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The aim of this project was to better understand nurse navigators work with children and families who are living with severe autism spectrum disorder to achieve improved health and wellbeing outcomes. Nurse navigators were introduced into the public health sector in Queensland in 2016, with 400 navigators currently working across 16 health services in diverse geographic and demographic settings. Narrative inquiry was used to explore one nurse navigator's journey working with children and families living with severe Autism. The challenges of rigid health systems to adapt to the requirements of children with special needs, particularly in relation to care in the emergency department and where interventional procedures are necessary were apparent. Nurse navigators can effectively co-ordinate the care of an extremely vulnerable patient cohort and provide essential advocacy in a health system that is rigid and lacking the flexibility to deal with individual needs.

Introduction: Nurse Navigators were introduced in Queensland, Australia, in 2016. Nurse Navigators coordinate person‐centred care, create partnerships, improve care coordination and outcomes and facilitate system improvement, independently of hospital or community models. They navigate across all aspects of hospital and social services, liaising, negotiating and connecting care as needed. People stay with Nurse Navigators for as long as required, though the intent is to transition them from high‐care needs to self‐management. Nurse Navigators are a working model in rural and remote areas of Queensland. Objective: To describe where the rural and remote Nurse Navigator position fits within the Rural Remote Nursing Generalist Framework and to define the depth and breadth of the rural and remote Nurse Navigator's scope of practice. Design: Using template analysis, data from focus groups and interviews were analysed against the domains of the recently released National Rural and Remote Nursing Generalist Framework. Navigators working in rural and remote areas across Queensland Health were invited to an interview (n = 4) or focus group (n = 9), conducted between October 2019 and August 2020. Findings: Rural and remote Nurse Navigators are proficient in all domains of the framework and actively champion for their patients, carers and the communities where they live and work. Discussion: This research demonstrates that rural and remote Nurse Navigators are a working model of advanced nursing practice, acting as 'champions' of The Framework. Conclusion: The Nurse Navigator model of care introduced to Queensland exemplifies proficient registered nurse practice to the full extent of their knowledge and skill. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of a co-designed intervention to reduce time spent on clinical documentation and increase time for direct patient care. Design: A pre- and post-test interventional study with multi-method evaluation, reported according to the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs guidelines. Methods: An intervention to decrease the burden of documentation was co-designed and implemented. Pre- and post-intervention data were collected via time and motion studies and the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. Documentation audits were conducted to assess intervention fidelity. Results: Twenty-six shifts were observed (13 pre-intervention, 13 post-intervention). Although the coronavirus pandemic contributed to decreases in staffing levels by 38% (from 118 to 73 staff), the number of task episodes completed increased post-intervention, across all shift patterns. Documentation took less time to complete postintervention when assessing time per episode. A mean increase of 201 episodes was observed on morning shifts, 78 on evening shifts and 309 on night shifts. There were small increases for time spent on direct patient care compared to pre-intervention but there was less time per episode. Results from the BurDoNsaM survey indicated that participants felt documentation took less time post-intervention. Documentation audits found completion improved as staff gained familiarity, but deteriorated when staffing levels were reduced. Conclusion: The intervention was able to reduce time spent completing documentation, increasing the time available for direct patient care. Implications for the profession and/or patient care: Completing clinical documentation is part of the daily work of nurses and midwives. Clinical documentation needs to accurately capture key information in a concise and streamlined manner to avoid unnecessary burdens and release time for direct patient care. Impact: • This study tested a co-designed intervention to address the burden of clinical documentation for nurses and midwives, • The intervention reduced time spent on clinical documentation and increased time for direct patient care, • This study could be replicated to reduce the burden of clinical documentation in other settings and benefit clinicians and patients by releasing more time for direct patient care. Reporting Method: The study is reported using the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs (TREND) guidelines. Patient or Public Contribution: The research project and intervention evaluated in this study were co-designed through a clinician-researcher collaboration. A research team that consisted of clinically based nurses and midwives and nurse scientists was formed to address the burden of clinical documentation. As the end-users of clinical documentation, the clinically based nurse and midwife co-investigators were involved in the design, conduct, interpretation of the data, and preparation of the manuscript. [ABSTRACT FROM AUTHOR]

Purpose: To explore levels of Navigator resilience, well‐being, burnout, and turnover intent. Design: A longitudinal, multi‐methods study concurrently collected quantitative and qualitative data over three years. Methods: A survey and Action Learning Groups. Findings: No statistically significant change in resilience, well‐being, burnout, or turnover intent. Supports, self‐care and leaving the position, were used to maintain well‐being. Conclusions: While quantitative measures did not change, qualitative data demonstrated how adaptive coping mechanisms maintain well‐being. Recommendations for nurses working in Navigator, or similar community/public health roles include work‐based programs targeting support, good leadership, governance systems including their impact on turnover intent. Clinical evidence: Job turnover intent can be used as a mechanism to monitor resilience and well‐being. [ABSTRACT FROM AUTHOR]