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Aim: To stimulate discussion and debate about the inclusion of vulnerable populations in primary research to inform practice change and improve health outcomes. Background: Current research practices to safeguard vulnerable people from potential harms related to power imbalances may in fact limit the generation of evidence‐based practice. Evaluation: The authors draw on their experience working and researching with a recognized group of vulnerable people, incarcerated pregnant women, to provide insight into the application of ethics in both research and clinical practice. In a novel approach, the ethical principles are presented in both contexts, articulating the synergies between them. Suggestions are presented for how individuals, managers and organizations may improve research opportunities for clinical practitioners and enhance the engagement of vulnerable people to contribute to meaningful practice and policy change. Key Issues: Ethical practice guidelines may limit the ability to create meaningful change for vulnerable populations, who need authentic system change to achieve good health outcomes. Conclusion: Inclusive research and practice are essential to ensuring a strengths‐based approach to healthcare and addressing health needs of the whole population. Health systems and models of care recognizing the diverse lives and health needs of the broader population demand practical, sustainable support from clinical managers. Implications for Nursing Management: Practical suggestions for clinical managers to support point of care research is provided, embedding vulnerable voices in policy, practice development and care provision. [ABSTRACT FROM AUTHOR]

Aims: This paper describes findings from a survey conducted in New Zealand exploring nurses' decision‐making about when to delay care, delegate care, hand care over or leave care undone. Unanticipated findings identified processes that nurses go through when deciding to take planned/unplanned leave when wards are constrained through budget limitations. Background: Missed/rationed care is increasingly the focus of attention in international studies, identifying a complex interplay of organisational, professional and personal factors affecting nurses' decision‐making when faced with limited organisational time, human and material resources to provide care. Methods: The survey presented nurses with Likert‐scale questions with option for free text comments. This paper reports on the commentaries about work–life balance. Results: Nurses described workload pressures that lead to rationing care affected them, and the long‐term effect on them as individuals. Nurses verbalized the difficulties and associated guilt about taking leaving and sick leave when wards were short staffed. Conclusions: Nurses consider how their absence will affect the workspace and their home first, considering the impact on themselves last. Implications: The findings may provide valuable insights for nurse managers in relation to workforce allocations and resources where acknowledgement of work–life balance is considered. [ABSTRACT FROM AUTHOR]

Background: Patients with complex chronic conditions experience fragmentation of care, unnecessary hospitalization and reduced quality of life, with an increased incidence of poor health outcomes. Aim(s): The aim of this paper was to explore how nurse navigators manage client care. This was achieved through an examination of narratives provided by the nurse navigator that evaluated their scope of practice. Method(s): All nurse navigators employed by Queensland Health were invited to participate in a study evaluating the effectiveness of the service. Eighty‐four self‐reported vignettes were thematically analysed to understand the work from the nurses' perspectives. Results: Two themes emerged from the vignettes. Theme 1, the layers of complexity, is comprised of three sub‐themes: the complex patient, the complex system and patient outcomes. Theme 2, professional attributes, has two sub‐themes: person‐centred care and clinical excellence. Conclusion: Navigators innovatively integrate services and address the fragmented nature of the health system. They apply expert clinical and social skills, through consistent and robust communication, to meet the needs of those with multiple chronic conditions. Implications for nursing management: Results provide insight into the new role, illuminating the work they achieve, despite system complexities. [ABSTRACT FROM AUTHOR]