Associate Professor Michael Roche is a mental health nurse with experience in clinical, education, IT and management positions in the NSW public health system. He has been involved in large research studies, including a multi-state study of nursing turnover, two state-wide studies of nursing workload and patient outcomes, and reviews of the mental health nursing practice environment and postgraduate education.
Michael has investigated the links between the practice environment and patient, nurse and system outcomes, including work that has explored the influence of the practice environment on the therapeutic relationships of nurses working in mental health. He has also investigated the introduction of nursing assistants in Western Australia, the role of AINs in mental health, the use of primary health care services by homeless men, the impact of parenting programs for incarcerated parents, and is currently exploring the safety culture of mental health units.
He supervises PhD, Masters and Honours students studying aspects of the practice environment, mental health, nurse outcomes and nursing leadership.
Australian College of Nursing
Australian College of Mental Health Nurses
Sigma Theta Tau International
Can supervise: YES
- Nursing practice environment
- Mental health
- Health services management
- Large data sets
- Therapeutic relationships
Can supervise: Yes
Areas of research supervision
- Mental health
- Nursing practice environment
- Therapeutic relationships
- Health services management
- Administrative data sets
- Quantitative methods
- Survey methods
Analysis and application of routinely collected data
Nursing self-awareness, communication and relationships
Fundamentals of quality and safety in the workplace
Information and communication technologies for practice
Delgado, C, Roche, M, Fethney, J & Foster, K 2020, 'Workplace resilience and emotional labour of Australian mental health nurses: Results of a national survey.', International Journal of Mental Health Nursing, vol. 29, no. 1, pp. 35-46.View/Download from: Publisher's site
Emotional labour is a form of adversity faced by mental health nurses in the context of their workplace interactions. Frequent exposure to emotional adversity can negatively impact mental health nurses' biopsychosocial well-being, workplace relationships, and performance. Workplace resilience is a dynamic interactive process within and between the person and their environment that promotes positive adaptation to adverse events and restores well-being. Workplace resilience could be a protective process that helps mental health nurses positively adapt to workplace emotional adversity. This study aimed to investigate Australian mental health nurses' workplace resilience and emotional labour and explore the relationship between them. A national cross-sectional online survey comprising the Resilience at Work and Emotional Labour scales was completed by registered nurses (n = 482) working in a mental health role or setting across Australia. There was a strong negative relationship between resilience and the emotional labour strategy of surface acting. A positive association between resilience, frequency of emotional labour, and clinical supervision was also found. These findings point to a potential link between mental health nurses' skills of cognitive reframing, and emotional and behavioural regulation needed to effectively manage their emotions and remain therapeutic in interpersonal interactions. Clinical supervision may be a key strategy in supporting mental health nurses' resilience. Further investigation of workplace individuals' internal and external resources, and organizational resources, supports, and strategies that can promote and strengthen mental health nurses' well-being is needed.
Foster, K, Roche, M, Giandinoto, J-A & Furness, T 2020, 'Workplace stressors, psychological well-being, resilience, and caring behaviours of mental health nurses: A descriptive correlational study.', International Journal of Mental Health Nursing, vol. 29, no. 1, pp. 56-68.View/Download from: Publisher's site
There is widespread recognition that workplace stress can have profound negative impacts on nurses' well-being and practice. Resilience is a process of positive adaptation to stress and adversity. This study aimed to describe mental health nurses' most challenging workplace stressors, and their psychological well-being, workplace resilience, and level of caring behaviours, explore the relationships between these factors, and describe differences in workplace resilience for sociodemographic characteristics. In a descriptive correlational study using convenience sampling, data were collected from N = 498 nurses working in mental health roles or settings in Victoria Australia via an online cross-sectional survey. Key findings included weak to strong (r = 0.301 to r = 0.750) positive relationships between workplace resilience with psychological well-being across all stressor categories (consumer/carer; colleague; organizational role; and organizational service). Psychological well-being was moderately high, but lower for nurses indicating consumer/carer-related stressors as their most stressful challenge. There were weak to moderate (r = 0.306 to r = 0.549) positive relationships between workplace resilience and psychological well-being, and no relationship between resilience and caring behaviours. Workplace resilience was lower (P < 0.05) for less experienced nurses compared with those with >5 years' experience, and lower for younger nurses compared with those aged ≥40 years. To improve their resilience and prevent psychological distress, there is prime opportunity to support nursing students with well-being and resilience-building strategies during their undergraduate education, and to support new graduates with similar programmes when they enter the workforce.
Duffield, C, Roche, M, Debono, D & Wise, S 2020, 'Harnessing ward level administrative data and expert knowledge to improve staffing decisions: a multi-method case study', Journal of Advanced Nursing, vol. 76, no. 1, pp. 287-296.View/Download from: Publisher's site
Wise, S, Duffield, C, Fry, M & Roche, M 2020, 'Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team', Human Resources for Health, vol. 18:17.View/Download from: Publisher's site
MacLeay, E, Fry, M, Roche, MA & Montilla, T 2020, 'Care planning and nonpharmacological interventions in a metropolitan inpatient dual diagnosis service: A retrospective exploratory study', INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING.View/Download from: Publisher's site
Foster, K, Roche, M, Delgado, C, Cuzzillo, C, Giandinoto, J-A & Furness, T 2019, 'Resilience and mental health nursing: An integrative review of international literature.', International journal of mental health nursing, vol. 28, no. 1, pp. 71-85.View/Download from: Publisher's site
Mental health nurses work in challenging and potentially high stress settings. Stressors can occur in the context of consumer, family, and/or staff relationships, as well as the work environment and organization. The cumulative effects of stress and professional challenges can lead to harmful impacts for mental health nurses including burnout and poorer physical and mental health. Resilience involves a process of positive adaptation to stress and adversity. The aims of this integrative review were to examine understandings and perspectives on resilience, and explore and synthesize the state of knowledge on resilience in mental health nursing. Following systematic search processes, screening, and data extraction, 12 articles were included. Constant comparative analysis and synthesis of the data resulted in two key categories: Theoretical concepts of resilience and Knowledge on mental health nurses' resilience. In mental health nursing, resilience has been variously constructed as an individual ability, collective capacity, or as an interactive person-environment process. Resilience was most often reported as low-moderate, with positive correlations with hardiness, self-esteem, life and job satisfaction, and negative correlations with depression and burnout. A resilience programme improved mental health nurses' coping self-efficacy and capacity to regulate thoughts and emotions and developed their resilient practice. Use of contemporary resilience definitions will inform more consistent investigation and progressively scaffold knowledge of this emergent construct in mental health nursing. Future research on the implementation of resilience programmes and resilience-building strategies for mental health nurses at the individual, work unit, and organizational levels is needed.
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, vol. 20, no. 4, pp. 228-238.View/Download from: Publisher's site
Zugai, JS, Stein-Parbury, J & Roche, M 2019, 'Dynamics of nurses' authority in the inpatient care of adolescent consumers with anorexia nervosa: A qualitative study of nursing perspectives.', International journal of mental health nursing, vol. 28, no. 4, pp. 940-949.View/Download from: Publisher's site
Nurses caring for adolescent consumers with anorexia nervosa in the inpatient setting are challenged in a unique way, in that they are caring for people with whom they do not have a mutually held concept of well-being. Their efforts to ensure weight gain are frequently against the wishes of the consumer. This dissonance results in challenging interactions, where nursing care and authority may be undermined. This study investigated the dynamics of nurses' authority within this context. Interviews with nurses (n = 10) were conducted and analysed through thematic analysis. Nurses reported that consumers, compelled by the psychopathology of anorexia nervosa, often sought to challenge or undermine their authority. Some nurses experienced the opposition and conflict as demoralizing, whereas others were able to maintain confidence in the therapeutic merit of their care. Younger, inexperienced nurses in this study were particularly vulnerable to interactions that mitigated their authority, due to their tendency to engage in friend-like relationships. Nurses caring for adolescents with anorexia nervosa should be prepared to be confronted by interactions that overtly and surreptitiously undermine their capacity to exercise professional authority. It is important that nurses recognize the importance of maintaining their authority, and how it can be threatened in subtle and unexpected ways.
Roche, MA, Jackson, D, Usher, K & Cross, W 2018, 'Meeting the needs of young people with psychosis: We must do better.', International Journal of Mental Health Nursing.View/Download from: Publisher's site
Foster, K, Shochet, I, Wurfl, A, Roche, M, Maybery, D, Shakespeare-Finch, J & Furness, T 2018, 'On PAR: A feasibility study of the Promoting Adult Resilience programme with mental health nurses', International Journal of Mental Health Nursing, vol. 27, no. 5, pp. 1470-1480.View/Download from: Publisher's site
© 2018 Australian College of Mental Health Nurses Inc. Mental health settings are recognized as complex, unpredictable environments, and challenging interpersonal situations are common for nurses in acute adult mental health services. Occupational stressors include verbal aggression and physical assault and are correlated with poor physical and mental health outcomes for nurses. There is a clear need for proactive approaches that address the negative impacts of stressors on the mental health nursing workforce. Resilience interventions are a preventive approach to strengthening skills for addressing workplace stress, improving health and well-being, and preventing adverse outcomes associated with occupational stressors. The aim of this study was to evaluate the feasibility of a workplace resilience education programme for nurses in high-acuity adult mental health settings. The outcomes were measured using a single-group pretest post-test design with follow-up at 3 months postintervention. The feasibility and acceptability of the programme were identified with descriptors of mental health, well-being, resilience, facilitator fidelity checklists, and participant satisfaction questionnaires. The programme was found to be feasible for nurses working in high-acuity inpatient settings. There were significant changes to mental health, well-being, and workplace resilience. The programme was delivered with fidelity by facilitators and accepted with high levels of satisfaction by participants. The study findings indicated that nurses can benefit from resilience education that equips them with cognitive, emotion regulation, and relational skills, in conjunction with available external supports and resources, to address workplace challenges. There is a need for comprehensive organizational approaches that include individual, work unit, and organizational-level strategies to support staff well-being.
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: Publisher's site
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: 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.
Fowler, C, Rossiter, C, Dawson, A, Power, T, Jackson, D & Roche, M 2018, 'When parenting doesn’t 'come naturally’: providers’ perspectives on parenting education for incarcerated mothers and fathers', Studies in Continuing Education, vol. 40, no. 1, pp. 98-114.View/Download from: Publisher's site
Learning to parent sensitively and safely can be challenging for adults with childhood abuse and neglect experiences. Such childhood experiences are prevalent among incarcerated parents whose ability to parent their own children is also limited by separation from them. Several prisons have developed programs to foster pro-social parenting skills among incarcerated mothers and fathers to assist them on release. This paper reports a qualitative research study that explored the factors affecting the delivery and outcomes of parenting programs in correctional facilities in New South Wales Australia from the perspective of individuals involved in developing and implementing the programs. Thematic analysis of 19 interviews identified two main themes: supporting parents’ learning in correctional settings and providers’ learning about parent education in correctional settings. Respondents reported the benefits of providing creative learning opportunities enabling parents to build on their strengths and to develop relationships. These factors contributed to changing prisoners’ attitudes and supporting them to consider alternative parenting approaches. The co-productive approach to parent education supported enhanced parenting knowledge among parents and greater insights among educators. Parenting education can be successfully delivered in correctional settings and can assist incarcerated parents to build on existing knowledge and adapt it to their own needs.
Zugai, JS, Stein-Parbury, J & Roche, M 2018, 'The nature of the therapeutic alliance between nurses and consumers with Anorexia Nervosa in the inpatient setting: A mixed-methods study.', Journal of Clinical Nursing, vol. 27, no. 1-2, pp. 416-426.View/Download from: Publisher's site
To develop a greater understanding of the nature of the inpatient therapeutic alliance between nurses and consumers with Anorexia Nervosa (AN).Consumers with AN value interpersonal relationships with nurses, finding these relationships meaningful and therapeutic. It is established that the therapeutic alliance enhances outcomes for consumers with AN. However, establishing the therapeutic alliance in the inpatient setting is considered challenging.This study employed a two-phase mixed-method explanatory sequential design. An initial quantitative survey, phase one, was followed by the collection and analysis of qualitative data, phase two.Phase one employed validated survey instruments, measuring the perceived degree of therapeutic alliance and elements of ward milieu. Phase two involved semi-structured interviews that focused on therapeutic relationships between nurses and consumers, with specific exploration of the results from phase one. Data collection commenced May 2014 and concluded February 2015.The therapeutic alliance involved interpersonal engagement and a balanced application of authority. In a therapeutic alliance, nurses cared for consumers with interpersonal finesse, whilst maintaining clear distinction between the consumer as an individual and AN as an illness. Nurses also developed a therapeutic alliance by occupying their position of power with consistent yet individualised expectations and by maintaining appropriate professional boundaries.The therapeutic alliance between nurses and consumers with AN is not developed through negotiation of equal partners. Rather, the therapeutic alliance is dependent on nurses' capacity to maintain their position of power, whilst demonstrating their trustworthiness to the consumer. In trusting nurses, consumers felt safer in investing in a new concept of well-being.By understanding the nature of the therapeutic alliance as it is described in this study, nurses have an enhanced capacity to develop effective therape...
Zugai, JS, Stein-Parbury, J & Roche, M 2018, 'Therapeutic alliance, anorexia nervosa and the inpatient setting: A mixed methods study.', Journal of advanced nursing, vol. 74, no. 2, pp. 443-453.View/Download from: Publisher's site
The aim of this study was to understand the context of the inpatient setting for the treatment of anorexia nervosa and the implications for the therapeutic alliance between nurses and consumers.The nature of the therapeutic alliance is dependent on the contextual factors that influence interactions. The inpatient setting for the treatment of anorexia nervosa is one such setting where the therapeutic alliance is operative, yet challenging and poorly understood.A two-phase explanatory sequential design was employed. Descriptive statistics from phase one informed phase two interviews. Phase two data were analysed through thematic analysis.A convenience sample of nurses and consumers were recruited from six wards, in five hospitals. Phase one involved the completion of a survey (N = 128) that measured the strength of the therapeutic alliance, as well as other elements of ward context. Phase two interviews (N = 54) were focused on the therapeutic alliance between nurses and consumers and the implications of the inpatient setting. Data collection occurred between May 2014 - February 2015.Anorexia nervosa as an illness carries destructive implications for the quality of the therapeutic alliance. Nurses' intimate position in the inpatient setting and interpersonal capacity is influential in overcoming the obstacles that impede the therapeutic alliance.Nurses' capacity for developing therapeutic alliances is in part dependent on a supportive ward organization and the adequacy of resources to permit meaningful interactions with consumers with anorexia nervosa. Understanding the contextual factors specific to the inpatient setting enhances nurses' ability to develop therapeutic alliances.
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: 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: 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.
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: 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.
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: 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: 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.
Romero, B, Fry, M & Roche, M 2017, 'The impact of evidence-based sepsis guidelines on emergency department clinical practice: a pre-post medical record audit.', Journal of Clinical Nursing, vol. 26, no. 21-22, pp. 3588-3596.View/Download from: Publisher's site
To explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, emergency department management and time to antibiotics.Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis. To improve patient outcomes, the New South Wales government in Australia introduced sepsis guidelines into emergency departments. However, the impact of the guidelines on clinical practice remains unclear.A 12-month pre-post retrospective randomised medical record audit of adult patients with a sepsis diagnosis. Data were extracted from the emergency department database and paper medical record. Data included patient demographic (age, gender), clinical information (time of arrival, triage code, seen by time, disposition, time to antibiotic, pathology, time to intravenous fluids) and patient assessment data (heart rate, respiratory rate, blood pressure, temperature, oxygen saturations, medication).This study demonstrated a statistically significant 230-minute reduction in time to antibiotics post implementation of the guidelines. The post group (n = 165) received more urgent triage categories (n = 81; 49·1%), a 758-minute reduction in mean time to second litre of intravenous fluids and an improvement in collection of lactate (n = 112, 67·9%), also statistically significant.The findings highlight the impact the guidelines can have on clinician decision-making and behaviour that support best practice and positive patient outcomes. The sepsis guidelines improved the early assessment, recognition and management of patients presenting with sepsis in one tertiary referral emergency department.The use of evidenced-based guidelines can impact clinical decision-making and behaviour, resulting in the translation and support of best practice...
Rossiter, C, Power, T, Fowler, C, Jackson, D, Roche, M & Dawson, A 2017, '"Learning to become a better man": Insights from a fathering programme for incarcerated indigenous men', Australian Journal of Social Issues, vol. 52, no. 1, pp. 13-31.View/Download from: Publisher's site
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...
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: 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: Publisher's site
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
Dean, SJ, Zaslawski, C, Roche, M & Adams, J 2016, '"Talk to Them": Teaching communication skills to students of traditional chinese medicine.', Journal of Nursing Education and Practice, vol. 6, no. 12, pp. 49-56.View/Download from: Publisher's site
Objective: To explore students' perceptions of the efficacy and value of teaching communication skills in a health professional course for Traditional Chinese Medicine (TCM).
Methods: Individual surveys were used to evaluate students' self-assessment of their communication skills pre and post a communication subject in a four-year degree course in a Bachelor of Health Science in TCM at a large metropolitan university in Australia. Quantitative and qualitative data were collected.
Results: Findings indicate that students recognise the need for good communication skills training as part of their professional training and self-reported that their communication skills improved following a semester of study of a communication subject.
Conclusions: One of the primary components driving increasing demand for complementary and alternative medicine (CAM), which includes TCM, is that consumers place a high value on effective communication and quality engagement with their CAM provider. Communication skills are often seen as the cornerstone of good health care practice, patient recovery and practitioner job satisfaction. Implementing a focused communication skills component in health professional educational programs, including those for TCM, is therefore essential. Further research is needed to explore the retention of these skills throughout health professionals' degree programs and after graduation and clinical experience, to evaluate the effectiveness and sustainability of personal communication skills education. Practice implications: Communication skills training should be incorporated into health care profession curricula, early in the program and integrated with clinical exposure.
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
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: 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
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: 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, 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: 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
Wise, S, Fry, M, Duffield, CM, Roche, MA & Buchanan, J 2015, 'Ratios and nurse staffing: The vexed case of emergency departments', Australasian Emergency Nursing Journal, vol. 18, no. 1, pp. 49-55.View/Download from: Publisher's site
Within Australia nursing unions are pursuing mandated nursepatient ratios tosafeguard patient outcomes and protect their members in healthcare systems where demandperpetually exceeds supply. Establishing ratios for an emergency department is more con-tentious than for hospital wards. The studys aim was to estimate average staffing levels, skillmix and patient presentations in all New South Wales (NSW) Emergency Departments (EDs).
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: 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.
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.
Zugai, JS, Stein-Parbury, J & Roche, MA 2015, 'Therapeutic Alliance in Mental Health Nursing: an Evolutionary Concept Analysis', Issues in Mental Health Nursing, vol. 36, no. 4, pp. 249-257.View/Download from: Publisher's site
The concept of therapeutic alliance is relevant in contemporary mental health care, as the consumer-led recovery movement promotes the development of collaborative relationships, and is focussed on the consumer's individual concept of wellbeing. An evolutionary concept analysis was undertaken to establish a contemporary interpretation of therapeutic alliance for mental health nursing. The CINAHL, Scopus and PsycINFO databases were searched for articles (n = 322), with 52 deemed appropriate for analysis. Therapeutic alliance is characterised by mutual partnerships between nurses and consumers, and is dependent on a humanistic healthcare culture. Therapeutic alliance is associated with enhanced consumer outcomes and experiences with care.
Gallagher, R, Gallagher, P, Roche, M, Fry, M, Chenoweth, L & Stein-Parbury, MJ 2015, 'Nurses' perspectives of the impact of the older person on nursing resources in the emergency department and their profile: A mixed methods study', International Emergency Nursing, vol. 23, no. 4, pp. 312-316.View/Download from: Publisher's site
Background: Nurses provide the majority of care in the ED, so increases in the number of older people (≥60 years) may impact nursing workload and provision of care.
Aim: To determine whom, of older people, emergency nurses perceive as using the most nursing re- sources and to profile this subgroup from the ED dataset, including illustrative cases.
Method: Amixed-methodsdesignstudyinametropolitanhospital.Datawerecollectedfromfocusgroup interviews with emergency nursing staff (n = 27), from the patient dataset for the corresponding year, and an audit of 13 patients' medical records.
Results: Emergency nurses perceived that the highest demand for their resources came from the older persons representing multiple times in short timeframes (cluster presenter). Cluster presenters had a longer length of stay and required intensive nursing time and vigilance because they had one or more chronic illnesses and comorbid conditions such as limited mobility and dementia. Cluster presenters had to have a full assessment each presentation, were usually admitted to the hospital and admitting spe- cialists were reluctant to assume care.
Conclusion: Emergency nurses associate a high workload with cluster presenters for reasons including ED processes and availability of expertise. Further research should examine more objectively and pre- cisely nursing workload in this area.
Kelly, MA, Forber, J, Conlon, LS, Roche, MA & Stasa, H 2014, 'Empowering the registered nurses of tomorrow: Student's perspectives of a simulation experience for recognising and managing a deteriorating patient', Nurse Education Today, vol. 34, pp. 724-729.View/Download from: Publisher's site
Recognising and responding to patients who are deteriorating are key aspects to improving outcomes. Simulations provide students with exposure to deteriorating patient scenarios and the role of nurses in such events. The number of programs seeking to provide best possible simulation experiences is growing exponentially. Robust evaluation of these experiences is crucial to ensure maximum benefit.
Blay, N, Duffield, 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.
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: 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.
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: Publisher's site
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: 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: 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.
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: 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.
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: 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: 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.
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: 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.
Fry, M, Horvat, L, Roche, MA, Fong, J & Plowes, J 2013, 'A four month prospective descriptive exploratory study of patients receiving antibiotics in one Emergency Department', International Emergency Nursing, vol. 21, no. 3, pp. 163-167.View/Download from: Publisher's site
Any infection can potentially develop into sepsis. Many patients present to the Emergency Department (ED) with infection and go on to require antibiotics. However, the timeliness of antibiotics can make a difference to patient survival and reduce the risk of infection developing into sepsis and or septic shock.
Zugai, JS, Stein-Parbury, J & Roche, MA 2013, 'Effective nursing care of adolescents with anorexia nervosa: a consumer perspective', Journal Of Clinical Nursing, vol. 22, no. 13-14, pp. 2020-2029.View/Download from: Publisher's site
This study indicates that the process of weight gain for consumers with anorexia nervosa may be enhanced when accompanied by a process of therapeutic engagement. The therapeutic alliance may be an effective way for nurses to ensure weight gain and an enhanced inpatient experience. Therapeutically beneficial relationships may enhance treatment, and possibly enhance outcomes for consumers.
Roche, 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: 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.
Fry, M, Horvat, L, Roche, MA, Fong, J & Plowes, J 2012, 'The prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital', Australasian Emergency Nursing Journal, vol. 15, pp. 127-132.View/Download from: Publisher's site
Globally, severe infection and or sepsis is a problem that is costing billions of dollars, using hundreds of hospital beds, and often results in patient death. Any infection can potentially develop a sepsis health trajectory if left unrecognised and unmanaged. We conducted a 12 month retrospective descriptive exploratory study. Our research explored the prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital. Electronic medical records were reviewed to identify patients that had a primary diagnosis related to infection. The study identified that 16% (n = 7756) of adult presentations had a discharge diagnosis related to infection. A significant difference (X2 = 297.83, df = 4, p .001) in Triage Code allocation for the infection group was identified compared with the non-infection patient group. Thirty-nine percent (n = 3027) of patients with infections were admitted to hospital. Of the patients (n = 1930; 4%) admitted to a critical care area, 6% (n = 122) had a primary diagnosis related to infection. Of the ED deaths (n = 81), 12% (n = 10) had a primary diagnosis related to infection.
Roche, MA 2011, 'Looking at the Bigger Picture', Nursing Standard, vol. 26, no. 13, pp. 62-63.
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: 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, 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: 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.
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: 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...
The high rate of executive turnover in the healthcare industry is a major issue for health service organisations and their staff both in Australia and internationally. In the course of planning a research project examining nurse turnover at the clinical level within three Australian States/Territories, the researchers became aware of frequent executive turnover at all levels (State Department of Health, Area Health Service, hospital). Over a period of approximately 2 years there were 41 executives occupying 18 different positions, highlighting the scope of this issue in Australia. Few studies have examined the causes and consequences of this phenomenon in depth. Factors such as age, gender, education, lack of career advancement opportunities and remuneration have all been identified in the literature as important contributors to executive turnover. High turnover rates have been found to be associated with a number of negative consequences, including organisational instability, high financial costs, loss of human capital and adverse effects on staff morale and patient care.
Roche, 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: 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.
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: 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.
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: 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.
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, 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: 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: 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
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.
White, EG & Roche, MA 2006, 'A selective review of mental health nursing in New South Wales, Australia, in relation to clinical supervision', International Journal of Mental Health Nursing, vol. 15, pp. 209-219.View/Download from: Publisher's site
Recent reports have suggested that mental health staff have added stress, which arose from poor working conditions, heavy workloads, and lack of resources, within a culture in which there was a large degree of burnout, low morale, lack of job satisfaction, poor status, insensitivity and indifference. This is particularly so for mental health nurses, who create the ambience in clinical settings. Previous research has shown that the introduction of clinical supervision, as a central plank of clinical governance arrangements, has a positive effect in some of these respects, but remains underdeveloped in Australia. The present scoping study examined the extent to which this was so in mental health nursing services in the state of New South Wales. Individual mental health nurses (n = 601) and Area Health Services (n = 17) provided data about their local circumstances. Findings revealed that mental health nursing in New South Wales was a committed, late middle-aged workforce, working in services about which there was a width of opinion with the prevailing management arrangements, yet to fully exploit their therapeutic potential, or engage the educational opportunities that would assist them in their endeavour. More specifically, it remained a workforce that has yet to engage clinical supervision in a systematically coherent manner. The study concluded, therefore, that clinical supervision offered a possible practical remedy to address the causes and the effects of suboptimal service provision and that the ready availability of dedicated funding and the immediate access to service development and research expertise was a rare and timely confluence.
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.
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, 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.
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.
Foster, K, Roche, M & Furness, T 2019, 'Mental health nurses' resilience, wellbeing, practice and workplace stress: integrating policy and practice', 45th International Mental Health Nursing Conference, Sydney.
Roche, M 2019, 'Innovation & Technology in Nursing Education, Research & Practice.', Universitas Indonesia Insympofest, Jakarta, Indonesia.
Roche, M 2019, 'Nursing Leadership: Impact & Key Elements.', The 4th International Conference for Global Health, Jakarta, Indonesia.
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.
Hansen, A, McGarry, D, Johnson, A & Roche, M 2018, 'Students’ Cultural Beliefs Towards Mental Health: Implications for Learning and Teaching', Sigma Theta Tau International Nursing Education Research Conference, Washington.
Roche, MA & Glover, S 2018, 'Extended Care Activities for Nursing Support Workers in Mental Health Inpatient Settings: Initial Implementation Study', National Nursing Forum, Gold Coast.
Roche, MA, Glover, S, Luo, X, Millar, J & Joyce, M 2018, 'Extended Care Activities for Nursing Support Workers in Mental Health Inpatient Settings: A Modified Delphi Study', Sigma Theta Tau 29th International Nursing Research Conference, Melbourne.
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, 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..
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.
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
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...
Roche, MA 2012, 'AINs: Staffing, Skill Mix And Outcomes', Assistants in Nursing Conference, 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.
Kelly, MA, Forber, J, Conlon, LS, Stasa, H & Roche, MA 2010, 'Empowering the RNs of tomorrow: pre and post simulation analysis of clinical skill parameters related to deteriorating patients', SimTecT Health, Melbourne.
Final year Bachelor of Nursing students in an adult medical surgical subject engaged in a deteriorating patient simulation encounter. Local Ethics Review Committee approval was obtained for the study. Sixty two students agreed to participate in the study and completed consent and confidentiality forms. A pre-simulation survey consisting of ten questions, with a 4 point Likert scale response was completed immediately prior to the activity. Students participated either actively in predetermined roles or as observers with structured questions to address and discuss during the debriefing. A post-simulation survey, of identical questions, was completed immediately after the simulation encounter.
Roche, 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.
Roche, MA 2009, 'The mental health work environment and therapeutic relationships', 35th International Australian College of Mental Health Nurses Conference 2009, Sheraton on the Park, Sydney, Australia, NSW.
Sara, G, Gill, K, Pennock, J, Gomez, F, Woodland, L, Siggens, A & Roche, MA 2002, 'Service Structures For Population Mental Health What Do We Need And Where Is The Evidence?', THE AUSTRALIAN AND NEW ZEALAND COLLEGE OF PSYCHIATRISTS 37TH ANNUAL CONGRESS, Blackwell Publishing Asia, Brisbane, pp. 846-849.