Professor Christine Duffield is an internationally acclaimed nursing workforce researcher and Australia’s leading voice on the impact of nursing workload and skill mix on patient outcomes and the quality of patient care. The Director of the Centre for Health Services Management, Duffield has used her work to transform the nursing sector over the course of her 30-year career.
The driving force behind the 2007 Glueing it Together report, Duffield delivered the first solid evidence of a link between effective nursing skill mix – that is, higher numbers of registered nurses on a hospital ward– and better patient outcomes. The report remains one of the largest studies ever conducted into nursing workforce issues, and went on to inform important changes in hospital staffing policies in New South Wales and the Northern Territory.
“We now know that the number of nurses on a ward is important for patient outcomes. We know that the proportion of hours of care provided by registered nurses is important to outcomes, and we know that the work environment such nurses’ relationship with doctors and leadership plays a really important role,” Duffield says.
These discoveries were verified during a 2008 coroner’s case in the NT, at which Duffield was called as an expert witness; the coroner used Duffield’s testimony to find that insufficient ratios of experienced nursing staff had directly contributed to the death of a patient at the Royal Darwin Hospital.
Duffield’s research interests have also led her to develop expertise on the topic of workforce churn, a term that she and her research colleagues coined in reference to the rapid movement of nurses and patients through hospital wards and departments. In one particular project, the research team found that first-year nurses were being rotated into new units every three months, and that patients were being rotated at a rate of 1.25 patients per bed per day, pointing to a significant lack of continuity of nursing care.
“What we saw was staff shuffling around, patients shuffling around – really, it was just like this continuum of movement. Some patients never saw the same nurse twice,” she says.
“One of the things that came out of the churn article was evidence to suggest that we need to think very seriously about how we staff our units. As a result, hospitals no longer, as a matter of principle, rotate their student nurses on such a rapid basis.”
The research also resonated deeply within clinical circles, providing an evidence base for issues that nursing staff already instinctively knew.
“When I talk about it, I see people in the room say ‘Yes! That’s exactly what it’s like.’ And that to me is a sign of good research – and I can say ‘Well, now you have the data to support your views’,” Duffield says.
As her research career matures, Duffield is now turning her attentions to advanced levels of nursing practice. She is currently involved in a study in partnership with the Queensland University of Technology that looks at the role of advanced practice nurses. This will build on previous research that showed an improvement in patient outcomes on wards where a clinical nurse consultant, an advanced role in NSW, is present. The new project seeks to define the scope of an advanced practice role, and to determine which professional domains need to be satisfied in order for a nurse to hold such a title.
“It’s actually not clear precisely what the term ‘advanced practice’ refers to,” she says.
“We know what registered nurses do, we know what nurse practitioners do, and they’re the two regulated titles. In between there are a whole lot of titles, positions, jobs and roles that may well be functioning at an advanced level, but we don't know who they are or what they’re doing.”
The results will be disseminated to nursing and health care organisations across Australia to assist the profession in developing an understanding of these issues at a national level.
Most recently, Duffield has taken up a research-only role, and now divides her time between UTS and Edith Cowan University in Western Australia. It’s another milestone in a career that has been filled with remarkable achievements and an unwavering passion for the betterment of the nursing profession.
“Workforce allows me to work with a whole range of really interesting people with really creative minds, and interests that are different to mine, so that’s constantly challenging,” Duffield says.
Surprisingly, she is adamant that the successes of the last 30 years, all of which have been spent at UTS, were more a happy accident rather than a matter of design.
“There are lots of ways that you can plan your career, I think, and there are some people who know precisely where they’re going and what they’re going to do – they’ve got it all mapped out. My view is different – a door opens, and I think, ‘I might just go and see what’s on the other side.’”