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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. © 2012 Royal College of Nursing, Australia.

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.

Background Nurse leaders and managers work in a context of high pressure, uncertainty and rapid change, and face unprecedented challenges on a daily basis. Evaluation and Key Issues In the present paper, we reflect on the issues and challenges facing providers of management education for nursing, and consider these challenges in relationship to current trends and imperatives. Conclusions Collaborative approaches between educational and clinical settings are needed to ensure quality, relevant educational support for managers and leaders, and enhance curriculum integrity. Implications for Nursing Management There is a need for contemporaneous and relevant research to inform innovative models of collaborative education. © 2011 Blackwell Publishing Ltd.

Aims An interim evaluation was conducted on the professional development components of the New South Wales (NSW) Health 'take the lead' ('ttl') programme, an initiative aimed at enhancing nursing/midwifery unit managers' (N/MUM) skills. Background Previous research has highlighted the importance of strong nurse leaders, and shown that training programmes may assist in improving leadership skills. The NSW Nursing and Midwifery Office (NaMO) developed the 'ttl' programme for N/MUMs with the intention of improving hospital quality by strengthening nurse leadership. The programme had three strands, with the professional development modules a key component. Method Semi-structured interviews were conducted with 17 participants who had completed components of the 'ttl' programme. The interviews explored participants' perceptions of the programme, and suggestions for improvement. Qualitative analysis was conducted on the transcribed interviews. Results The N/MUMs reported feeling increasingly empowered, knowledgeable and supported as a result of attending the 'ttl' workshops. Conclusions The results suggest that the studied components of the 'ttl' programme may be effective in assisting nurse leaders gain new leadership skills and institute positive changes in the nursing work environment. Implications for Nursing Management Leadership programmes such as 'ttl' may provide an effective tool for improving N/MUM performance and role confidence. © 2011 Blackwell Publishing Ltd.

Background: The past few years has seen a growth in the number of new nursing rn of the profession provides an opportunity for the profession to debate and determine some consistency in position titles, responsibilities and areas ooles and position titles in many countries, including Australia. The Australian situation is unique due to the lack of professional engagement and debate in determining the purpose of some of these new positions. Often these new roles have been poorly defined, and there is no national consistency in nomenclature. The recent move to a national nursing registration system provides an opportunity for change. Method: Discursive paper. Results: New roles arise for a number of reasons, including a change in function or title for a pre-existing role or in response to the establishment a completely new position. However, the lack of a co-ordinated approach to introduction of new roles may lead to role proliferation (the rapid increase or spread of new positions and position titles), role blurring (where the boundaries of different positions become less distinct) and role confusion (where both nurses and health system clients experience a lack of clarity regarding the precise scope of roles). Conclusion: Professional nursing practice is defined by the impact on patient outcomes, not by position titles. As such, the potential positive impact of a new role on patient outcomes should be the primary consideration when considering its introduction. National regulatiof specialty practice. © 2011 Royal College of Nursing, Australia.

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 2004-2006. 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. Results: A nursing manager who was perceived to be a good leader, was visible, consulted with staff, provided praise and recognition and where flexible work schedules were available was found to distinguish the positive and negative wards. However, for a ward to be rated as positive overall, nurse leaders need to perform well on all the leadership items. Conclusion: An effective nursing unit manager who consults with staff and provides positive feedback and who is rated highly on a broad range of leadership items is instrumental in increasing job satisfaction and satisfaction with nursing. Relevance to clinical practice: Good nurse managers play an important role in staff retention and satisfaction. Improved retention will lead to savings for the organisation, which may be allocated to activities such as training and mentorship to assist nurse leaders in developing these critical leadership skills. Strategies also need to be put in place to ensure that nurse leaders receive adequate organisational support from nursing executives. © 2010 Blackwell Publishing Ltd.