Background: There is a direct link between job satisfaction, nurses' job performance and improved... more Background: There is a direct link between job satisfaction, nurses' job performance and improved patient outcomes. Understanding what job characteristics influence job satisfaction is vital if health organizations are to optimize individual employee satisfaction and performance. This is particularly necessary in the Nurse Consultant role, which is a multifaceted role that has evolved to meet the dynamic and changing needs of health services. This study aims to examine how job characteristics influence Nurse Consultant job satisfaction and identify differences across metropolitan and rural contexts. Methods: This paper presents quantitative findings that are part of a larger prospective cross sectional mixed method study. An online survey consisting of a variety of job characteristic factors was administered to all NCs working in a large Local Health District in New South Wales, Australia over an 8-week period in 2010. Descriptive analysis identified NC's perceptions of job satisfaction and job characteristics in their current role and factor and regression analysis identified relationships between these factors. Results: Job satisfaction was identified as high (mean 4.3) and is strongly correlated with job autonomy, role clarity, role conflict and job support. A high level of role clarity has a moderating effect on the relationship between job autonomy and job satisfaction. Conclusions: Study findings inform how we prepare nurses for the NC role and how managers engage with and support NCs in their role taking into account context. Understanding the factors that influence job satisfaction and role effectiveness gives managers valuable information to assist in positioning and supporting these roles to maximize effectiveness across integrated and contemporary models of health care delivery.
Http Dx Doi Org 10 5172 Conu 2010 35 2 171, Dec 17, 2014
The need for research in practice is well documented within nursing and other health care discipl... more The need for research in practice is well documented within nursing and other health care disciplines. This acceptance is predicated on the belief that clinically applied research will inform and improve practice and health service delivery resulting in better outcomes for consumers and their families. Nurses, however, fi nd doing clinical research challenging. This paper describes nurses' experiences of doing clinical research. The main challenges of doing clinical research arise from a culture that prioritises practice where nursing work is core business and there is the need to address immediate and short term goals. There are also problems associated with the use of research language amongst clinical nurses and ambiguity in relation to research role expectations. Lack of support and resources for doing research along with keeping up the momentum for a research project also pose signifi cant challenges. The benefi ts of doing clinical nursing research include experiential learning that has the potential to lead to practice change and improved patient outcomes that are evidence based.
ABSTRACT Transformational leadership has consistently been argued to enhance diverse team outcome... more ABSTRACT Transformational leadership has consistently been argued to enhance diverse team outcomes, yet related research has generated ambiguous findings. We suggest that effectiveness is enhanced in interprofessional teams when transformational leaders engender dynamics that are characterized by interprofessional motivation and openness to diversity. Drawing on the mood-as-information perspective, we argue that negative affective tone moderates the impact of these mediators on team effectiveness. Further, we suggest that this moderating role is such that conditions of high negative affect enhance the mediating role of interprofessional motivation, while low negative affect strengthens the mediating role of openness to diversity. In order to investigate these divergent effects, the current study develops a model of leadership and interprofessional team effectiveness through two pathways reflecting the parallel mediating effects of interprofessional motivation and openness to diversity, and a moderating role for negative affect. Findings from a survey-based study of 75 healthcare teams support the utility of this model.
Background: Advanced practice nursing and midwifery roles are integral to the provision of high q... more Background: Advanced practice nursing and midwifery roles are integral to the provision of high quality health care across a range of clinical contexts and health care sectors. The continued relevance and importance of these roles requires that they be systematically evaluated and revised where necessary to ensure maximum effectiveness and career satisfaction for incumbents.
Interprofessional approaches to health and social care have been linked to improved planning and ... more Interprofessional approaches to health and social care have been linked to improved planning and policy development, more clinically effective services, and enhanced problem solving; however, there is evidence that professionals tend to operate in uniprofessional silos and that attempts to share knowledge across professional borders are often unsuccessful.
The purpose is to report the findings of a study designed to evaluate the uptake and utility of a... more The purpose is to report the findings of a study designed to evaluate the uptake and utility of a delirium alert protocol for delirium prevention. Research design: A mixed methods design was used in this evaluation study. Intervention: An audit of patient records provided evaluation data before and after implementation of the Delirium Alert Protocol (DAP). Clinical nurses were surveyed to determine uptake and utility of the DAP. A focus group was conducted with clinicians to determine their perceptions of the DAP. Context: The setting for the study was a busy medical ward in a large tertiary referral hospital in NSW Australia. Participants: Participants for the study included 26 clinical nurses. Outcomes: Findings revealed an increase in the diagnosis of delirium and use of interventions for the prevention of delirium. The survey revealed an increased knowledge of delirium and a high level of satisfaction with the DAP. The focus group suggests that "delirium" is referred to more often and that nurses took a more active role in preventing delirium.
The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse... more The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse has been described as enhancing health care outcomes largely through extensive collaboration with consumers, nurses, and other health professionals. However, little is known about the actual nature, amount, and quality of NC interactions. This study examines the connectivity of the NC role across metropolitan and rural contexts, using a mixed method sequential design with an online survey and focus groups with NCs and other stakeholders. Results demonstrated that NCs most commonly have high density connectivity patterns with other nursing colleagues, medical staff, patients/clients, and administrative staff. Position grade (1, 2 or 3) influences density of connectivity, as does location, with those based in metropolitan roles engaging significantly less with other clinicians. Findings demonstrate that many NCs are highly collaborative and predominantly embedded into interprofessional pr...
The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse... more The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse has been described as enhancing health care outcomes largely through extensive collaboration with consumers, nurses, and other health professionals. However, little is known about the actual nature, amount, and quality of NC interactions. This study examines the connectivity of the NC role across metropolitan and rural contexts, using a mixed method sequential design with an online survey and focus groups with NCs and other stakeholders. Results demonstrated that NCs most commonly have high density connectivity patterns with other nursing colleagues, medical staff, patients/clients, and administrative staff. Position grade (1, 2 or 3) influences density of connectivity, as does location, with those based in metropolitan roles engaging significantly less with other clinicians. Findings demonstrate that many NCs are highly collaborative and predominantly embedded into interprofessional practice models. This study provides valuable insight into the diverse and often complex NC role and the way in which NC expertise and influence is deployed and integrated across a large local health district.
Interprofessional health care teams are increasingly utilized in health care organizations. Altho... more Interprofessional health care teams are increasingly utilized in health care organizations. Although there is support for their capacity to solve complex problems, there is also evidence that such teams are not always successful. In an effort to understand the capacity of interprofessional teams to innovate successfully, we investigate the role of cognitive diversity to establish whether and how knowledge differences lead to innovation. The aim of this study was to construct and investigate a model of team innovation predicted by cognitive diversity. In addition to investigating the direct impact of cognitive diversity in interprofessional health care teams, we develop a model incorporating mediated and moderated effects. In this study, we explore the role of debate as a mediating factor capable of explaining the impact of cognitive diversity on innovation. We further propose that the link between cognitive diversity and innovation through debate is contingent upon trans-specialist knowledge, knowledge shared by health care professionals, spanning specialist divides and enabling mutual understanding. The hypotheses were investigated using a cross-sectional, correlational design. Survey data received from 75 interprofessional teams employed in an acute care setting, representing a 36% response rate, were used to investigate our model. Analysis supports a significant relationship between cognitive diversity and debate, which is stronger when teams rate highly for trans-specialist knowledge. Results also support a positive relationship between debate and innovation and our full moderated mediated pathway. A range of strategies are indicated by our results to increase innovation in interprofessional teams. In particular, interventions such as interprofessional education and training, which have been shown to facilitate the development of shared language and meaning, are recommended by our findings.
Background Although interprofessional practice (IPP) offers the potential to enhance rural health... more Background Although interprofessional practice (IPP) offers the potential to enhance rural health services and provide support to rural clinicians, IPP may itself be problematic due to workforce limitations and service fragmentation. Differing socioeconomic and geographic characteristics of rural communities means that the way that IPP occurs in rural contexts will necessarily differ from that occurring in metropolitan contexts. The aim of this study was to investigate the factors contributing to effective IPP in rural contexts, to examine how IPP happens and to identify barriers and enablers. Methods Using Realistic Evaluation as a framework, semi-structured interviews were conducted with health professionals in a range of rural healthcare contexts in NSW, Australia. Independent thematic analysis was undertaken by individual research team members, which was then integrated through consensus to achieve a qualitative description of rural IPP practice. Results There was clear evidence...
Introduction: The aim of this project was to develop and implement an innovative nurse-led model ... more Introduction: The aim of this project was to develop and implement an innovative nurse-led model of care in the use and management of indwelling urinary catheters (IUC) utilising evidence-based 'bundle interventions' to reduce the incidence of catheter-associated urinary tract infections (CAUTI).
In Australia, as in many other developed countries, the current healthcare environment is charact... more In Australia, as in many other developed countries, the current healthcare environment is characterised by increasing differentiation and patient acuity, aging of patients and workforce, staff shortages and a varied professional skills mix, and this is particularly so in rural areas. Rural healthcare clinicians are confronted with a broad range of challenges in their daily practice. Within this context, the challenges faced by rural acute care clinicians were explored and innovative strategies suggested. This article reports the findings of a study that explored these challenges across disciplines in acute healthcare facilities in rural New South Wales (NSW), Australia. A mixed method approach, involving a consultative, participatory 3 stage data collection process was employed to engage with a range of healthcare clinicians from rural acute care facilities in NSW. Participants were invited to complete a survey, followed by focus group discussions and finally facilitated workshops u...
Background: There is a direct link between job satisfaction, nurses' job performance and improved... more Background: There is a direct link between job satisfaction, nurses' job performance and improved patient outcomes. Understanding what job characteristics influence job satisfaction is vital if health organizations are to optimize individual employee satisfaction and performance. This is particularly necessary in the Nurse Consultant role, which is a multifaceted role that has evolved to meet the dynamic and changing needs of health services. This study aims to examine how job characteristics influence Nurse Consultant job satisfaction and identify differences across metropolitan and rural contexts. Methods: This paper presents quantitative findings that are part of a larger prospective cross sectional mixed method study. An online survey consisting of a variety of job characteristic factors was administered to all NCs working in a large Local Health District in New South Wales, Australia over an 8-week period in 2010. Descriptive analysis identified NC's perceptions of job satisfaction and job characteristics in their current role and factor and regression analysis identified relationships between these factors. Results: Job satisfaction was identified as high (mean 4.3) and is strongly correlated with job autonomy, role clarity, role conflict and job support. A high level of role clarity has a moderating effect on the relationship between job autonomy and job satisfaction. Conclusions: Study findings inform how we prepare nurses for the NC role and how managers engage with and support NCs in their role taking into account context. Understanding the factors that influence job satisfaction and role effectiveness gives managers valuable information to assist in positioning and supporting these roles to maximize effectiveness across integrated and contemporary models of health care delivery.
Http Dx Doi Org 10 5172 Conu 2010 35 2 171, Dec 17, 2014
The need for research in practice is well documented within nursing and other health care discipl... more The need for research in practice is well documented within nursing and other health care disciplines. This acceptance is predicated on the belief that clinically applied research will inform and improve practice and health service delivery resulting in better outcomes for consumers and their families. Nurses, however, fi nd doing clinical research challenging. This paper describes nurses' experiences of doing clinical research. The main challenges of doing clinical research arise from a culture that prioritises practice where nursing work is core business and there is the need to address immediate and short term goals. There are also problems associated with the use of research language amongst clinical nurses and ambiguity in relation to research role expectations. Lack of support and resources for doing research along with keeping up the momentum for a research project also pose signifi cant challenges. The benefi ts of doing clinical nursing research include experiential learning that has the potential to lead to practice change and improved patient outcomes that are evidence based.
ABSTRACT Transformational leadership has consistently been argued to enhance diverse team outcome... more ABSTRACT Transformational leadership has consistently been argued to enhance diverse team outcomes, yet related research has generated ambiguous findings. We suggest that effectiveness is enhanced in interprofessional teams when transformational leaders engender dynamics that are characterized by interprofessional motivation and openness to diversity. Drawing on the mood-as-information perspective, we argue that negative affective tone moderates the impact of these mediators on team effectiveness. Further, we suggest that this moderating role is such that conditions of high negative affect enhance the mediating role of interprofessional motivation, while low negative affect strengthens the mediating role of openness to diversity. In order to investigate these divergent effects, the current study develops a model of leadership and interprofessional team effectiveness through two pathways reflecting the parallel mediating effects of interprofessional motivation and openness to diversity, and a moderating role for negative affect. Findings from a survey-based study of 75 healthcare teams support the utility of this model.
Background: Advanced practice nursing and midwifery roles are integral to the provision of high q... more Background: Advanced practice nursing and midwifery roles are integral to the provision of high quality health care across a range of clinical contexts and health care sectors. The continued relevance and importance of these roles requires that they be systematically evaluated and revised where necessary to ensure maximum effectiveness and career satisfaction for incumbents.
Interprofessional approaches to health and social care have been linked to improved planning and ... more Interprofessional approaches to health and social care have been linked to improved planning and policy development, more clinically effective services, and enhanced problem solving; however, there is evidence that professionals tend to operate in uniprofessional silos and that attempts to share knowledge across professional borders are often unsuccessful.
The purpose is to report the findings of a study designed to evaluate the uptake and utility of a... more The purpose is to report the findings of a study designed to evaluate the uptake and utility of a delirium alert protocol for delirium prevention. Research design: A mixed methods design was used in this evaluation study. Intervention: An audit of patient records provided evaluation data before and after implementation of the Delirium Alert Protocol (DAP). Clinical nurses were surveyed to determine uptake and utility of the DAP. A focus group was conducted with clinicians to determine their perceptions of the DAP. Context: The setting for the study was a busy medical ward in a large tertiary referral hospital in NSW Australia. Participants: Participants for the study included 26 clinical nurses. Outcomes: Findings revealed an increase in the diagnosis of delirium and use of interventions for the prevention of delirium. The survey revealed an increased knowledge of delirium and a high level of satisfaction with the DAP. The focus group suggests that "delirium" is referred to more often and that nurses took a more active role in preventing delirium.
The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse... more The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse has been described as enhancing health care outcomes largely through extensive collaboration with consumers, nurses, and other health professionals. However, little is known about the actual nature, amount, and quality of NC interactions. This study examines the connectivity of the NC role across metropolitan and rural contexts, using a mixed method sequential design with an online survey and focus groups with NCs and other stakeholders. Results demonstrated that NCs most commonly have high density connectivity patterns with other nursing colleagues, medical staff, patients/clients, and administrative staff. Position grade (1, 2 or 3) influences density of connectivity, as does location, with those based in metropolitan roles engaging significantly less with other clinicians. Findings demonstrate that many NCs are highly collaborative and predominantly embedded into interprofessional pr...
The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse... more The nurse consultant (NC) role in Australia is a senior classification of advanced practice nurse has been described as enhancing health care outcomes largely through extensive collaboration with consumers, nurses, and other health professionals. However, little is known about the actual nature, amount, and quality of NC interactions. This study examines the connectivity of the NC role across metropolitan and rural contexts, using a mixed method sequential design with an online survey and focus groups with NCs and other stakeholders. Results demonstrated that NCs most commonly have high density connectivity patterns with other nursing colleagues, medical staff, patients/clients, and administrative staff. Position grade (1, 2 or 3) influences density of connectivity, as does location, with those based in metropolitan roles engaging significantly less with other clinicians. Findings demonstrate that many NCs are highly collaborative and predominantly embedded into interprofessional practice models. This study provides valuable insight into the diverse and often complex NC role and the way in which NC expertise and influence is deployed and integrated across a large local health district.
Interprofessional health care teams are increasingly utilized in health care organizations. Altho... more Interprofessional health care teams are increasingly utilized in health care organizations. Although there is support for their capacity to solve complex problems, there is also evidence that such teams are not always successful. In an effort to understand the capacity of interprofessional teams to innovate successfully, we investigate the role of cognitive diversity to establish whether and how knowledge differences lead to innovation. The aim of this study was to construct and investigate a model of team innovation predicted by cognitive diversity. In addition to investigating the direct impact of cognitive diversity in interprofessional health care teams, we develop a model incorporating mediated and moderated effects. In this study, we explore the role of debate as a mediating factor capable of explaining the impact of cognitive diversity on innovation. We further propose that the link between cognitive diversity and innovation through debate is contingent upon trans-specialist knowledge, knowledge shared by health care professionals, spanning specialist divides and enabling mutual understanding. The hypotheses were investigated using a cross-sectional, correlational design. Survey data received from 75 interprofessional teams employed in an acute care setting, representing a 36% response rate, were used to investigate our model. Analysis supports a significant relationship between cognitive diversity and debate, which is stronger when teams rate highly for trans-specialist knowledge. Results also support a positive relationship between debate and innovation and our full moderated mediated pathway. A range of strategies are indicated by our results to increase innovation in interprofessional teams. In particular, interventions such as interprofessional education and training, which have been shown to facilitate the development of shared language and meaning, are recommended by our findings.
Background Although interprofessional practice (IPP) offers the potential to enhance rural health... more Background Although interprofessional practice (IPP) offers the potential to enhance rural health services and provide support to rural clinicians, IPP may itself be problematic due to workforce limitations and service fragmentation. Differing socioeconomic and geographic characteristics of rural communities means that the way that IPP occurs in rural contexts will necessarily differ from that occurring in metropolitan contexts. The aim of this study was to investigate the factors contributing to effective IPP in rural contexts, to examine how IPP happens and to identify barriers and enablers. Methods Using Realistic Evaluation as a framework, semi-structured interviews were conducted with health professionals in a range of rural healthcare contexts in NSW, Australia. Independent thematic analysis was undertaken by individual research team members, which was then integrated through consensus to achieve a qualitative description of rural IPP practice. Results There was clear evidence...
Introduction: The aim of this project was to develop and implement an innovative nurse-led model ... more Introduction: The aim of this project was to develop and implement an innovative nurse-led model of care in the use and management of indwelling urinary catheters (IUC) utilising evidence-based 'bundle interventions' to reduce the incidence of catheter-associated urinary tract infections (CAUTI).
In Australia, as in many other developed countries, the current healthcare environment is charact... more In Australia, as in many other developed countries, the current healthcare environment is characterised by increasing differentiation and patient acuity, aging of patients and workforce, staff shortages and a varied professional skills mix, and this is particularly so in rural areas. Rural healthcare clinicians are confronted with a broad range of challenges in their daily practice. Within this context, the challenges faced by rural acute care clinicians were explored and innovative strategies suggested. This article reports the findings of a study that explored these challenges across disciplines in acute healthcare facilities in rural New South Wales (NSW), Australia. A mixed method approach, involving a consultative, participatory 3 stage data collection process was employed to engage with a range of healthcare clinicians from rural acute care facilities in NSW. Participants were invited to complete a survey, followed by focus group discussions and finally facilitated workshops u...
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Papers by Michelle Giles