Professor Christine Duffield RN, BScN (Western) MHP (UNSW), PhD (UNSW). Prior to her appointment to UTS she worked for several years as a clinical nurse, educator and manager in a variety of acute care hospitals in Canada, Australia, New Zealand and the United Kingdom.
Christine is a Professor of Nursing and Health Services Management in the Faculty of Health at UTS. Her research focuses on nurse staffing and the use of nurses, nursing leadership and a range of current issues facing the nursing workforce. She led the first study in Australia which examined the relationship between nursing numbers, the mix of staff and patient and staff outcomes. Other funded research projects include defining advanced practice in a range of clinical facilities, the impact of adding nursing support workers, the costs and consequences of nursing turnover, factors impacting on nurses health and the role of nurse managers and leaders in ensuring positive patient and staff outcomes. The translation of her research findings into management and clinical practice across a range of care facilities nationally and internationally.
She has obtained over $10M in research funding and currently holds ARC-linkage grants as a Chief Investigator. Christine supervises PhD, Masters and Honours students studying a range of aspects of nursing workforce and service delivery. Examples of her research interests include recruitment and retention of nurses; costs and consequences of nursing turnover; nurse to patient ratios; staffing hospitals to improve patient outcomes; workforce reform in the emergency department; the impact of patient movements on nursing workload; advanced practice for nurses.
She is the President of the Australian College of Nursing.
- Fellow - American Academy of Nursing
- Fellow - Australian College of Nursing
- Fellow - Australasian College of Health Service Management (NSW)
- Fellow - Institute of Company Directors
- Adjunct Professor - Edith Cowan University, Perth
- Adjunct Professor - University of Western Ontario, Canada
- Conjoint Professor - School of Public Health & Community Medicine, UNSW
Can supervise: YES
Nursing workforce: retention, turnover, job satisfaction, staffing, work environment, patient outcomes, advanced practice nursing
Developing workforce capacity, leaders and managers, nursing career paths
Health Services Management - postgraduate
Crevacore, CA, Duffield, CM & Twigg, DE 2019, 'Undergraduate registered nursing students working as assistants in nursing within the acute care environment: Program development and discussion', Collegian, vol. 26, pp. 256-261.View/Download from: UTS OPUS or Publisher's site
© 2018 Australian College of Nursing Ltd Background: Most pre-registration nursing students require employment during their studies which may entail undertaking another qualification. This paper describes how one university developed a program whereby undergraduate nursing students complete the national vocational education – HLT33115 Assistant in Nursing qualification through recognition of prior learning, a self-directed education package and completion of an objective structured clinical examination. Objective: To discuss the development of an 'Assistant in Nursing' in the acute care environment program for pre-registration undergraduate nursing degree students using the national vocational education framework. Design: This program maps the national 'Assistant in Nursing- Acute Care' vocational qualification to the pre-registration registered nurse degree. Upon successful completion of this program students can work as Assistants in Nursing within the acute care environment. Conclusions: This program enables student nurses to work as Assistants in Nursing within the acute care environment. This provides employment in a health facility and opportunities for students to immerse themselves in the clinical environment whilst continuing their studies. This may assist students to gain a deeper insight into their future role as a nurse, build networks within the nursing community and assimilate into the clinical environment. This program design may prove useful as a template for other nursing faculties wishing to implement a similar program.
Duffield, C, Gardner, G, Doubrovsky, A & Wise, S 2019, 'Manager, clinician or both? Nurse managers' engagement in clinical care activities', JOURNAL OF NURSING MANAGEMENT, vol. 27, no. 7, pp. 1538-1545.View/Download from: Publisher's site
Duffield, C, Roche, M, Debono, D & Wise, S 2019, 'Harnessing ward level administrative data and expert knowledge to improve staffing decisions: a multi-method case study', Journal of Advanced Nursing.View/Download from: UTS OPUS or Publisher's site
Duffield, C, Twigg, D, Roche, M, Williams, A & Wise, S 2019, 'Uncovering the disconnect between nursing workforce policy intentions, implementation, and outcomes: lessons learned from the addition of a nursing assistant role', Policy, Politics, and Nursing Practice.View/Download from: UTS OPUS or Publisher's site
Jacob, ER, Duffield, C & Jacob, AM 2019, 'Validation of data using RASCH analysis in a tool measuring changes in critical thinking in nursing students.', Nurse education today, vol. 76, pp. 196-199.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:In Australia there is no national examination to assess student competency with respect to critical thinking skills on graduation from undergraduate registered nurse program. OBJECTIVES:To describe the use of Rasch analysis for the validation of a tool that measures critical thinking in nursing students in Australia. DESIGN:A cross sectional survey was used to assess students' critical thinking. SETTINGS:One Australian university. PARTICIPANTS:Seventy-four first year and third year nursing students participated in the project. METHODS:Nursing students at one university were requested to undertake a multiple choice question survey to determine their level of critical thinking. The survey tool was validated using Rasch analysis software. RESULTS:Rasch analysis enabled identification of the difficulty of each question, enabling the assessment to identify difference between students and for each student cohort. The use of Rasch analysis demonstrated marked differences in the students' critical thinking abilities, showing higher levels of critical thinking for third year students with greater ability to answer the more difficult questions. CONCLUSION:Rasch analysis enables the matching of test questions to the cognitive skill level of students, and is a useful tool for validating multiple choice questionnaires. Use of this method of analysis can provide a robust assessment in which questions are matched to the level of the learner and enable differentiation between high and low achieving students.
Wise, S & Duffield, C 2019, 'Has the search for better leadership come at the expense of management?', International Journal of Nursing Studies, vol. 97, pp. A1-A2.View/Download from: UTS OPUS or Publisher's site
Drennan, J, Duffield, C, Scott, AP, Ball, J, Brady, NM, Murphy, A, Dahly, D, Savage, E, Corcoran, P, Hegarty, J & Griffiths, P 2018, 'A protocol to measure the impact of intentional changes to nurse staffing and skill-mix in medical and surgical wards.', Journal of advanced nursing, vol. 74, no. 12, pp. 2912-2921.View/Download from: UTS OPUS or Publisher's site
AIM:The aim of this research is to measure the impact that planned changes to nurse staffing and skill-mix have on patient, nurse, and organizational outcomes. BACKGROUND:It has been highlighted that there are several design limitations in studies that explore the relationship between nurse staffing and patient, nurse and organizational outcomes; not least that the vast majority of research in this area emanates from studies that are predominantly observational in design. There are limited studies that measure nurse, patient, organizational, and economic outcomes using a longitudinal design following a planned change in nurse staffing. DESIGN:The research will employ a longitudinal, multimethod approach to evaluate the impact that planned changes in nurse staffing and skill-mix have on wards in three pilot hospitals. METHODS:Administrative data collection will take place on a shift-by-shift basis prospectively over a three-year period including the measurement of nursing sensitive outcomes: cross-sectional patient experience data and nurse outcomes (nursing work, job satisfaction, burnout, missed care) will be collected at intervals prior to, during and after the implementation of planned changes in nurse staffing and skill-mix. Data will be analysed using interrupted time-series models, adjusted for key hospital, ward and patient-level factors. An economic costing of the changes will further investigate the resources required for the intervention that can then be aggregated to a national level for future roll-out plans. DISCUSSION:The study aims to provide evidence on the impact of planned changes to nurse staffing and skill-mix based on a systematic approach using a longitudinal design and to determine the extent to which the approach can be implemented at a national level.
Duffield, C, Roche, M, Twigg, D, Williams, A, Rowbotham, S & Clarke, S 2018, 'Adding unregulated nursing support workers to ward staffing: Exploration of a natural experiment', JOURNAL OF CLINICAL NURSING, vol. 27, no. 19-20, pp. 3768-3779.View/Download from: UTS OPUS or Publisher's site
Jacob, E, Duffield, C & Jacob, D 2018, 'Development of an Australian nursing critical thinking tool using a Delphi process.', Journal of Advanced Nursing, vol. 74, no. 9, pp. 2241-2247.View/Download from: UTS OPUS or Publisher's site
To develop a critical thinking assessment tool for Australian undergraduate nurses.Critical thinking is an important skill but difficult to assess in nursing practice. There are often many responses a nurse can make to a clinical problem or situation. Some responses are more correct than others and these decisions have an impact on a patient's care and safety. Differences in a response can relate to the depth of knowledge, experience and critical thinking ability of the individual nurse.This study used a Delphi process to develop five clinical case studies together with the most appropriate clinical responses to 25 clinical questions.The Delphi technique was undertaken using the Qualtrics survey tool between October 2016-January 2017. A panel of 13 nursing experts from various geographical locations in Australia participated in the study to review the case scenarios and answers to questions posed. Four rounds of participation were required to achieve a minimum of 80% agreement between participants. Participants were asked to rank answers for 25 multi-choice questions based on the correct nursing management of case scenarios provided and provide feedback as to the accuracy and relevance of the scenarios and answers.Four rounds of Delphi questions were required to reach consensus on the correct wording and answers for the scenarios. Five case studies have been developed with nursing responses to patient management in rank order from most correct to least correct.Use of the tool should provide confidence that a nurse has met a certain level of critical thinking ability.
Roche, MA, Duffield, C, Smith, J, Kelly, D, Cook, R, Bichel-Findlay, J, Saunders, C & Carter, DJ 2018, 'Nurse-led primary health care for homeless men: a multimethods descriptive study.', International Nursing Review, vol. 66, no. 3, pp. 392-399.View/Download from: UTS OPUS or Publisher's site
To explore the primary healthcare needs and health service use of homeless men in inner Sydney.People experiencing homelessness have greater health needs than the general population and place high demands on tertiary care, which is expensive and may not be the optimum service for their needs. Accessible, approachable and affordable primary healthcare services could improve the health of homeless persons and potentially decrease costs to the healthcare system.A multimethod design using a cross-sectional survey (n = 40) and administrative data (n = 2 707 daily summaries) collected from a nurse-led primary healthcare clinic for homeless men in Sydney.Survey respondents were aged 27-76 years. Health problems reflected multimorbidity, with mental health issues present in almost all respondents. The majority had attended the clinic more than 20 times in the past year and said the services, treatments and referrals helped them avoid the emergency department. Administrative data indicated that medication administration was the most frequent service provided. Referrals to other health services doubled over the 7-year period.Multiple morbidities, particularly mental health issues, are associated with homelessness. A proactive approach by nurses including preventative services appeared to overcome barriers to health service use.This nurse-led primary healthcare clinic highlights the importance of providing services to homeless men with multiple comorbidities. Respect and trust in addition to easy access to health services appear to be important facilitators of health service use.A greater number of primary health services that collaborate with specialist services, including nurse-led clinics, may facilitate health care for persons who are homeless, reducing the burden on acute services.
Gallagher, R, Perry, L, Duffield, C, Sibbritt, D & Ying Ko, CM 2018, 'The health of working nurses: Hypertension prevalence, awareness, treatment and control by medication.', Journal of nursing management, vol. 26, no. 4, pp. 403-410.View/Download from: UTS OPUS or Publisher's site
AIMS:To investigate hypertension awareness, prevalence and treatment in nurses. BACKGROUND:Nurses are the largest health workforce group, currently facing an ageing demographic and the risk of chronic disease such as hypertension. Little is known about hypertension in nurses despite the potential impact on work productivity. METHODS:A cross-sectional online survey was distributed to nurses and midwives via the professional association and nursing directors. Questions were taken from published longitudinal health studies for blood pressure, hypertension and key sociodemographic and health factors. RESULTS:The participants' (n = 5,041) mean age was 47.99 (SD 11.46) years. The majority knew their blood pressure, more so if they were female, of higher body mass index and aged 45-64 years, but less so if they were smokers. Hypertension prevalence increased with age, peaking at the oldest ages and the majority were treated (anti-hypertensive medication), less so if aged <55 years. Many nurses treated for hypertension had poor blood pressure control, were most often aged 45-54 years and were smokers. CONCLUSIONS:Hypertension prevalence is less in nurses than in the general population, however, once diagnosed treatment is not optimized. IMPLICATIONS FOR NURSING MANAGEMENT:The potential impact of hypertension on older nurses' work productivity justifies work-based support for risk reduction behaviours.
Perry, L, Xu, X, Gallagher, R, Nicholls, R, Sibbritt, D & Duffield, C 2018, 'Lifestyle Health Behaviors of Nurses and Midwives: The 'Fit for the Future' Study.', International journal of environmental research and public health, vol. 15, no. 5.View/Download from: UTS OPUS or Publisher's site
Nurses and midwives (nurses) are the principle role models and health educators for the wider population. This study sought to identify the health-related behaviors of the nursing workforce of New South Wales (NSW), Australia, compared to contemporary recommendations for healthy living and to the Australian general population, matched by gender and age. An electronic cross-sectional survey delivered in 2014⁻2015 recruited 5041 nurses through the NSW Nurses and Midwives Association and professional networks. Validated health behavior measures were collected and compared to Australian National Health Survey data. Compared with younger nurses, older nurses reported greater adherence to fruit and vegetable guideline recommendations, but were more likely to be overweight or obese. Younger nurses (25⁻34 years) had the highest risk of harmful drinking. Compared with the Australian general population, slightly higher percentages of nurses met dietary recommendations and slightly fewer were obese, had central adiposity or smoked. Nurses had lower physical activity levels and higher levels of risky drinking across most gender and age groups. Many nurses have lifestyle health behaviors that place them at high risk for developing non-communicable diseases, sometimes at higher risk than the Australian population to whom they deliver health education. Health promotion strategies for nurses are urgently required.
Blay, N, Roche, M, Duffield, C & Xu, X 2017, 'Intrahospital transfers and adverse patient outcomes: An analysis of administrative health data.', Journal of Clinical Nursing, vol. 26, no. 23-24, pp. 4927-4935.View/Download from: UTS OPUS or Publisher's site
To determine whether there was an association between intra-hospital transfers and adverse outcomes.Transfers between clinical units and between beds on the same unit are routine aspects of an episode of care in acute hospitals. The rate of these transfers per episode has increased in response to high occupancy levels, a decline in bed numbers, and increased demand for hospital services. The impact of the number of transfers between both wards and beds on patient outcomes is not widely explored.Retrospective cross sectional design using hospital administrative data.Data were extracted from existing hospital administrative datasets for one large metropolitan hospital for the financial year 2008-09 in Australia (n = 14,133). Descriptive analyses and logistic regression models were developed for each of 3 selected patient outcomes.Nearly one-tenth of patients (9.2%) experienced a fall with injury, 3.8% of surgical patients a wound infection and 0.1% a complication from medication errors. For each bed or ward transfer, the odds of falls and wound infections increased. Medication errors were not associated with either bed or ward moves.Hospitals should minimise the number of bed and ward transfers per episode of care in order to reduce the likelihood of adverse patient outcomes. Current bed management policies and practices should be evaluated and further refined to address this need. Additional strategies include improving coordination and communication during and after transfer.Nurses must consider the potential cost of intrahospital transfers on patients, length of stay and bed availability.
Blay, N, Roche, MA, Duffield, C & Gallagher, R 2017, 'Intrahospital transfers and the impact on nursing workload.', Journal of Clinical Nursing, vol. 26, no. 23-24, pp. 4822-4829.View/Download from: UTS OPUS or Publisher's site
AIMS AND OBJECTIVES: To determine the rate of patient moves and the impact on nurses' time. BACKGROUND: Bed shortages and strategies designed to increase patient flow have led to a global increase in patient transfers between wards. The impact of transferring patients between wards and between beds within a ward on nurses' workload has not previously been measured. DESIGN: A two-stage sequential study. Retrospective analysis of hospital data and a prospective observational-timing study. METHODS: Secondary analysis of an administrative data set to inform the rate of ward and bed transfers (n = 34,715) was undertaken followed by an observational-timing study of nurses' activities associated with patient transfers (n = 75). RESULTS: Over 10,000 patients were moved 34,715 times in 1 year which equates to an average of 2.4 transfers per patient. On average, patient transfers took 42 min and bed transfers took 11 min of nurses' time. Based on the frequency of patient moves, 11.3 full-time equivalent nurses are needed to move patients within the site hospital each month. CONCLUSION: Transferring patients is workload intensive on nurses' time and should be included in nursing workload measurement systems. RELEVANCE TO CLINICAL PRACTICE: Nurses at the site hospital spend over 1700 hr each month on activities associated with transferring patients, meaning that less time is available for nursing care.
Duffield, C 2017, 'Nurse leaders shaping health care', Journal of Advanced Nursing.
Duffield, CM, Chapman, S, Rowbotham, S & Blay, N 2017, 'Nurse performed endoscopy: Implications for the nursing profession in Australia.', Policy, Politics, and Nursing Practice, vol. 18, no. 1, pp. 36-43.View/Download from: UTS OPUS or Publisher's site
Increasing demands for health care globally often lead to discussions about expanding the involvement of nurses in a range of
nontraditional roles. Several countries have introduced nurse endoscopists as a means of easing the burden of demand for a
range of endoscopic procedures. A shortage of medical staff in Australia combined with increasing demand for endoscopy led
to the implementation of nurse endoscopists as a pilot program in the state of Queensland, where a nurse practitioner model
was implemented, and Victoria, where an advanced practice model was used. This article will discuss the implementation of
and responses from the nursing, medical, and policy community to nurse-performed endoscopy in this country. Regarding
health policy, access to cancer screening may be improved by providing nurses with advanced training to safely perform
endoscopy procedures. Moreover, issues of nurse credentialing and payment need to be considered appropriate to each
country's health system model.
Elliott, D, Allen, E, McKinley, S, Perry, L, Duffield, CM, Fry, M, Gallagher, R, Iedema, R & Roche, M 2017, 'User compliance with documenting on a track and trigger-based observation and response chart: a two-phase multi-site audit study.', Journal of Advanced Nursing, vol. 73, no. 12, pp. 2892-2902.View/Download from: UTS OPUS or Publisher's site
To examine user compliance and completeness of documentation with a newly designed observation and response chart and whether a rapid response system call was triggered when clinically indicated.
Timely recognition and responses to patient deterioration in hospital general wards remain a challenge for healthcare systems globally. Evaluating practice initiatives to improve recognition and response are required.
Following introduction of the charts in ten health service sites in Australia, an audit of chart completion was conducted during a short trial for initial usability (Phase 1; 2011). After chart adoption as routine use in practice, retrospective and prospective chart audits were conducted (Phase 2; 2012).
Overall, 818 and 1,058 charts were audited during the two phases respectively. Compliance was mixed but improved with the new chart (4%–14%). Contrary to chart guidelines, numbers rather than dots were written in the graphing section in 60% of cases. Rates of recognition of abnormal vital signs improved slightly with new charts in use, particularly for higher levels of surveillance and clinical review. Based on local calling criteria, an emergency call was initiated in 33% of cases during the retrospective audit and in 41% of cases with the new chart.
User compliance was less than optimal, limiting full function of the chart sections and compliance with local calling criteria. Overcoming apparent behavioural and work culture barriers may improve chart completion, aiding identification of abnormal vital signs and triggering a rapid response system activation when clinical deterioration is detected.
Gardner, G, Duffield, C, Doubrovsky, A, Bui, UT & Adams, M 2017, 'The structure of nursing: a national examination of titles and practice profiles.', International Nursing Review, vol. 64, no. 2, pp. 233-241.View/Download from: UTS OPUS or Publisher's site
To identify the practice patterns of the Australian registered nurse workforce according to position title and to map these disparate titles across all jurisdictions of the country.Effective nursing workforce planning can contribute to improved patient care and increased effectiveness and efficiency of healthcare systems.The prevailing approach to nursing workforce planning focuses on number of nursing staff needed in relation to the number of patients. The level of expertise and skill mix of registered nurses as a variable in workforce planning is rarely considered.A national cross-sectional electronic survey of registered nurses in Australia was conducted using the validated Advanced Practice Role Delineation tool developed from the Strong Model of Advanced Practice. The study involved a sample of 5599 registered nurses.Sixty-six nursing position titles nationally were mapped using cluster analysis technique and gave rise to seven clusters of equivalent Australian jurisdictional nursing position titles and practice profiles.Effective workforce policy and planning is reliant upon access to reliable evidence. This research is an international first in that it has provided comprehensive knowledge of the clinical level and practice profiles of a national nursing workforce.Effective, patient-centred workforce planning must consider both the numerical and expertise mix of a nursing workforce. This research provides Australian health service and policy planners with evidence-base knowledge of the nursing workforce. Internationally, this research establishes a platform from which to develop validated tools and established processes to support replication of this research.
Jacob, E, Duffield, C & Jacob, D 2017, 'A protocol for the development of a critical thinking assessment tool for nurses using a Delphi technique.', Journal of Advanced Nursing, vol. 73, no. 8, pp. 1982-1988.View/Download from: UTS OPUS or Publisher's site
AIM: The aim of this study was to develop an assessment tool to measure the critical thinking ability of nurses. BACKGROUND: As an increasing number of complex patients are admitted to hospitals, the importance of nurses recognizing changes in health status and picking up on deterioration is more important. To detect early signs of complication requires critical thinking skills. Registered Nurses are expected to commence their clinical careers with the necessary critical thinking skills to ensure safe nursing practice. Currently, there is no published tool to assess critical thinking skills which is context specific to Australian nurses. DESIGN: A modified Delphi study will be used for the project. METHODS: This study will develop a series of unfolding case scenarios using national health data with multiple-choice questions to assess critical thinking. Face validity of the scenarios will be determined by an expert reference group of clinical and academic nurses. A Delphi study will determine the answers to scenario questions. Panel members will be expert clinicians and educators from two states in Australia. Rasch analysis of the questionnaire will assess validity and reliability of the tool. Funding for the study and Research Ethics Committee approval were obtained in March and November 2016, respectively. DISCUSSION: Patient outcomes and safety are directly linked to nurses' critical thinking skills. This study will develop an assessment tool to provide a standardized method of measuring nurses' critical thinking skills across Australia. This will provide healthcare providers with greater confidence in the critical thinking level of graduate Registered Nurses.
Nicholls, R, Perry, L, Duffield, C, Gallagher, R & Pierce, H 2017, 'Barriers and facilitators to healthy eating for nurses in the workplace: an integrative review.', Journal of Advanced Nursing, vol. 73, no. 5, pp. 1051-1065.View/Download from: UTS OPUS or Publisher's site
AIM: The aim was to conduct an integrative systematic review to identify barriers and facilitators to healthy eating for working nurses. BACKGROUND: There is growing recognition of the influence of the workplace environment on the eating habits of the workforce, which in turn may contribute to increased overweight and obesity. Overweight and obesity exact enormous costs in terms of reduced well-being, worker productivity and increased risk of non-communicable diseases. The workplace is an ideal place to intervene and support healthy behaviours. This review aimed to identify barriers and facilitators to nurses' healthy eating in the workplace. DESIGN: Integrative mixed method review. DATA SOURCES: Five electronic databases were searched: CINAHL, MEDLINE, PROQUEST Health and Medicine, ScienceDirect and PsycINFO. Reference lists were searched. Included papers were published in English between 2000-2016. Of 26 included papers, 21 were qualitative and five quantitative. REVIEW METHODS: An integrative literature review was undertaken. Quality appraisal of included studies used standardized checklists. A social-ecological framework was used to examine workplace facilitators and constraints to healthy eating, derived from the literature. Emergent themes were identified by thematic analysis. RESULTS: Review participants were Registered, Enrolled and/or Nurse Assistants primarily working in hospitals in middle or high income countries. The majority of studies reported barriers to healthy eating related to adverse work schedules, individual barriers, aspects of the physical workplace environment and social eating practices at work. Few facilitators were reported. Overall, studies found the workplace exerts a considerable negative influence on nurses' dietary intake. CONCLUSION: Reorientation of the workplace to promote healthy eating among nurses is required.
Perry, L, Nicholls, R, Duffield, C & Gallagher, R 2017, 'Building expert agreement on the importance and feasibility of workplace health promotion interventions for nurses and midwives: A modified Delphi consultation.', Journal of Advanced Nursing, vol. 73, no. 11, pp. 2587-2599.View/Download from: UTS OPUS or Publisher's site
AIM: To use a Delphi panel to determine the relative importance and feasibility of workplace health promotion interventions to promote and support the health of the Australian nursing and midwifery workforce. BACKGROUND: The nursing workforce experiences rates of ill health above that of other workforces, yet there is little investment in workplace health promotion. DESIGN: The study used a modified Delphi design conducted between September and November 2015. METHODS: Eleven of 19 purposively selected expert panellists discussed, rated and provided feedback through two rounds of an electronic questionnaire about the relative importance and feasibility of 46 workplace health promotion interventions and processes for nurses and midwives. Scores for importance and feasibility were calculated and ranked and a composite score of importance multiplied by feasibility. RESULTS: Mental health strategies were prioritized as the most important and feasible of the intervention topics, followed closely by healthy eating and physical activity interventions; smoking cessation ranked lowest. The most highly ranked interventions targeted healthy eating, stress management and resilience training. Highest ranked processes to support development of a healthy work environment included intersectoral collaboration and employee wellness groups. CONCLUSIONS: Study findings prompt consideration of health promotion opportunities to support nurses' health and well-being. Findings identified key workplace health promotion priorities and provide direction for policy makers and managers to promote nursing and midwifery workforce health.
Roche, MA, Friedman, S, Duffield, C, Twigg, DE & Cook, R 2017, 'A comparison of nursing tasks undertaken by regulated nurses and nursing support workers: a work sampling study', Journal of Advanced Nursing, vol. 73, no. 6, pp. 1421-1432.View/Download from: UTS OPUS or Publisher's site
AIMS: The aim of this study was to determine which tasks unregulated nursing support staff spend their work time undertaking and to determine differences between the work undertaken by licensed/regulated nurses on units which have nursing support workers and those on units which do not. BACKGROUND: Acute hospital nursing teams often include nursing support staff; little is known about what kinds of tasks these unregulated support workers do and how it affects the work tasks of their licensed/regulated team members. DESIGN: Cross-sectional analysis of nurse work sampling data. METHODS: Data collection took place between March-October 2013. The proportion of time spent on 25 work activities by nursing support staff and licensed/regulated nursing staff was compared. Logistic regression models estimated whether nursing support staff or licensed/regulated nurses were more likely to conduct direct and indirect patient care tasks and whether licensed/regulated nurses on units with nursing support staff were more likely to conduct direct or indirect tasks compared with those on units without nursing support workers. RESULTS: Nursing support staff spent the majority of their time engaged in direct care tasks, e.g. admission and assessment, hygiene and mobility. Although licensed/regulated nurses were less likely to undertake direct care tasks compared with support workers, those who worked on units with support workers undertook more direct care compared with those who worked on units without support workers. CONCLUSIONS: Nursing support workers were given tasks that required substantial amounts of patient interaction. These staff may be associated with an increase in direct care tasks for licensed/regulated nurses, who may duplicate the direct care done by nursing support workers.
Wise, S, Duffield, C, Fry, M & Roche, M 2017, 'Workforce flexibility - in defence of professional healthcare work.', Journal of Health Organization and Management, vol. 31, no. 4, pp. 503-516.View/Download from: UTS OPUS or Publisher's site
Purpose The desirability of having a more flexible workforce is emphasised across many health systems yet this goal is as ambiguous as it is ubiquitous. In the absence of empirical studies in healthcare that have defined flexibility as an outcome, the purpose of this paper is to draw on classic management and sociological theory to reduce this ambiguity. Design/methodology/approach The paper uses the Weberian tool of "ideal types". Key workforce reforms are held against Atkinson's model of functional flexibility which aims to increase responsiveness and adaptability through multiskilling, autonomy and teams; and Taylorism which seeks stability and reduced costs through specialisation, fragmentation and management control. Findings Appeals to an amorphous goal of increasing workforce flexibility make an assumption that any reform will increase flexibility. However, this paper finds that the work of healthcare professionals already displays most of the essential features of functional flexibility but many widespread reforms are shifting healthcare work in a Taylorist direction. This contradiction is symptomatic of a failure to confront inevitable trade-offs in reform: between the benefits of specialisation and the costs of fragmentation; and between management control and professional autonomy. Originality/value The paper questions the conventional conception of "the problem" of workforce reform as primarily one of professional control over tasks. Holding reforms against the ideal types of Taylorism and functional flexibility is a simple, effective way the costs and benefits of workforce reform can be revealed.
Dimitrelis, S, Perry, L, Gallagher, R, Duffield, C, Sibbritt, D, Nicholls, R & Xu, X 2017, 'Does nurses' role, health or symptoms influence their personal use of ingestible complementary and alternative medicines?', Complementary Therapies in Medicine, vol. 35, pp. 39-46.View/Download from: UTS OPUS or Publisher's site
To investigate the influence of work-related characteristics, health, health behaviours and symptoms on ingestible biologically-based Complementary and Alternative Medicine (CAM) use within the Australian nursing and midwifery workforce.CAM use is widespread worldwide, but there is little research into nurses' and midwives' personal use of ingestible CAM in Australia.An online survey in 2014-15 used validated instruments and items to examine use of ingestible biologically-based CAM (herbs, foods and vitamins, minerals, amino acids, enzymes and other supplements), and the health and work-related characteristics of 5041 nurses and midwives recruited through the New South Wales Nurses and Midwives Association and professional networks.A small proportion of nurses (6.8%) identified as personal CAM users. Most were female, older, worked in foundational roles (frontline Registered and Enrolled Nurses/Midwives) and used one CAM, most commonly a multivitamin, although Vitamin D, Fish Oil, Calcium and Glucosamine±Chondroitin were also common. In comparison to non-users, CAM users were less likely to take sick days or indulge in risky drinking, but more likely to be symptomatic (with stiff joints, bodily/joint pain, severe tiredness, allergies, indigestion/heartburn), diagnosed with osteoarthritis and to adhere to healthy diet recommendations.Findings showed a credible pattern of front line workers with physically demanding workloads that impact their physical health and are linked to frequent symptoms, using CAM treatments and achieving some success in being able to continue working and avoid sickness absence. Further investigation is warranted to protect and maintain the health of the nursing and midwifery workforce.
Lamont, S, Brunero, S, Perry, L, Duffield, C, Sibbritt, D, Gallagher, R & Nicholls, R 2017, ''Mental health day' sickness absence amongst nurses and midwives: workplace, workforce, psychosocial and health characteristics.', Journal of Advanced Nursing, vol. 73, no. 5, pp. 1172-1181.View/Download from: UTS OPUS or Publisher's site
AIM: To examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as 'mental health days'. BACKGROUND: The occupational stress associated with the nursing profession is increasingly recognized and nurse/midwifery absenteeism is a significant global problem. Taking a 'mental health day' as sickness absence is a common phenomenon in Australian health care. No previous studies have empirically explored the characteristics of nurses and midwives using such sickness absence. DESIGN: Online cross-sectional survey. METHODS: Survey comprising validated tools and questions on workplace and health characteristics was distributed to nurses and midwives in New South Wales, Australia, between May 2014 - February 2015. Sample characteristics were reported using descriptive statistics. Factors independently predictive of 'mental health day' reportage were determined using logistic regression. RESULTS: Fifty-four percentage of the n = 5041 nurse and midwife respondents took 'mental health days'. Those affected were significantly more likely to be at younger ages, working shifts with less time sitting at work; to report workplace abuse and plans to leave; having been admitted to hospital in previous 12 months; to be current smokers; to report mental health problems, accomplishing less due to emotional problems and current psychotropic medication use. CONCLUSION: Specific characteristics of nurses and midwives who report taking 'mental health day' sickness absence offer healthcare administrators and managers opportunities for early identification and intervention with workplace measures and support frameworks to promote well-being, health promotion and safety.
Nicholls, R, Perry, L, Gallagher, R, Duffield, C, Sibbritt, D & Xu, X 2017, 'The personal cancer screening behaviours of nurses and midwives.', Journal of Advanced Nursing, vol. 73, no. 6, pp. 1403-1420.View/Download from: UTS OPUS or Publisher's site
AIM: The aim of this study was to identify the personal cancer screening behaviours of nurses and midwives in New South Wales, Australia, and identify factors predictive of cancer screening uptake. BACKGROUND: The nursing workforce may have a higher risk for some cancers and is ageing. In Australia, more than 40% are over 50 years - an age where cancer incidence rises rapidly, but when screening may reduce cancer mortality. Nurses and midwives are important health role models for the population, but their engagement in cancer screening is unknown. DESIGN: A cross-sectional survey conducted in 2014-2015. METHODS: Data were obtained from the 'Fit for the Future' study on 5041 working nurses and midwives in New South Wales, Australia and analyses were conducted on subsets of age-eligible respondents. Demographic, geographical and occupational data were analysed in relation to population-based screening for breast, cervical and bowel cancers and opportunistic screening for prostate and skin cancer screening participation, in line with Australian recommendations. RESULTS: Nurses' and midwives' recent screening rates were higher than the Australian general population across relevant age groups. Compared with full-time nurses and midwives, part-time/casual/pool workers were significantly more likely to undertake cervical, breast and bowel screening. Compared with those working office hours, shift workers were significantly less likely to undertake breast and bowel screening, but more likely to undertake skin screening. CONCLUSIONS: Disparities in reported screening prevalence and factors predictive of screening uptake indicate opportunities for targeted strategies to inform and/or promote workforce engagement with screening programmes and protect the health of this ageing workforce.
Perry, L, Xu, X, Duffield, CM, Gallagher, R, Nicholls, R & Sibbritt, D 2017, 'Health, workforce characteristics, quality of life and intention to leave: The 'Fit for the Future' survey of Australian nurses and midwives', Journal of Advanced Nursing, vol. 73, no. 11, pp. 2745-2756.View/Download from: UTS OPUS or Publisher's site
To examine the quality of life of nurses and midwives in New South Wales, Australia and compare values with those of the Australian general population; to determine the influence of workforce, health and work life characteristics on quality of life and its effect on workforce intention to leave.
Few studies have examined nurses' and midwives' quality of life and little is known of its effects on workforce longevity.
This was a cross-sectional survey conducted in 2014-2015.
The "Fit for the Future" electronic survey, delivered to nurses and midwives, examined demographic, work and health-related factors, which were compared with Australian general population normative values for physical and mental components of quality of life (the Short Form-12). Univariate and multivariate logistic regression models assessed associations with workforce intention to leave.
Physical and mental component scores, calculated for 4,592 nurses and midwives, revealed significantly higher physical but lower mental component scores than the general population. Physical component scores decreased with increasing age; higher scores were seen in nurses with better health indices and behaviours. Mental well-being scores increased with increasing age; in nurses who reported job satisfaction, no work injury, sleep problems or frequent pain and non-smokers. The odds of intention to leave decreased with increasing mental well-being.
Managers and decision-makers should heed study recommendations to implement health promotion strategies for nurses and midwives, aiming to improve mental health, specifically to promote workforce retention.
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, vol. 72, no. 9, pp. 2218-2225.View/Download from: Publisher's site
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.
Elliott, D, Allen, E, McKinley, S, Perry, L, Duffield, C, Fry, M, Gallagher, R, Iedema, R & Roche, M 2016, 'User acceptance of observation and response charts with a track and trigger system: a multisite staff survey.', Journal of Clinical Nursing, vol. 25, no. 15-16, pp. 2211-2222.View/Download from: Publisher's site
To examine user acceptance with a new format of charts for recording observations and as a prompt for responding to episodes of clinical deterioration in adult medical-surgical patients.Improving recognition and response to clinical deterioration remains a challenge for acute healthcare institutions globally. Five chart templates were developed in Australia, combining human factors design principles with a track and trigger system for escalation of care. Two chart templates were previously tested in simulations, but none had been evaluated in clinical practice.Prospective multisite survey of user acceptance of the charts in practice.New observation and response charts were trialled in parallel with existing charts for 24 hours across 36 adult acute medical-surgical wards, covering 108 shifts, in five Australian states. Surveys were completed by 477 staff respondents, with open-ended comments and narrative from short informal feedback groups providing elaboration and context of user experiences.Respondents were broadly supportive of the chart format and content for monitoring patients, and as a prompt for escalating care. Some concerns were noted for chart size and style, use of ranges to graph vital signs and with specific human factors design features. Information and training issues were identified to improve usability and adherence to chart guidelines and to support improved detection and response for patients with clinical deterioration.This initial evaluation demonstrated that the charts were perceived as appropriate for documenting observations and as a prompt to detect clinical deterioration. Further evaluation after some minor modifications to the chart is recommended.Explicit training on the principles and rationale of human factors chart design, use of embedded change management strategies and addressing practical issues will improve authentic engagement, staff acceptance and adoption by all clinical users when implementing a similar observation and res...
Gardner, G, Duffield, C, Doubrovsky, A & Adams, M 2016, 'Identifying advanced practice: A national survey of a nursing workforce', International Journal of Nursing Studies, vol. 55, pp. 60-70.View/Download from: Publisher's site
Background: The size and flexibility of the nursing workforce has positioned nursing as central to the goals of health service improvement. Nursing's response to meeting these goals has resulted in proliferation of advanced practice nursing with a confusing array of practice profiles, titles and roles. Whilst numerous models and definitions of advanced practice nursing have been developed there is scant published research of significant scope that supports these models. Consequently there is an ongoing call in the literature for clarity and stability in nomenclature, and confusion in the health industry on how to optimise the utility of advanced practice nursing. Objectives: To identify and delineate advanced practice from other levels of nursing practice through examination of a national nursing workforce. Design: A cross-sectional electronic survey of nurses using the validated Advanced Practice Role Delineation tool based on the Strong Model of Advanced Practice. Participants: Study participants were registered nurses employed in a clinical service environment across all states and territories of Australia. Methods: A sample of 5662 registered nurses participated in the study. Domain means for each participant were calculated then means for nursing position titles were calculated. Position titles were grouped by delineation and were compared with one-way analysis of variance on domain means. The alpha for all tests was set at 0.05. Significant effects were examined with Scheffe post hoc comparisons to control for Type 1 error. Results: The survey tool was able to identify position titles where nurses were practicing at an advanced level and to delineate this cohort from other levels of nursing practice, including nurse practitioner. The results show that nurses who practice at an advanced level are characterised by high mean scores across all Domains of the Strong Model of Advanced Practice. The mean scores of advanced practice nurses were significantly differ...
Roche, MA, 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.View/Download from: UTS OPUS or Publisher's site
Roche, MA, Duffield, CM, Friedman, S, Twigg, D, Dimitrelis, S & Rowbotham, S 2016, 'Changes to nurses' practice environment over time.', Journal of Nursing Management, vol. 24, no. 5, pp. 666-675.View/Download from: UTS OPUS or Publisher's site
Saunders, C, Carter, D, Jordan, A, Duffield, CM & Bichel-Findlay, J 2016, 'Cancer patient experience measures - an evidence review', Journal of Psychosocial Oncology, vol. 34, no. 3, pp. 200-222.View/Download from: UTS OPUS or Publisher's site
Objectives: This research investigates the instruments currently available to measure the cancer patient experience of health care. An investigation of the number of instruments, the domains covered by the instruments, and the structure and psychometric performance of instruments is undertaken. Methods: A narrative synthesis approach is used to gather evidence from multiple studies and explain the findings. Purposely broad search terms and strategies are used to capture studies with cancer patients at all stages of disease and across a range of cancer types and health care settings. Results: The majority of identified instruments were originally designed for the oncology field. Twelve of the studies developed new cancer patient measures; eight studies adapted existing or utilized items from existing instruments, and seven studies assessed the psychometric properties of existing instruments or assessed validated tools under different conditions (e.g., cross-cultural adaptation). The number of instruments assessing cancer patient experience that have sound psychometric properties across items was found to be low. The properties least tested are test–retest reliability, construct, convergent and discriminant validity, scale variability (floor/ceiling effects), and interpretability. Conclusion: This review examined 10 years of research on the development of instruments to measure the cancer patient experience of health care. It found that research in this area is still in early stages of development. Further inquiry based on development and validation of cancer patient experience measures is required to support improvements in cancer care based on the perspective of cancer patients.
Twigg, DE, Myers, H, Duffield, C, Pugh, JD, Gelder, L & Roche, M 2016, 'The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data', INTERNATIONAL JOURNAL OF NURSING STUDIES, vol. 63, pp. 189-200.View/Download from: Publisher's site
Perry, L, Gallagher, R, Duffield, CM, Sibbritt, D, Bichel-Findlay, J & Nicholls, R 2016, 'Does nurses' health affect their intention to remain in their current position', Journal of Nursing Management, vol. 24, no. 8, pp. 1088-1097.View/Download from: UTS OPUS or Publisher's site
Baldwin, R, Duffield, CM, 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.View/Download from: Publisher's site
Buchan, J, Duffield, C & Jordan, A 2015, ''Solving' nursing shortages: do we need a New Agenda?', Journal of Nursing Management, vol. 23, no. 5, pp. 543-545.View/Download from: UTS OPUS or Publisher's site
Buchan, J, Twigg, D, Dussault, G, Duffield, C & Stone, PW 2015, 'Policies to sustain the nursing workforce: An international perspective', International Nursing Review, vol. 62, no. 2, pp. 162-170.View/Download from: Publisher's site
Aim: Examine metrics and policies regarding nurse workforce across four countries. Background: International comparisons informs health policy makers. Methods: Data from the OECD were used to compare expenditure, workforce and health in: Australia, Portugal, the United Kingdom (UK) and the United States (US). Workforce policy context was explored. Results: Public spending varied from less than 50% of gross domestic product in the US to over 80% in the UK. Australia had the highest life expectancy. Portugal has fewer nurses and more physicians. The Australian national health workforce planning agency has increased the scope for co-ordinated policy intervention. Portugal risks losing nurses through migration. In the UK, the economic crisis resulted in frozen pay, reduced employment, and reduced student nurses. In the US, there has been limited scope to develop a significant national nursing workforce policy approach, with a continuation of State based regulation adding to the complexity of the policy landscape. The US is the most developed in the use of nurses in advanced practice roles. Ageing of the workforce is likely to drive projected shortages in all countries. Limitations: There are differences as well as variation in the overall impact of the global financial crisis in these countries. Conclusion: Future supply of nurses in all four countries is vulnerable. Implications for nursing and health policy: Work force planning is absent or restricted in three of the countries. Scope for improved productivity through use of advanced nurse roles exists in all countries.
Duffield, C, Graham, E, Donoghue, J, Griffiths, R, Bichel-Findlay, J & Dimitrelis, S 2015, 'Why older nurses leave the workforce and the implications of them staying.', Journal of Clinical Nursing, vol. 24, no. 5-6, pp. 824-831.View/Download from: UTS OPUS or Publisher's site
To identify factors that motivate older nurses to leave the workforce.As many older nurses are now reaching retirement age and will be eligible for government-funded pensions, governments are concerned about the impending financial burden. To prepare for this scenario, many are looking at increasing the age of retirement to 67 or 70 years. Little is known about how this will affect the continuing employment of older nurses and the consequences for employers and the nurses themselves if they remain longer in the workforce.Prospective randomised quantitative survey study.The Mature Age Workers Questionnaire, Job Descriptive Index and Job in General Scale were used to measure job satisfaction, intention to retire and factors encouraging retirement in registered nurses aged 45 years and over (n = 352) in Australia (July-August 2007).There were 319 respondents. The mean age proposed for leaving the workforce was 61·7 years. Key motivators were: financial considerations (40·1%), primarily financial security; nurse health (17·4%) and retirement age of partner (13·3%).Older nurses are leaving the workforce prior to retirement or pension age, primarily for financial, social and health reasons, taking with them significant experience and knowledge. As financial considerations are important in older nurses decisions to continue to work, increasing the age of retirement may retain them. However, consideration will need to be given to ensure that they continue to experience job satisfaction and are physically and mentally able to undertake demanding work.Increasing retirement age may retain older nurses in the workforce, however, the impact on the health of older nurses is not known, nor is the impact for employers of older nurses continuing to work known. Employers must facilitate workplace changes to accommodate older nurses.
Duffield, C, Graham, E, Donoghue, J, Griffiths, R, Bichel-Findlay, J & Dimitrelis, S 2015, 'Workforce shortages and retention of older nurses', Australian nursing & midwifery journal, vol. 22, no. 7, pp. 18-19.
Duffield, CM, Roche, MA, 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.View/Download from: UTS OPUS or Publisher's site
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.
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.View/Download from: UTS OPUS or Publisher's site
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
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...
Fry, M, Duffield, CM, Baldwin, RJ, Roche, MA, Stasa, H & Solman, A 2015, 'Development of a tool to describe the role of the clinical nurse consultant in Australia (vol 22, pg 1531, 2013)', JOURNAL OF CLINICAL NURSING, vol. 24, no. 5-6, pp. 882-882.View/Download from: Publisher's site
Geale, SK & Duffield, CM 2015, 'Nurses – are we disaster ready?', Australian nursing & midwifery journal, vol. 23, no. 1, pp. 23-23.
Merrick, ET, Fry, M, Duffield, C & Stasa, H 2015, 'Trust and decision-making: How nurses in Australian general practice negotiate role limitations', Collegian, vol. 22, no. 2, pp. 225-232.View/Download from: Publisher's site
Aim: To explore the importance of role recognition and relationships between the opportunities for decision-making, social support, and skill development, in a sample of nurses working in general practice in New South Wales, Australia. Background: Understanding how nurses make decisions about patients and their care in general practice will benefit organisations and public policy. This understanding is important as the role changes and opportunities for further role development emerge. Design: A sequential mixed methods design was used. Study 1 utilised the internationally validated Job Content Questionnaire to collect data about decision making, social support, skill development, and identity derived from the role. In 2008 a purposive sample of nurses working in general practice (n = 160) completed and submitted an online Job Content Questionnaire. Study 2 used a set of open-ended questions informed by Study 1 to guide semi-structured interviews. In 2010 fifteen interviews were undertaken with nurses in general practice. Demographic characteristics of both samples were compared, and the findings of both studies were integrated. Results: The integration of findings of Study 1 and 2 suggests that nurses defined their expertise as being able to identify patient need and communicate this to the general practitioner, the ability to do so led to the development of trusting relationships. Trusting relationships led to greater support from the general practitioner and this support allowed the nurse greater freedom to make decisions about patient care. Conclusions: Nurses gained influence in clinical decision-making by building trusting relationships with patients and medical colleagues. They actively collaborated in and made decisions about patient care. These results suggest that there is a need to consider how nursing can more effectively contribute to care in general practice settings.
Perry, L, Gallagher, R & Duffield, C 2015, 'The health and health behaviours of Australian metropolitan nurses: an exploratory study.', BMC Nursing, vol. 14, pp. 45-45.View/Download from: Publisher's site
BACKGROUND: Nurses make up the largest component of the health workforce and provide the majority of patient care. Most health education is delivered by nurses, who also serve as healthy living and behavioural role models. Anything that diminishes their health status can impact their credibility as role models, their availability and ability to deliver quality care, and is potentially disadvantageous for the health of the population. Study aims were to investigate nurses' overall health and the presence of chronic disease; to describe nurses' health-related behaviours and to compare them to those of the general population, with both groups matched by age and gender. METHODS: Cross-sectional descriptive paper-based survey of nurses from two Sydney metropolitan hospitals using established instruments and questions and measurements taken with standardised methods. RESULTS: This nursing sample (n = 381) had a mean age of 39.9 (SD 11.7, range 20-67) years, Most (n = 315; 82.7 %) were female, worked full-time (80.0 %), and were shift workers (93.0 %). The majority (94.0 %) indicated good, very good or excellent health, despite 42.8 % indicating they had chronic disease. The most common risk factors for chronic disease were inadequate vegetable (92.6 %) and fruit intake (80.1 %), overweight and obesity (44.0 %) and risky alcohol intake (34.7 %); health screening behaviours were not ideal. Aside from overweight and obesity, these risk factors were more prevalent in nurses than the equivalent group of the New South Wales population, particularly for risky alcohol intake which was much more common in female nurses and most marked in those aged under 35 years. However, 80 % met the guidelines for physical activity, more than the equivalent group of the New South Wales population. CONCLUSION: There are early 'warning signs' concerning the health status of nurses. Despite perceiving current good health, support is required for nurses to prevent future chronic disease, particu...
Perry, L, Lamont, S, Brunero, S, Gallagher, R & Duffield, C 2015, 'The mental health of nurses in acute teaching hospital settings: a cross-sectional survey.', BMC Nursing, vol. 14, pp. 15-15.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Nursing is an emotionally demanding profession and deficiencies in nurses' mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses' health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals. METHODS: A cross sectional survey design was used. The Registered and Enrolled Nurse workforce, employed on any form of contract, at two teaching hospitals in Sydney Australia were invited to participate. The survey tool was compiled of validated tools and questions. Family and medical history and health risk-related characteristics, current psycho-active medications, smoking status, alcohol intake, eating disorders, self-perceived general health, mental health and vitality, demographic, social and occupational details were collected. RESULTS: A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n = 49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12 month. Nurses had better mental health if they had better general health, lived with a spouse/ partner rather than alone, had fewer symptoms, sleep problems or disordered eating behaviours, were not an informal carer and did not work nights. Nurses had greater vitality if they were male, had better general health, fewer sleep problems or symptoms generally and lived with a spouse/ partner rather than alone; less vitality if they were an informal carer or had disordered eating. CONCLUSION: Nurses and their managers should strive to create workplaces where wo...
Roche, MA, 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.View/Download from: UTS OPUS or Publisher's site
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.
Roche, MA, Duffield, CM, Homer, CS, Buchan, J & Dimitrelis, S 2015, 'The Rate and Cost of Nurse Turnover in Australia', Collegian, vol. 22, no. 4, pp. 353-358.View/Download from: UTS OPUS or Publisher's site
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.
Roche, MA, Laschinger, HKS & 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.View/Download from: UTS OPUS or Publisher's site
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
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
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
Scott, A, Witt J, Duffield, CM & Kalb G 2015, 'What do nurses and midwives value about their jobs? Results from a discrete choice experiment', Journal of Health Services Research and Policy, vol. 20, no. 1, pp. 31-38.View/Download from: Publisher's site
Objectives: To examine nurses' and midwives' preferences for the characteristics of their jobs.
Methods: A discrete choice experiment of 990 nurses and midwives administered as part of a survey of nurses and
midwives in Victoria, Australia.
Results: Autonomy, working hours, and processes to deal with violence and bullying were valued most highly. Nurses
and midwives would be willing to forgo 19% and 16% of their annual income for adequate autonomy and adequate
processes to deal with violence and bullying, compared to poor autonomy and poor processes for violence and bullying.
They would need to be paid an additional 24% to increase their working hours by 10% ($73 per hour). Job characteristics
that were less important were shift work, nurse to patient ratios, and public or private sector work.
Conclusions: Policies to improve retention and job satisfaction of nurses and midwives should initially focus on
autonomy, processes to deal with violence and bullying, and reasonable working hours. Further research on the costeffectiveness
of these different policies is needed.
Twigg, DE, Myers, H, Duffield, C, Giles, M & Evans, G 2015, 'Is there an economic case for investing in nursing care - what does the literature tell us?', Journal of Advanced Nursing, vol. 71, no. 5, pp. 975-990.View/Download from: Publisher's site
Background: Within Australia nursing unions are pursuing mandated nursepatient 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 studys aim was to estimate average staffing levels, skill mix and patient presentations in all New South Wales (NSW) Emergency Departments (EDs). Methods: The design was a retrospective historical census audit. Nurse rosters and patient presentation data were collected for three randomly selected census days in May 2010. Twenty six valid responses out of 44 were returned. A ratio of the number of beds per nurse was calculated as well as skill mix and bed occupancy. Results: The average beds per nurse ratios found were 3.8 (morning shift), 3.6 (evening), and 5.1(night). However, ratios as high as 8.4 (morning), 7.3 (evening) and 16.0 (night) were identified on particular shifts. Overall a rich skill mix was found with an average of 90% of nursing hours being provided by Registered Nurses. The average daily bed occupancy of 4 patients per bed was similar across ED levels. Conclusions: The study adds to the limited literature on ED staffing and demonstrates the utility in the simplicity of ratios in flagging potential staffing problems. The audit revealed wide variation in staffing levels which was not always linked to patient activity. Of particular concern were the regional EDs (Level 5) which have the capacity to deal with all types of emergencies but where ratios as high as 7 beds per nurse were found during the day. Ratios cannot be used to determine the optimal staffing levels in every clinical situation; their purpose is to force an increase in nursing supply and to prevent individual units from becoming understaffed.
Abbenbroek, B, Duffield, C & Elliott, D 2014, 'Selection of an instrument to evaluate the organizational environment of nurses working in intensive care: an integrative review', Journal of Hospital Administration, vol. 3, no. 6, pp. 143-162.View/Download from: UTS OPUS or Publisher's site
Objective: To determine an appropriate survey instrument to evaluate the impact of organizational structures on the work environment of intensive care nurses.
Background: Internationally the demand for intensive care is increasing. Solely increasing bed capacity is not sustainable. Large capacity multi-specialty Intensive Care Units are emerging as the preferred organizational model with benefits resulting from optimizing operational synergies and economies of scale. The impact of this organizational transition on intensive care nurses is not well understood. An appropriate survey instrument for intensive care nurses is required. Design: Integrative literature review. Data Sources: CINAHL, PubMed, EMBASE and OVID Nursing databases searched for studies published between 2005 and 2013.
Review methods: An integrative review and quality assessment of the studies was undertaken to select nurse outcome measures associated with organizational structures across a range of acute and critical care settings. Congruence between nurse outcome measures and nurse survey instruments tested in the literature was assessed to select instruments for further psychometric evaluation.
Results: Thirty-one cross sectional quantitative studies, from fourteen countries, were reviewed. Twenty one nurse outcome measures associated with organizational factors were identified and a total of twenty five survey instruments used in the studies reviewed. Assessment of congruence and psychometric properties determined that a combination of two instruments is required to comprehensively assess the organizational environment of nurses working in intensive care units.
Conclusion: The environment of nurses working in intensive care is effectively evaluated with an instrument that combines subscales from the Practice Environment Scale-Nurse Work Index and Maslach's Burnout Inventory.
Abbenbroek, BJ, Duffield, CM & Elliott, D 2014, 'The intensive care unit volume-mortality relationship, is bigger better? An integrative literature review', Australian Critical Care, vol. 27, no. 4, pp. 157-164.View/Download from: UTS OPUS or Publisher's site
Objective: To explore the association between patient volume in intensive care units (ICUs) and risk-adjusted mortality.Background: Large multi-speciality ICUs are emerging in response to increasing demand for criticalcare. Consolidation of resources through regionalisation of services aims to contain costs and optimise demand management and operational synergies. Higher patient volumes in ICU have been associatedwith improved outcomes. Limited evidence exists, however, to suggest an optimal volume of patients interms of risk-adjusted mortality.
Blay, N, Duffield, CM, Gallagher, R & Roche, MA 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.View/Download from: Publisher's site
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.
Blay, N, Duffield, CM, Gallagher, RD & Roche, MA 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.View/Download from: Publisher's site
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.
Chenoweth, L, Merlyn, T, Jeon, YH, Tait, FM & Duffield, CM 2014, 'Attracting and retaining qualified nurses in aged and dementia care: outcomes from an Australian study', Journal of Nursing Management, vol. 22, pp. 234-247.View/Download from: UTS OPUS or Publisher's site
To identify key issues and factors affecting retention of qualified nurses who care for older people and persons with dementia in Australian acute, subacute, community and residential health-care settings.
As the number of older people with chronic conditions needing health care continues to increase research is needed to optimize nurse retention.
Qualified nurses were surveyed with a set of items derived from four published nurse workforce questionnaires (Cronbach's alpha range 0.75-0.96). There were 3983 complete responses and 10 focus groups with 58 volunteer survey respondents.
In addition to reporting a number of workplace issues, nurses also reported reasonable levels of satisfaction. Intrinsic factors related to caregiving, work relations and colleague support. Extrinsic factors included professional opportunities and organisational support.
Altruism is a primary motivation for choosing to nurse older people and persons with dementia. Nurses are most positive when they feel valued and supported by their organisation and colleagues, through education, training, supervision, mentoring opportunities and appropriate remuneration.
IMPLICATIONS FOR NURSING MANAGEMENT:
Nursing managers need to take positive steps to address the organisational factors outlined in this paper that either inhibit or promote nurse retention.
Dawson, A, Buchan, J, Duffield, CM, Homer, CS & Wijewardena, K 2014, 'Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence', Health Policy and Planning, vol. 29, no. 3, pp. 396-408.View/Download from: UTS OPUS or Publisher's site
Reducing maternal mortality and providing universal access to reproductive health in resource poor settings has been severely constrained by a shortage of health workers required to deliver interventions. The aim of this article is to determine evidence to optimize health worker roles through task shifting/sharing to address Millennium Development Goal 5 and reduce maternal mortality and provide universal access to reproductive health. A narrative synthesis of peer-reviewed literature from 2000 to 2011 was undertaken with retrieved documents assessed using an inclusion/exclusion criterion and quality appraisal guided by critical assessment tools. Concepts were analysed thematically. The analysis identified a focus on clinical tasks (the delivery of obstetric surgery, anaesthesia and abortion) that were shifted to and/or shared with doctors, non-physician clinicians, nurses and midwives.
Dawson, A, Stasa, H, Roche, MA, Homer, CS & Duffield, CM 2014, 'Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies', BMC Nursing, vol. 13, no. 11.View/Download from: UTS OPUS or Publisher's site
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.
Doran, D, Duffield, CM, Rizk, P, Nahm, S & Chu, CH 2014, 'A Descriptive Study of Employment Patterns and Work Environment Outcomes of Specialist Nurses in Canada', Clinical Nurse Specialist, vol. 28, no. 2, pp. 105-114.View/Download from: Publisher's site
The purpose was to describe the number, demographic characteristics, work patterns, exit rates, and work perceptions of nurses in Ontario, Canada, in 4 specialty classifications: advanced practice nurse (APN)Yclinical nurse specialist (CNS), APN-other, primary healthcare nurse practitioner [RN(extended class [EC])], and registered nurse (RN) with specialty certification. The objectives were to (1) describe how many qualified nurses are available by specialty class; (2) create a demographic profile of specialist nurses;(3) determine the proportions of specialist and nonspecialist nurses who leave (a) direct patient care and (b) nursing practice annually; (4) determinewhether specialist and nonspecialist nurses differ in their self-ratings of work environment, job satisfaction, and intention to remain in nursing.
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.View/Download from: UTS OPUS or Publisher's site
Duffield, CM, Roche, MA, Homer, CS, 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.View/Download from: UTS OPUS or Publisher's site
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.
Duffield, CM, Twigg, D, Pugh, J, Evans, G, Dimitrelis, S & Roche, MA 2014, 'The Use of Unregulated Staff: Time for Regulation?', Policy Politics and Nursing Practice, vol. 15, no. 1-2, pp. 42-48.View/Download from: UTS OPUS or Publisher's site
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.
Elliott, D, McKinley, SM, Perry, L, Duffield, CM, Iedema, RA, Gallagher, R, Fry, M, Roche, MA & 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.View/Download from: UTS OPUS or Publisher's site
Graham, E, Donoghue, J, Duffield, C, Griffiths, R, Bichel-Findlay, J & Dimitrelis, S 2014, 'Why Do Older RNs Keep Working?', JONA: The Journal of Nursing Administration, vol. 44, no. 11, pp. 591-597.View/Download from: UTS OPUS or Publisher's site
Mather, B, Roche, MA & Duffield, CM 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.View/Download from: Publisher's site
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.
Aims and objectives. To explore whether or not the context of Australian practice nursing supports collaborative decision-making about organisation and delivery of patient care.
Background. Positive patient outcomes depend on Australian practice nurses participating in collaborative and interprofessional services, particularly for patients with chronic disease(s). It is unclear whether Australian practice nurses have the opportunity to collaborate in decision-making or how traditional organisational structures may support or hinder collaboration.
Design. This is a descriptive exploratory study. Semi-structured interviews were conducted using a purposive sample of practice nurses (n = 15). Thematic analysis was used to provide meaningful and contextual insights into how practice nurses participate in decision-making.
Method. An interview tool, based on available literature, was developed and consisted of thirty open-ended questions to direct discussion during telephone interviews. Transcribed data were imported into NVivo(tm) for analysis and interpretation. The collection, analysis and thematic interpretation of data were an iterative process.
Findings. Participants fostered trusting interprofessional relationships, which enabled them to influence medical decision-making and thereby advocate for patient need. Trusting interprofessional relationships were perceived to alter the relative roles of the medical practitioner and practice nurse and enhance the opportunities for collaborative decision-making.
Conclusions and relevance to clinical practice. Collaborative interprofessional care in Australian general practice must occur if increased demands for care are to be met. It is timely to consider how government policy, financial regulations and the organisation of Australian general practice can better support and enhance a collaborative contribution to care by practice nurses.
Meyer, R, O'Brien-Pallas, L, Doran, D, Streiner, D, Ferguson-Pare, M & Duffield, CM 2014, 'Boundary spanning by nurse managers: effects of managers' characteristics and scope of responsibility on teamwork.', Canadian Journal of Nursing Leadership, vol. 27, no. 2, pp. 42-55.
Increasing role complexity has intensified the work of managers in supporting healthcare teams. This study examined the influence of front-line manager characteristics and scope of responsibility on teamwork.
Davidson, PM, Newton, PJ, Ferguson, C, Daly, J, Elliott, D, Homer, CS, Duffield, CM & Jackson, DE 2014, 'Rating and Ranking the Role of Bibliometrics and Webometrics in Nursing and Midwifery', The Scientific World Journal, vol. 2014.View/Download from: UTS OPUS or Publisher's site
Background. Bibliometrics are an essential aspect of measuring academic and organizational performance. Aim. This review seeks to describe methods for measuring bibliometrics, identify the strengths and limitations of methodologies, outline strategies for interpretation, summarise evaluation of nursing and midwifery performance, identify implications for metric of evaluation, and specify the implications for nursing and midwifery and implications of social networking for bibliometrics and measures of individual performance.
Baldwin, RJ, Duffield, CM, Fry, M, Roche, MA, 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.View/Download from: UTS OPUS or Publisher's site
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.
Fry, M, Duffield, CM, 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.View/Download from: UTS OPUS or Publisher's site
Aims and objectives. To develop a tool for defining and measuring the role characteristics and responsibilities of an advancedpractice nursing role in Australia.Background. Internationally, there is considerable confusion about the precise role responsibilities of advanced practice nursingpositions. 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, anonline survey, and position descriptions were used to generate the a priori themes for the initial template. Semi-structuredinterviews were conducted (in 2010) to test the template characteristics. The template underwent multiple iterations in itsdevelopment.Results. A 50-item tool was devised, which consisted of five domains with a ten-point hierarchical scale within each domain. Inpreliminary testing, the revised template was found to provide greater clarity regarding roles and grades than the originalposition descriptions.Conclusions. Further testing and refinement of the modified rating scale is needed, but it offers the possibility of a new tool thatcan be used by health service managers to determine the grade of a clinical nurse consultant position and for evaluating roleperformance.Relevance to clinical practice. This preliminary study suggests that the tool provides a useful means of measuring advancednursing practice and responsibilities across different domains and levels of appointment. The tool may be able to be adapted foruse with other advanced practice nursing roles both within Australia and internationally.
Gardner, G, Chang, AM, Duffield, CM & Doubrovsky, A 2013, 'Delineating the practice profile of advanced practice nursing: a cross-sectional survey using the modified strong model of advanced practice', Journal of Advanced Nursing, vol. 69, no. 9, pp. 1931-1942.View/Download from: UTS OPUS or Publisher's site
Aims. To test a model that delineates advanced practice nursing from the practice profile of other nursing roles and titles.
Roche, MA, Duffield, CM, Wise, S, Baldwin, RJ, 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.View/Download from: UTS OPUS or Publisher's site
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.
Twigg, DE, Duffield, CM & Evans, G 2013, 'The critical role of nurses to the successful implementation of the National Safety and Quality Health Service Standards', Australian Health Review, vol. 37, no. 4, pp. 541-546.View/Download from: UTS OPUS or Publisher's site
The National Safety and Quality Health Service Standards requires health service compliance by 2013 and covers several areas including governance arrangements, partnerships with consumers and eight key clinical processes. Nurses in Australia comprise 62% of the hospital workforce, are the largest component and hence play a critical role in meeting these standards and improving the quality of patient care.
Twigg, DE, Geelhoed, E, Bremner, A & Duffield, CM 2013, 'The economic benefits of increased levels of nursing care in the hospital setting', Journal of Advanced Nursing, vol. 69, no. 10, pp. 2253-2261.View/Download from: UTS OPUS or Publisher's site
Aim. To assess the economic impact of increased nursing hours of care on health outcomes in adult teaching hospitals in Perth, Western Australia.
Blay, N, Duffield, CM & Gallagher, RD 2012, 'Patient transfers in Australia: implications for nursing workload and patient outcomes', Journal of Nursing Management, vol. 20, no. 3, pp. 302-310.View/Download from: UTS OPUS or Publisher's site
To discuss the impact of patient transfers on patient outcomes and nursing workload. Many patient transfers are essential and occur in response to patients. However, increasingly within Australia transfers are performed in response to reductions in bed numbers, resulting in 'bed block'. A discussion of the literature related to inpatient transfers, nursing workload and patient safety. Measures to increase patient flow such as short-stay units may result in an increase in patient transfers and nursing workload. Frequent patient transfers may also increase the risk of medication incidents, health-care acquired infections and patient falls. The continuing demand for health care has led to a reactionary bed management system that, in an attempt to accommodate patients, has resulted in increased transfers between wards. This can have a negative effect on nursing workload and affect patient outcomes. High nursing workload is cited as one reason for nurses leaving the profession. Reductions in non-essential transfers may reduce nurse workload, improve patient outcomes and enhance continuity of patient care.
Chang, A, Gardner, G, Duffield, CM & Ramis, M 2012, 'Advanced Practice Nursing Role Development: Factor Analysis Of A Modified Role Delineation Tool', Journal of Advanced Nursing, vol. 68, no. 6, pp. 1369-1379.View/Download from: UTS OPUS or Publisher's site
Aim. This study reports the use of exploratory factor analysis to determine construct validity of a modified advanced practice role delineation tool. Background. Little research exists on specific activities and domains of practice within advanced practice nursing roles, making it difficult to define service parameters of this level of nursing practice. A valid and reliable tool would assist those responsible for employing or deploying advanced practice nurses by identifying and defining their service profile. This is the third article from a multi-phase Australian study aimed at assigning advanced practice roles. Methods. A postal survey was conducted of a random sample of state government employed Registered Nurses and midwives, across various levels and grades of practice in the state of Queensland, Australia, using the modified Advanced Practice Role Delineation tool. Exploratory factor analysis, using principal axis factoring was undertaken to examine factors in the modified tool. Cronbachs alpha coefficient determined reliability of the overall scale and identified factors. Results. There were 658 responses (42% response rate). The five factors found with loadings of =400 for 40 of the 41 APN activities were similar to the five domains in the Strong model. Cronbachs alpha coefficient was 0·94 overall and for the factors ranged from 0·83 to 0·95. Conclusion. Exploratory factor analysis of the modified tool supports validity of the five domains of the original tool. Further investigation will identify use of the tool in a broader healthcare environment.
Clarke, E, Diers, D, Kunisch, J, Duffield, CM, Thoms, D, Hawes, S, Stasa, H & Fry, M 2012, 'Strengthening the nursing and midwifery unit manager role: an interim programme evaluation', Journal of Nursing Management, vol. 20, no. 1, pp. 120-129.View/Download from: UTS OPUS or Publisher's site
Aims: An interim evaluation was conducted on the professional development components of the New South Wales (NSW) Health 'take the lead' ('ttl') programme, an initiative aimed at enhancing nursing/midwifery unit managers' (N/MUM) skills. Background: Previous research has highlighted the importance of strong nurse leaders, and shown that training programmes may assist in improving leadership skills. The NSW Nursing and Midwifery Office (NaMO) developed the 'ttl' programme for N/MUMs with the intention of improving hospital quality by strengthening nurse leadership. The programme had three strands, with the professional development modules a key component. Method: Semi-structured interviews were conducted with 17 participants who had completed components of the 'ttl' programme. The interviews explored participants' perceptions of the programme, and suggestions for improvement. Qualitative analysis was conducted on the transcribed interviews. Results: The N/MUMs reported feeling increasingly empowered, knowledgeable and supported as a result of attending the 'ttl' workshops. Conclusions: The results suggest that the studied components of the 'ttl' programme may be effective in assisting nurse leaders gain new leadership skills and institute positive changes in the nursing work environment. Implications for Nursing Management: Leadership programmes such as 'ttl' may provide an effective tool for improving N/MUM performance and role confidence
Dignam, DM, Duffield, CM, Stasa, H, Gray, JE, Jackson, DE & Daly, J 2012, 'Management and leadership in nursing: an Australian educational perspective', Journal of Nursing Management, vol. 20, no. 1, pp. 65-71.View/Download from: UTS OPUS or Publisher's site
Aim: In this article, we present an Australian perspective on issues influencing management and leadership education in nursing. Background: Nurse leaders and managers work in a context of high pressure, uncertainty and rapid change, and face unprecedented challenges on a daily basis. Evaluation and Key Issues: In the present paper, we reflect on the issues and challenges facing providers of management education for nursing, and consider these challenges in relationship to current trends and imperatives. Conclusions: Collaborative approaches between educational and clinical settings are needed to ensure quality, relevant educational support for managers and leaders, and enhance curriculum integrity. Implications for Nursing Management: There is a need for contemporaneous and relevant research to inform innovative models of collaborative education.
Hayes, LJ, O'Brien-Pallas, L, Duffield, CM, Shamian, J, Buchan, J, Hughes, FA, Laschinger, H & North, N 2012, 'Nurse turnover: A literature review - An update', International Journal of Nursing Studies, vol. 49, no. 7, pp. 887-905.View/Download from: UTS OPUS or Publisher's site
Background: Concerns related to the complex issue of nursing turnover continue to challenge healthcare leaders in every sector of health care. Voluntary nurse turnover is shown to be influenced by a myriad of inter-related factors, and there is increasing evidence of its negative effects on nurses, patients and health care organizations. Objectives: The objectives were to conduct a comprehensive review of the related literature to examine recent findings related to the issue of nursing turnover and its causes and consequences, and to identify on methodological challenges and the implications of new evidence for future studies. Design: A comprehensive search of the recent literature related to nursing turnover was undertaken to summarize findings published in the past six years. Data sources: Electronic databases: MEDLINE, CINAHL and PubMed, reference lists of journal publications. Review methods: Keyword searches were conducted for publications published 2006 or later that examined turnover or turnover intention in employee populations of registered or practical/enrolled or assistant nurses working in the hospital, long-term or community care areas. Literature findings are presented using an integrative approach and a table format to report individual studies. Results: From about 330 citations or abstracts that were initially scanned for content relevance, 68 studies were included in this summary review. The predominance of studies continues to focus on determinants of nurse turnover in acute care settings. Recent studies offer insight into generational factors that should be considered in strategies to promote stable staffing in healthcare organizations. Conclusions: Nursing turnover continues to present serious challenges at all levels of health care. Longitudinal research is needed to produce new evidence of the relationships between nurse turnover and related costs, and the impact on patients and the health care team.
Merrick, ET, Duffield, CM, Baldwin, RJ & Fry, M 2012, 'Nursing in general practice: organizational possibilities for decision latitude, created skill, social support and identity derived from role', Journal of Advanced Nursing, vol. 68, no. 3, pp. 614-624.View/Download from: UTS OPUS or Publisher's site
Abstract Aim. This article is a report of a study to describe the factors that support organizational opportunities for practice nurse decision-making and skill development for nurses employed in general practice in New South Wales, Australia. Background. Corresponding to the availability of subsidies from the Australian universal health insurer (Medicare), there has been an increase in the number of nurses employed in general practice. Currently, there is no Australian evidence as to the organizational possibilities for these practice nurses to make decisions, develop their own skills and abilities, derive identity from their role or how their role is influenced by social support. Methods. Over a 8-month period in 2008 practice, nurses employed in general practice in the State of New South Wales were invited to complete a 26-item selfadministered online questionnaire utilizing constructs from Karaseks (1998) Job Content Questionnaire (valid n = 160). Results. Confirmatory Factor Analysis indicated that all scales demonstrated acceptable levels of internal consistency. Sequential regression models revealed that social support exerts a weak influence on decision latitude (R2 = 0Ã07); the addition of self-identity through work significantly improved the predictive ability of the model (R2 = 0Ã16). Social support and self-identity through work exerted a negative influence on created skill (R2 = 0Ã347), whereas social support was effective in predicting self-identity through work (R2 = 0Ã148). Conclusions. Collegial and supervisory support in the work environment predicts organizational possibilities for practice nurse decision-making.
Merrick, ET, Duffield, CM, Baldwin, RJ, Fry, M & Stasa, H 2012, 'Expanding the role of practice nurses in Australia', Contemporary Nurse, vol. 41, no. 1, pp. 133-140.View/Download from: UTS OPUS or Publisher's site
Like other countries, Australia is looking to reforms in the primary health care sector to meet the growing demand for care. Expansion of the role of practice nurses (PNs) is one way in which this demand may be met. To date the Federal Australian government has played a significant role in encouraging growth in the PN worforce. If the PNs tend to be GP directed, with little autonomy, care must be taken to consider whether to expand existing scopes of practice.
Roche, MA, Duffield, CM, 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.View/Download from: UTS OPUS or Publisher's site
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.
Twigg, DE, Duffield, CM, Bremner, A, Rapley, P & Finn, J 2012, 'Impact of skill mix variations on patient outcomes following implementation of nursing hours per patient day staffing: a retrospective study', Journal of Advanced Nursing, vol. 68, no. 12, pp. 2710-2718.View/Download from: UTS OPUS or Publisher's site
Aims. This article is a report of a study of the association between skill mix and 14 nursing-sensitive outcomes following implementation of the nursing hours per patient day staffing method in Western Australian public hospitals in 2002, which determined nursing hours by ward category but not skill mix. Background. Findings from previous studies indicate that higher nurse staffing levels and a richer skill mix are associated with improved patient outcomes. Measuring skill mix at a hospital level for specific staffing methods and associated nursing-sensitive patient outcomes are important in providing staffing for optimal patient care. Design. The research design for the larger study was retrospectively analysing patient and staffing administrative data from three adult tertiary hospitals in metropolitan Perth over 4 years. Methods. A subset of data was used to determine the impact of skill mix on nursing-sensitive outcomes following implementation of the staffing method. All patient records (N = 103,330) and nurse staffing records (N = 73,770) from nursing hours per patient day wards from October 2002âJune 2004 following implementation were included. Results. Increases in Registered Nurse hours were associated with important decreases in eight nursing-sensitive outcomes at hospital level and increases in three nursing-sensitive outcomes. The lowest skill mix saw the greatest reduction in nursing-sensitive outcome rates. Conclusions. The skill mix of nurses providing care could impact patient outcomes and is an important consideration in strategies to improve nurse staffing. Levels of hospital nurse staffing and skill mix are important organizational characteristics when predicting patient outcomes.
Duffield, CM, Diers, D, O'Brien-Pallas, L, Aisbett, C, Roche, MA, King, MT & Aisbett, K 2011, 'Nursing Staffing, Nursing Workload, the Work Environment and Patient Outcomes', Applied Nursing Research, vol. 24, no. 4, pp. 244-255.View/Download from: UTS OPUS or Publisher's site
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.
Duffield, CM, Gardner, G, Chang, AM, Fry, M & Stasa, H 2011, 'National regulation in Australia: A time for standardisation in roles and titles', Collegian, vol. 18, no. 2, pp. 45-49.View/Download from: UTS OPUS or Publisher's site
Background: The past few years has seen a growth in the number of new nursing roles and position titles in many countries, including Australia. The Australian situation is unique due to the lack of professional engagement and debate in determining the purpose of some of these new positions. Often these new roles have been poorly de?ned, and there is no national consistency in nomenclature. The recent move to a national nursing registration system provides an opportunity for change. Method: Discursive paper.
Duffield, CM, Roche, MA, 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.View/Download from: UTS OPUS or Publisher's site
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, 80·3% 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, CM, Roche, MA, Blay, N, Thoms, D & Stasa, H 2011, 'The consequences of executive turnover', Journal of Research in Nursing, vol. 16, no. 6, pp. 503-514.View/Download from: UTS OPUS or Publisher's site
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.
Meyer, RM, O'Brien-Pallas, L, Doran, D, Streiner, D, Ferguson-Pare, M & Duffield, CM 2011, 'Front-line managers as boundary spanners: effects of span and time on nurse supervision satisfaction', Journal of Nursing Management, vol. 19, no. 5, pp. 611-622.View/Download from: UTS OPUS or Publisher's site
Aim To examine the influence of nurse manager span (number of direct report staff), time in staff contact, transformational leadership practices and operational hours on nurse supervision satisfaction. Background Increasing role complexity has intensified the boundary spanning functions of managers. Because work demands and scope vary by management position, time in staff contact rather than span may better explain managersâ capacity to support staff. Methods A descriptive, correlational design was used to collect cross-sectional survey and prospective work log and administrative data from a convenience sample of 558 nurses in 51 clinical areas and 31 front-line nurse managers from four acute care hospitals in 2007â2008. Data were analysed using hierarchical linear modelling. Results Span, but not time in staff contact, interacted with leadership and operational hours to explain supervision satisfaction. Conclusions With compressed operational hours, supervision satisfaction was lower with highly transformational leadership in combination with wider spans. With extended operational hours, supervision satisfaction was higher with highly transformational leadership, and this effect was more pronounced under wider spans. Implications for Nursing Management Operational hours, which influence the managerâs daily span (average number of direct report staff working per weekday), should be factored into the design of front-line management positions.
Moran, P, Duffield, CM, Donoghue, JM, Stasa, H & Blay, N 2011, 'Factors impacting on career progression for nurse executives', Advances in Contemporary Nursing, vol. 38, no. 1-2, pp. 45-55.View/Download from: UTS OPUS or Publisher's site
This discursive paper examines recent research on career progression for nurse executives in Australia. In particular, it focuses on the personal, work-related and professional factors which influence progression. The role of gender, location and the provision of mentoring are also considered. It is suggested that family friendly policies (such as the option to job share or to perform an executive role on a part-time basis), the availability of a mentor, and the opportunity to pursue further education/training are vital in assisting nurses to progress in their executive careers.
Roche, MA, Duffield, CM & White, EG 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.View/Download from: UTS OPUS or Publisher's site
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...
Twigg, DE, Duffield, CM, Bremner, A, Rapley, P & Finn, J 2011, 'The characteristics of hospital nursing staff and patient outcomes: A response to Garland and Glenn (2011)', International Journal of Nursing Studies, vol. 48, no. 5, pp. 657-658.View/Download from: UTS OPUS or Publisher's site
A reply to Garland and Glenn's (2011) critique of Twigg, D.,Duffield,C.,Thompson,P.L.,Rapley,P.,2010.Theimpactof nurses onpatientmorbidityandmortalityâtheneedforapolicy change inresponsetothenursingshortage.AustralianHealthReview 34, 312â316.
Twigg, DE, Duffield, CM, Bremner, A, Rapley, P & Finn, J 2011, 'The Impact Of The Nursing Hours Per Patient Day (Nhppd) Staffing Method On Patient Outcomes: A Retrospective Analysis Of Patient And Staffing Data', International Journal of Nursing Studies, vol. 48, no. 5, pp. 540-548.View/Download from: UTS OPUS or Publisher's site
Background: In March 2002 the Australian Industrial Relations Commission ordered the introduction of a new staffing method - nursing hours per patient day (NHPPD) - for implementation in Western Australia public hospitals. This method used a
Westbrook, JI, Duffield, CM, Li, L & Creswick, NJ 2011, 'How much time do nurses have for patients? a longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals', BMC Health Services Research, vol. 11, pp. 319-319.View/Download from: UTS OPUS or Publisher's site
Background: Time nurses spend with patients is associated with improved patient outcomes, reduced errors, and patient and nurse satisfaction. Few studies have measured how nurses distribute their time across tasks. We aimed to quantify how nurses distrib
Daly, J, Davidson, P, Duffield, CM, Campbell, T & Ward, R 2011, 'Interdisciplinary, cross- institutional collaborations: The Academic Health Sciences Centre as a key to addressing complex health problems and advancing research-based health care', Collegian, vol. 18, no. 1, pp. 1-2.View/Download from: UTS OPUS
Daly, J, Davidson, PM, Duffield, CM, Campbell, T & Ward, R 2011, 'Interdisciplinary, cross- institutional collaborations: The Academic Health Sciences Centre as a key to addressing complex health problems and advancing research-based health care', Collegian, vol. 15, no. 1, pp. 1-2.View/Download from: Publisher's site
Changes in disease patterns and the economic climate have created challenges for contemporary health care systems (Bennett, 2009). Meeting increased demands for care in a fiscally responsible manner requires new collaborative approaches involving not only health care professionals but also, managers, researchers, educators and basic scientists. In addition it is increasingly recognised that unless we engage consumers, policy makers and clinicians actively in the research process, the relevance, application and uptake of research findings are limited (Lavis et al., 2005). Unfortunately, efforts to ensure the collaboration and synergy required between all of these stakeholders are often challenged by organisational boundaries, and differences in research cultures and paradigms (Smith, Mitton,Peacock,Cornelissen, & MacLeod, 2009). It is not uncommon for researchers and clinicians working in the same organisation to have limited conversations and dialogue. Yet when they come together solutions to challenging problems are often enabled by merging unique perspectives and the sharing of knowledge (Boivin et al., 2009).
Davidson, PM, Homer, CS, Duffield, CM & Daly, J 2011, 'A moment in history and a time for celebration: The performance of nursing and midwifery in Excellence in Research for Australia', Collegian, vol. 18, no. 2, pp. 43-44.View/Download from: Publisher's site
The long awaited and much anticipated results of Australia's first national university system wide research evaluation exercise were delivered in February this year. The Excellence in Research Assessment (ERA) examined `research quality within Australia's higher education institutions using a combination of indicators and expert review by committees comprising experienced, internationally-recognised experts' (Australian Research Council, 2011). In the discipline review for nursing some twenty three universities were assessed. Midwifery was included in the Nursing category as the Field of Research (FoR) code (the way the groups were clustered together) for nursing includes midwifery. The results for nursing and midwifery were impressive and they demonstrated that nine of the twenty three research programs in this category that were assessed were world class or above world class. In fact, nursing and midwifery in the FoR code 1110 was noted to be a `particularly strong performer' (Australian Research Council, 2011). This demonstrates that nurses and midwives in Australia are engaged in high quality research which is influencing practice and policy and making a difference to the health care of Australians. In addition, the research of many nurses and midwives was also considered in other categories including public health, health services and clinical medicine. This shows that our disciplines are well represented across the health field and the commitment to interdisciplinary practice to solve complex health care problems.
It is a given that university research underpins economic and social developments. In 2010, it was reported that Â£3.5 Billion of publicly funded research generates Â£45 Billion a year in job creation and new products (THE, 2010). However, the benefits are not limited to industrial innovation and products. In the United Kingdom (UK), the Arts and Humanities Research Council asserted that for every Â£1 spent on arts and humanities research each year, the UK reaps up to Â£10 in immediate benefit and another Â£15-Â£20 in the long term (Owens, 2010). Similar metrics have been provided in Australia with similar returns on investment for research dollars spent. In Australia it has been estimated that there is a $5 AUD return for every $1 AUD invested in health and medical research (National Health & Medical Research Council, 2003).
Chang, AM, Gardner, G, Duffield, CM & Ramis, M 2010, 'A Delphi study to validate an Advanced Practice Nursing tool', Journal of Advanced Nursing, vol. 66, no. 10, pp. 2320-2330.View/Download from: UTS OPUS or Publisher's site
Aim. This paper is a report of a study conducted to validate an instrument for measuring advanced practice nursing role delineation in an international contemporary health service context using the Delphi technique. Background. Although most countries now have clear definitions and competency standards for nurse practitioners, no such clarity exists for many advanced practice nurse roles, leaving healthcare providers uncertain whether their service needs can or should be met by an advanced practice nurse or a nurse practitioner. The validation of a tool depicting advanced practice nursing is essential for the appropriate deployment of advanced practice nurses. This paper is the second in a three-phase study to develop an operational framework for assigning advanced practice nursing roles. Method. An expert panel was established to review the activities in the Strong Model of Advanced Practice Role Delineation tool. Using the Delphi technique, data were collected via an on-line survey through a series of iterative rounds in 2008. Feedback and statistical summaries of responses were distributed to the panel until the 75% consensus cut-off was obtained. Results. After three rounds and modification of five activities, consensus was obtained for validation of the content of this tool. Conclusion. The Strong Model of Advanced Practice Role Delineation tool is valid for depicting the dimensions of practice of the advanced practice role in an international contemporary health service context thereby having the potential to optimize the utilization of the advanced practice nursing workforce.
Duffield, CM, Conlon, LS, Kelly, MA, Catling, C & Stasa, H 2010, 'The Emergency Department Nursing Workforce: Local Solutions for Local Issues', International Emergency Nursing, vol. 18, no. 4, pp. 181-187.View/Download from: UTS OPUS or Publisher's site
Demand for health services especially emergency services has increased substantially in recent years. As a consequence, Emergency Departments and hospitals have focused greater attention on the way they provide care using the workforce differently to meet efficiency targets. A strategy frequently implemented is either the initiation or restructuring of Emergency Nurse Practitioner roles. The future role of the emergency nurse is likely to be different from that of today, as health services adapt and evolve to meet demand. However, the authors caution against the notion of implementing new positions or restructuring existing positions without first analysing patient throughput, case-mix, staff competency levels, cross-professional boundaries and relevant local issues.
Duffield, CM, Roche, MA, 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.View/Download from: UTS OPUS or Publisher's site
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.
Gardner, G, Gardner, A, Middleton, S, Gibb, M, Della, P & Duffield, CM 2010, 'Development And Validation Of A Novel Approach To Work Sampling: A Study Of Nurse Practitioner Work Patterns', Australian Journal Of Advanced Nursing, vol. 27, no. 4, pp. 4-12.View/Download from: UTS OPUS
Objectives This methodological paper reports on the development and validation of a work sampling instrument and data collection processes to conduct a national study of nurse practitioners' work patterns. Design Published work sampling instruments provi
There are well documented workforce shortages in nursing. Many strategies have been suggested to resolve the issue, including increasing migration or training places, changing skill mix or nursesâ roles, redesigning nursing work, and greater use of unregulated or unlicensed workers. One of the contributing and growing factors is the ageing of the workforce, but methods of retaining older employees have been given very little attention. This paper examines the impact of ageing on individuals, the ageing nursing workforce and the implications for government policy given its current status.
Roche, MA & Duffield, CM 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.View/Download from: UTS OPUS or Publisher's site
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.
Roche, MA, Diers, D, Duffield, CM & Catling, C 2010, 'Violence toward nurses, the work environment, and patient outcomes', Journal of Nursing Scholarship, vol. 42, no. 1, pp. 13-22.View/Download from: UTS OPUS or Publisher's site
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.
Twigg, DE, Duffield, CM, Thompson, PL & Rapley, P 2010, 'The impact of nurses on patient morbidity and mortality- the need for a policy change in response to the nursing shortage', Australian Health Review, vol. 34, no. 3, pp. 312-316.View/Download from: UTS OPUS or Publisher's site
CONTEXT: Workforce projections indicate that by 2012 there will be a shortfall of 61,000 registered nurses in Australia. There is a growing body of evidence that links registered nurse staffing to better patient outcomes. PURPOSE: This article provides a comprehensive review of the research linking nurse staffing to patient outcomes at a time of growing shortages, highlighting that a policy response based on substituting registered nurses with lower skilled workers may have adverse effects on patient outcomes. METHOD: An electronic search of articles published in English using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Journals @ OVID and Medline was undertaken. FINDINGS: Robust evidence exists nationally and internationally that links nurse staffing to patient outcomes. Recent meta-analyses have found that there was a 3-12% reduction in adverse outcomes and a 16% reduction in the risk of mortality in surgical patients with higher registered nurse staffing. Evidence confirms that improvements in nurse staffing is a cost-effective investment for the health system but this is not fully appreciated by health policy advisors. CONCLUSIONS: An appropriate policy response demands that the evidence that patient safety is linked to nurse staffing be recognised. Policy makers must ensure there are sufficient registered nurses to guarantee patient safety.
Duffield, CM 2009, 'Bring back the veil', Journal Of Clinical Nursing, vol. 18, pp. 783-785.
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, CM, Gardner, G, Chang, AM & Catling, C 2009, 'Advanced nursing practice: A global perspective', Collegian - Journal of Royal College of Nursing, Aust..., vol. 16, no. 2, pp. 55-62.View/Download from: UTS OPUS or Publisher's site
To review the titles, roles and scope of practice of Advanced Practice Nurses internationally. Background: There is a worldwide shortage of nurses but there is also an increased demand for nurses with enhanced skills who can manage a more diverse, complex and acutely ill patient population than ever before. As a result, a variety of nurses in advanced practice positions has evolved around the world. The differences in nomenclature have led to confusion over the roles, scope of practice and professional boundaries of nurses in an international context. Method: CINAHL, MEDLINE, and the Cochrane database of Systematic Reviews were searched from 1987 to 2008. Information was also obtained through government health and professional organisation websites. All information in the literature regarding current and past status, and nomenclature of advanced practice nursing was considered relevant. Findings: There are many names for Advanced Practice Nurses, and although many of these roles are similar in their function, they can often have different titles. Conclusion: Advanced Practice Nurses are critical for the future, provide cost effective care and are highly regarded by patients/clients. They will be a constant and permanent feature of future health care provision. However, clarification regarding their classification and regulation is necessary in some countries.
Duffield, CM, Roche, MA, 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.View/Download from: UTS OPUS or Publisher's site
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, CM, Roche, MA, O'Brien-Pallas, L, Catling, C & King, MT 2009, 'Staff satisfaction and retention and the role of the Nursing Unit Manager', Collegian, vol. 16, no. 1, pp. 11-17.View/Download from: UTS OPUS or Publisher's site
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
Hoffman, KA, Aitken, LM & Duffield, CM 2009, 'A comparison of novice and expert nurses' cue collection during clinical decision-making: Verbal protocol analysis', International Journal of Nursing Studies, vol. 46, no. 10, pp. 1335-1344.View/Download from: UTS OPUS or Publisher's site
The type of cues used during clinical decision-making contexts is not well understood. Further, there are conflicting findings in relation to how novice and expert nurses use cues. The aim of this study was to determine if there were differences between novice and expert nurses in the range and type of cues selected as well as how cues were clustered together when making clinical decisions while caring for post-operative patients in an Intensive Care Unit. Expert nurses collected a wider range of cues than novice nurses, almost twice as many different cues. The expert nurses also clustered more cues together to identify patient status when making decisions. Expert nurses were more proactive in collecting relevant cues and anticipating problems that may help identify patient problems. In the real world of practice expert nurses collect a broader range of cues to assess patient status than novice nurses. This differs to expert nurses cue collection in simulations where expert nurses may select only those cues that are necessary for the identified problem. This difference, if identified in other studies, may have important implications for nursing research and education.
Twigg, DE & Duffield, CM 2009, 'A review of workload measures: A context for a new staffing methodology in Western Australia', International Journal of Nursing Studies, vol. 46, no. 1, pp. 132-140.View/Download from: UTS OPUS or Publisher's site
Objectives This paper critically reviews various approaches to measuring nursing workload to provide a context for the introduction of a different approach to staffing. Nurse hours per patient day (NHPPD), which classifies wards into various groupings, was applied to all public hospitals in Western Australia. Results This method was introduced in response to industrial imperatives to determine reasonable workloads for nurses. As a result, the limited evaluation has focused only on the impact on workload management; reporting target versus actual nurse hours, staff retention and nurse feedback. This method improved ward staffing significantly without imposing restrictive nurse-to-patient ratios and facilitates the use of professional discretion within ward groupings to enable diversion of resources to match reported acuity changes. Conclusion While successful in attracting nurses back into hospitals and increasing nursing numbers, there is no empirical evidence of the impact this method had on patient outcomes or whether the guiding principles used in the development of this method are appropriate. The model would also benefit from further refinement to be more sensitive to direct acuity measures.
Chaboyer, W, Wallis, M, Duffield, CM, Courtney, M, Seaton, P, Holzhauser, K, Schluter, J & Bost, N 2008, 'A comparison of activities undertaken by enrolled and registered nurses on medical wards in Australia: An observational study', International Journal of Nursing Studies, vol. 45, no. 9, pp. 1274-1284.View/Download from: UTS OPUS or Publisher's site
Background The past decade has seen increasing patient acuity and shortening lengths of stays in acute care hospitals, which has implications for how nursing staff organise and provide care to patients. Objective The aim of this study was to describe the activities undertaken by enrolled nurses (ENs) and registered nurses (RNs) on acute medical wards in two Australian hospitals. Design This study used structured observation, employing a work sampling technique, to identify the activities undertaken by nursing staff in four wards in two hospitals. Nursing staff were observed for two weeks. The data collection instrument identified 25 activities grouped into four categories, direct patient care, indirect care, unit related activities and personal activities. Setting Two hospitals in Queensland, Australia. Results A total of 114 nursing staff were observed undertaking 14,528 activities during 482 h of data collection. In total, 6870 (47.3%) indirect, 4826 (33.2%) direct, 1960 (13.5%) personal and 872 (6.0%) unit related activities were recorded. Within the direct patient care activities, the five most frequently observed activities (out of a total of 10 activities) for all classifications of nursing staff were quite similar (admission and assessment, hygiene and patient/family interaction, medication and IV administration and procedures), however the absolute proportion of Level 2 RN activities were much lower than the other two groups. In terms of indirect care, three of the four most commonly occurring activities (out of a total of eight activities) were similar among groups (patient rounds and team meetings, verbal report/handover and care planning and clinical pathways). The six unit related activities occurred rarely for all groups of nurses.
Duffield, C 2008, 'The future nursing workforce: Neonatal, paediatric and child health nurses', Neonatal, Paediatric and Child Health Nursing, vol. 11, no. 3, pp. 3-8.
Modern technology and treatments are improving survival rates of children, but with the consequence of an increasing number of children growing up with chronic disease and disability. The increase in numbers will provide challenges for families caring for these children, the community, health services and the nursing workforce. This paper discusses some of the challenges facing the paediatric, neonatal and child health nursing workforce in meeting future demands. Issues such as increasing specialisation, direct entry and separate registration, disparity in nomenclature of positions, future role development and advanced nursing practice will be discussed.
Modern technology and treatments are improving survival rates of children, but with the consequence of an increasing number of children growing up with chronic disease and disability. The increase in numbers will provide challenges for families caring for these children, the community, health services and the nursing workforce. This paper discusses some of the challenges facing the paediatric, neonatal and child health nursing workforce in meeting future demands. Issues such as increasing specialisation, direct entry and separate registration, disparity in nomenclature of positions, future role development and advanced nursing practice will be discussed.
Aim: To find that changes in models of service delivery together with the dynamic nature of the contemporary health care context have changed the direction and focus of nurses' work. The aim of this paper is to explore some of the drivers for change and their impact and recommend a way forward to optimising nurses' work in the hospital environment. Background: The healthcare workplace has been transformed over the past 20 years in response to economic and service pressures. However, some of these reforms have had undesirable consequences for nurses' work in hospitals and the use of their time and skills. Results: As the pace and complexity of hospital care increases, nursing work is expanding at both ends of the complexity continuum. Nurses often undertake tasks which less qualified staff could do while at the other end of the continuum, are unable to use their high level skills and expertise. This inefficiency in the use of nursing time may also impact negatively on patient outcomes. Conclusions: Nurses' work that does not directly contribute to patient care, engage higher order cognitive skills or provide opportunity for role expansion may decrease retention of well-qualified and highly skilled nurses in the health workforce. Relevance to clinical practice: In this climate of nursing shortages, we need to use nurses in a cost-effective but also, intellectually satisfying manner, to achieve a sustainable nursing workforce.
Policy development in palliative and end-of-life care has changed significantly since its origins as a "boutique" specialist area of hospice care in the 1960s and 1970s. International agencies have shifted the emphasis away from solely caring for cancer patients to a much broader definition of palliative care, which encompasses people with life-limiting illnesses who are not going to die immediately but still need to plan for death while undergoing life-prolonging treatment. This article explores the development of and demand for palliative and end-of life care in developed countries and the implications of this development for available workforce and future workforce planning. It argues that human resource planners in healthcare need to turn their attention to the growing demands of caring for the dying and the elderly and work closely with service planners to ensure that sufficient and qualified staff are available.
Duffield, CM, Kearin, M, Johnston, J & Leonard, JM 2007, 'The impact of hospital structure and restructuring on the nursing workforce', Australian Journal of Advanced Nursing, vol. 24, no. 4, pp. 42-46.View/Download from: UTS OPUS
OBJECTIVE: Health systems throughout much of the world have been subject to 'reform' in recent years as countries have attempted to contain the rapidly rising costs of health care. Changes to hospital structures (restructuring) have been an important part of these reforms. A significant impact of current approaches to restructuring is the loss of, or changes to, nursing management roles and functions. SETTING: Australian hospitals PRIMARY ARGUMENT: Little evaluation has been undertaken to determine the impact of hospital structure and organisational restructuring on the nursing workforce. CONCLUSIONS: There is some indication that nurses have experienced a loss of key management positions, which may impact on their capacity to ensure that adequate and safe care is provided at the ward level
Gardner, G, Chang, A & Duffield, C 2007, 'Making nursing work: breaking through the role confusion of advanced practice nursing', JOURNAL OF ADVANCED NURSING, vol. 57, no. 4, pp. 382-391.View/Download from: Publisher's site
Gardner, G, Chang, A & Duffield, CM 2007, 'Making nursing work: breaking through the role confusion of advanced practice nursing', Journal of Advanced Nursing, vol. 57, no. 4, pp. 382-391.View/Download from: UTS OPUS or Publisher's site
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.
Hayes, LJ, O'Brien-Pallas, L, Duffield, CM, Shamian, J, Buchan, J, Hughes, FA, Spence Laschinger, H, North, N & Stone, P 2006, 'Nurse turnover: A literature review', International Journal of Nursing Studies, vol. 43, no. 2, pp. 237-263.View/Download from: UTS OPUS or Publisher's site
Ongoing instability in the nursing workforce is raising questions globally about the issue of nurse turnover. A comprehensive literature review was undertaken to examine the current state of knowledge about the scope of the nurse turnover problem, defini
To compare views of nurse executives with those of nurses who have left the profession on the importance of retention strategies. Although much has been written about nursing turnover, there continues to be dissonance among decision makers as to why nurses leave the profession and what the most crucial issues are for retention. Factor analysis was undertaken to compare responses of nurse executives with those of nurses employed outside of nursing. Contract requirements represented the greatest discrepancy, 1.07, followed by legal and employer issues, 1.02; worklife/homelife balance, 0.91; external values and beliefs about nursing, 0.75; and professional practice, 0.29. A disparity exists between perceptions of nurse executives and those of nurses who have left the profession as to which issues are most critical in retention. We suggest that nurse executives ensure sufficient organizational support for nursing unit managers who are more likely to understand methods of retaining nurses at the clinical interface
O'Brien-Pallas, L, Griffin, P, Shamian, J, Buchan, J, Duffield, CM, Hughes, FA, Spence Laschinger, H, North, N & Stone, P 2006, 'The impact of nurse turnover on patient, nurse, and system outcomes: A pilot study and focus for a multicenter international study', Policy, Politics and Nursing, vol. 7, no. 3, pp. 169-179.View/Download from: UTS OPUS
Duffield, CM, Forbes-Madden, JL, Fallon, A, Roche, MA, Wise, W & Merrick, ET 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.View/Download from: UTS OPUS
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.
Duffield, CM, O'Brien-Pallas, L & Aitken, LM 2005, 'Are skills learned in nursing transferable to other careers?', Nursing Leadership (Canadian Journal of Nursing Leadership), vol. 18, no. 3, pp. 68-82.View/Download from: UTS OPUS
Objective: To determine the influence of skills gained in nursing on the transition to a non-nursing career. Background: Little is known about the impact that nursing skills have on the transition to new careers or about the transferability of nursing skills to professions outside nursing. Method: A postal questionnaire was mailed to respondents who had left nursing. The questionnaire included demographic, nursing education and practice information, reasons for entering and leaving nursing, perceptions of the skills gained in nursing and the ease of adjustment to a new career. Data analysis included exploratory and confirmatory factor analysis, Pearson product moment correlations and linear and multiple regression analysis. Results: Skills learned as a nurse that were valuable in acquiring a career outside nursing formed two factors, including "management of self and others" and "knowledge and skills learned," explaining 32% of the variation. The highest educational achievement while working as a nurse, choosing nursing as a "default choice," leaving nursing because of "worklife/homelife balance" and the skills of "management of self and others" and "knowledge and skills" had a significant relationship with difficulty adjusting to a non-nursing work role and, overall, explained 28% of the variation in this difficulty adjusting. Conclusion: General knowledge and skills learned in nursing prove beneficial in adjusting to roles outside nursing.
Pelletier, DS, Donoghue, JM & Duffield, CM 2005, 'Understanding the nursing workforce: A longitudinal study of Australian nurses six years after graduate study concludes with a snapshot', Australian Journal of Advanced Nursing, vol. 23, no. 1, pp. 37-43.View/Download from: UTS OPUS
The challenge posed by the worldwide nursing shortage is significant not only for workforce and facility planners, but also for those who educate nurses for practice and nurses themselves. The provision of skilled and competent advanced nurses is clearly a goal of postgraduate education. An increasing shortage of skilled and qualified nursing staff to provide the required level of care is evident in Australia.
Pelletier, DS, Duffield, CM & Donoghue, JM 2005, 'Documentation and transfer of clinical information in two aged care settings', Australian Journal of Advanced Nursing, vol. 22, no. 4, pp. 40-45.View/Download from: UTS OPUS
Increasingly, documentation, both formal and informal, is being undertaken by nurses using a range of modalities. In Australia there is a sense that the demand for this in the aged care sector is increasing in line with requirements of funding agencies. However, the scope of this activity and its impact on nursing workload in aged care facilities has not been rigorously investigated. Funding of aged care facilities in the public hospital system in Australia is dependent on documentation of care.
Algase, DL, Beattie, ER, Song, J, Milke, DL, Duffield, CM & Cowan, B 2004, 'Validation of the Algase Wandering Scale (Version 2) in a cross cultural sample', Ageing and Mental Health, vol. 8, no. 2, pp. 133-142.View/Download from: UTS OPUS or Publisher's site
Duffield, CM, Aitken, LM, O'Brien-Pallas, L & Wise, W 2004, 'Nursing: a stepping stone to future careers.', Journal of Nursing Administration (JONA), vol. 34, no. 5, pp. 238-245.View/Download from: UTS OPUS or Publisher's site
Hoffman, KA, Donoghue, JM & Duffield, CM 2004, 'Decision-making in clinical nursing: investigating contributing factors.', Journal of Advanced Nursing, vol. 45, no. 1, pp. 53-62.View/Download from: UTS OPUS or Publisher's site
Hoffman, KA, Duffield, CM & Donoghue, JM 2004, 'Barriers to clinical decision-making in nurses in Australia', Australian Journal of Advanced Nursing (AJAN), vol. 21, no. 3, pp. 8-13.View/Download from: UTS OPUS
O'Brien-Pallas, L, Duffield, CM & Alksnis, C 2004, 'Who will be there to nurse? Retention of nurses nearing retirement', Journal Of Nursing Administration, vol. 34, no. 6, pp. 298-302.View/Download from: UTS OPUS or Publisher's site
Aims: To determine the impact on nursing work-force supply of delaying retirement. Background Data: The nursing workforce is aging, and the Baby Boomer generation is nearing retirement age. This potential loss of experienced nurses is likely to exacerbate current nursing shortages. Methods: An analysis of loss rates of nurses in New South Wales (Australia) is provided using 2 different retirement ages-58 and 65 years. Supply numbers were used and then aged to determine the impact of retirement on workforce numbers. The impact of potential retention strategies on the numbers who could be retained were determined if 100% of 50- to 55-year-old nurses was retained, 75% of those 56 to 60 years, and 50% of those 61 to 65 years.
Creegan, R, Duffield, CM & Forrester, K 2003, 'Casualisation of the nursing workforce in Australia: driving forces and implications', Australian Health Review, vol. 26, no. 1, pp. 201-208.View/Download from: UTS OPUS
Pelletier, DS & Duffield, CM 2003, 'Work sampling: Valuable methodology to define nursing practice patterns.', Nursing and Health Sciences, vol. 5, pp. 31-38.View/Download from: UTS OPUS or Publisher's site
Pelletier, DS, Donoghue, JM & Duffield, CM 2003, 'Australian nurses' perception of the impact of their postgraduate studies on their patient care activities', Nurse Education Today, vol. 23, no. 6, pp. 434-442.View/Download from: UTS OPUS or Publisher's site
Song, J, Algase, DL, Beattie, ER, Milke, DL, Duffield, CM & Cowan, B 2003, 'Comparison of U.S., Canadian, and Australian participants' performance on the Algase Wandering Scale - Version 2 (AWS-V2).', Research and Theory for Nursing Practice: An International Journal, vol. 17, no. 3, pp. 241-256.View/Download from: UTS OPUS
Stone, P, Tourangeau, A, Duffield, CM, Hughes, FA, Jones, CB, O'Brien-Pallas, L & Shamian, J 2003, 'Evidence of nurse working conditions: A global perspective.', Policy, Politics and Nursing Practice, vol. 4, no. 2, pp. 120-130.View/Download from: UTS OPUS or Publisher's site
Donoghue, JM, Pelletier, DS, Adams, AF & Duffield, CM 2002, 'Recognition of prior learning as University entry criteria is successful in postgraduate nursing studies', Innovations and Eduation and Teaching International, vol. 39, no. 1, pp. 54-62.View/Download from: UTS OPUS or Publisher's site
Duffield, CM & Franks, H 2002, 'Career paths beyond nursing and the contribution of nursing experience and skills in attaining these positions.', International journal of nursing practice, vol. 39, no. N/A, pp. 601-609.View/Download from: UTS OPUS
Duffield, CM & Franks, H 2002, 'Qualifications and experience: how well prepared are nurse managers compared to health service executives?', Australian Health Review, vol. 25, no. 2, pp. 182-190.View/Download from: UTS OPUS
Johnston, J & Duffield, CM 2002, 'Strategic public governance in Australian health: the unsmart, incapacitated state?', Administrative Theory and Praxis, vol. 24, no. 1, pp. 125-144.View/Download from: UTS OPUS
Moran, P, Duffield, CM, Beutel, J, Bunt, S, Thornton, A, Wills, J, Cahill, P & Franks, H 2002, 'Nurse Managers in Australia: Mentoring, Leadership and Career Progression', Canadian Journal of Nursing Leadership, vol. 15, no. 2, pp. 14-20.View/Download from: UTS OPUS
Pelletier, D, Duffield, C, Gietzelt, D, Larkin, P & Franks, H 2002, 'The complexities of documenting clinical information in long-term care settings in Australia.', Journal of gerontological nursing, vol. 28, no. 5, pp. 8-12.
Clinical nursing documentation, written, verbal or supported by technology, is being affected by both the worldwide "information explosion" and budgetary constraints. In Australia, the necessity of documenting complex care needs and treatment plans in older adult care settings has become more imperative because funding levels and sources are frequently tied to these documents. As a consequence, the statutory requirements for documentation have become a significant driving force in shaping nursing practice. Although the value of quality documentation is or should be recognized, the seemingly vast amounts of time required inevitably distracts nurses from what they see as their primary purpose-the provision of direct patient care. Older adults who are frail are among the most complex clients requiring services in what is traditionally a poorly resourced sector. Under-funding frequently impacts on the staff skill mix, resulting in low levels of senior, highly qualified, and skilled staff. These factors impact the quality of the documentation and possibly the usage of the information itself. This article will provide an overview of the issues related to documentation of clinical information in older adult care settings with particular reference to some of the "unique" inefficiencies inherent in the Australian system.
Duffield, CM & Franks, H 2001, 'The role and preparation of first-line nurse managers in Australia. Where are we going and how do we get there?', Journal of Nursing Management, vol. 9, pp. 87-91.View/Download from: UTS OPUS
Duffield, CM, Moran, P, Beutel, J, Bunt, S, Thornton, A, Wills, J, Cahill, P & Franks, H 2001, 'Profile of first-line managers in NSW, Australia in the 1990's', Journal of Advanced Nursing, vol. 36, pp. 785-793.View/Download from: UTS OPUS or Publisher's site
Duffield, C, Macneil, F, Bullock, C & Franks, H 2000, 'The role of the Advanced Casualty Management Team in St John Ambulance Australia (New South Wales District).', Australian health review : a publication of the Australian Hospital Association, vol. 23, no. 1, pp. 90-99.View/Download from: Publisher's site
St John Ambulance is a household name synonymous with the teaching and provision of first aid. Recently the organisation has developed pre-hospital emergency care services through the introduction of the St John Ambulance Australia Advanced Casualty Management Team in New South Wales. The Advanced Casualty Management Team represents a move away from the practice of first aid by lay personnel and is a natural extension of the traditional work and principles of St John Ambulance. This article provides an overview of the Advanced Casualty Management Team and discusses its contribution to pre-hospital trauma care delivery.
Pelletier, D, Duffield, C, Adams, A, Mitten-Lewis, S, Crisp, J & Nagy, S 2000, 'Australian clinicians and educators identify gaps in specialist cardiac nursing practice.', The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation, vol. 17, no. 3, pp. 24-30.
Change is endemic in both the health care and higher education sectors in Australia. Consequently professional roles and educational pathways must also evolve and adapt, often catalysed by those in leadership positions. Two national Delphi panels, one of cardiac nurse educators and the other of cardiac nurses, were convened to answer the question 'What knowledge, skills and attitudes are required for an expert nurse practising in the highly technological cardiac care environment?' Respondents indicated on a Likert scale the importance of 107 items to the nurse's role in both the 'real' and 'ideal' worlds of practice. Overall there was very strong agreement between the two panels with results indicating that Australian nurses perform close to their ideal in many areas of practice. For 31 of the items, both panels identified that the reality of practice is quite far from their ideal. Both panels agree that 10 of the behaviours are carried out or valued very little in practice. Reasons why nurses are not carrying out these elements of the role to their satisfaction are discussed and remediation strategies suggested. The findings can inform both curriculum development and clinical practice. In the dynamic health care arena, the nursing profession continues to respond to community and professional needs, seeking to establish sound research-based practice and maintain a high quality of clinical care and nursing management. The development of competencies by the Confederation of Critical Care Nurses (1996) is a good example of professional groups taking the initiative both in defining the practice role and providing tools that assist educational bodies to develop programs appropriate for a practice based discipline. Specialty nursing practice is 'under the microscope' in Australia as the profession seeks the best methods to weight nursing activities, measure nursing outcomes and recruit, retain and justify the use of specialist practitioners.
Pelletier, D, Duffield, C, Adams, A, Nagy, S, Crisp, J & Mitten-Lewis, S 2000, 'Australian nurse educators identify gaps in expert practice.', Journal of continuing education in nursing, vol. 31, no. 5, pp. 224-231.
In Australia, nurses face a double-barreled challenge to their role. With the rapid adoption of new health care technologies coupled with increasing economic constraints, they find themselves "doing more with less." In this context of continuous change, it is useful to determine what expert nurse clinicians deem the most essential skills, attitudes and knowledge required for practice in complex technological environments. Separate panels of 28 educators and 43 cardiac nurse clinicians participated in a national Delphi study rating the importance to the nursing role of 107 items drawn from the international literature on expert practice and technology. Indicating the importance of each item in both the "real" and "ideal" worlds of practice, educators identified 58 items where they felt actual practice was substantially far from the ideal. For 16 of these items relating to empowerment of patients, nursing research, and technology policy, the educators rated clinical behavior below the median of the real world scale, indicating substandard performance of a role or inadequate assimilation of a concept. The implications for the definition of expert practice and for curricula development are discussed.
Crisp, J, Pelletier, D, Duffield, C, Nagy, S & Adams, A 1999, 'It's all in a name. When is a 'Delphi study' not a Delphi study?', The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation, vol. 16, no. 3, pp. 32-37.
As nursing researchers we need to fully understand the origins of the methods we are using in research investigations. Without an in-depth understanding, we may find ourselves violating fundamental underpinning assumptions or conventions through ignorance, and the resulting studies are unlikely to stand up to tests of congruence and rigour. This paper is a discussion of some complexities encountered while exploring the literature on the Delphi technique, a research method we had believed to be straightforward. The Delphi method had been used extensively since its development in the 1950s, and its use in nursing research appears to be increasing. Our explorations revealed that, rather than a simple means of obtaining the judgments of experts, modifications and adaptations over the years have dramatically changed 'the' Delphi. Anyone wishing to use the method needs a sound knowledge of complex theoretical issues associated with its implementation.
Tang, KC, Duffield, C, Chen, XC, Choucair, S, Creegan, R, Mak, C & Lesley, G 1999, 'Nursing as a career choice: perceptions of school students speaking Arabic, Serbo-Croatian, Spanish, Turkish or Vietnamese at home.', Australian health review : a publication of the Australian Hospital Association, vol. 22, no. 1, pp. 107-121.
Australia is a multicultural society and nowhere is this more evident than in Sydney where 25% of the population speaks a language other than English. In one of the largest area health services in New South Wales, the five most frequently spoken languages at home are Arabic, Serbo-Croatian, Spanish, Turkish or Vietnamese, with these language groups comprising 12% of Sydney's population. Yet nurses speaking one of these five languages comprise less than 1% of the nursing workforce. A cost-effective method of addressing the shortage of nurses speaking languages other than English is to recruit students who already speak another language into the profession. This study examined high school students' perceptions of nursing in order to determine appropriate methods of recruiting students speaking one of these languages. Implications for the design of recruitment campaigns are also discussed.
Donoghue, J, Pelletier, D, Duffield, C & Torres, M 1998, 'Australian men's experience of cystoscopic day surgery part 2', Ambulatory Surgery, vol. 6, no. 4, pp. 189-196.View/Download from: Publisher's site
To investigate the preparation for and recovery from cystoscopic day surgery (DS) 100 male patients completed a preoperative written questionnaire and two postoperative telephone questionnaires. Findings indicated that DS cystoscopy minimally disrupted paid work, had minor postoperative symptoms, a readmission rate of only 2% and utilised few community support services such as visits to general practitioners. However, 37% of participants said that they would have liked more information. Participants' perceptions of their level of preparation were significantly related to various outcome measures such as the intensity of postoperative symptoms and the use of resources postoperatively.
Pelletier, D, Donoghue, J, Duffield, C & Adams, A 1998, 'Nurses' perceptions of their professional growth on completion of two years of postgraduate education.', The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation, vol. 16, no. 2, pp. 26-35.
In a climate of diminishing financial resources in service industries such as health care and education, it is not surprising that a focus on measuring and ensuring appropriate outcomes is widespread. Graduate education has the potential to make a significant difference to the professional behaviour of graduates. Postgraduate nursing coursework programs have been developed and offered in such a climate, many now charging full course fees, which no doubt stimulates participants and employers to look for value for money in terms of outcomes. A ten year longitudinal study began in 1992 and was designed to determine the impact of postgraduate coursework nursing education on the careers and the professional and personal development of graduates. This paper reports graduates' perception of their personal and professional growth in terms of professional activities such as writing for publication, research, mentoring, and involvement in professional organisations at the completion of their university course. Respondents indicated the course had contributed to increased professional behaviours in all aspects and to a marked improvement in their clinical confidence. Improved self esteem and increased participation in professional activities reflects changing attitudes towards nursing work that have important implications for improved quality of patient care.
Pelletier, D, Donoghue, J, Duffield, C & Adams, A 1998, 'The impact of graduate education on the career paths of nurses.', The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation, vol. 15, no. 3, pp. 23-30.
This paper reports the findings of the first phase of a ten year longitudinal study of nurses graduating with higher degrees and diplomas. The higher education sector in Australia has been subjected to a variety of changes in the past decade. Amalgamations and restructuring, altered funding formulae, recognition of prior learning and credit transfer are some of the initiatives, many dictated by governmental bodies, which impact on the education system. Within this volatile context, graduate education in nursing has developed significantly in both quality and variety. These courses have been taken up vigorously by professionals who, until 1990, had limited opportunities for tertiary study in the discipline. Perhaps one of the most significant changes within education, and interestingly paralleled in the health sector, is the move to examine more carefully the outcomes of the process or service provided. The demographic profile, career movements and career plans of graduating students over a five year period from December 1992- December 1996 are presented.
Pelletier, D, Duffield, C, Mitten-Lewis, S, Nagy, S & Crisp, J 1998, 'Australian nurses and device use: the ideal and the real in clinical practice', Australian Critical Care, vol. 11, no. 1, pp. 10-14.View/Download from: Publisher's site
Clinical nurses use an increasing number of technological devices when providing care. While the clinical devices themselves must undergo rigorous multidimensional assessment, it is the proficiency of the user that ultimately determines the devices' efficacy. Thus, the knowledge, skills and attitudes that nurses bring to their decision-making and use of technology are crucial elements in the technology assessment process. Technological proficiency is imperative in the current climate of rapid patient throughput in complex technological environments. This paper reports some of the findings of an Australian study, using two national Delphi panels, whose primary objective was to determine the knowledge, skills and attitudes required of expert clinicians for practice m cardiac care. Panels of 28 educators and 42 cardiac nurse clinicians completed a questionnaire indicating the importance of 107 characteristics of expert cardiac practice for both the 'real' and 'ideal' worlds of practice. Comparative results will be reported for 29 items within the thematic groups Effective use of technology, Informed decisions regarding equipment and Critical approach to the use of technology. Both panels accepted all 29 items in these three thematic groups but indicated differences in the level of agreement on the importance of items between the 'real' and 'ideal' worlds of practice. Discussion centres around those areas where improvement is needed. © 1998 Australian College of Critical Care Nurses Ltd.
Adams, A, Pelletier, D, Duffield, C, Nagy, S, Crisp, J, Mitten-Lewis, S & Murphy, J 1997, 'Determining and discerning expert practice: a review of the literature.', Clinical nurse specialist CNS, vol. 11, no. 5, pp. 217-222.View/Download from: Publisher's site
Although the nature and characteristics of expert practice have been described in the literature, the description is incomplete. How expertise is gained is not fully understood, and definitions of expert competencies have yet to be developed. Essential issues for education arise from the demand for knowledge for expert practice. Because expertise is gained in the context of practice, expertise cannot be achieved out of context or taught as an academic exercise. A clear picture of the practice of expert nurses is necessary so that those in the profession can know and articulate expert practice and direct it to the community.
The New South Wales health care system is experiencing considerable growth in the number of day surgery procedures and in all likelihood the complexity of these will increase. Urological procedures have led the way for a variety of reasons including the rapid growth in technological innovations in this field. An assessment of the effect of decreased contact with medical and nursing professionals, particularly in the postoperative recovery phase, and the experience of home recovery specially for the elderly and potentially less well population, is warranted. Semi-structured interviews were used to investigate the experience of cystoscopic day surgery and the recovery process of 21 men. In most cases no significant complications were recorded. Eight patients have had previous experience with cystoscopic day surgery, and expected the same uncomplicated recovery as they have had in the past. Generally patients felt that they were adequately prepared for their experience. However, some did not know who to contact or what to do in case of unexpected symptoms presenting postoperatively.
Pelletier, D, Duffield, C, Adams, A, Mitten-Lewis, S, Nagy, S & Crisp, J 1997, 'The cardiac nurse's role: an Australian Delphi study perspective.', Clinical nurse specialist CNS, vol. 11, no. 6, pp. 255-263.View/Download from: Publisher's site
In Australia, as in many parts of the Western world, technological advances in healthcare have affected the roles of healthcare professionals, including nurses. Cost constraints, efficiency, and effectiveness measures also influence staffing numbers, roles, and skill mix. Specialty nurse education programs are changing, and many are moving from the hospital environment to the higher education sector. Initiatives to introduce the American Advanced Nurse Practitioner role in some environments have begun, although the current advanced practice roles are proving problematic. Specialist professional groups are striving to develop competencies or standards for practice. An understanding of what is required of expert clinicians for practice in complex technological environments such as cardiac care would be useful for both practitioners and academics. A national Delphi study was undertaken to determine what knowledge, skills, and attitudes were required of expert cardiac nurses in relation to technology in the cardiac care environments in both the "real" and the "ideal" worlds of practice. Separate panels of 28 cardiac educators and 42 cardiac nurse clinicians were given a questionnaire of 107 items and asked to indicate on a 6-point Likert scale the importance of each item to the nursing roles in both the "real" and "ideal" worlds. On the final, third round, respondents ranked the three most important items in each of the 13 thematic groups. Overall, the clinicians accepted all 107 items as important to their role, and for the majority of these they, felt that they were performing quite close to their "ideal." This article presents the 32 items for which the clinicians felt the "real" world was quite far from the "ideal" as represented by a gap of > or = 2 between the real and ideal medians. Also, despite being accepted as part of the role through the ideal scores, 21 items achieved a real world median of 3.5 or less, which indicates that in the real world these aspect...
Tang, KC, Duffield, C, Chen, J, Choucair, S, Creegan, R, Mak, C & Lesley, G 1997, 'Predictors of intention to study nursing among school students speaking a language other than English at home.', The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation, vol. 15, no. 2, pp. 33-39.
There is currently a shortage of bilingual nurses in New South Wales. It is important to include bilingual nurses in the workforce to meet not only the cultural and social needs of people speaking a language other than English at home, but also to facilitate the achievement of appropriate health outcomes for a multicultural population. The purpose of this study was to identify demographic and social factors which explain students' intention to study nursing. Respondents were 789 year 11 or 12 students speaking Arabic, Serbo-Croatian, Spanish, Turkish or Vietnamese from twenty-five schools in South Eastern, South Western and Western Sydney. Data were collected through a self-completed questionnaire. Chi square, t-test and logistic regression analysis were used for data analysis. Logistic regression analysis concluded that perceived parental income, years of settlement in Australia and father's occupation were significant factors. Bivariate analysis also revealed that significant differences were found in the intention to study nursing between male and female students and between students with a higher and lower Tertiary Entrance Rank (TER). Parental influence also affects students' intention. However, gender and TER were found to be insignificant after adjustment for other variables in the logistic regression model.
Duffield, CM, Donoghue, JM & Pelletier, DS 1996, 'Do Clinical Nurse Specialists And Nursing Unit Managers Believe That The Provision Of Quality Care Is Important?', Journal Of Advanced Nursing, vol. 24, no. 2, pp. 334-340.View/Download from: Publisher's site
The nursing profession has a long tradition of evaluating the quality of its product in order to ensure that the best possible care can be given. However, in the climate of economic rationalism which prevails worldwide, it is possible that the emphasis o
Pelletier, D, Duffield, C, Adams, A, Crisp, J, Nagy, S & Murphy, J 1996, 'The impact of the technological care environment on the nursing role', INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE, vol. 12, no. 2, pp. 358-366.View/Download from: Publisher's site
Pelletier, DS, Duffield, CM, Adams, AF, Crisp, J, Nagy, SA & Murphy, JE 1996, 'The Impact Of The Technological Care Environment On The Nursing Role', International Journal Of Technology Assessment In Health Care, vol. 12, no. 2, pp. 358-366.View/Download from: Publisher's site
Proliferation of acute health care technology creates problems and benefits for nurses and patients. In this paper the impact of technology on the nursing work role is reviewed through the international literature. The thrust of the nursing literature ha
Donoghue, J, Pelletier, D, Duffield, C & Gomez-Fort, R 1995, 'Laparoscopic day surgery: the process of recovery for women', Ambulatory Surgery, vol. 3, no. 4, pp. 171-177.View/Download from: Publisher's site
Day surgery procedures are rapidly increasing in number and complexity and will continue to do so in line with government policy. These changes warrant an assessment of the effect of decreased contact with medical and nursing professionals, particularly in the postoperative recovery phase. Semi-structured interviews used to investigate women's experiences of laparoscopic day surgery and their perceived recovery revealed that women in the study were not optimally prepared for the experience. In particular, they were surprised about the severity and duration of pain, extent of the disability, the level of disruption to their work and home lives and the need for physical and emotional support following the procedure. These findings have implications for pre- and postoperative education, community support services and aftercare. © 1996.
A survey of 373 CNSs employed in hospitals in New South Wales, Australia, was undertaken to determine the competencies they believed necessary to fulfill that role. This study was designed as a sequel to a similar study of role competencies of first-line nurse managers in the same state. Factor analysis was used to identify a variety of role dimensions. Results indicate that CNSs perceive their role as extremely comprehensive, yet a significant potential to overlap with the role of managers was evident. In addition, some interesting features of the CNS role emerged that may generate both professional approval and concern. The strength of the respondents' acceptance of competencies that link their clinical role to activities that directly influence the quality of care is heartening; however, a number of clinically based competencies, including some of those related to patient care management or quality of care, either loaded weakly or did not load at all on the factor structure. Concern may be felt regarding the claim of these specialized clinicians to competencies traditionally seen as strongly associated with the managerial role. Should specialist clinicians take on too many managerial functions, significant role overload could result, and affect quality care provision.
Duffield, C, Pelletier, D & Donoghue, J 1995, 'A profile of the clinical nurse specialist in one Australian state.', Clinical nurse specialist CNS, vol. 9, no. 3, pp. 149-154.View/Download from: Publisher's site
The nursing profession in Australia implemented progressively in each state new clinical career structures commencing in 1986. While the structures differ, all states introduced the position of CNS. The role and responsibilities associated with this position also differ. The role of CNS in Australia is different from that described in the North American literature. Findings of a study that established a profile of CNSs in the heavily populated state of New South Wales are described. Data on education, experience, and career plans were obtained from 373 CNSs in 19 hospitals. The results enable some comparison with first-line nurse managers whose role is very similar to the American position of head nurse. As with their managerial counterparts, the Australian CNSs' lack formal educational preparation and were demonstrating a low rate of participation in educational programs at the time of the study. However, 82% of respondents intended to remain in clinical practice. This is significant since this was a major goal in development of a clinical career structure.
The goal of International Perspectives is to share the views of nurse leaders, from countries other than the United states, on global healthcare issues. The focus is on identifying healthcare management problems and their implications, research prioritie
Duffield, C 1994, 'Nursing unit managers: Defining a role', Nursing Management, vol. 25, no. 4, pp. 63-67.
Duffield, C & Lumby, J 1994, 'Caring nurses: the dilemma of balancing costs and quality.', Australian health review : a publication of the Australian Hospital Association, vol. 17, no. 2, pp. 72-83.
This paper explores the tensions visible in the rhetoric and practice of today's health care system. This system is becoming dominated by the views of economic rationalists where decisions are based on principles more frequently associated with private enterprise. One could argue that health care should be managed as a business, however, the ethics which guide such a business must be examined closely to ensure the integrity of the caring which is implicit in much of the practice in health care. Individuals in today's society value humanistic functions more than ever before. The caring function of nursing is perhaps the most significant determinant of the quality of care received from a patient's perspective, and one to which there is little cost attached in dollar terms. While it is difficult to measure and cost the caring that nurses provide, it must be done to ensure that these qualities are maintained and enhanced. More importantly, strategies must be developed to provide cost-effective quality indicators of the caring function implicit in the nurse's role. (This is an abridged version of a paper delivered at the Nursing Economic$ International Symposium 1993 in Hobart, Tamsania.)
DUFFIELD, CM & LUMBY, J 1994, 'CONTEXT AND CULTURE - THE INFLUENCE ON ROLE TRANSITION FOR FIRST-LINE NURSE-MANAGERS', INTERNATIONAL JOURNAL OF NURSING STUDIES, vol. 31, no. 6, pp. 555-560.View/Download from: Publisher's site
Role ambiguity is a serious and costly phenomenon that the healthcare delivery system can ill afford. Classically, it results from a lack of clarity or information concerning the expectations of a role, and it often results in several staff members unde
Pelletier, D & Duffield, C 1994, 'Is there enough mentoring in nursing?', The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation, vol. 11, no. 4, pp. 6-11.
This paper examines the debate about the benefits of mentoring in nursing and argues that the evidence indicates that mentoring is a professional behaviour that contributes to career success and the development of professional leaders. Some strategies to facilitate mentoring are suggested. As well, the paper presents the findings from analysis of four studies which provided data on the incidence of mentoring among 317 nursing unit managers, 368 clinical nurse specialists, 478 RNs entering a graduate course and 235 of the latter group on completion of their course. The results show that, of those who reported their mentoring experience, more unit managers (45%) than clinical specialists (35%) experiencing mentoring and that 79% of graduating RNs reported that they had increased their mentoring of others since beginning their course. The overall incidence of mentoring was lower than that reported in the United States. Reasons for the findings are discussed.
Pelletier, DS, Duffield, CM, Gallagher, RD, Soars, L, Donoghue, JM & Adams, AF 1994, 'The Effects Of Graduate Nurse Education On Clinical-practice And Career Paths - A Pilot-study', Nurse Education Today, vol. 14, no. 4, pp. 314-321.View/Download from: Publisher's site
The recent proliferation of graduate courses in nursing has increased the need for educational administrators to evaluate the impact of such programmes on clinical practice and the career of participants. 40 registered nurses undertaking graduate studies
Duffield, C, Donoghue, J, Pelletier, D & Adams, A 1993, 'First-line nurse managers in NSW: Perceived role competencies (Part I)', Contemporary Nurse, vol. 2, no. 2, pp. 56-63.View/Download from: Publisher's site
A survey of 412 first-line nurse managers employed in hospitals in New South Wales, Australia was undertaken to determine the competencies they believed an individual should possess to fulfil that managerial role. Factor analyses identified both the significant functions of the role as well as areas of role conflict and confusion. Thirteen factors identified from four major scales indicated that first-line nurse managers perceived their role to be extremely comprehensive in terms of managerial knowledge and skills. The analyses clearly indicate that competencies related to staffing and financial issues are perceived to be essential to role performance. However, the correlation coefficients (factor loadings) indicate that ambiguity exists with competencies concerning patient care, perhaps as the remnants of the charge nurse role are discarded. Decentralisation and restructuring within the health care system in Australia have ensured that increased authority, autonomy and responsibility have devolved to firstline management positions. The role of first-line managers in ensuring organizational effectiveness and efficiency is now well acknowledged, particularly following the work of Peters and Water an (1982). The devolvement recommended by these authors has also occurred within many Australian nursing divisions (Duffield 1992). For firstline nurse managers overseas this devolution has meant a greater involvement in decisions relating to the recruitment, selection and retention of staff. In addition, budgeting, marketing and public relations activities have become major functions of their role. Despite what appears to be a substantial body of overseas literature regarding firstline nurse managers, little comparable work has been done in Australia. A lack of understanding as to the precise nature of the role makes it very difficult to determine the skills required to function effectively. However, earlier work using the Delphi technique and an expert panel, has identi...
Duffield, C, Donoghue, J, Pelletier, D & Adams, A 1993, 'First-line nurse managers in NSW: Perceived role competencies (Part II)', Contemporary Nurse, vol. 2, no. 3, pp. 110-117.View/Download from: Publisher's site
A survey of 412 first-line nurse managers employed in hospitals in New South Wales, Australia was undertaken to determine the competencies they believed an individual should possess to fulfil that managerial role. Factor analyses identified both significant functions of the role as well as areas of role conflict and confusion. 13 factors were identified from 4 major scales indicating that first-ine nurse managers perceived their role to be extremely comprehensive in terms of managerial knowledge and skills. The analyses clearly indicate that competencies related to staffing and financial issues are perceived to be essential to role performance. However, the correlation coefficient (factor loadings) indicate that ambiguity exists with competencies concerning patient care, perhaps as the remnants of the charge nurse role are discarded. The findings in this study have been presented in two parts: Part 1 discussed the factors identified in two scales, Functional Management and Patient Care Management; Part II discusses the factors identified in the remaining two scales, Staff Management and Leadership (subdivided into two subscales for analysis). The role of first-line nurse managers is vital for organisational efficiency and effectiveness. Perhaps more importantly, these managers have been shown to be essential in establishing an appropriate climate in which staff are able to provide quality care (Duffield 1989b, Lumby 1989, Chenoweth 1991). However, as has been shown in the literature in Part I, the role has been poorly defined and researched, particularly in Australia. Following Duffield's (1989a, b) work, the study described herein and in Part I investigated the role competencies of first-line nurse managers as perceived by those performing the role. First-line nurse managers in a variety of hospitals were sampled and asked to identify which of the 156 competencies, retained by the Delphi panel in an earlier study, they perceived were necessary for the role. Part...
Duffield, CM 1993, 'The Delphi Technique - A Comparison Of Results Obtained Using 2 Expert Panels', International Journal Of Nursing Studies, vol. 30, no. 3, pp. 227-237.View/Download from: Publisher's site
The Delphi technique is a useful method of obtaining group consensus. However, 'consensus'' is not usually defined when this technique is used. This paper describes a study in which two panels of experts (registered nurses who were nurse managers or invo
Duffield, C 1992, 'Future Responsibility and Requirements for First‐line Nurse Managers in New South Wales', Image: the Journal of Nursing Scholarship, vol. 24, no. 1, pp. 39-43.View/Download from: Publisher's site
Changes to the structure and funding of hospitals in Australia are progressing at a rapid pace. Decentralized organizational structures based on a product concept have increased the responsibility and managerial skills needed of first‐line nurse managers. The purpose of this study was to determine a profile of first‐line nurse managers in hospitals in New South Wales. Data related to education, experience and career plans were obtained from 318 respondents in 34 hospitals. The results indicate a lack of experience and educational preparation in management which has implications for the role of more senior nurse managers. Copyright © 1992, Wiley Blackwell. All rights reserved
Adams, A & Duffield, C 1991, 'The value of drills in developing and maintaining numeracy skills in an undergraduate nursing programme', Nurse Education Today, vol. 11, no. 3, pp. 213-219.View/Download from: Publisher's site
The purpose of this study was to determine whether mathematical drills enhaced the ability of students of nursing to calculate drug dosages accurately. First year students were drilled and then tested over the next 2 years in drug calculations. It was found that repeated drilling improved students' ability to calculate drug doses but that this skill level diminished over time, in some instances to predrill levels of accuracy. An increase in the number of correct calculations was noticed in the two semesters in which students had a clinical placement leading the authors to conclude that, contrary to previous findings, work experiences do enhance the ability to calculate medication dosages. As safety and competency are essential in those areas of nursing practice which depend on mathematical ability, educational strategies which develop and retain mathematical skills are needed. © 1991.
Duffield, C 1991, 'A shared vision - Bridging the theory-practice gap', Australian Health Review, vol. 14, no. 2, pp. 155-162.
The recruitment and retention of nurses continues to be an issue which the nursing profession must address. This paper will argue that the resolution of this problem lies in greater collaboration between the higher education and health care sectors. Collaborative strategies should focus on two major aspects. First of all, strategies to bridge the theory-practice gap are important for the retention of new graduates. Secondly, support for first-line nurse managers is needed since these managers are significant in the assimilation of new graduates into the workforce.
Duffield, CM 1991, 'Maintaining Competence For 1st-line Nurse Managers - An Evaluation Of The Use Of The Literature', Journal Of Advanced Nursing, vol. 16, no. 1, pp. 55-62.View/Download from: Publisher's site
Donoghue, JM, Duffield, CM, Pelletier, DS & Adams, AF 1990, 'Health Promotion As A Nursing Function - Perceptions Held By University-students Of Nursing', International Journal Of Nursing Studies, vol. 27, no. 1, pp. 51-60.View/Download from: Publisher's site
Duffield, CM 1990, 'Point Of View', Omni, vol. 12, no. 8, pp. 25-25.
Duffield, C 1989, 'The role of nursing unit managers in New South Wales-a delphi survey', Australian Health Review, vol. 12, no. 2, pp. 14-32.
This study identified the competencies expected of first-line nursing managers in New South Wales hospitals. The competencies were determined from the literature and submitted to a Delphi panel of 16 expert nursing administrators and academics whose task it was to delineate those competencies which first-line nursing managers (nursing unit managers) should possess. Considerable consensus existed as only two rounds were required, with little change in opinion occurring between the two rounds. Of the 168 competencies, 12 did not reach the baseline mean of 3.000 (maximum 4.000) and were excluded. The results from both rounds are presented.
The transfer of basic nursing education from the hospital to the tertiary education sector provided unique opportunities for research. This study examined student perceptions of the functions in which they believed nurses were involved in the performance of their role. The entry perceptions of students over three years were eamined, during which time perceptions of nursing functions did vary. Two student groups were monitored throughout the three years of the nursing program. It was found that perceptions of nursing functions varied according to curriculum content and exposure to a variety of health and illness experiences as well as role models.
The much publicised total transfer of basic nurse education to the tertiary sector in 1985, created in New South Wales (Australia) a unique opportunity to study certain aspects of nurse education which, although previously explored, would most likely alter with this new situation. One such issue, that of student attrition from the new nursing programs assumed a new importance, since any significant change to the existing trends could have far reaching implications for the health care system of this State. Indeed, while the individual tertiary education institutions introduced their respective and different philosophies, educational requirements for entry, and curricula, it seemed inevitable that patterns of attrition would alter. This three year exploratory study of student attrition sought to determine reasons for withdrawal and any significant relationships with variables such as age, high school results, demographic data, reasons for entering nursing and inducements that might have prevented withdrawal. Financial constraints emerged as the major factor in student's withdrawal from the program.
Duffield, C 1988, 'Nursing managers - a time to change', Australian Health Review, vol. 11, no. 4, pp. 266-269.
The health care delivery system and the nursing profession have a dynamic relationship. The increasingly complex nature of nursing is reflected in recent industrial awards which have created a clinical career structure. The introduction of a clinical pathway should enable nursing managers to focus their attention on management issues and practices, rather than clinical problems. However, two significant barriers to effective management remain: the basis of appointment of nurses to managerial positions and the lack of management education available. Both issues must be addressed by the profession.
Duffield, C 1988, 'The Delphi technique.', The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation, vol. 6, no. 2, pp. 41-45.
The Delphi technique is an easy-to-use research instrument which has become an accepted method of achieving consensus among individuals and experts. This paper describes its techniques, parameters for its successful application, variety of uses and some advantages and disadvantages.
Duffield, C 1986, 'Disaster planning strategies for hospitals', Australian Health Review, vol. 9, no. 2, pp. 176-182.
Duffield, CM 2015, 'Clinical Leadership' in Chang, E & Daly, J (eds), Transitions in Nursing, Elsevier.
Duffield, CM 2015, 'Nursing workforce sustainability: Australia' in Buchan, J (ed), Nursing workforce sustainability: The international connection, International Centre on Nurse Migration, Philadelphia, pp. 27-41.
Duffield, CM, Roche, MA, 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.View/Download from: UTS OPUS
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.
Roche, M, Duffield, C, Wise, S & Debono, D 2019, 'The impact of ward reconfiguration on nursing workload: Integrating administrative data with expert knowledge', International Council of Nurses 2019 Congress, Singapore.
Roche, M, Duffield, C, Smith, J, Kelly, D, Cook, R, Bichel-Findlay, JM, Saunders, C & Carter, D 2017, 'Addressing the complex health needs of homeless men in inner Sydney', International Journal of Mental Health Nursing, Wiley, pp. 36-37.
Duffield, CM 2016, 'The power of no(w)', Australian College of Nursing National Nursing Forum, Melbourne, Victoria.
Duffield, CM 2016, 'The structure of Australian nursing', Australian Nursing and Midwifery Federation, Launceston. Tasmania..
Duffield, CM, Roche, M & Twigg, D 2016, 'The impact of adding nursing support workers on patient, nurse and system outcomes', Sigma Theta Tau International Research Congress, Cape Town, South Africa..
Duffield, CM, Perry, L, Gallagher, R, Sibbritt, D & Nicholls, R 2016, 'Fit for the future? The health and health behaviours of the nursing and midwifery workforce.', RCN International nursing research conference, Edinburgh, Scotland..
Duffield, CM 2015, 'Inspiring research for aspiring researchers.', Townsville Health Symposium, Townsville.
Duffield, CM 2015, 'We can't keep doing what we've always done', Metro North Hospital and Health Service Leadership and Workforce Conference, Brisbane, Australia.
Duffield, CM, Buchan, J, Clarke, S & Fronteira, I 2015, 'Achieving nursing workforce sustainability: The critical international connection', International Council of Nurses, Seoul, South Korea.
Duffield, CM, Scott, A, Duckett, S, Dillon, K, Brown, D, Taylor, T, Laurence, C & McGrail, M 2015, 'Researching the health workforce', Health Services and Policy Research Conference, Melbourne, Victoria.
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.
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.
Duffield, CM 2014, 'How long is forever?', 3rd Biennial Australian Capital Region Nursing and Midwifery Research Centre Conference., 3rd Biennial Australian Capital Region Nursing and Midwifery Research Centre Conference, Canberra.
Duffield, CM 2014, 'Nursing turnover – costs and consequences', Nursing & Midwifery Unit Managers Annual Congress, Tweed Heads.
Duffield, CM & Gardener, G 2014, 'Advancing practice nursing', Australian College of Nursing National Nursing Forum, Adelaide.
Roche, MA & Duffield, CM 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...
Baldwin, RJ, Duffield, CM, Fry, M, Roche, MA, 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
Duffield, CM 2013, 'Nurse staffing: The Australian experience', The African Health Profession Regulatory Collaborative (ARC), Gaborone, Botswana.
Duffield, CM 2013, 'Staffing complexities and safety outcomes.', ANF Queensland Annual Congress, Brisbane.
Duffield, CM 2013, 'Who's packing your parachute?', 11th International Conference for Emergency Nurses, International Conference for Emergency Nurses, Melbourne.
Duffield, CM 2013, 'Workforce reform in the emergency department.', Asian Conference on Emergency Medicine, Tokyo, Japan.
Duffield, CM & Twigg, D 2013, 'Are there economic benefits from increased nursing staffing in acute hospitals?', Sigma Theta Tau International Research Congress, Prague.
Duffield, CM, Morton, L & Thoms, D 2013, 'Clinical leadership and governance in the 'new' age of care delivery', Leading Age Services Australia National Congress, Sydney.
Duffield, CM, Twigg, D, Stone, P, Buchan, J & Dussault, G 2013, 'The Nursing Workforce Contribution to Health Outcomes: Evidence Informed Policy Making', International Council of Nurses, Melbourne.
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...
Duffield, CM 2012, 'Changing roles for changing times.', Neurosurgical nursing annual conference, Sydney.
Duffield, CM 2012, 'Leadership, Workforce & Staffing', Nursing & Midwifery Leaders Forum. NSW Nurses Association, Terrigal.
Duffield, CM 2012, 'Nursing and midwifery workforce- skill mix and ratios', 2012 Professional Issues in Practice Conference: The Future is Now, Melbourne Convention and Exhibition Centre.
Australian Nurses Federation (Victoria Branch)
Duffield, CM 2012, 'Our Nursing and Midwifery Workforce: Key issues for managers', Have Your Say-We are listening, Terrigal.
New South Wales Nurses Association
Duffield, CM 2012, 'Staffing (in)stability. Nursing Extremes – riding the waves of change', Association of Queensland Nurse Leaders, Brisbane.
Duffield, CM, Westbrook, JL, Creswick, N, Li, L & Dunsmuir, W 2012, 'Changes in nurses' work associated with computerised information systems: Opportunities for international comparative studies using the revised Work Observation Method by Activity Timing (WOMBAT)', 11th International Congress on Nursing Informatics, International Congress on Nursing Informatics, IMIA, Montreal, Canada.View/Download from: UTS OPUS
An important step in advancing global health through informatics is to understand how systems support health professionals to deliver improved services to patients. Studies in several countries have highlighted the potential for clinical information systems to change patterns of work and communication, and in particular have raised concerns that they reduce nurses' time in direct care. However measuring the effects of systems on work is challenging and comparisons across studies have been hindered by a lack of standardised definitions and measurement tools. This paper describes the Work Observation Method by Activity Time (WOMBAT) technique version 1.0 and the ways in which the data generated can describe different aspects of health professionals' work. In 2011 a revised WOMBAT version 2.0 was developed specifically to facilitate its use by research teams in different countries. The new features provide opportunities for international comparative studies of nurses' work to be conducted.
Westbrook, JI, Creswick, NJ, Duffield, C, Li, L & Dunsmuir, WTM 2012, 'Changes in nurses' work associated with computerised information systems: Opportunities for international comparative studies using the revised Work Observation Method By Activity Timing (WOMBAT).', NI 2012 : 11th International Congress on Nursing Informatics, June 23-27, 2012, Montreal, Canada. International Congress in Nursing Informatics (11th : 2012 : Montreal, Quebec), p. 448.View/Download from: UTS OPUS
An important step in advancing global health through informatics is to understand how systems support health professionals to deliver improved services to patients. Studies in several countries have highlighted the potential for clinical information systems to change patterns of work and communication, and in particular have raised concerns that they reduce nurses' time in direct care. However measuring the effects of systems on work is challenging and comparisons across studies have been hindered by a lack of standardised definitions and measurement tools. This paper describes the Work Observation Method by Activity Time (WOMBAT) technique version 1.0 and the ways in which the data generated can describe different aspects of health professionals' work. In 2011 a revised WOMBAT version 2.0 was developed specifically to facilitate its use by research teams in different countries. The new features provide opportunities for international comparative studies of nurses' work to be conducted.
Duffield, CM 2011, 'Clinical Leadership', 2nd Abu Dhabi International Nursing Conference, Abu Dhabi.
Duffield, CM 2011, 'Nurse staffing and patient outcomes', 2nd Abu Dhabi International Nursing Conference, Abu Dhabi.
Duffield, CM 2011, 'The clinical workforce: Have we got it right?', Hunter New England 2011 Quality and Scientific Program., Pokolbin.
Duffield, CM 2011, 'The past is a rudder...', SV&MHS Nursing research symposium. Forging ahead with multidisciplinary research, Sydney.
Roche, MA & Duffield, CM 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.
Duffield, CM 2010, 'If you get too far in front....(Keynote address)', Australian College of Critical Care Nurses Annual Conference, Sydney.
Gardner, G, Duffield, CM & Chang, AM 2010, 'Development and validation of a tool for differentiating advanced practice nursing roles', RCN International Nursing Research Conference, United Kingdom.
Roche, MA, Diers, D & Duffield, CM 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.
Duffield, CM 2009, 'Challenges and threats of nurse specialisation: The effects on our nursing identity (Keynote address)', Australian Nursing Federation (Victorian Branch) Professional Day: Am I Responsible? Responsibility, accountability and expectations placed on nurses, Melbourne, Australia.
Duffield, CM 2009, 'Is anybody listening? Patient safety and the nursing and midwifery workforce (Keynote address)', Women's and Children's Hospitals Australasia Annual Conference: The times they are a-changin': Engaging in health care reform, Brisbane, Australia.
Duffield, CM 2009, 'Leadership, decision-making and safe staffing (Keynote address)', Flinders Nurses' Education & Research Fund, Adelaide.
Duffield, CM 2009, 'Nurse staffing and patient safety', Total nursing care and skillmix conference (Keynote address), Taichung City, Taiwan.
Duffield, CM 2009, 'Nursing workforce: New roles for new times (Keynote address)', The International Council of Nurses 24th Quadrennial Conference, Durban, South Africa.
Duffield, CM 2008, 'Are we changing with the times?', Royal College of Nursing Australia Annual Conference, Perth, Australia.
Duffield, CM 2008, 'Challenges for the nursing workforce: Staffing for patient safety. Globalization and social determinants of health: Implications for human resource development and health systems', Ribeirao Preto SP, Brazil.
Duffield, CM 2008, 'Glueing it together: Nursing Workload', Ballina, NSW.
Duffield, CM 2008, 'Leadership is about action', Deakin University Leadership Conference, Melbourne.
Duffield, CM 2008, 'Nurses: We are in a new place. Safety and quality is everyone's business', National Forum on Safety and Quality in Health Care, Adelaide.
Duffield, CM 2008, 'Panel discussion: Getting recognition and policy action from research', Coalition of National Nursing Organisations National Nursing Research Symposium, Melbourne, Australia.
Duffield, CM 2008, 'Utilising the nursing workforce appropriately', Australian Nursing Federation Annual Delegates Conference, Adelaide.
Duffield, CM 2008, 'We are all children... (Keynote address)', 10th International Paediatric and Child Health Nursing Conference, Darwin, Australia.
Duffield, CM, Sivey, P, Cheng, T, Scott, A, Joyce, C & Turner, C Health Workforce Australia 2012, Patterns and determinants of medical and nursing workforce exits.
Duffield, CM, Roche, MA, O'Brien-Pallas, L, Diers, D, Aisbett, C, King, MT, Aisbett, K & Hall, JP Centre for Health Services Management, UTS 2007, Glueing it together: nurses, their work environment and patient safety., pp. 1-243, Sydney.
Duffield, CM, O'Brien-Pallas, L, Tomblin-Murphy, G, Birch, S & Meyer, R ICN - International Council of Nurses 2005, Nursing Workforce Planning: Mapping the Policy Trail, The Global Nursing Review Initiative, pp. 1-44, Geneva, Switzerland.
Planning for the efficient and effective delivery of health care services to meet the health needs of the populations is a significant challenge. Globally policy makers, educators, health service researchers, leaders of unions and professional associations, and other key stakeholders struggle with the best way to plan for a workforce to fulfill the health needs of populations. To meet this challenge, achieving the appropriate balance between human and non-human resources is important and requires continuous monitoring, careful attention to the country specific context in which policy decisions are made, and evidence-based decision-making. This paper provides an overview of current evidence and policy initiatives pertinent to the nursing workforce including: health human resource (HHR) planning, service planning and modelling; nursing workforce imbalances and internal migration; and approaches to nursing deployment and utilisation. Policy implications and recommendations are offered.