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Preface As an initiative of The University of Melbourne and partner universities, The University of Gadja Mada and Universitas Indonesia, a workshop of port researchers and senior practitioners was convened in Melbourne from 4th April to 6th April 2018. The researchers and practitioners have been brought together as a part of the Infrastructure policy and finance research being undertaken under the auspice of the Infrastructure Cluster Agenda of the Australia Indonesia Centre. This set of proceedings collates the presentations on the research day of the workshop conducted on the 4th April 2018. The researchers have been considering infrastructure and finance associated in improving port efficiency in situations where the port directly interfaces with a major city. The researchers have collectively critically reviewed the international literature, conducted surveys in Indonesia and Australia, conducted focus group meetings in Indonesia and Australia, conducted in‐depth interviews, participated in field trips to major port establishments and explored a range of case study projects in both countries. This workshop created the opportunity for researchers to seek opportunity to syntheses their collective research.

© 2018 by the authors. Extant literature lacks a systematic framework addressing the mechanisms of the alliance functional process and its impacts on management activities together with performance in delivering Engineering-procurement-construction (EPC) projects. This study quantitatively investigates the cause-effect relationships among these themes by building and validating a conceptual model of contractor-designer alliance in international hydropower EPC projects. With the support of data collected from an industry survey, the results reveal the key design problems, application of contractor-designer alliance, design management level and performance, which form a sound basis for design management emphasis in EPC activities, e.g., sufficiently considering sustainability of hydropower projects by incorporating environmental, social, and economic factors into designs. The path analysis indicates that the contractor-designer alliance can not only improve design performance by enhancing design management, but also directly promote design performance. This research has significant contributions to the body of knowledge by building interdisciplinary linkages between the areas of alliance, design management, and performance, theoretically demonstrating the mechanism of how interfirm cooperation functions to achieve superior design outcomes of hydropower EPC projects. Understanding these causal relationships will be crucial for contractors and designers to optimally allocate their complementary resources for seeking better design solutions in dealing with both technical issues and sustainability factors.

© 2017 International Council of Nurses Aim: To explore the primary healthcare needs and health service use of homeless men in inner Sydney. Background: 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. Methods: 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. Findings: 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. Discussion: 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. Conclusion: 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. Implications for Nursing, and Implications for Health Policy: 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.

© 2018 John Wiley & Sons Ltd Aim: To develop a critical thinking assessment tool for Australian undergraduate nurses. Background: Critical thinking is an important skill but difficult to assess in nursing practice. There are often many responses a nurse can make to a clinical problem or situation. Some responses are more correct than others and these decisions have an impact on a patient's care and safety. Differences in a response can relate to the depth of knowledge, experience and critical thinking ability of the individual nurse. Design: This study used a Delphi process to develop five clinical case studies together with the most appropriate clinical responses to 25 clinical questions. Method: The Delphi technique was undertaken using the Qualtrics survey tool between October 2016–January 2017. A panel of 13 nursing experts from various geographical locations in Australia participated in the study to review the case scenarios and answers to questions posed. Four rounds of participation were required to achieve a minimum of 80% agreement between participants. Participants were asked to rank answers for 25 multi-choice questions based on the correct nursing management of case scenarios provided and provide feedback as to the accuracy and relevance of the scenarios and answers. Results: Four rounds of Delphi questions were required to reach consensus on the correct wording and answers for the scenarios. Five case studies have been developed with nursing responses to patient management in rank order from most correct to least correct. Conclusion: Use of the tool should provide confidence that a nurse has met a certain level of critical thinking ability.

© 2018 John Wiley & Sons Ltd Aim: The aim of this research is to measure the impact that planned changes to nurse staffing and skill-mix have on patient, nurse, and organizational outcomes. Background: It has been highlighted that there are several design limitations in studies that explore the relationship between nurse staffing and patient, nurse and organizational outcomes; not least that the vast majority of research in this area emanates from studies that are predominantly observational in design. There are limited studies that measure nurse, patient, organizational, and economic outcomes using a longitudinal design following a planned change in nurse staffing. Design: The research will employ a longitudinal, multimethod approach to evaluate the impact that planned changes in nurse staffing and skill-mix have on wards in three pilot hospitals. Methods: Administrative data collection will take place on a shift-by-shift basis prospectively over a three-year period including the measurement of nursing sensitive outcomes: cross-sectional patient experience data and nurse outcomes (nursing work, job satisfaction, burnout, missed care) will be collected at intervals prior to, during and after the implementation of planned changes in nurse staffing and skill-mix. Data will be analysed using interrupted time-series models, adjusted for key hospital, ward and patient-level factors. An economic costing of the changes will further investigate the resources required for the intervention that can then be aggregated to a national level for future roll-out plans. Discussion: The study aims to provide evidence on the impact of planned changes to nurse staffing and skill-mix based on a systematic approach using a longitudinal design and to determine the extent to which the approach can be implemented at a national level.

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. Nurses and midwives (nurses) are the principle role models and health educators for the wider population. This study sought to identify the health-related behaviors of the nursing workforce of New South Wales (NSW), Australia, compared to contemporary recommendations for healthy living and to the Australian general population, matched by gender and age. An electronic cross-sectional survey delivered in 2014–2015 recruited 5041 nurses through the NSW Nurses and Midwives Association and professional networks. Validated health behavior measures were collected and compared to Australian National Health Survey data. Compared with younger nurses, older nurses reported greater adherence to fruit and vegetable guideline recommendations, but were more likely to be overweight or obese. Younger nurses (25–34 years) had the highest risk of harmful drinking. Compared with the Australian general population, slightly higher percentages of nurses met dietary recommendations and slightly fewer were obese, had central adiposity or smoked. Nurses had lower physical activity levels and higher levels of risky drinking across most gender and age groups. Many nurses have lifestyle health behaviors that place them at high risk for developing non-communicable diseases, sometimes at higher risk than the Australian population to whom they deliver health education. Health promotion strategies for nurses are urgently required.

© 2018 John Wiley & Sons Ltd Aims and objectives: To explore the impact of an initiative to add unregulated nursing support workers to wards in acute care hospitals. Background: Adding nursing support workers to existing nurse staffing may be one solution to reduce nursing workloads and improve outcomes. However, the effects of this addition on nurse, patient and system outcomes are not well documented. In one state of Australia, a trial deployment of nursing support workers to wards across the public health system provided opportunity for the exploration of their impact in a natural, real-world, environment. Design: Cross-sectional study. Methods: A sample of five wards where nursing support workers had been added matched to a group of five wards where there were no nursing support workers. Data were collected via patient survey (n = 141) and nurse survey (n = 154). Analysis was comparative with regression models constructed for the different ward types. Results: Nursing leadership, staffing and resources, and nurse experience were linked to outcomes on both ward types. Instability was a significant predictor of reduced quality of care and increased turnover intention on wards where support workers were added. Conclusion: Adding nursing support workers to ward staffing did not lead to improvements in patient care. Findings suggest that staffing a nursing ward is a complex activity and that a simple approach to staffing is unlikely to be successful. Future research should explore the process of implementation and the conditions under which this strategy is likely to be successful. Relevance to clinical practice: Ward-level factors are key in making appropriate staffing and skill mix choices to limit instability and to consequently avoid negative patient, staff and system outcomes. Consideration of the ward context, alongside effective delegation processes and integration into the care team are imperative when adding nursing support workers.

© 2018 John Wiley & Sons Ltd Aims: To investigate hypertension awareness, prevalence and treatment in nurses. Background: Nurses are the largest health workforce group, currently facing an ageing demographic and the risk of chronic disease such as hypertension. Little is known about hypertension in nurses despite the potential impact on work productivity. Methods: A cross-sectional online survey was distributed to nurses and midwives via the professional association and nursing directors. Questions were taken from published longitudinal health studies for blood pressure, hypertension and key sociodemographic and health factors. Results: The participants’ (n = 5,041) mean age was 47.99 (SD 11.46) years. The majority knew their blood pressure, more so if they were female, of higher body mass index and aged 45–64 years, but less so if they were smokers. Hypertension prevalence increased with age, peaking at the oldest ages and the majority were treated (anti-hypertensive medication), less so if aged <55 years. Many nurses treated for hypertension had poor blood pressure control, were most often aged 45–54 years and were smokers. Conclusions: Hypertension prevalence is less in nurses than in the general population, however, once diagnosed treatment is not optimized. Implications for Nursing Management: The potential impact of hypertension on older nurses’ work productivity justifies work-based support for risk reduction behaviours.

This paper discusses issues related to risk management, governance, and financing of public-private partnerships transportation projects. The allocation of risks and the requirements for ownership and equity provision were examined through analysis of a range of contracts. Lessons learnt from a series of Australia’s public-private partnerships transportation projects are also presented. The results showed that from the perspective of risk allocation, the arrangements were consistent among the projects. Some fluctuations, however, were observed in terms of equity provision. Initially, the contracts were developed based on the private sector taking full traffic demand risk and promising outcomes led to revenue sharing clauses being introduced. Consequently, overoptimistic demand forecasts resulted in the market rejecting the acceptance of traffic demand risk. The paper also presents the variation between the case study projects in terms of excess revenue sharing. The analysis also suggests that, in arranging these types of projects, traffic demand issue would be prominent and should be given major concern since it would be closely related with the revenue of the projects, which in turn would affect the equity of the projects.

Bridges play an important role in economic development and bring important social benefits. The development of innovative bridge monitoring techniques will enable road authorities to optimize operational and maintenance activities for bridges. However, monitoring the dynamic behavior of a bridge requires a comprehensive understanding of the interaction between the bridge and traffic loading which has not been fully achieved so far. In the present study, an integrated bridge health monitoring framework is developed using advanced 3D Finite Element modeling in conjunction with Weight-in-motion (WIM) technology and interferometric radar sensors (IBIS-S). The realistic traffic loads imposed on the bridge will be obtained through calibration and validation of traffic loading prediction model using real-time bridge dynamic behavior captured by IBIS-S and WIM data. Using the Merlynston Creek Bridge in Melbourne, Australia as a case study, it demonstrated that the proposed bridge monitoring framework can both efficiently and accurately capture the real-time dynamic behavior of the bridge under traffic loading as well as the dynamic characteristics of the bridge. The outcomes from this research could potentially enhance the durability of bridges which is an important component of the sustainability of transport infrastructure.

Much attention has gone towards ‘up‐front’ processes when delivering infrastructure public–private partnerships (PPPs), but less on how to best govern after the ribbon is cut and the infrastructure built. This paper identifies the primary contractual and institutional governance challenges arising in the medium to long term of PPP concession contracts and explores these governance challenges through interviews with high‐level PPP industry insiders. The paper presents new findings on the importance of good public administration for successful PPP operation, and on the interesting evolution of medium‐ to long‐term governance arrangements. It finds that although industry interviewees agreed PPP governance had improved significantly, they had differing views on how capable Australian states were in governing PPP and how well this task was being undertaken. They were also split on the adequacy of transparency; half feeling satisfied with the current contractual arrangements, and the other half favouring greater transparency, because commercial confidentiality had alienated the public.

Purpose The purpose of this paper is to investigate the outcomes of Indonesian power projects as representative projects of Asian emerging economies that were procured via public-private partnerships (PPPs) and traditional public sector procurement. Power generation infrastructure delivery in emerging economies frequently seeks private participation via PPPs as one of the key mechanisms to attract private finance. Undertaking a comparative benchmark study of the outcomes of Indonesian power projects provides an opportunity to explore the historic evidence as to whether PPPs deliver better outcomes than traditional public procurement in emerging economies. Design/methodology/approach This paper reports on a study of the performance of 56 Indonesian power projects procured via either PPPs or traditional procurement. First, it focusses on project time and cost outcomes of power plant facility during construction and commissioning and then extends this comparison to consider the operating availability of power plants during their first two years of operation. Findings The results indicate that PPP projects had superior time and operating availability to those procured traditionally whereas no significant differences were identified in the cost performance between PPPs and traditionally procured projects. These findings highlight the importance of adopting policies that are supported by broader sources of international financiers and high quality power plant developers. Research limitations/implications The quality performance analyses of projects (based on equivalent available factor indices) were limited to the power plants in the Java-Bali region where the majority of projects are large scale power plants. Practical implications This study provides an empirical basis for governments of emerging economies to select the most beneficial procurement strategy for power plant projects. It highlights the importance of selecting experienced providers and to adopt policies tha

In large public infrastructure projects, political risks due to the power imbalance between central and delivery agencies are often overlooked or underestimated. The primary motive of the delivery agency in distorting information for political gains should be deemed a risk that creates uncertainty for large projects planning the outcome. In this study, seven large infrastructure projects in the state of Victoria, Australia are examined through a workshop involving key stakeholders who had played active roles in these projects. The findings revealed that power asymmetry between central and delivery agencies exist and would lead to optimism bias, which in turn creates uncertainty and risk of overpromising in the business case. Power asymmetry exist in large infrastructure projects because the central agencies usually only have the responsibility but not the skill set needed to measure the robustness of the business case. These types of political risks are difficult to quantify and even detect. This paper recommends a few managerial strategies that have referential values and/or can be used to mitigate and circumvent this risk.

© 2017 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd. Aims: 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. Background: 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. Design: Two-phase audit. Methods: 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). Findings: 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. Conclusions: 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.

© 2017 John Wiley & Sons Ltd 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.

© 2017, © Emerald Publishing Limited. 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.

© 2017 John Wiley & Sons Ltd Aim: The aim of this study was to develop an assessment tool to measure the critical thinking ability of nurses. Background: As an increasing number of complex patients are admitted to hospitals, the importance of nurses recognizing changes in health status and picking up on deterioration is more important. To detect early signs of complication requires critical thinking skills. Registered Nurses are expected to commence their clinical careers with the necessary critical thinking skills to ensure safe nursing practice. Currently, there is no published tool to assess critical thinking skills which is context specific to Australian nurses. Design: A modified Delphi study will be used for the project. Methods: This study will develop a series of unfolding case scenarios using national health data with multiple-choice questions to assess critical thinking. Face validity of the scenarios will be determined by an expert reference group of clinical and academic nurses. A Delphi study will determine the answers to scenario questions. Panel members will be expert clinicians and educators from two states in Australia. Rasch analysis of the questionnaire will assess validity and reliability of the tool. Funding for the study and Research Ethics Committee approval were obtained in March and November 2016, respectively. Discussion: Patient outcomes and safety are directly linked to nurses’ critical thinking skills. This study will develop an assessment tool to provide a standardized method of measuring nurses’ critical thinking skills across Australia. This will provide healthcare providers with greater confidence in the critical thinking level of graduate Registered Nurses.

© 2017 International Council of Nurses Aim: To identify the practice patterns of the Australian registered nurse workforce according to position title and to map these disparate titles across all jurisdictions of the country. Introduction: Effective nursing workforce planning can contribute to improved patient care and increased effectiveness and efficiency of healthcare systems. Background: The prevailing approach to nursing workforce planning focuses on number of nursing staff needed in relation to the number of patients. The level of expertise and skill mix of registered nurses as a variable in workforce planning is rarely considered. Methods: A national cross-sectional electronic survey of registered nurses in Australia was conducted using the validated Advanced Practice Role Delineation tool developed from the Strong Model of Advanced Practice. The study involved a sample of 5599 registered nurses. Results: Sixty-six nursing position titles nationally were mapped using cluster analysis technique and gave rise to seven clusters of equivalent Australian jurisdictional nursing position titles and practice profiles. Discussion: Effective workforce policy and planning is reliant upon access to reliable evidence. This research is an international first in that it has provided comprehensive knowledge of the clinical level and practice profiles of a national nursing workforce. Implications for nursing policy: Effective, patient-centred workforce planning must consider both the numerical and expertise mix of a nursing workforce. This research provides Australian health service and policy planners with evidence-base knowledge of the nursing workforce. Internationally, this research establishes a platform from which to develop validated tools and established processes to support replication of this research.

© 2016 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd. Aim: To examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as ‘mental health days’. Background: The occupational stress associated with the nursing profession is increasingly recognized and nurse/midwifery absenteeism is a significant global problem. Taking a ‘mental health day’ as sickness absence is a common phenomenon in Australian health care. No previous studies have empirically explored the characteristics of nurses and midwives using such sickness absence. Design: Online cross-sectional survey. Methods: Survey comprising validated tools and questions on workplace and health characteristics was distributed to nurses and midwives in New South Wales, Australia, between May 2014 - February 2015. Sample characteristics were reported using descriptive statistics. Factors independently predictive of ‘mental health day’ reportage were determined using logistic regression. Results: Fifty-four percentage of the n = 5041 nurse and midwife respondents took ‘mental health days’. Those affected were significantly more likely to be at younger ages, working shifts with less time sitting at work; to report workplace abuse and plans to leave; having been admitted to hospital in previous 12 months; to be current smokers; to report mental health problems, accomplishing less due to emotional problems and current psychotropic medication use. Conclusion: Specific characteristics of nurses and midwives who report taking ‘mental health day’ sickness absence offer healthcare administrators and managers opportunities for early identification and intervention with workplace measures and support frameworks to promote well-being, health promotion and safety.

© 2016 John Wiley & Sons Ltd 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.

© 2017 John Wiley & Sons Ltd Aims and objectives: To determine whether there was an association between intra-hospital transfers and adverse outcomes. Background: 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. Design: Retrospective cross sectional design using hospital administrative data. Method: 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. Results: 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. Conclusion: 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. Relevance to clinical practice: Nurses must consider the potential cost of intrahospital transfers on patients, length of stay and bed availability.

© 2017 Elsevier Ltd Objectives To investigate the influence of work-related characteristics, health, health behaviours and symptoms on ingestible biologically-based Complementary and Alternative Medicine (CAM) use within the Australian nursing and midwifery workforce. Background CAM use is widespread worldwide, but there is little research into nurses’ and midwives’ personal use of ingestible CAM in Australia. Methods An online survey in 2014–15 used validated instruments and items to examine use of ingestible biologically-based CAM (herbs, foods and vitamins, minerals, amino acids, enzymes and other supplements), and the health and work-related characteristics of 5041 nurses and midwives recruited through the New South Wales Nurses and Midwives Association and professional networks. Results A small proportion of nurses (6.8%) identified as personal CAM users. Most were female, older, worked in foundational roles (frontline Registered and Enrolled Nurses/Midwives) and used one CAM, most commonly a multivitamin, although Vitamin D, Fish Oil, Calcium and Glucosamine ± Chondroitin were also common. In comparison to non-users, CAM users were less likely to take sick days or indulge in risky drinking, but more likely to be symptomatic (with stiff joints, bodily/joint pain, severe tiredness, allergies, indigestion/heartburn), diagnosed with osteoarthritis and to adhere to healthy diet recommendations. Conclusions Findings showed a credible pattern of front line workers with physically demanding workloads that impact their physical health and are linked to frequent symptoms, using CAM treatments and achieving some success in being able to continue working and avoid sickness absence. Further investigation is warranted to protect and maintain the health of the nursing and midwifery workforce.

Objectives The aim of this study was to assess the impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes using administrative health data. Design Logistic regression modelling was used with linked administrative health data to examine the association between seven adverse patient outcomes and use of assistants in nursing utilising a pre-test/post-test design. Outcomes included were in-hospital 30-day mortality, failure to rescue, urinary tract infection, pressure injury, pneumonia, sepsis and falls with injury. Setting Eleven acute care metropolitan hospitals in Western Australia. Sample Patients were retained in the dataset if they spent any time on a medical, surgical or rehabilitation ward during their admission and excluded if they only spent time on other ward types, as the outcomes used in this study are only validated for these patient populations. There were 256,302 patient records in the total sample with 125,762 in the pre-test period (2006–2007) and 130,540 in the post-test period (2009–2010). Results The results showed three significant increases in observed to expected adverse outcomes on the assistant in nursing wards (failure to rescue, urinary tract infection, falls with injury), with one significant decrease (mortality). On the non-assistant in nursing wards there was one significant decrease (pneumonia) in the observed to expected adverse outcomes and one significant increase (falls with injury). Post-test analysis showed that spending time on assistant in nursing wards was a significant predictor for urinary tract infection and pneumonia. For every 10% of extra time patients spent on assistant in nursing wards they had a 1% increase in the odds of developing a urinary tract infection and a 2% increase in the odds of developing pneumonia. Conclusion The results suggest that the introduction of assistants in nursing into ward staffing in an additive role should be done under a protocol which cl

Aim To assess the impact of adding nursing support workers to ward staffing. Background 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. Design A mixed longitudinal and cross-sectional design using administrative data sets and prospective data from a sample of wards. Methods 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. Discussion The study aims to provide evidence about the impact of adding nursing support workers to ward staffing for patients, staff and the work environment.

Purpose Unlike manufacturing and research and developments, major infrastructure projects rarely emphasize or drive their objectives on the basis of innovation. This is in part because of a risk-averse culture, yet conceivably great benefits and opportunities are being lost because of this behavior. Design/methodology/approach The case for focusing on innovation in infrastructure projects is that the reasons driving innovation are not fully understood, and this impedes the effective implementation of lessons learned for the numerous innovative projects into practice more generally. The purpose of this study was to discover how innovation is produced and captured in major infrastructure projects in Australia and to understand how innovation may be replicated for future projects through refinement of design, project management, finance and procurement. Findings Engineering and project managers may find this paper helpful to better understand how innovation might happen in infrastructure projects and what different forms it can take. Originality/value The findings of this study demonstrate that people and culture drive consistent successful infrastructure outcomes more than simply the development of new products or processes.

Tsinghua University News, 20 April 2016