This paper will explore the application of situation awareness in nursing to determine its suitab... more This paper will explore the application of situation awareness in nursing to determine its suitability as a framework to study how the decision to admit or not admit a person as an involuntary patient is made. The decision by a specially qualified nurse to admit or not admit a person to a mental health facility against their will remains a central component of contemporary mental health legislation. The decision has an impact on a person's autonomy and human rights. Conversely, the decision to admit may facilitate urgent assessment and treatment and ensure the safety of the individual and others. Research highlights that decision-making in this context is challenging due to the multiple information sources and often incomplete information available to the clinician. Situation awareness is a concept used to explain how practitioners identify, use and make meaning of a multitude of factors and elements relevant to their practice. Discussion paper. A search of terms related to situ...
, VERRALL C and BLACKMAN I. Nursing Inquiry 2015 Rounding, work intensification and new public ma... more , VERRALL C and BLACKMAN I. Nursing Inquiry 2015 Rounding, work intensification and new public management In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposes rounding as a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour. In this study, we argue that contemporary nursing is driven by the dictates of new public management (NPM), rather than patient-centred care. In making our arguments , we draw on research conducted in South Australia, specifically data on missed care, and illustrate how nurse managers in one public hospital have responded to this through mandating rounding. The study begins with a brief overview of rounding and then proceeds to outline the major tenets of NPM as it has rolled out in the Australian public health sector. Following an overview of the methodology used for this study, we detail the way nurses experience rounding at the ward level. In the final section, we argue that rounding as a NPM strategy reduces nursing to a time and task set of activities that impact negatively on the nurse–patient relationship.
Work intensification is assumed to incorporate either longer working hours or a quickening of the... more Work intensification is assumed to incorporate either longer working hours or a quickening of the pace or speed of work. In this paper, we argue that 'missed care' is a proxy for work intensification or work effort in nursing. Using Kalisch's MISSCARE survey tool, with modifications to suit the South Australian context we surveyed 354 registered and enrolled nurses between October and December 2012. Survey participants were recruited through the Australian Nursing and Midwifery Federation (SA Branch). The MISSCARE survey tool presents participants with a 5-point scale where 1 is never omitted care and 5 is always omitted care. Survey findings suggest that the tasks most often missed are ambulation of patients and mouth care. Tasks lest likely to be missed are blood glucose monitoring; hand washing; IV/central line care and providing PRN medication within 15 minutes. These findings suggest that when nurses are forced to ration care, priority is given to clinical tasks that will impact on immediate patient outcomes. In identifying the reasons why they missed care, nurses reported that while staffing often appeared adequate, sudden and unexpected rises in patient volume, heavy admissions and discharges, and inadequate numbers of staff or clerical support were key indicators of missed care. These unpredictable events resulted in an increase in work intensity and pace that was independent of extended working hours or overtime. We argue that one of the outcomes of work intensification is missed care.
Theintensificationofworkingtimeisamajorimpedimenttotherecruitmentandretentionofnursesworldwide.Th... more Theintensificationofworkingtimeisamajorimpedimenttotherecruitmentandretentionofnursesworldwide.Thisarticle examines the outcomes of negotiations between theAustralian NursingFederation(SouthAustralia),themajornursingunionand theSouthAustralianGovernment,withaparticularfocusonworking-time tools introduced to deintensify nurses' labour.The article comparestwostrategiesnegotiatedbytheunion:oneforpublicsector nursesworkinginacutehospitalswherethethroughputofpatientsis short term, the other in the community sector where most patients have chronic mental or physical conditions and their care requirements are long term. The outcomes of the two tools for reducing workintensificationreflectgenderedrelationstotime,butarecontradictoryintermsofcontroloverthelabourprocess.Thetoolused intheacutesectorishighlysuccessfulinreducingworkintensitybut shiftscontrolofthelabourprocesstomanagement.Thecommunitybasedtoolprovidesnurseswithcontroloverthelabourprocess,but islesssuccessfulinreducingworkintensificationorworkinghours.
AIM. The article reports the development of and data from a preliminary evaluation of a staffing ... more AIM. The article reports the development of and data from a preliminary evaluation of a staffing methodology equalization tool (SMET) designed for the South Australian Department of Health to equalize the workload of community mental health and community health nurses working within multidisciplinary teams. BACKGROUND. Shorter admissions, increasing patient acuity, and shortages of beds have intensified the work of community nurses. Existing workload models have limitations for community nursing settings. METHOD. A workload tool for community mental health and community nurses was developed in consultation with a reference group of nurses. A trial was conducted at six sites, and the tool was evaluated using qualitative and quantitative data. RESULTS. The tool increased transparency and equity of workloads in community teams and provided a means of reducing workload through demonstration of a capacity to take new clients, however, further work is required to factor the intensity of caseload into the tool. CONCLUSIONS. The tool needs further evaluation to determine its applicability to a range of clinical settings.
In this paper, we suggest a blueprint for combining bibliometrics and critical analysis as a way ... more In this paper, we suggest a blueprint for combining bibliometrics and critical analysis as a way to review published scientific works in nursing. This new approach is neither a systematic review nor meta-analysis. Instead, it is a way for researchers and clinicians to understand how and why current nursing knowledge developed as it did. Our approach will enable consumers and producers of nursing knowledge to recognize and take into account the social processes involved in the development, evaluation, and utilization of new nursing knowledge. We offer a rationale and a strategy for examining the socially-sanctioned actions by which nurse scientists signal to readers the boundaries of their thinking about a problem, the roots of their ideas, and the significance of their work. These actions -based on social processes of authority, credibility, and prestige -have bearing on the careers of nurse scientists and on the ways the knowledge they create enters into the everyday world of nurse clinicians and determines their actions at the bedside, as well as their opportunities for advancement.
This paper explores labour negotiations between nurses and government in the public health sector... more This paper explores labour negotiations between nurses and government in the public health sector in Australia between 1996 and 2005. During this period, industrial negotiations between nurses and government in the public health sector moved from centralized wage determinations to agreements made at the level of the enterprise through the Workplace Relations Act 1996. Simultaneously, public sector nurses reported increased work intensification, a result of new public management strategies. This led to the Australian Nursing Federation negotiating enterprise agreements that included the introduction of highly specified workload algorithms in an attempt to de-intensify nurses’ labour. The irony of this strategy is that these calculations and tools operate as both a human resource mechanism for maximizing productivity as well as an industrial relations tool for reducing work intensification.
This article examines missed care through dialogues examining the perceptions of nurses in regard... more This article examines missed care through dialogues examining the perceptions of nurses in regard to missed care occasions. Using a critical discourse analysis (CDA), the study explores the truth claims of participants who describe the challenges they encounter in daily attempts to deliver what they consider effective patient care. These are compared to the mandates of state and organisational policy prescribing clinical practice. The boundaries of tension that are expressed by nurses within the milieu of missed care are explored through in-depth interviews. CDA is interested in social organisation and the interplay of people's activities within it, the focus being on how they construe and internalise such activity. Nurses' perceptions and realities become central to any investigation because they are often organised by more than their own intentions or motivations, with influences such as professional standards or organisa-tional rules subconsciously locating their reality. Instead of identifying occasions of omitted care, nurses spoke of constraints related to budget, staffing, skill mix and mandated policy as constraining their ability to complete care activities. Factors emerged that suggest that missed care is the consequence of routinised and standar-dised practice, cited as cost effective care, at the expense of professional autonomy.
In this paper we examine the outcomes of the 2001, 2004, 2007 Enterprise Bargaining Agreements be... more In this paper we examine the outcomes of the 2001, 2004, 2007 Enterprise Bargaining Agreements between the Australian Nursing Federation (SA) and the South Australian Government with particular focus on union-based strategies for de-intensifying nurses' labour in the acute and community sectors. Consistent with the theoretical and empirical research on time the strategies employed in the acute sector reflect rational, linear, bureaucratic, logical and masculinist relations to time through the use of computerised time and task measures. Community sector solutions are characterised by cyclical, messy and highly relational feminised approaches to reducing work intensification. We argue that the outcomes of these two approaches are contradictory. The community-based solution of case management is less successful in reducing workload, but maintains worker control over the labour process, while in the acute sector, the highly Taylorist approach is successful in de-intensifying workload but at the cost of reduced control over the labour processes.
Chapter16 Progress in nursing: multidisciplinary and shared care When you finish this chapter you... more Chapter16 Progress in nursing: multidisciplinary and shared care When you finish this chapter you should be able to: identify the scope of practice, and range of settings and roles of registered and enrolled nurses briefly describe the features of the nursing career structure ...
... Lisa McKenna 18 The professionalisation of paramedics: the development of pre-hospital care 2... more ... Lisa McKenna 18 The professionalisation of paramedics: the development of pre-hospital care 201 Louise Reynolds and Madeleine ... Trobe University, Melbourne Sandra Dunn RN, PhD, FRCNA Professor, Graduate School for Health Practice, Charles Darwin University, Darwin ...
This paper will explore the application of situation awareness in nursing to determine its suitab... more This paper will explore the application of situation awareness in nursing to determine its suitability as a framework to study how the decision to admit or not admit a person as an involuntary patient is made. The decision by a specially qualified nurse to admit or not admit a person to a mental health facility against their will remains a central component of contemporary mental health legislation. The decision has an impact on a person's autonomy and human rights. Conversely, the decision to admit may facilitate urgent assessment and treatment and ensure the safety of the individual and others. Research highlights that decision-making in this context is challenging due to the multiple information sources and often incomplete information available to the clinician. Situation awareness is a concept used to explain how practitioners identify, use and make meaning of a multitude of factors and elements relevant to their practice. Discussion paper. A search of terms related to situ...
, VERRALL C and BLACKMAN I. Nursing Inquiry 2015 Rounding, work intensification and new public ma... more , VERRALL C and BLACKMAN I. Nursing Inquiry 2015 Rounding, work intensification and new public management In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposes rounding as a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour. In this study, we argue that contemporary nursing is driven by the dictates of new public management (NPM), rather than patient-centred care. In making our arguments , we draw on research conducted in South Australia, specifically data on missed care, and illustrate how nurse managers in one public hospital have responded to this through mandating rounding. The study begins with a brief overview of rounding and then proceeds to outline the major tenets of NPM as it has rolled out in the Australian public health sector. Following an overview of the methodology used for this study, we detail the way nurses experience rounding at the ward level. In the final section, we argue that rounding as a NPM strategy reduces nursing to a time and task set of activities that impact negatively on the nurse–patient relationship.
Work intensification is assumed to incorporate either longer working hours or a quickening of the... more Work intensification is assumed to incorporate either longer working hours or a quickening of the pace or speed of work. In this paper, we argue that 'missed care' is a proxy for work intensification or work effort in nursing. Using Kalisch's MISSCARE survey tool, with modifications to suit the South Australian context we surveyed 354 registered and enrolled nurses between October and December 2012. Survey participants were recruited through the Australian Nursing and Midwifery Federation (SA Branch). The MISSCARE survey tool presents participants with a 5-point scale where 1 is never omitted care and 5 is always omitted care. Survey findings suggest that the tasks most often missed are ambulation of patients and mouth care. Tasks lest likely to be missed are blood glucose monitoring; hand washing; IV/central line care and providing PRN medication within 15 minutes. These findings suggest that when nurses are forced to ration care, priority is given to clinical tasks that will impact on immediate patient outcomes. In identifying the reasons why they missed care, nurses reported that while staffing often appeared adequate, sudden and unexpected rises in patient volume, heavy admissions and discharges, and inadequate numbers of staff or clerical support were key indicators of missed care. These unpredictable events resulted in an increase in work intensity and pace that was independent of extended working hours or overtime. We argue that one of the outcomes of work intensification is missed care.
Theintensificationofworkingtimeisamajorimpedimenttotherecruitmentandretentionofnursesworldwide.Th... more Theintensificationofworkingtimeisamajorimpedimenttotherecruitmentandretentionofnursesworldwide.Thisarticle examines the outcomes of negotiations between theAustralian NursingFederation(SouthAustralia),themajornursingunionand theSouthAustralianGovernment,withaparticularfocusonworking-time tools introduced to deintensify nurses' labour.The article comparestwostrategiesnegotiatedbytheunion:oneforpublicsector nursesworkinginacutehospitalswherethethroughputofpatientsis short term, the other in the community sector where most patients have chronic mental or physical conditions and their care requirements are long term. The outcomes of the two tools for reducing workintensificationreflectgenderedrelationstotime,butarecontradictoryintermsofcontroloverthelabourprocess.Thetoolused intheacutesectorishighlysuccessfulinreducingworkintensitybut shiftscontrolofthelabourprocesstomanagement.Thecommunitybasedtoolprovidesnurseswithcontroloverthelabourprocess,but islesssuccessfulinreducingworkintensificationorworkinghours.
AIM. The article reports the development of and data from a preliminary evaluation of a staffing ... more AIM. The article reports the development of and data from a preliminary evaluation of a staffing methodology equalization tool (SMET) designed for the South Australian Department of Health to equalize the workload of community mental health and community health nurses working within multidisciplinary teams. BACKGROUND. Shorter admissions, increasing patient acuity, and shortages of beds have intensified the work of community nurses. Existing workload models have limitations for community nursing settings. METHOD. A workload tool for community mental health and community nurses was developed in consultation with a reference group of nurses. A trial was conducted at six sites, and the tool was evaluated using qualitative and quantitative data. RESULTS. The tool increased transparency and equity of workloads in community teams and provided a means of reducing workload through demonstration of a capacity to take new clients, however, further work is required to factor the intensity of caseload into the tool. CONCLUSIONS. The tool needs further evaluation to determine its applicability to a range of clinical settings.
In this paper, we suggest a blueprint for combining bibliometrics and critical analysis as a way ... more In this paper, we suggest a blueprint for combining bibliometrics and critical analysis as a way to review published scientific works in nursing. This new approach is neither a systematic review nor meta-analysis. Instead, it is a way for researchers and clinicians to understand how and why current nursing knowledge developed as it did. Our approach will enable consumers and producers of nursing knowledge to recognize and take into account the social processes involved in the development, evaluation, and utilization of new nursing knowledge. We offer a rationale and a strategy for examining the socially-sanctioned actions by which nurse scientists signal to readers the boundaries of their thinking about a problem, the roots of their ideas, and the significance of their work. These actions -based on social processes of authority, credibility, and prestige -have bearing on the careers of nurse scientists and on the ways the knowledge they create enters into the everyday world of nurse clinicians and determines their actions at the bedside, as well as their opportunities for advancement.
This paper explores labour negotiations between nurses and government in the public health sector... more This paper explores labour negotiations between nurses and government in the public health sector in Australia between 1996 and 2005. During this period, industrial negotiations between nurses and government in the public health sector moved from centralized wage determinations to agreements made at the level of the enterprise through the Workplace Relations Act 1996. Simultaneously, public sector nurses reported increased work intensification, a result of new public management strategies. This led to the Australian Nursing Federation negotiating enterprise agreements that included the introduction of highly specified workload algorithms in an attempt to de-intensify nurses’ labour. The irony of this strategy is that these calculations and tools operate as both a human resource mechanism for maximizing productivity as well as an industrial relations tool for reducing work intensification.
This article examines missed care through dialogues examining the perceptions of nurses in regard... more This article examines missed care through dialogues examining the perceptions of nurses in regard to missed care occasions. Using a critical discourse analysis (CDA), the study explores the truth claims of participants who describe the challenges they encounter in daily attempts to deliver what they consider effective patient care. These are compared to the mandates of state and organisational policy prescribing clinical practice. The boundaries of tension that are expressed by nurses within the milieu of missed care are explored through in-depth interviews. CDA is interested in social organisation and the interplay of people's activities within it, the focus being on how they construe and internalise such activity. Nurses' perceptions and realities become central to any investigation because they are often organised by more than their own intentions or motivations, with influences such as professional standards or organisa-tional rules subconsciously locating their reality. Instead of identifying occasions of omitted care, nurses spoke of constraints related to budget, staffing, skill mix and mandated policy as constraining their ability to complete care activities. Factors emerged that suggest that missed care is the consequence of routinised and standar-dised practice, cited as cost effective care, at the expense of professional autonomy.
In this paper we examine the outcomes of the 2001, 2004, 2007 Enterprise Bargaining Agreements be... more In this paper we examine the outcomes of the 2001, 2004, 2007 Enterprise Bargaining Agreements between the Australian Nursing Federation (SA) and the South Australian Government with particular focus on union-based strategies for de-intensifying nurses' labour in the acute and community sectors. Consistent with the theoretical and empirical research on time the strategies employed in the acute sector reflect rational, linear, bureaucratic, logical and masculinist relations to time through the use of computerised time and task measures. Community sector solutions are characterised by cyclical, messy and highly relational feminised approaches to reducing work intensification. We argue that the outcomes of these two approaches are contradictory. The community-based solution of case management is less successful in reducing workload, but maintains worker control over the labour process, while in the acute sector, the highly Taylorist approach is successful in de-intensifying workload but at the cost of reduced control over the labour processes.
Chapter16 Progress in nursing: multidisciplinary and shared care When you finish this chapter you... more Chapter16 Progress in nursing: multidisciplinary and shared care When you finish this chapter you should be able to: identify the scope of practice, and range of settings and roles of registered and enrolled nurses briefly describe the features of the nursing career structure ...
... Lisa McKenna 18 The professionalisation of paramedics: the development of pre-hospital care 2... more ... Lisa McKenna 18 The professionalisation of paramedics: the development of pre-hospital care 201 Louise Reynolds and Madeleine ... Trobe University, Melbourne Sandra Dunn RN, PhD, FRCNA Professor, Graduate School for Health Practice, Charles Darwin University, Darwin ...
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