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Dr Michael Roche

Biography

Michael is a mental health nurse with experience in clinical, educational, information technology, and management positions in the New South Wales public health system. He has coordinated a number of large research studies, including a State-wide study of nursing workload and patient outcomes, and reviews of the mental health nursing practice environment and postgraduate education. He is currently one of the chief investigators on two ARC-Linkage funded multi-state studies, and a UTS Partnership grant. He is also involved with health services on several site-specific research projects. He has experience in survey research, the analysis of large datasets, and quantitative analysis methods.

Michael’s studies have investigated the links between the practice environment and patient, nurse and system outcomes, including his doctoral work that focused on influences on the therapeutic relationships of nurses working in mental health using a path modeling approach. He supervises PhD, Masters and Honours students studying aspects of the practice environment, mental health interventions, nurse outcomes and nursing leadership. He teaches in the Master of Health Services Management and Bachelor of Nursing programs along with post-graduate research subjects, and on the exploration of administrative data in health services.

Professional

Australian College of Mental Health Nurses

Sigma Theta Tau International

Australian College of Nursing

Image of Michael Roche
Senior Lecturer, Faculty of Health
Member, Centre for Health Services Management (CHSM)
Core Member, CHSP - Health Services and Practice
DipAppSc Nurs (SCAE), BSc Nurs (Syd), MHSc (CSU), PhD (UTS)
Member, Australian College of Mental Health Nurses
 
Phone
+61 2 9514 4811

Research Interests

Practice environment
Large datasets
Therapeutic relationships
Mental health
Health services management

Can supervise: Yes
Yes

Analysis of routinely collected data
Research methods
Nursing self-awareness, communication and relationships
Working in groups
Fundamentals of quality and safety in the workplace
Information and communication technologies for practice

Chapters

Duffield, C.M., Roche, M.A., Diers, D. & Stasa, H. 2011, 'Australia: What has changed?' in Nelson, S. & Doran, D. (eds), Mapping the field: Nursing scholarship in health human resources, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada, pp. 25-37.
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This chapter will describe some of the recent changes to health services practice and policy in the Australian context, using as a basis a research study completed in 2007 in New South Wales (NSNSW) (Glueing it together: Nurses, their work environment and patient safety, hereafter referred to as 'The Glue Report' [Duffield, Roche, O'Brien-Pallas, Diers, Aisbett, King, et al., 2007]) which built on the work of other researchers in health human resources for nursing, and in which Dr. Linda O'Brien-Pallas played a leading role.

Conferences

Roche, M.A., Duffield, C. & Twigg, D. 2015, 'The nursing practice environment 2004-2013', International Council of Nurses Conference, ICN, Seoul, Republic of Korea.
Positive practice environments have been linked to increased nurse satisfaction, nurse retention and better patient outcomes. Nursing workforce shortages have focused greater attention on the importance of retention, in which a positive work environment can play a significant role. This study aimed to examine nurses' perceptions of the quality of the nursing practice environment in Australia, over a ten-year period. In order to address the aim, a secondary analysis was undertaken of nurse survey data collected between 2004-2013, from six acute-care hospitals across three Australian states. Across the period, nurses report a marked increase in instability (being forced to change jobs), a lower intent to leave their current job but also fewer employment opportunities. Broadly, nurse satisfaction with the practice environment is, and remains, positive. However, a decline was noted over the past decade. With large future shortages projected, organizations that aim at improving the nursing work environment may benefit in the form of greater staff retention, higher nurse satisfaction and better quality patient care and outcomes.
Roche, M.A., Laschinger, H.K.S. & Duffield, C. 2015, 'Nursing worklife and turnover intention in Australia and Canada', International Council of Nurses, Seoul, Republic of Korea.
With the worldwide shortage of nurses, retaining staff within fiscally challenged health care systems is critical to sustaining the future of the nursing workforce, and ultimately to safe patient care. This study tests a model, derived from the Nursing Worklife Model, that links elements of a supportive practice environments to nurses' turnover intentions and behaviours in Canada and Australia. A secondary analysis of data collected in two cross-sectional studies in Canada and Australia (n=4816) was conducted. Multigroup structural equation modelling techniques were used to determine the validity of the theoretical model in both countries, and to identify differences between countries. The findings show that the hypothesized model relationships were supported in both countries with few differences between groups. Components of supportive professional practice work environments were significantly linked to nurses' turnover intentions and active search for new jobs. Leadership was a critical factor in shaping the pattern of relationships to other elements of supportive practice environments and turnover behaviours. The Nursing Worklife Model was shown to be valid in both countries.
Roche, M.A. & Duffield, C.M. 2014, 'Nursing Support Workers and Tasks Performed, Delayed or Not Completed', http://www.nursinglibrary.org/vhl/handle/10755/335156, Sigma Theta Tau International 25th International Nursing Research Congress, Hong Kong.
Purpose Direct patient care has been undertaken by a combination of licensed and unlicensed nurses for many years. However, persistent nursing workforce shortages and increased patient acuity and throughput has led to increased employment of large numbers of nursing support workers internationally (Bureau of Labor Statistics, 2013; Health Workforce Australia, 2012; NHS, 2013). Concurrently, tasks formerly completed by registered nurses have moved to the nursing support worker (Gillen & Graffin, 2010; Plawecki & Amrheim, 2010). This change has raised questions regarding the role and effective utilization of support workers. However, there has been limited research on the impact of these workers in the acute hospital workplace. This paper compares the nature of tasks performed, delayed or not completed by nursing support workers and licensed nurses, and the factors associated with these outcomes. Methods This paper reports a secondary analysis of data collected in three studies of medical and surgical units across three states of Australia. Data from a recently completed project were combined with that from two previously reported studies (Duffield et al., 2011; Roche, Duffield, Aisbett, Diers, & Stasa, 2012). In total, data were collected on 132 randomly selected units in 25 public general acute hospitals across three Australian states between 2004 and 2010. Data collection procedures in all studies were similar. All direct personal care workers on the selected wards were asked to complete a survey anonymously. An overall response rate of 60.4% was achieved (3945 of 6528 potential consenting respondents). The survey included demographic items, employment characteristics, six questions on specific tasks performed, and 11 questions on direct-care interventions delayed or left undone at the end of the most recent shift. The survey also included the Practice Environment Scale (Lake, 2002) and the Environmental Complexity Scale (O'Brien-Pallas, Irvine, Peereboom, & Mur...
Roche, M.A. & Duffield, C.M. 2013, 'Nurse Turnover, Patient, Nurse and System Outcomes', Sigma Theta Tau International 24th International Nursing Research Congress, Prague, Czech Republic.
Purpose Workforce shortages and retention are critical issues facing healthcare organizations. Turnover rates in Australia have been estimated at between 12% (Eley et al. 2007) and 38% (Garnett et al. 2008). This variation is also seen internationally, from 14% in the United Kingdom (Frijters, Shields & Wheatley Price 2004), 19.9% in Canada (O'Brien-Pallas et al. 2008), to 39.2% in New Zealand (North et al. 2006). Turnover costs have been estimated to account for 5% of an organisations annual operating budget (Waldman et al. 2004). Both individual and organisation factors have been linked to turnover intention (Duffield, et al. 2009), but the impact of turnover on nurse and patient outcomes have been less frequently examined (Hayes et al. 2012). This study describes the rate and costs of nurse turnover in Australia and investigated the impact of turnover. It is part of an international project to examine the cost of nurse turnover and the impact of turnover on patient safety and nurse health and safety outcomes. Methods Data were collected on 62 nursing units in 11 public general acute hospitals in three states of Australia, for two three-month periods, one year apart, between 2008 and 2010. Data included details of turnover, a unit profile, patient outcomes and demographics, and the nurse survey (Practice Environment Scale (Lake, 2002), job satisfaction (Mueller & McCloskey 1990) and other information). Turnover was defined as the voluntary transfer or resignation of nursing staff from their primary employment position. The turnover rate was calculated in accordance with previous studies (Jones 1990, OBrien-Pallas et al 2006). Ethics approval was granted by seven Human Research Ethics Committees representing the participating hospitals and the university. A total of 1673 Nurse Surveys were received (44% response rate) during this study and over 5000 patient files were audited. In accordance with previous research that found significant differences between nursi...
Baldwin, R.J., Duffield, C.M., Fry, M., Roche, M.A., Stasa, H. & Solman, A. 2013, 'What does a Clinical Nurse Consultant do', ACCCN NSW and ICCMU conference, Australian Critical Care Nurses Association, Sycney, pp. 1-1.
The research collected both quantitative and qualitative data to examine what CNCs do in their current roles It examined role and functions what CNCs did how they went about their jobs how they spent their time was focused more broadly than duties or tasks did not attempt to measure outcomes or validate claims The instrument developed has now been used in three studies into nurses with advance practice roles
Roche, M.A. 2012, 'AINs: Staffing, Skill Mix And Outcomes', Assistants in Nursing Conference, Sydney.
Roche, M.A. & Duffield, C.M. 2011, 'Environmental Influences on the Therapeutic Relationships of Nurses Working in Mental Health', Sigma Theta Tau International 22nd International Nursing Research Congress, Cancun, Mexico.
The therapeutic relationship is considered the central focus of nursing work in mental health and has been linked to patients? involvement in care and patient outcomes (Horvath, 2005). Therefore, factors that may improve or impeded the nurse?s ability to engage effectively in this relationship have the potential to have a corresponding influence on the patient and their outcomes. Studies in mental health and other nursing domains have identified a range of environmental factors that have an influence on nurses (Aiken, et al., 2008; Hanrahan et al., 2008, 2010). This study investigated the impact of characteristics of the work environment on the willingness and ability of nurses to engage in therapeutic relationships.
Roche, M.A., Diers, D. & Duffield, C.M. 2010, 'Nursing resources, workload, the work environment and patient outcomes', National Database of Nursing Quality Indicators 4th Annual Data Use Conference, New Orleans, United States.
Kelly, M.A., Forber, J., Conlon, L.S., Stasa, H. & Roche, M.A. 2010, 'Empowering the RNs of tomorrow: pre and post simulation analysis of clinical skill parameters related to deteriorating patients', SimTecT Health, Melbourne.
Final year Bachelor of Nursing students in an adult medical surgical subject engaged in a deteriorating patient simulation encounter. Local Ethics Review Committee approval was obtained for the study. Sixty two students agreed to participate in the study and completed consent and confidentiality forms. A pre-simulation survey consisting of ten questions, with a 4 point Likert scale response was completed immediately prior to the activity. Students participated either actively in predetermined roles or as observers with structured questions to address and discuss during the debriefing. A post-simulation survey, of identical questions, was completed immediately after the simulation encounter.
Roche, M.A. & Duffield, C.M. 2009, 'Aggression Towards Nurses', International Council of Nurses 24th Quadrennial Congress 2009, Durban, South Africa.
Roche, M.A. 2009, 'The mental health work environment and therapeutic relationships', 35th International Australian College of Mental Health Nurses Conference 2009, Sheraton on the Park, Sydney, Australia, NSW.
Sara, G., Gill, K., Pennock, J., Gomez, F., Woodland, L., Siggens, A. & Roche, M.A. 2002, 'Service Structures For Population Mental Health What Do We Need And Where Is The Evidence?', THE AUSTRALIAN AND NEW ZEALAND COLLEGE OF PSYCHIATRISTS 37TH ANNUAL CONGRESS, Blackwell Publishing Asia, Brisbane, pp. 846-849.
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Journal articles

Roche, M.A., Duffield, C., Friedman, S., Dimitrelis, S. & Rowbotham, S. 2016, 'Regulated and Unregulated Nurses in the Acute Hospital Setting: Tasks Performed, Delayed or Not Completed', Journal of Clinical Nursing, vol. 25, no. 1-2, pp. 153-162.
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Roche, M.A., Duffield, C.M., Friedman, S., Twigg, D., Dimitrelis, S. & Rowbotham, S. 2016, 'Changes to nurses' practice environment over time.', Journal of Nursing Management.
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Duffield, C., Roche, M., Twigg, D., Williams, A. & Clarke, S. 2016, 'A protocol to assess the impact of adding nursing support workers to ward staffing.', Journal of advanced nursing.
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To assess the impact of adding nursing support workers to ward staffing.Nurses' capacity to provide safe care is compromised by increased workloads and nursing shortages. Use of unregulated workers is an alternative to increasing the number of regulated nurses. The impact of adding nursing support workers on patient, nurse and system outcomes has not been systematically evaluated.A mixed longitudinal and cross-sectional design using administrative data sets and prospective data from a sample of wards.Payroll data will identify wards on which unregulated staff work. To assess the impact on nursing-sensitive outcomes, retrospective analysis of morbidity and mortality data of all patients admitted to Western Australia hospitals for over 24 hours across 4 years will be undertaken. For the cross-sectional study, a sample of 20 pairs of matched wards will be selected: 10 with unregulated workers added and 10 where they have not. From this sample the impact on patients will be assessed using the Patient Evaluation of Emotional Care during Hospitalisation survey. The impact on nurses will be assessed by a nurse survey used extensively which includes variables such as job satisfaction and intention to leave. The impact on system outcomes will be explored using work sampling of staff activities and the Practice Environment Scale. Interviews will determine nurses' experience of working with nursing support workers.The study aims to provide evidence about the impact of adding nursing support workers to ward staffing for patients, staff and the work environment.
Wise, S., Fry, M., Duffield, C.M., Roche, M.A. & Buchanan, J. 2015, 'Ratios and nurse staffing: The vexed case of emergency departments', Australasian Emergency Nursing Journal, vol. 18, no. 1, pp. 49-55.
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Within Australia nursing unions are pursuing mandated nursepatient ratios tosafeguard patient outcomes and protect their members in healthcare systems where demandperpetually exceeds supply. Establishing ratios for an emergency department is more con-tentious than for hospital wards. The studys aim was to estimate average staffing levels, skillmix and patient presentations in all New South Wales (NSW) Emergency Departments (EDs).
Roche, M.A., Duffield, C.M., Homer, C.S., Buchan, J. & Dimitrelis, S. 2015, 'The Rate and Cost of Nurse Turnover in Australia', Collegian, vol. 22, no. 4, pp. 353-358.
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Nurse turnover is a critical issue facing workforce planners across the globe, partic- ularly in light of protracted and continuing workforce shortages. An ageing population coupled with the rise in complex and chronic diseases, have contributed to increased demands placed on the health system and importantly, nurses who themselves are ageing. Costs associated with nurse turnover are attracting more attention; however, existing measurements of turnover show inconsistent findings, which can be attributed to differences in study design, metrics used to calculate turnover and variations in definitions for turnover. This paper will report the rates and costs of nurse turnover across three States in Australia.
Elliott, D., Allen, E., Perry, L., Fry, M., Duffield, C., Gallagher, R., Iedema, R., McKinley, S. & Roche, M. 2015, 'Clinical user experiences of Observation and Response Charts: Focus group findings of using a new format chart incorporating a track and trigger system', BMJ Quality and Safety, vol. 24, no. 1, pp. 65-75.
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Background Optimising clinical responses to deteriorating patients is an international indicator of acute healthcare quality. Observation charts incorporating track and trigger systems are an initiative to improve early identification and response to clinical deterioration. A suite of track and trigger 'Observation and Response Charts' were designed in Australia and initially tested in simulated environments. This paper reports initial clinical user experiences and views following implementation of these charts in adult general medical-surgical wards. Methods Across eight trial sites, 44 focus groups were conducted with 218 clinical ward staff, mostly nurses, who received training and had used the charts in routine clinical practice for the preceding 2–6 weeks. Transcripts of audio recordings were analysed for emergent themes using an inductive approach. Findings In this exploration of initial user experiences, key emergent themes were: tensions between vital sign 'ranges versus precision' to support decision making; using a standardised 'generalist chart in a range of specialist practice' areas; issues of 'clinical credibility', 'professional autonomy' and 'influences of doctors' when communicating abnormal signs; and 'permission and autonomy' when escalating care according to the protocol. Across themes, participants presented a range of positive, negative or mixed views. Benefits were identified despite charts not always being used up to their optimal design function. Participants reported tensions between chart objectives and clinical practices, revealing mismatches between design characteristics and human staff experiences. Overall, an initial view of 'increased activity/uncertain benefit' was uncovered. Conclusions Findings particularly reinforced the significant influences of organisational workbased cultures, disciplinary boundaries and interdisciplinary communication on implementation of this new practice chart. Optimal use of all chart design characteri...
Roche, M.A., Laschinger, H.K.S. & Duffield, C. 2015, 'Testing the Nursing Worklife Model in Canada and Australia: A Multi-group Comparison Study', International Journal of Nursing Studies, vol. 52, no. 2, pp. 525-534.
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Study aim: To test a model derived from the Nursing Worklife Model linking elements of supportive practice environments to nurses' turnover intentions and behaviours in Canada and Australia. Background: With the worldwide shortage of nurses, retaining nurses within fiscally challenged health care systems is critical to sustaining the future of the nursing workforce and ultimately safe patient care. The Nursing Worklife Model describes a pattern of relationships amongst environmental factors that support nursing practice and link to nurse turnover. This model has been tested in north American settings but not in other countries. Methods: A secondary analysis of data collected in two cross-sectional studies in Canadian and Australian hospitals (N = 4816) was conducted to test our theoretical model. Multigroup structural equation modelling techniques were used to determine the validity of our model in both countries and to identify differences between countries. Results: The hypothesized model relationships were supported in both countries with few differences between groups. Components of supportive professional practice work environments, particularly resources, were significantly linked to nurses' turnover intentions and active search for new jobs. Leadership played a critical role in shaping the pattern of relationships to other components of supportive practice environments and ultimately turnover behaviours. Conclusion: The Nursing Worklife Model was shown to be valid in both countries, suggesting that management efforts to ensure that features of supportive practice environments are in place to promote the retention of valuable nursing resources
Duffield, C.M., Roche, M.A., Dimitrelis, S., Homer, C. & Buchan, J. 2015, 'Instability in patient and nurse characteristics, unit complexity and patient and system outcomes.', Journal of Advanced Nursing, vol. 71, no. 6, pp. 1288-1298.
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AIMS: To explore key factors related to nursing unit instability, complexity and patient and system outcomes. BACKGROUND: The relationship between nurse staffing and quality of patient outcomes is well known. The nursing unit is an important but different aspect that links to complexity and to system and patient outcomes. The relationship between the instability, complexity and outcomes needs further exploration. DESIGN: Descriptive. METHODS: Data were collected via a nurse survey, unit profile and review of patient records on 62 nursing units (wards) across three states of Australia between 2008-2010. Two units with contrasting levels of patient and nurse instability and negative system and patient outcomes, were profiled in detail from the larger sample. RESULTS: Ward A presented with greater patient stability (low occupancy, high planned admissions, few ICU transfers, fewer changes to patient acuity/work re-sequencing) and greater nurse instability (nurses changing units, fewer full-time staff, more temporary/casual staff) impacting system outcomes negatively (high staff turnover). In contrast, Ward B had greater patient instability, however, more nurse stability (greater experienced and permanent staff, fewer casuals), resulting in high rates for falls, medication errors and other adverse patient outcomes with lower rates for system outcomes (lower intention to leave). CONCLUSION: Instability in patient and nurse factors can contribute to ward complexity with potentially negative patient outcomes. The findings highlight the variation of many aspects of the system where nurses work and the importance of nursing unit managers and senior nurse executives in managing ward complexity.
Gallagher, R., Gallagher, P., Roche, M., Fry, M., Chenoweth, L. & Stein-Parbury, M.J. 2015, 'Nurses' perspectives of the impact of the older person on nursing resources in the emergency department and their profile: A mixed methods study', International Emergency Nursing, vol. 23, no. 4, pp. 312-316.
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Background: Nurses provide the majority of care in the ED, so increases in the number of older people (60 years) may impact nursing workload and provision of care. Aim: To determine whom, of older people, emergency nurses perceive as using the most nursing re- sources and to profile this subgroup from the ED dataset, including illustrative cases. Method: Amixed-methodsdesignstudyinametropolitanhospital.Datawerecollectedfromfocusgroup interviews with emergency nursing staff (n = 27), from the patient dataset for the corresponding year, and an audit of 13 patients' medical records. Results: Emergency nurses perceived that the highest demand for their resources came from the older persons representing multiple times in short timeframes (cluster presenter). Cluster presenters had a longer length of stay and required intensive nursing time and vigilance because they had one or more chronic illnesses and comorbid conditions such as limited mobility and dementia. Cluster presenters had to have a full assessment each presentation, were usually admitted to the hospital and admitting spe- cialists were reluctant to assume care. Conclusion: Emergency nurses associate a high workload with cluster presenters for reasons including ED processes and availability of expertise. Further research should examine more objectively and pre- cisely nursing workload in this area.
Baldwin, R., Duffield, C.M., Fry, M., Roche, M., Stasa, H. & Solman, A. 2015, 'Corrigendum to "The role and functions of Clinical Nurse Consultants, an Australian advanced practice role: A descriptive exploratory cohort study" [Int. J. Nurs. Stud. 50(3) (2013) 326-334]', INTERNATIONAL JOURNAL OF NURSING STUDIES, vol. 52, no. 1, pp. 504-504.
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Zugai, J.S., Stein-Parbury, J. & Roche, M.A. 2015, 'Therapeutic Alliance in Mental Health Nursing: an Evolutionary Concept Analysis', Issues in Mental Health Nursing, vol. 36, no. 4, pp. 249-257.
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The concept of therapeutic alliance is relevant in contemporary mental health care, as the consumer-led recovery movement promotes the development of collaborative relationships, and is focussed on the consumer's individual concept of wellbeing. An evolutionary concept analysis was undertaken to establish a contemporary interpretation of therapeutic alliance for mental health nursing. The CINAHL, Scopus and PsycINFO databases were searched for articles (n = 322), with 52 deemed appropriate for analysis. Therapeutic alliance is characterised by mutual partnerships between nurses and consumers, and is dependent on a humanistic healthcare culture. Therapeutic alliance is associated with enhanced consumer outcomes and experiences with care.
Roche, M.A., Duffield, C., Dimitrelis, S. & Frew, B. 2015, 'Leadership skills for nursing unit managers to decrease intention to leave', Nursing: Research and Reviews, vol. 5, pp. 57-64.
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Aim: To examine specific elements of nursing leadership linked to intention to leave, in public acute care hospitals. Background: Nurse turnover is a global issue receiving widespread attention due to prolonged and projected workforce shortages. Nurse management and leadership qualities have been associated with intention to leave and turnover of nurses. The role of the nurse unit managers in the retention of nurses is becoming increasingly important, particularly because of their strong influence on the quality and stability of the work environment. Methods: Data were collected from 62 medical, surgical, and mixed units across eleven public acute care hospitals in three Australian states (September 2008 to August 2010). A total of 1,673 nurses completed a nurse survey that included measures of intention to leave and leadership aspects of the practice environment. Analyses explored specific leadership characteristics that were associated with turnover intent. Results: The role of nursing unit managers was confirmed to be a major factor in nurses' intention to remain or leave their current workplace. Nurses valued 'human skills more highly than other leadership characteristics, including their manager's connection with nurses' concerns, clarity, participation in decisions, and encouragement. Conclusion: Strong leadership qualities in the nursing unit manager have been associated with greater job satisfaction, reduced turnover intention among nursing staff, and improved patient outcomes. Nurse leaders need to be supported in an effort to retain nurses given ongoing workforce issues and to ensure high-quality patient care.
Kelly, M.A., Forber, J., Conlon, L.S., Roche, M.A. & Stasa, H. 2014, 'Empowering the registered nurses of tomorrow: Student's perspectives of a simulation experience for recognising and managing a deteriorating patient', Nurse Education Today, vol. 34, pp. 724-729.
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Recognising and responding to patients who are deteriorating are key aspects to improving outcomes. Simulations provide students with exposure to deteriorating patient scenarios and the role of nurses in such events. The number of programs seeking to provide best possible simulation experiences is growing exponentially. Robust evaluation of these experiences is crucial to ensure maximum benefit.
Blay, N., Duffield, C.M., Gallagher, R.D. & Roche, M.A. 2014, 'A systematic review of time studies to assess the impact of patient transfers on nurse workload', International Journal of Nursing Practice, vol. 20, no. 6, pp. 662-673.
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Patients in hospital are increasingly being moved between clinical units and between bedspaces; however, the impact of patient transfers and bedspace moves on nurses workload is not known. Time studies are an established observational research method that can be used to determine the duration of time taken to perform an activity or process. This review systematically searched four databases for literature published between 2000 and 2013 for observational time study techniques and patient transfers as a nurse activity. Eleven publications from three countries were included in the review. All studies used timing techniques to explore nurse work associated with the transfer process. The review highlights the duration of time spent by nurses on certain aspects of the transfer process. However, as few studies published results from timings, the impact on nurse time is likely to be higher than indicated. Further research is recommended.
Dawson, A., Stasa, H., Roche, M.A., Homer, C.S. & Duffield, C.M. 2014, 'Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies', BMC Nursing, vol. 13, pp. 11-11.
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Background This study aimed to reveal nurses' experiences and perceptions of turnover in Australian hospitals and identify strategies to improve retention, performance and job satisfaction. Nursing turnover is a serious issue that can compromise patient safety, increase health care costs and impact on staff morale. A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories. Method A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories. Results Key factors affecting nursing turnover were limited career opportunities; poor support; a lack of recognition; and negative staff attitudes. The nursing working environment is characterised by inappropriate skill-mix and inadequate patient-staff ratios; a lack of overseas qualified nurses with appropriate skills; low involvement in decision-making processes; and increased patient demands. These issues impacted upon heavy workloads and stress levels with nurses feeling undervalued and disempowered. Nurses described supportive strategies: improving performance appraisals, responsive preceptorship and flexible employment options. Conclusion Nursing turnover is influenced by the experiences of nurses. Positive steps can be made towards improving workplace conditions and ensuring nurse retention. Improving performance management and work design are strategies that nurse managers could harness to reduce turnover.
Duffield, C.M., Twigg, D., Pugh, J., Evans, G., Dimitrelis, S. & Roche, M.A. 2014, 'The Use of Unregulated Staff: Time for Regulation?', Policy Politics and Nursing Practice, vol. 15, no. 1-2, pp. 42-48.
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Internationally, shortages in the nursing workforce, escalating patient demands, and financial constraints within the health system have led to the growth of unlicensed nursing support workers. Recently, in relation to the largest publicly funded health system (National Health Service), it was reported that extensive substitution of registered nurses with unskilled nursing support workers resulted in inadequate patient care, increased morbidity and mortality rates, and negative nurse outcomes. We argue that it is timely to consider regulation of nursing support workers with their role and scope of practice clearly defined. Further, the addition of these workers in a complementary model of care (rather than substitutive model) should also be explored in future research, in terms of impact on patient and nurse outcomes.
Blay, N., Duffield, C.M., Gallagher, R. & Roche, M.A. 2014, 'Methodological integrative review of the work sampling technique used in nursing workload research', Journal of Advanced Nursing, vol. 70, no. 11, pp. 2434-2449.
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Work sampling is a technique that can be used to explore the many facets of nursing work. Standardized reporting measures would enable greater comparison between studies and contribute to knowledge more effectively. Author suggestions for the reporting of results may act as guidelines for researchers considering work sampling as a research method.
Elliott, D., McKinley, S.M., Perry, L., Duffield, C.M., Iedema, R.A., Gallagher, R., Fry, M., Roche, M.A. & allen, E. 2014, 'Clinical utility of an observational and response chart with human factors design characteristics and a track and trigger system: study protocol of a two-phase multi-site multiple methods design', JMIR Research Protocols, vol. 3, no. 3, pp. e40-e40.
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Duffield, C.M., Roche, M.A., Homer, C.S., Buchan, J. & Dimitrelis, S. 2014, 'A comparative review of nurse turnover rates and costs across countries', Journal of Advanced Nursing, vol. 70, no. 12, pp. 2703-2712.
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Measuring and comparing the costs and rates of turnover is difficult because of differences in definitions and methodologies. A comparative review of turnover data was conducted using four studies that employed the original Nursing Turnover Cost Calculation Methodology. A significant proportion of turnover costs are attributed to temporary replacement, highlighting the importance of nurse retention.
Mather, B., Roche, M.A. & Duffield, C.M. 2014, 'Disparities in Treatment of People With Mental Disorder in Non-Psychiatric Hospitals: A Review of the Literature', Archives of Psychiatric Nursing, vol. 28, no. 2, pp. 80-86.
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People with mental disorder experience a heavy burden of physical ill-health. This, alongside structural health-system changes, means more people with mental disorder are being cared for in non-psychiatric hospitals. This article reports on 32 studies that have investigated the care and outcomes of people with comorbid mental and physical health problems in non-psychiatric hospitals. Prevalence of mental disorder ranged between 4%46%, and rates of psychiatric referral was 2%10%. The receipt of invasive cardiac procedures was markedly reduced for those with mental disorder. Likelihood of experiencing an adverse event, post-operative complication or increased length of stay was also elevated for those with mental disorder.
Duffield, C., Baldwin, R., Roche, M. & Wise, S. 2014, 'Job enrichment: creating meaningful career development opportunities for nurses', Journal of Nursing Management, vol. 22, no. 6, pp. 697-706.
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Fry, M., Duffield, C.M., Baldwin, R.J., Roche, M.A., Stasa, H. & Solman, A. 2013, 'Development of a tool to describe the role of the clinical nurse consultant in Australia', Journal Of Clinical Nursing, vol. 22, no. 11, pp. 1531-1538.
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Aims and objectives. This article is a report of a study that used template analysis to develop a tool for defining and measuring the role characteristics and responsibilities of an advanced practice nursing role in Australia. Background. Internationally, there is considerable confusion about the precise role responsibilities of advanced practice nursing positions. In Australia, the Clinical Nurse Consultant is an advanced practice role with five nominated domains of practice. However, there are no tools for measuring the performance of Clinical Nurse Consultants against the listed domains. Design and methods. Participants were 56 clinical nurse consultants at a tertiary public hospital. The existing literature, an online survey, and position descriptions were used to generate the a priori themes for the initial template. Semi-structured interviews were conducted (in 2010) to test the template characteristics. The template underwent multiple iterations in its development. Results. A 50-item tool was devised, which consisted of five domains with a ten-point hierarchical scale within each domain. In preliminary testing, the revised template was found to provide greater clarity regarding roles and grades than the original position descriptions. Conclusions. Further testing and refinement of the modified rating scale is needed, but it offers the possibility of a new tool that can be used by health service managers to determine the grade of a clinical nurse consultant position and for evaluating role performance.
Fry, M., Horvat, L., Roche, M.A., Fong, J. & Plowes, J. 2013, 'A four month prospective descriptive exploratory study of patients receiving antibiotics in one Emergency Department', International Emergency Nursing, vol. 21, no. 3, pp. 163-167.
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Any infection can potentially develop into sepsis. Many patients present to the Emergency Department (ED) with infection and go on to require antibiotics. However, the timeliness of antibiotics can make a difference to patient survival and reduce the risk of infection developing into sepsis and or septic shock.
Baldwin, R.J., Duffield, C.M., Fry, M., Roche, M.A., Stasa, H. & Solman, A. 2013, 'The role and functions of Clinical Nurse Consultants, an Australian advanced practice role: A descriptive exploratory cohort study', International Journal of Nursing Studies, vol. 50, no. 3, pp. 326-334.
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The study provides evidence of great diversity and prioritisation within CNC roles. The CNC typology identified in this study is similar to the categorisation of the roles of APNs reported by other researchers. With further testing, the CNC typology could be useful to service managers and policy makers in making decision on the category of CNC required for a position and may also be able to be applied to other APN roles.
Zugai, J.S., Stein-Parbury, J. & Roche, M.A. 2013, 'Effective nursing care of adolescents with anorexia nervosa: a consumer perspective', Journal Of Clinical Nursing, vol. 22, no. 13-14, pp. 2020-2029.
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This study indicates that the process of weight gain for consumers with anorexia nervosa may be enhanced when accompanied by a process of therapeutic engagement. The therapeutic alliance may be an effective way for nurses to ensure weight gain and an enhanced inpatient experience. Therapeutically beneficial relationships may enhance treatment, and possibly enhance outcomes for consumers.
Roche, M.A., Duffield, C.M., Wise, S., Baldwin, R.J., Fry, M. & Solman, A. 2013, 'Domains of practice and Advanced Practice Nursing in Australia', Nursing and Health Sciences, vol. 15, no. 4, pp. 497-503.
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A key component of workforce reform is the international growth in Advanced Practice Nursing (APN) roles. This study evaluated one APN role in Australia, the Clinical Nurse Consultant (CNC). All 56 CNCs employed in a tertiary hospital in New South Wales took part in the study. Demographic and work activity data were collected by an online questionnaire. Face-to-face interviews included the administration of a 50-point tool to score the level of practice of each CNC against five domains.The domains of practice did not appear to have played a central role in the design of these CNC roles despite being defined in the industrial legislation and linked to a pay structure.There was widespread variability in the level of practice both within and between the CNC grades as well as significant differences in job content. Few CNCs managed to achieve a moderate level of practice across all five domains. The findings suggest that the distinctive features of the CNC roles as articulated in the domains of practice are often not realized in practice.
Roche, M.A., Duffield, C.M., Aisbett, C., Diers, D. & Stasa, H. 2012, 'Nursing work directions in Australia: Does evidence drive the policy?', Collegian, vol. 19, no. 4, pp. 231-238.
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A significant body of research has shown a relationship between nurse staffing (in particular, skill-mix: the proportion of Registered Nurses [RNs]) and both morbidity and mortality. This relationship is typically investigated by measuring the incidence of Nursing Sensitive Outcomes (NSOs) under different skill-mix levels. Yet whilst the evidence suggests that richer skill-mix is associated with a lower incidence of NSOs, recent Australian policy reforms have proposed the replacement of Registered Nurses with less qualified staff. The present study sought to examine the relationship between staffing, skill-mix, and incidence of NSOs at two hospitals in one Australian state. The study sought to determine the rate of occurrence of several NSOs, the relationship of skill-mix to that rate, and the number of patients affected per annum. It was found that the current rate of NSOs across wards ranged from 0.17% to 1.05%, and that there was an inverse relationship between the proportion of hours worked by RNs and NSO rates: an increase of 10% in the proportion of hours worked by RNs was linked to a decrease in NSO rates by between 11% and 45%. It was estimated that increasing the RN staffing percentage by 10% would mean 160 fewer adverse outcomes for patients per year across these two hospitals. Importantly, increases in nursing hours overall (without increases in skill-mix) had no significant effect on patient outcomes. These findings challenge current policy recommendations, which propose increasing the number of unregistered staff without increasing skill-mix.
Fry, M., Horvat, L., Roche, M.A., Fong, J. & Plowes, J. 2012, 'The prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital', Australasian Emergency Nursing Journal, vol. 15, pp. 127-132.
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Globally, severe infection and or sepsis is a problem that is costing billions of dollars, using hundreds of hospital beds, and often results in patient death. Any infection can potentially develop a sepsis health trajectory if left unrecognised and unmanaged. We conducted a 12 month retrospective descriptive exploratory study. Our research explored the prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital. Electronic medical records were reviewed to identify patients that had a primary diagnosis related to infection. The study identified that 16% (n = 7756) of adult presentations had a discharge diagnosis related to infection. A significant difference (X2 = 297.83, df = 4, p .001) in Triage Code allocation for the infection group was identified compared with the non-infection patient group. Thirty-nine percent (n = 3027) of patients with infections were admitted to hospital. Of the patients (n = 1930; 4%) admitted to a critical care area, 6% (n = 122) had a primary diagnosis related to infection. Of the ED deaths (n = 81), 12% (n = 10) had a primary diagnosis related to infection.
Fry, M., Duffield, C.M., Baldwin, R., Roche, M. & Stasa, H. 2012, 'The development of a tool to analyse domains of practice for Clinical Nurse Consultants.', Journal of Clinical Nursing, vol. 22, no. 11-12, pp. 1531-1538.
Duffield, C.M., Roche, M.A., Blay, N. & Stasa, H. 2011, 'Nursing unit managers, staff retention and the work environment', Journal Of Clinical Nursing, vol. 20, no. 1-2, pp. 23-33.
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Aim and objective. This paper examined the impact of leadership characteristics of nursing unit managers, as perceived by staff nurses, on staff satisfaction and retention. Background. A positive work environment will increase levels of job satisfaction and staff retention. Nurse leaders play a critical role in creating a positive work environment. Important leadership characteristics of the front-line nurse manager include visibility, accessibility, consultation, recognition and support. Design. Secondary analysis of data collected on 94 randomly selected wards in 21 public hospitals across two Australian states between 20042006. Methods. All nurses (n = 2488, 803% response rate) on the selected wards were asked to complete a survey that included the 49-item Nursing Work Index-Revised [NWI-R] together with measures of job satisfaction, satisfaction with nursing and intention to leave. Subscales of the NWI-R were calculated. Leadership, the domain of interest, consisted of 12 items. Wards were divided into those reporting either positive or negative leadership. Data were analysed at the nurse level using spss version 16.
Duffield, C.M., Diers, D., O'Brien-Pallas, L., Aisbett, C., Roche, M.A., King, M.T. & Aisbett, K. 2011, 'Nursing Staffing, Nursing Workload, the Work Environment and Patient Outcomes', Applied Nursing Research, vol. 24, no. 4, pp. 244-255.
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Abstract: Nurse staffing (fewer RNs), increased workload and unstable ward environments were linked to negative patient outcomes including falls and medication errors on medical/surgical wards in a mixed method study combining longitudinal data (5 years) and primary data collection.
Roche, M.A. 2011, 'Looking at the Bigger Picture', Nursing Standard, vol. 26, no. 13, pp. 62-63.
Roche, M.A., Duffield, C.M. & White, E.G. 2011, 'Factors in the practice environment of nurses working in inpatient mental health: A partial least squares path modeling approach', International Journal of Nursing Studies, vol. 48, no. 12, pp. 1475-1486.
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Background: Developing a therapeutic relationship with consumers is considered as the central aspect of nursing work in mental health. The importance of this relationship stems from its association with enhanced patient care and improved patient outcomes. Factors within the practice environment may influence the nurse's ability to engage effectively in this relationship. Objective: This study explored a model that added characteristics of the individual and practice environment to a central framework incorporating therapeutic commitment: a nurse's ability and willingness to engage in a therapeutic relationship. Setting and participants: Data were collected at six mental health nursing units in five public general acute hospitals in New South Wales, Australia for 14 days per unit, between 2005 and 2006. All nurses in participating wards were invited to partake in the study. Seventy-six (51%) responses were analyzed. Method: The data were collected using a Nurse Survey inclusive of the Practice Environment Scale of the Nursing Work Index (NWI-PES), and the Mental Health Problems Perception Questionnaire (MHPPQ). A Unit Profile form was used concurrently to collect staffing, skill mix and patient turnover data. Partial least squares path modeling (PLS-PM) was chosen as the analytical method to test the model and identify the most influential factors. Results: Experienced nurses who perceived themselves to be competent and supported were more likely to express a willingness to engage therapeutically with patients. Environmental factors associated with these perceptions included foundations of quality nursing care, opportunities to participate in hospital affairs and clinical supervision. Not all elements in the proposed model were supported. Conclusion: Positive hospital practice environments can improve the capacity of nurses working in mental health to engage therapeutically with patients. Specific approaches may include access to preceptorship, continued education...
Duffield, C.M., Roche, M.A., Blay, N., Thoms, D. & Stasa, H. 2011, 'The consequences of executive turnover', Journal of Research in Nursing, vol. 16, no. 6, pp. 503-514.
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The high rate of executive turnover in the healthcare industry is a major issue for health service organisations and their staff both in Australia and internationally. In the course of planning a research project examining nurse turnover at the clinical level within three Australian States/Territories, the researchers became aware of frequent executive turnover at all levels (State Department of Health, Area Health Service, hospital). Over a period of approximately 2 years there were 41 executives occupying 18 different positions, highlighting the scope of this issue in Australia. Few studies have examined the causes and consequences of this phenomenon in depth. Factors such as age, gender, education, lack of career advancement opportunities and remuneration have all been identified in the literature as important contributors to executive turnover. High turnover rates have been found to be associated with a number of negative consequences, including organisational instability, high financial costs, loss of human capital and adverse effects on staff morale and patient care.
Roche, M.A., Diers, D., Duffield, C.M. & Catling, C. 2010, 'Violence toward nurses, the work environment, and patient outcomes', Journal of Nursing Scholarship, vol. 42, no. 1, pp. 13-22.
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This study's purpose was to relate nurses' self-rated perceptions of violence (emotional abuse, threat or actual violence) on medical/surgical units to the nursing working environment and to patient outcomes. Cross sectional collection of data by surveys and primary data collection for one week periods on 94 nursing wards in 21 hospitals in two states of Australia.
Roche, M.A. & Duffield, C.M. 2010, 'A Comparison of the Nursing Practice Environment in Mental Health & Medical-Surgical Settings', Journal Of Nursing Scholarship, vol. 42, no. 2, pp. 195-206.
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Examined the differences between characteristics of the work environment of nurses working in mental health and general acute inpatient nursing settings. Analysis of data collected on randomly selected medical and surgical (general), and mental health wards in 24 public acute general hospitals across two Australian states between 2004 and 2006.
Duffield, C.M., Roche, M.A., Diers, D., Catling, C. & Blay, N. 2010, 'Staffing, skill mix and the model of care', Journal of Clinical Nursing, vol. 19, no. 15-16, pp. 2242-2251.
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The study explored whether nurse staffing, experience and skill mix influenced the model of nursing care in medical-surgical wards. Nurses (n=2278, 80.9% response rate) were surveyed using The Nursing Care Delivery System and the Nursing Work Index-Revised. Staffing and skill mix was obtained from the ward roster and other data from the patient record. Models of care were examined in relation to these practice environment and organisational variables.
Duffield, C.M., Roche, M.A., O'Brien-Pallas, L. & Catling, C. 2009, 'The Implications of Staff 'Churn' for Nurse Managers, Staff, and Patients', Nursing Economic, vol. 27, no. 2, pp. 103-110.
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The article discusses a study of 40 hospital wards that analyzed staff skills and patient outcomes. The author explores factors that influence staff turnover, the consequences and their effect on the quality of patient care, and the costs. The study found that the changes that occur during staff turnover have an impact on the continuity of patient care and present challenges to the nurse manager in areas such as scheduling, supervision, and leadership.
Duffield, C.M., Diers, D., Aisbett, C. & Roche, M.A. 2009, 'Churn: Patient Turnover and Case Mix', Nursing Economic, vol. 27, no. 3, pp. 185-191.
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The article discusses a research study that examined the movement of patients on and off hospital wards in public hospitals in Australia. Case-mix changes on nursing wards were also examined. Researchers found that the absence of ward-level metrics compromises the ability of nursing unit managers to meet quality and efficiency standards. Researchers believe that measurements of turnover give nurses another way to talk to management about the work of nursing.
Duffield, C.M., Roche, M.A., O'Brien-Pallas, L., Catling, C. & King, M.T. 2009, 'Staff satisfaction and retention and the role of the Nursing Unit Manager', Collegian, vol. 16, no. 1, pp. 11-17.
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Despite recent increases in nursing recruitment in Australia, participation in the workforce is still below the numbers predicted to meet future needs. This paper discusses factors impacting on nurses' job satisfaction, satisfaction with nursing and intention to leave in public sector hospitals in New South Wales (NSW), Australia. Staffing and patient data were collected on 80 medical and surgical units during 2004/5. This included a wide range of individual nurse data from a Nurse Survey; detailed and comprehensive staffing data including skill mix variables; patient characteristics; workload data; a profile of the ward's characteristics; and adverse event patient data. Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward. Most nurses reported being satisfied with their profession, while a lower proportion reported satisfaction with their current position. Work environment factors such as nurses' autonomy, control over their practice and nursing leadership on the ward were statistically significant predictors of job satisfaction. This study will inform decision-making and policy for managers in both the public and private hospital sectors. This is the first large study which explored the work environment at the ward/unit level in public hospitals in NSW (Australia). It illustrates that there are no typical wards; each ward functions differently. The importance of nursing leadership at the ward level to job satisfaction, satisfaction with nursing and intention to leave, cannot be overstated
Roche, M.A. & Duffield, C.M. 2007, 'Issues and Challenges in the mental health workforce development', Contemporary Nurse, vol. 25, no. 1/2, pp. 94-103.
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As in many other developed countries, the proportion of the population in Australia that will experience a mental health disorder is increasing. To respond adequately and appropriately to what some might say is an epidemic will require not only an available workforce but also one which is highly skilled. Unfortunately the current protracted shortage of nurses generally, and which is projected to worsen over the next few years, will also have a significant impact on the provision of care for a large and vulnerable portion of the population, those who experience mental illness. This article will provide an overview of the issues and challenges confronting the development of a sustainable mental health nursing workforce.
Duffield, C.M., O'Brien-Pallas, L., Aitken, L.M., Roche, M.A. & Merrick, E.T. 2006, 'Recruitment of nurses working outside nursing', The Journal of Nursing Administration (JONA), vol. 36, no. 2, pp. 58-62.
White, E.G. & Roche, M.A. 2006, 'A selective review of mental health nursing in New South Wales, Australia, in relation to clinical supervision', International Journal of Mental Health Nursing, vol. 15, pp. 209-219.
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Recent reports have suggested that mental health staff have added stress, which arose from poor working conditions, heavy workloads, and lack of resources, within a culture in which there was a large degree of burnout, low morale, lack of job satisfaction, poor status, insensitivity and indifference. This is particularly so for mental health nurses, who create the ambience in clinical settings. Previous research has shown that the introduction of clinical supervision, as a central plank of clinical governance arrangements, has a positive effect in some of these respects, but remains underdeveloped in Australia. The present scoping study examined the extent to which this was so in mental health nursing services in the state of New South Wales. Individual mental health nurses (n = 601) and Area Health Services (n = 17) provided data about their local circumstances. Findings revealed that mental health nursing in New South Wales was a committed, late middle-aged workforce, working in services about which there was a width of opinion with the prevailing management arrangements, yet to fully exploit their therapeutic potential, or engage the educational opportunities that would assist them in their endeavour. More specifically, it remained a workforce that has yet to engage clinical supervision in a systematically coherent manner. The study concluded, therefore, that clinical supervision offered a possible practical remedy to address the causes and the effects of suboptimal service provision and that the ready availability of dedicated funding and the immediate access to service development and research expertise was a rare and timely confluence.
Roche, M.A. & Duffield, C.M. 2005, 'Methods of measuring nursing workload in Australia'.
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Forrester, K., Duffield, C.M., Roche, M.A. & Merrick, E.T. 2005, 'Clinical handover: Can we afford the time?', Journal of Law and Medicine, vol. 13, no. 2, pp. 176-179.
Duffield, C.M., Forbes-Madden, J.L., Fallon, A., Roche, M.A., Wise, W. & Merrick, E.T. 2005, 'Nursing skill mix and nursing time: the roles of registered nurses and clinical nurse specialists', Australian Journal of Advanced Nursing, vol. 23, no. 2, pp. 14-21.
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OBJECTIVE: The roles of clinical nurse specialists (CNS) and registered nurses, while similar, should also be quite different, with the CNS functioning as an advanced practice nurse. Differences in roles can be partially explained and understood by examining the use of their time. Adjustments to skill mix usually involve using more plentiful but less-skilled workers, and there is a growing body of overseas research in this field. In contrast, little research has examined and compared the use of nursing time for the RN and CNS role, particularly in an Australian context. Comparing work activities enables employers to begin to answer the question: Are skilled nursing personnel being used effectively and efficiently? DESIGN: A work-sampling study conducted over eight weeks. Data were analysed descriptively using SPSS, v.9. SETTING: Six wards in a large private not-for-profit hospital. MAIN OUTCOME MEASURE: To determine whether there is a differentiation in the roles of CNS and RN by examining the percentage of time spent in 25 specific activities. RESULTS: In some activities it is not possible to distinguish differences in the amount of time spent by RNs and CNSs. In other activities such as clerical, meetings and administration, CNSs are spending more time than anticipated. Consideration needs to be given to employing clerical staff to relieve the CNS of these non-clinical aspects. CONCLUSION: The study extends the understanding of the roles of registered nurses and clinical nurse specialists and provides a basis on which to begin to understand similarities and differences in their roles.

Reports

Duffield, C.M., Roche, M.A., O'Brien-Pallas, L., Diers, D., Aisbett, C., Aisbett, K. & Homer, C.S. University of Technology, Sydney 2009, Nursing workload and staffing: Impact on patients and staff, pp. 1-161.
Duffield, C.M., Roche, M.A., O'Brien-Pallas, L., Diers, D., Aisbett, C., King, M.T., Aisbett, K. & Hall, J.P. Centre for Health Services Management, UTS 2007, Glueing it together: nurses, their work environment and patient safety., pp. 1-243, Sydney.