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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

Image of Michael Roche
Senior Lecturer, Faculty of Health
Core Member, Health Services and Practice Research Strength
DipAppSc Nurs (SCAE), BSc Nurs (Syd), MHSc (CSU), PhD (UTS)
Member, Australian College of Mental Health Nurses
 
Phone
+61 2 9514 4811
Room
CB10.07.220

Research Interests

Practice environment
Large datasets
Therapeutic relationships
Mental health
Health services management

Can supervise: 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.
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.M. 2014, 'Nursing Support Workers and Tasks Performed, Delayed or Not Completed'.
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, & Murray, 1997; O'Brien-Pallas, Meyer, & Thomson, 2005). In addition, a profile of each unit that included bed numbers, support services and other characteristics was obtained. Analyses explored differences between groups and potential explanatory factors via regression models. Results Significant differences were found between nursing support workers and licensed nurses in tasks undertaken, delayed and not completed. As expected, nursing support workers undertook more tasks such as delivering meal trays and housekeeping, although also undertaking some tasks that may have been out of their scope of practice. Nursing support workers also reported fewer tasks delayed (completion of vital signs, responses to call bell, routine mobilization and documenting nursing care). Unit support services, the practice environment, violence towards nurses and overtime were important explanatory factors in relation to tasks delayed or not completed for both licensed nurses and support workers. Conclusion Increasingly, nursing support workers are providing direct care to patients in the acute hospital setting and this may have implications for patient safety and quality of care. Along with effective delegation of tasks, an important consideration is the model of care (i.e. a substitutive or supportive model) adopted when support workers are included in the staff mix. The ongoing shortage of registered nurses and increased use of support workers challenges nursing unit managers to effectively integrate these staff into their workplace and to confirm these support workers are operating within their scope of practice.
Roche, M.A. & Duffield, C.M. 2013, 'Nurse Turnover, Patient, Nurse and System Outcomes'.
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 nursing units (Duffield et al 2011), data were analysed at that level. Descriptive and correlational analyses were undertaken. Results Turnover rates showed substantial variation between units. The temporary replacement of staff vacancies represented the largest proportion of turnover costs. Patient falls, medication errors and other patient outcomes also varied per unit, and were associated with nurse experience and the practice environment. There was a relationship between nurse turnover, long work hours and the practice environment. Conclusion Nurse turnover rates and costs are significant challenges to hospitals, but vary substantially between organisations. Improvements to the nursing practice environment, including access to continued education, career development opportunities and enhanced continuity of care, may influence turnover rates and patient outcomes.
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'.
Roche, M.A. & Duffield, C.M. 2011, 'Environmental Influences on the Therapeutic Relationships of Nurses Working in Mental Health'.
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'.
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'.
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'.
Roche, M. 2009, 'The mental health work environment and therapeutic relationships', INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, pp. A21-A21.
Roche, M.A. & Duffield, C.M. 2005, 'Methods of measuring nursing workload in Australia'.
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, Carlton, pp. 846-849.
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Journal articles

Kelly, M.A., Forber, J., Conlon, L., Roche, M. & Stasa, H. 2014, 'Empowering the registered nurses of tomorrow: Students' perspectives of a simulation experience for recognising and managing a deteriorating patient', NURSE EDUCATION TODAY, vol. 34, no. 5, pp. 724-729.
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Wise, S., Fry, M., Duffield, C., Roche, M. & Buchanan, J. 2014, 'Ratios and nurse staffing: The vexed case of emergency departments.', Australas Emerg Nurs J.
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Within Australia nursing unions are pursuing mandated nurse-patient ratios to safeguard patient outcomes and protect their members in healthcare systems where demand perpetually exceeds supply. Establishing ratios for an emergency department is more contentious than for hospital wards. The study's aim was to estimate average staffing levels, skill mix and patient presentations in all New South Wales (NSW) Emergency Departments (EDs).
Blay, N., Duffield, C.M., Gallagher, R. & Roche, M. 2014, 'A systematic review of time studies to assess the impact of patient transfers on nurse workload.', Int J Nurs Pract.
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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.J., Stasa, H., Roche, M.A., Homer, C.S.E. & Duffield, C. 2014, 'Nursing churn and turnover in Australian hospitals: Nurses perceptions and suggestions for supportive strategies', BMC Nursing, vol. 13, no. 1.
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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. 2014 Dawson et al.; licensee BioMed Central Ltd.
Duffield, C.M., Twigg, D.E., Pugh, J.D., Evans, G., Dimitrelis, S. & Roche, M.A. 2014, 'The Use of Unregulated Staff: Time for Regulation?', Policy Polit Nurs Pract, 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.
Roche, M.A., Duffield, C.M., Homer, C.S., Buchan, J. & Dimitrelis, S. 2014, 'The Rate and Cost of Nurse Turnover in Australia', Collegian, vol. IN PRESS.
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Blay, N., Duffield, C.M., Gallagher, R. & Roche, M. 2014, 'Methodological integrative review of the work sampling technique used in nursing workload research.', J Adv Nurs, vol. 70, no. 11, pp. 2434-2449.
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To critically review the work sampling technique used in nursing workload research.
Elliott, D., McKinley, S., Perry, L., Duffield, C., Iedema, R., Gallagher, R., Fry, M., Roche, M. & Allen, E. 2014, 'Clinical utility of an observation and response chart with human factors design characteristics and a track and trigger system: study protocol for a two-phase multisite multiple-methods design.', JMIR Res Protoc, vol. 3, no. 3, p. e40.
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Clinical deterioration of adult patients in acute medical-surgical wards continues to occur, despite a range of systems and processes designed to minimize this risk. In Australia, a standardized template for adult observation charts using human factors design principles and decision-support characteristics was developed to improve the detection of and response to abnormal vital signs.
Duffield, C.M., Roche, M.A., Homer, C., Buchan, J. & Dimitrelis, S. 2014, 'A comparative review of nurse turnover rates and costs across countries.', J Adv Nurs, vol. 70, no. 12, pp. 2703-2712.
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To compare nurse turnover rates and costs from four studies in four countries (US, Canada, Australia, New Zealand) that have used the same costing methodology; the original Nursing Turnover Cost Calculation Methodology.
Mather, B., Roche, M. & Duffield, C. 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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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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Elliott, D., Allen, E., Perry, L., Fry, M., Duffield, C., Gallagher, R., Iedema, R., McKinley, S. & Roche, M. 2014, 'Clinical user experiences of observation and response charts: focus group findings of using a new format chart incorporating a track and trigger system.', BMJ Qual Saf.
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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.
Fry, M., Duffield, C., Baldwin, R., Roche, M., 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. 11-12, pp. 1531-1538.
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Fry, M., Horvat, L., Roche, M., 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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Baldwin, R., Duffield, C.M., Fry, M., Roche, M., 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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Zugai, J., Stein-Parbury, J. & Roche, M. 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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Roche, M., Duffield, C., Wise, S., Baldwin, R., Fry, M. & Solman, A. 2013, 'Domains of practice and Advanced Practice Nursing in Australia', NURSING & HEALTH SCIENCES, vol. 15, no. 4, pp. 497-503.
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Roche, M., Duffield, C., 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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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.
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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Duffield, C., Diers, D., O'Brien-Pallas, L., Aisbett, C., Roche, M., King, M. & 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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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.
Roche, M.A. 2011, 'Looking at the Bigger Picture', Nursing Standard, vol. 26, no. 13, pp. 62-63.
Roche, M., Duffield, C. & White, E. 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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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., Diers, D., Duffield, C. & Catling-Paull, 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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Roche, M.A. & Duffield, C.M. 2010, 'A Comparison of the Nursing Practice Environment in Mental Health and Medical-Surgical Settings', JOURNAL OF NURSING SCHOLARSHIP, vol. 42, no. 2, pp. 195-206.
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Duffield, C., Roche, M., Diers, D., Catling-Paull, 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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Duffield, C., Roche, M., O'Brien-Pallas, L. & Catling-Paull, C. 2009, 'The Implications of Staff 'Churn' for Nurse Managers, Staff, And Patients', NURSING ECONOMICS, vol. 27, no. 2, pp. 103-110.
Duffield, C., Diers, D., Aisbett, C. & Roche, M. 2009, 'Churn: Patient Turnover And Case Mix', NURSING ECONOMICS, vol. 27, no. 3, pp. 185-191.
Duffield, C., Roche, M., O'Brien-Pallas, L., Catling-Paull, C. & King, M. 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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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.
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.
Roche, M. & Duffield, C. 2007, 'Issues and challenges in the mental health workforce development', CONTEMPORARY NURSE, vol. 25, no. 1-2, pp. 94-103.
Duffield, C., Roche, M. & Merrick, E.T. 2006, 'Methods of measuring nursing workload in Australia.', Collegian, vol. 13, no. 1, pp. 16-22.
Continuing and worsening nurse shortages nationally and internationally have reignited the debate in Australia about the methods of measuring nursing workload. As workload is one of the most significant factors in nursing retention, measuring nursing workload reliably is the critical initial step to understanding the relationship between workload, nursing retention and patient safety. In Australia, some states and territories have no measure of nursing workload and those states that have introduced measurement methods are inconsistent in their approach. This paper provides a critical review of the methods of measuring nursing workload with particular reference to Australia. It also explores the strengths and limitations of each approach in terms of its reliability and utility. This review highlights the implications of not understanding fully the impact of excessive workload on patient and nurse safety outcomes.
Duffield, C., Pallas, L.O., Aitken, L.M., Roche, M. & Merrick, E.T. 2006, 'Recruitment of nurses working outside nursing', JOURNAL OF NURSING ADMINISTRATION, vol. 36, no. 2, pp. 58-62.
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White, E. & Roche, M. 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, no. 3, pp. 209-219.
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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.
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.
Roche, M.A., Laschinger, H.K.S. & Duffield, C., 'Testing the Nursing Worklife Model in Canada and Australia: A Multi-group Comparison Study', International Journal of Nursing Studies.
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Study AimTo 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.

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.