement and future planning:
- Engaging staff early and consistently through co-design processes has been critical to the success of NICU Empower. By involving nurses, educators and leadership in identifying challenges and shaping solutions, we fostered a sense of ownership and ensured interventions were practical and grounded in real-world needs.
- Introducing the multidisciplinary mid-shift safety huddle, though simple, has had a meaningful impact on communication, situational awareness and team responsiveness. Early feedback suggests improved staff satisfaction, with many reporting that the huddles help them feel more supported and connected, especially during periods of high acuity.
- Flexibility is essential to sustaining education in a 24/7 unit. Implementing a rotating in-service schedule across shifts demonstrated the importance of adapting educational delivery to match clinical demands. Participation improved, and staff reported feeling more valued and engaged in their professional development. The ACCESS pathway and study day model also offered structured growth opportunities while supporting workforce capability.
View this project's poster from the Centre for Healthcare Redesign graduation August 2025.
