Ways of Working in Nursing

Resource Package

NSW DEPARTMENT OF HEALTH

73 Miller Street

NORTH SYDNEY NSW 2060

Tel. (02) 9391 9000

Fax. (02) 9391 9101

TTY. (02) 9391 9900

www.health.nsw.gov.au

Produced by:

Nursing and Midwifery Office

NSW Department of Health

Tel. (02) 9816 0373

Fax. (02) 9816 0240

This work is copyright. It may be reproduced in whole or in part for study

training purposes subject to the inclusion of an acknowledgement of the source.

It may not be reproduced for commercial usage or sale. Reproduction for purposes

other than those indicated above requires written permission from the

NSW Department of Health.

© NSW Department of Health 2011

SHPN (NM) 110125

Further copies of this document can be downloaded from the

NSW Health website www.health.nsw.gov.au

June 2011

WOW Resource Package NSW HealtH PaGe i

Preface

The healthcare environment in which we work is constantly changing and evolving.

Healthcare professionals in hospitals today provide care for an increasing number

of acutely ill patients often with a number of chronic conditions and associated

co-morbidities. Consequently, acute care hospitals are busy places accommodating

sicker patients requiring more intensive treatment and nursing care. Advances in care

have also led to a reduced length of stay and a higher patient turnover as well as an

increase in the complexity of specialist and general medical and surgical nursing care.

At the same time we are experiencing changes in our nursing workforce. Different levels of nurses, an aging workforce

and an increasing number of novice practitioners compel nurses to constantly assess and reassess the way that work is

managed within their wards/units. Nurses today need to support and grow the workforce of the future by ensuring that

not only the “science” but also the “art” of nursing is supported through the way that work is organised. The initial

education we all receive provides a solid foundation on which we build further skills and knowledge through practical

application. This growth in practice is supported by colleagues willing to share their knowledge and skills.

The NSW Department of Health Nursing and Midwifery Office commenced the Ways of Working (WOW) Project in

2010 to explore the ways that nurses organise their clinical work and to develop a suitable framework and guidelines

to support a collaborative nursing model (CNM).

The Project Officer visited many sites and spoke to key stakeholders regarding the way that work is organised on wards

and units across NSW. Many ways of working were observed and discussed but it was identified that a more collaborative

approach would provide support for the development of the workforce into the future and enhance patient care by:

• More efficient use of nursing resources

• Improved communication between staff

• Improved support for staff new to an area of practice

• Improved capacity to effectively utilise different skills within the nursing team.

One of the strategies to assist nurses in working more collaboratively is the WOW Resource.

Nurses throughout the system are encouraged to actively consider their Ways of Working on a regular basis and

to be prepared to change these to better meet the needs of patients and also support a positive work environment.

This Resource recognises that Ways of Working can vary across and within health services and does not seek to suggest

a particular model but provides guidance for wards/units in reviewing their Way of Working and principles that can

guide the ward/unit in developing a collaborative nursing model.

Adjunct Professor Debra Thoms

Chief Nursing and Midwifery Officer

NSW

PaGe ii NSW HealtH WOW Resource Package

Contents

1. WOWResourcePackageOverview....................................................................................................1 Purpose .............................................................................................................................................................. 1

Objectives ........................................................................................................................................................... 1

Background ........................................................................................................................................................ 2

What is a collaborative nursing model? ............................................................................................................... 2

What does working in a CNM look like?.............................................................................................................. 5

2. ImplementingaCNM:GettingStarted...............................................................................................6 Evaluating your efforts ........................................................................................................................................ 7

Impact on nursing staff ....................................................................................................................................... 7

Impact on patient care ........................................................................................................................................ 8

3. ImplementingaCNM:Planning...........................................................................................................9 The implementation plan .................................................................................................................................... 9

Team member roles ............................................................................................................................................ 9

The NUM ............................................................................................................................................................ 9

TeamRoles.........................................................................................................................................12 Role of the RN ...................................................................................................................................................12

Role of the team leader ......................................................................................................................................13

Role of the EN ................................................................................................................................................... 14

Role of the AIN ..................................................................................................................................................15

4. ImplementingaCNM:Whathavewedone?....................................................................................16 Re-evaluating your efforts ................................................................................................................................. 16

Sustaining the work .......................................................................................................................................... 16

Appendices.................................................................................................................................................18Appendix 1: Glossary of terms ...................................................................................................................................... 18

Appendix 2: Useful reading and references – Further help ............................................................................................. 19

WOW Resource Package NSW HealtH PaGe 1

WOW Resource Package Overview

SECTION 1

Purpose

The WOW Resource has been developed to assist nurses1

in their efforts to introduce a collaborative nursing model

(CNM) into their ward/unit. It is envisaged that the NUM

will be coordinating the project and the WOW Resource

has been designed accordingly.

Objectives

The WOW Resource will:

1. Introduce the evidence for considering a CNM in your

ward/unit

2. Provide guidelines for implementing a CNM in your

ward/unit

3. Provide an audiovisual representation of nurses working

collaboratively

4. Provide tools that can be used to support and evaluate

a CNM.

1   Nurse will be used throughout this document.  

If you are considering introducing a collaborative midwifery  

model refer to midwifery models of care resources:   

http://www.health.nsw.gov.au/nursing/midwifery.asp#para_5.

Throughout the WOW Resource the reader is directed to:

Helpful tools

Internet sites

The WOW Film – Making it Real

Note: An internet connection is required to review

these element links of the package. Should you have

any difficulty with the links through this pdf resource,

please access the elements via the website at:

http://www.health.nsw.gov.au/nursing/projects/WOW.asp

To allow the reader to evaluate progress in

implementing a CNM he/she is provided with:

Reflection spaces

Regular checkpoints

Note: This package is designed as an electronic

resource and if printing is necessary it will take

considerable time and paper to print out in its entirety.

The WOW Resource is freely available through the

Department of Health website link at:

http://www.health.nsw.gov.au/nursing/projects/WOW.asp

PaGe 2 NSW HealtH WOW Resource Package

Background

There are a plethora of studies conducted on the

topic of the ways that nurses organise their clinical

care and it is beyond the scope of this package to

provide a comprehensive literature review.

Follow this link to a short summary of the different ways of working nurses use including:

– Patient allocation

– Task/functional

– Team/modular

– Primary nursing and case

management

Apart from the ways that nurses organise their clinical

care, there is considerable literature available regarding

components of a collaborative nursing model (CNM).

A comprehensive list of references and appropriate

web-based documents is provided at the end of the

WOW Resource and some will be discussed under

the appropriate sections of the package.

WhatisaCollaborativeNursingModel?

A collaborative nursing model is:

A model of care delivery based on collaboration

where an appropriately skilled nurse takes

responsibility for leading a team. The team can

accommodate different levels of nurses working

together with a shared goal, to meet the

comprehensive holistic care needs of a

group of patients.

The aim of a CNM is to utilise and develop the skills

of the nurses to the fullest extent by providing a

supportive learning environment. Clear guidelines

and communication and reporting structures are

required to enable the team to function efficiently.

WOW Resource Package NSW HealtH PaGe 3

Table 1

A Collaborative Nursing Model

n Allows nurses at different levels of training and expertise to perform their work more effectively

n Ensures improved supervision and support of nurses transitioning to practice and non permanent members of the nursing team by more senior staff

n Takes advantage of each member’s skills and level of experience – leading to professional development and enhancement of knowledge and skills of junior staff

n Reduces staff isolation and allows for a supportive working environment

n Can improve patient outcomes and satisfaction with care provision

n Allows individual team members to become familiar with all team members’ skills and capacities

n Assists continuity of patient care and support for part time nurses by assigning full-time and part-time nurses to the same team

n Reduces the risk of missed care (any aspect of required patient care that is omitted or significantly delayed)

n Allows for team members to share the burden of ‘difficult’ patients and a heavy workload leading to reduced nurse stress levels and manual handling injuries

n Can improve job satisfaction and lead to increased morale

n Leads to reduced complaints from other healthcare workers and visitors about their inability to seek up-to-date information about the condition of patients. There are more nurses involved in the one patient’s care and less ‘I don’t know. I am not looking after them’ responses for assistance

n Ensures that relief for escort duties and meal breaks is provided by from someone who ‘knows’ the patients

n Should make it easier to have medications and intravenous therapy checked if team members are working together in the same relative location negating the need to search the ward for assistance.

A CNM is based on the principles of teams and teamwork.

Teams are increasingly becoming the format for the way

of working for all healthcare professionals as the nature

of the clinical work is being dramatically transformed.

Simply a team is:

‘….a group of people who are mutually dependent

on one another to achieve a common goal’.

The most common team we hear about in healthcare is the

multidisciplinary team. A multidisciplinary team comprises

all the healthcare workers involved in a particular patient or

a group of patients’ care and might include a number of

doctors, allied health and nursing staff. On a shift to shift

basis there are a number of nurses providing direct patient

care and the emphasis of the WOW Resource is on this

nursing team.

The team can comprise whatever groups or levels of nurses

deemed appropriate by the ward/unit staff. It will depend

on the number of beds on the ward/unit and the level of

staffing and skill mix. A team should consist of a staff

member who takes on the team leader role. This would

commonly be a registered nurse (RN). The NUM will remain

in an overarching coordination role for the combined

nursing teams and the team leaders and NUM will meet

regularly throughout the shift to provide updates on

patient progress and nursing care requirements.

Some teams will be big and some will be small and as

highlighted there is no limit to how the team is configured

as long as the configuration meets the needs of the ward/

unit. There will be more information regarding the makeup

of the teams and how a CNM can be implemented

throughout the WOW Resource.

PaGe 4 NSW HealtH WOW Resource Package

Teamwork is different things to different people but the best analogy is to consider the teams in which you are involved outside of your nursing work. Most people will be involved with a sporting team or a social team such as a school P&C. For example a basketball team is made up of a number of players each having different roles, with the common goal to win the game or play the game to their best possible ability. It is an assumption that the members of the team function well together and teamwork is an important component of successful team functioning.

For the purpose of classifying the characteristics, goals

and actions of a CNM – A Model for Building Teamwork

(Biech, 2007) has been adapted to examine the attributes

of successful teamwork and the fundamental actions to

be taken to support nurses using collaborative nursing

models. The first four characteristics must be in place

from the beginning. The subsequent characteristics are

not in any order but are necessary for building effective

teams. See Table 2 for a summary and application of

A Model for Building Teamwork to a CNM.

Table 2 

A Model for Building Teamwork (adapted from Biech, 2007)

1 A clear visionn The ward/unit nurses must have a clear vision for the future and shared values displayed and

revisited frequently n Individual team goals must be agreed at the start of the shift to ensure that everyone is ‘pulling

in the one direction’.

2 Roles determined

n Team member’s roles are clearly defined and all team members know what their jobs are. The team will include different levels of nursing and the team leader role.

3 Open and clear communication

n The importance of open and clear communication cannot be stressed enough n Communication skills which are most important to a CNM are listening and providing constructive

feedback n Communication strategies must also be in place to keep the team informed, focused and moving

forward. This includes handover processes, convening team meetings (huddles) throughout the shift, effective report writing and up-to-date care plans.

4 Effective decision making

n Methods for effective decision making should be discussed and established n All nurses must be familiar with the Framework for Effective Nursing Practice Decisions (ANMC, 2007).

5 Balanced participation

n Ensure that everyone on the team is fully involved. ‘Without participation you don’t have a team, you have a group of bodies’.

6 Valued diversity

n All team members no matter what level or experiences are valued for the contributions that they bring to the team.

7 Managed conflict

n When people work together there is sure to be conflict. A process for managing conflict ensures that problems are not ‘swept under the rug’.

8 Positive atmosphere

n To be truly successful a team must have a climate of trust and openness. Everyone has to feel comfortable working with different nurses. Building trust on a team will be a challenge because it does not happen overnight and everyone perceives trustworthiness in different ways.

9 Cooperative relationships

n Occurs when there is a sense of belonging and a willingness to make things work for the good of the whole team.

10 Participative leadership

n Where team leaders share the responsibility and the glory, are supportive and fair, create a climate of trust and openness and are good coaches and teachers.

WOW Resource Package NSW HealtH PaGe 5

WhatdoesWorkinginaCNMLookLike?Ruth Hansten (2009) suggests that when ‘a bundle of best

bedside practices’ are integrated into practice they become

a shared standard resulting in optimum clinical outcomes.

The ten steps are applicable to the way an ideal shift might

Table 3 

Best Bedside Practices – shift steps – based on Hansten (2009)

1 Make assignments for care providers based on the patient’s 4 Ps n purpose, for being engaged in this episode of caren picture, of success including short and long term goalsn plan of caren part each person plays

and the skills and expertise of the nurses in the team.

2 Handover performed at the bedside. This doubles as an Introductory round where the team meets the patients and performs a quick assessment.

3 The team leader in consultation with the team thinks critically about the plan for the shift, prioritising the care and assigning utilising the 5 Rights of Delegation:n right taskn right circumstancesn right personn right direction and communicationn right evaluation

Plans are also made for meal breaks and team checkpoints

4 All team members pitch in and help each other with the work at hand. Priority is given to less experienced staff to allow them to gain competency in the skills required to care for patients during the shift.

5 Throughout the shift care plans are made in partnership with the patient/family.

6 The plan is communicated to all care providers via the team leader. Mechanisms are put in place to ensure that all team members and the NUM are kept up-to-date.

7 Participation in interdisciplinary rounding to share and evaluate progress.

8 Teamwork checkpoints convened at appropriate intervals to evaluate the care.

9 Reciprocal feedback and celebration checkpoint held near the end of the shift to determine whether the goals for the shift have been achieved.

10 Critical thinking and problem solving are used to plan for the next shift and the handover of care.

look when nurses are working in a CNM. The steps are

underpinned by most of the key components of The Model

of Teamwork which include; goal setting, communication,

delegation, support and coaching. The steps have been

modified for our NSW healthcare context and are

summarised in Table 3.

PaGe 6 NSW HealtH WOW Resource Package

SECTION 2

Implementing a CNM – Getting Started

On some wards/units a change to a CNM will be a big adjustment for the staff. The majority of nurses are used to working in a patient allocation model. They value the contribution working in a patient allocation model makes to the level of expert care they provide, although it has been identified that most newly graduated nurses and nurses new to the ward/unit or specialty appreciate a more team approach to care.

Consider your team’s readiness for change and the ways that you might approach this project.

Getting started is the most time consuming phase of

the project and involves lots of discussion and planning.

Encourage all of the nurses to be involved in the CNM

Project by using principles of Practice Development

methodology. Practice Development is gaining momentum

in NSW as clinicians come to appreciate the value of using

a systematic approach to delivering person-centred care

that encompasses the needs of patients, families and staff.

Person-centred care incorporates the Practice Development

principles of inclusiveness, respect for each other, valuing

individual contributions and connecting. If you require

further information on Practice Development please

follow this link.

Link to PD explanation on NaMO website

As highlighted in The Model for Teamwork, the first

place to start is to have a clear vision for the ward/unit.

Everyone needs to have the opportunity to contribute to

the shared vision. It is quite likely that common themes will

arise that indicate support and teamwork are values the

nurses would like to experience on the ward/unit. The vision

for the ward/unit must be displayed where all staff, visitors

and patients can see it. It should also be reviewed and

discussed regularly to ensure that it still represents the

collective values of the current staff.

If your ward/unit is participating in the Essentials of Care

(EOC) Project you should already have a clear vision but

you might like to revisit it before you consider discussing

a CNM. If you need more information regarding values

clarification please discuss with an EOC facilitator or click

on the link below.

Link to values clarification discussion and exercise on the NaMO PD site

You will require the engagement of all nurses on your

ward/unit in understanding that a CNM is the most

effective way for them to practice. The best way to

commence useful discussions is to provide them with the

evidence for change. Perhaps your nurses already work in

a collaborative way and would benefit from discussions on

some of the improvements they could make to that CNM.

To assist you in this process a WOW PowerPoint presentation

containing evidence and information supporting a CNM is

provided. The PowerPoint presentation is available at the

following link.

Link to Powerpoint presentation

Just because a group of people come together as a team,

it does not mean that they function effectively. Teams

develop over time and the project to support a CNM will

also take time to enact.

This would be an appropriate time to encourage staff to

view the WOW film – Making it Real.

Making it Real has been produced to show a nursing team

role modeling the bundle of best bedside practices and

how the shift might look when working in a CNM.

Link to Making it Real

WOW Resource Package NSW HealtH PaGe 7

Take the time to examine how the WOW on your ward/unit might be modified to reflect a CNM

As part of the discussions about the WOW on the ward/

unit it might be useful to conduct an exercise to address

any Claims Concerns and Issues the staff might have about

modifying or changing their current WOW to a CNM.

Information on how to conduct a Claims Concerns and

Issues exercise is found at the following link.

Link to conducting a claims, concerns and issues exercise

Evaluating Your Efforts

When introducing change it is always helpful to know what

difference you have made. You need to know where you

have been and where you are now. Therefore, evaluation

must be established at baseline before the implementation

of the new WOW and followed at regular intervals dependant

on the strategies used. Another reason to evaluate your

efforts is to ensure that the project is on track and moving

toward meeting the project objectives and that CNM

changes are identified and adjusted accordingly on

an ongoing basis:

Evaluation of a CNM at a ward/unit level could:n Identify the effectiveness of a CNM on patient and/or

quality outcomes n Identify the effectiveness of the nurses working within

the team in regard to teamwork and collaborationn Identify nursing and key stakeholder satisfaction with

the model by capturing and comparing:

– Ward unit workforce data

– Nursing satisfaction

– Key stakeholder satisfaction.n Capture the improvements as a result of implementation

of CN modelsn Identify if the CNM is sustained, becoming part of

the culture and the way things are done on a

day-to-day basis.

You will need to consider the evaluation strategies you will

use. The following are some ideas that you might consider.

Impact on nursing staff

Evaluation of the impact of the CNM on nursing staff

can be approached in two ways: the way that the nurse

collaborates and functions within the nursing team and

secondly, the satisfaction of the nurse with the CNM.

Nurse functioning within the team

The Nursing Teamwork Survey (NTS) was developed and

validated for use in the United States (Kalisch, Lee & Salas,

2010). The NTS measures the level of nursing teamwork in

acute care settings. Permission has been sought from the

authors to use this tool with minor demographic changes

required for the Australian context. Follow the links below:

Links to

– A copy of the short survey – A copy of the long survey

– Instructions for using the NTS

– An excel spreadsheet which can be used to enter and analyse the survey responses

Nurse satisfaction

Nurse satisfaction with the model of care is pivotal to

the success of the CNM. The Nursing Workplace

Satisfaction Questionnaire (NWSQ) was developed

specifically to evaluate job satisfaction with a new model

of team nursing within a large Sydney Teaching Hospital

(Fairbrother, Jones & Rivas, 2009). The tool is available

to use for the project with permission from the authors.

Follow the link below to find the tools required to conduct

this questionnaire.

Links to

– A copy of the questionnaire

– Instructions for using the NWSQ

– An excel spreadsheet which can be used to enter and analyse the questionnaire responses

If your ward/unit is involved in EOC the nurses may have

already completed the NWSQ or the Person Centred

Nursing Index (PCNI) and there will be no need to

re-evaluate. Some facilities have their own version of a staff

satisfaction survey but they may not be appropriate because

most do not contain questions about the organisation of

care and collaboration and teamwork which are essential

components of a CNM.

PaGe 8 NSW HealtH WOW Resource Package

Workforce data

Recruitment and retention are often used to identify a work

place or situation which has a positive or negative work

culture. Nurses are more likely to be attracted to a place or

remain on staff in a ward/unit where there is a positive work

environment and supportive team (Duddle & Boughton,

2007; Aiken, Clarke, Sloane, Lake & Cheney, 2008; Kalisch,

Weaver & Salas, 2009). A comparative study of team nursing

vs. allocation nursing was conducted in a large Sydney

Teaching Hospital. The intervention (team nursing) group

had a reduction in vacancy rate below that of the control

group (allocation) following the study by Fairbrother (2010).

ImpactonPatientCare

Teamwork is essential for patient safety and the provision of

quality care (NHS, 2007). Therefore, evaluation could

include nurse sensitive safety and quality outcomes. The

problem is that these outcomes are often difficult to define

as most patient outcomes are not wholly sensitive to the

nursing care provided. There has been considerable work

conducted in the USA which indicates a relationship

between nursing care and some specific indicators including

falls and pressure ulcers (Montalvo, 2007). Fowler, Hardy &

Howarth (2006) attempted to measure the effect of a

collaborative nursing model on clinical outcomes. There was

an increase in incident/accident reports which may be due

to an increased reporting rather than an actual increase.

Heinemann, et al (1996) measured the effect of a project

titled ‘Partners in patient care’ on quality indicators.

Indicators included falls, medication errors and intravenous

device infection rates and found that there was no significant

difference between the pilot wards which instituted a team

based model compared to the control ward.

Data can be sourced from existing systems including the

Incident Information Management System (IIMS), complaints

and compliments and nurse sensitive indicators and audits

deemed appropriate for the ward/unit. Ward/unit staff

could audit the nursing care activities which have meaning

for them in their particular context eg falls in aged care

or line infection in an ICU.

NB: You may have already done this as part of EOC.

Although the evidence is not conclusive it would be

worthwhile investigating whether there is a change

in patient outcomes after introducing a CNM on

your ward/unit.

In addition to the ward/unit nurses, it is always a good idea

to share the evaluation with key stakeholders including

management. This will assist by substantiating the time and

effort put into conducting the CNM project, demonstrating

the impact of your endeavours and hopefully to celebrate

you and your nurses’ success.

Project Checkpoint One

Is Practice Development methodology being used? 3Are regular meetings scheduled? 3Has a values clarification exercise been conducted? 3Do the ward/unit nurses have a clear vision guiding their work? 3Has the WOW PowerPoint Presentation been shown and discussed with all staff? 3Has a Claims, Concerns and Issues exercise been conducted? 3Have all staff seen the WOW Presentation – Making it Real? 3Has pre-evaluation been conducted? 3

If the above are in place, you should be able to progress to Implementing a CNM – Planning.

WOW Resource Package NSW HealtH PaGe 9

SECTION 3

Implementing a CNM – Planning

Again the planning and implementation phase must be a

collaborative effort; all ward/unit nurses should have a clear

understanding of the project. Do not jump in and expect

everyone to work in a CNM. Discussions will need to occur

around how and when. If a Claims Concerns and Issues

exercise has been conducted, revisit the questions which

were formulated and start by addressing them.

The big question is:

What has to be done to Start a CNM on the Ward/Unit?

This will help identify where the deficiencies lie and what

will need to be developed and what education supports

might be required. The next section of the WOW Resource

will provide assistance on aspects of a CNM which might

require development.

TheImplementationPlan

Develop a clear implementation plan and identify an

implementation timeframe. Health is an unpredictable

environment and there will be interruptions and hurdles

along the way. In times of increased workload project work

is often given reduced priority. If you find that there are more

critical priorities, just return to your plan and pick up where

you left off when things settle.

TeamMemberRolesFor a CNM to work effectively everyone needs to

be aware of each other’s roles in the team. This is

emphasised in A model for building teamwork:

‘Defining the team roles lets all team members

know what their jobs are and recognises individual

talent tapping into the expertise each member

brings to the team.’

It also recognises that regardless of how long we have

been in practice we can all be at different stages in our

professional development. The aim is to use the full

capacity of skills and knowledge available in the team.

The team will be constructed of different categories of

nurses including:n NUMn Registered nurses including: – newly registered nurses – agency and casualn Enrolled nurses including agency and casualn Assistants in nursing.

Nursing students should be included in the team providing

the opportunity to experience a CNM.

No matter where a nurse is working he/she must work

within their scope of practice at all times:

A profession’s scope of practice is the full spectrum

of roles, functions, responsibilities, activities and

decision making capacity which individuals within

the profession are educated, competent and

authorised to perform.

Delegation and Supervision for Nurses and Midwives (2007)

TheNUM

It is quite likely that the NUM is overseeing or coordinating

the CNM Project. Whether or not the NUM is the project

coordinator, the NUM will need to have a clear understanding

of the project and be fully involved in its implementation.

PAGE 10 NSW HEAltH WOW Resource Package

Think about how you can achieve this big task.

Try not to tackle it all on your own. Get support of some likeminded colleagues who are also implementing a CNM Project on their ward/unit and also seek out some champions within your ward/unit nursing team.

Consider the skills you may have gained through ‘take the lead’ and how they can be utilised in this project.

It might be possible to allocate some protected time for the CNE or a CNS to coordinate the project. Most of all, remember that the Practice Development principles of inclusiveness, respect for each other, valuing individual contributions and connecting will lead to greater acceptance of the new CNM.

Rostering for appropriate teams

One of the NUM’s major contributions will be rostering for

appropriate teams. The clinical area should be divided

geographically into distinct areas to reduce the amount of

unnecessary travel for the team members. Also take into

consideration the patient mix within these areas. If the

ward/unit has more acutely unwell patients within one area

then the team for that area might be bigger or they might

need to be allocated less patients. The patient load for a

team can be flexible dependent on the skill mix and the

acuity of the patients.

When preparing the rosters it will be important to divide

the roster into levels of expertise. One good way to

determine the level of expertise is to use the framework

proposed by Patricia Benner (1984) – ‘Novice to Expert’.

This framework is used widely and is acknowledged as an

effective way to classify nurse skill acquisition. Click on the

following link to a comprehensive overview of Benner’s

stages of clinical competence.

Link to comprehensive overview of Benner’s stages of clinical competence

Experience as it is used in this resource, does not necessarily

refer to the length of time in a position, rather it refers to a

very active process of refining and changing preconceived

theories, notions and ideas when confronted with actual

situations (Benner, 1984). Some nurses will progress to an

expert in a relatively short period of time while others may

spend ten years on a ward without being classified as expert.

In addition, you do not need to be an RN to be seen as an

experienced nurse.

A proficient/expert nurse must be allocated to each team to

fulfill the team leader role. It is important to be flexible in the

way the team is composed to allow for patient acuity, changes

to skill mix and to cover untoward situations such as sick

leave replacement. Perhaps there will be situations where

there is no proficient/expert RN to lead a team. It might be

necessary to alter team assignments and perhaps one

proficient/expert RN could be allocated to leading the ward/

unit team in its entirety. This might be the option of choice

for some smaller wards/units where the staffing allocation

is less. Sample schemata for the shift staffing have been

developed and can be found at the link below.

Link to

view sample schemata for team assignment

Communication

The NUM will need to organise an appropriate allocation

board which can be hung clearly at the nurses’ station so

that the nurses and other health professionals and visitors

are aware of the team looking after the patient and the

designated team leader.

Another necessary housekeeping duty will be to organise a

communication system for the staff. A comprehensive

and up-to-date care plan will help guide the team in the

goals and activities to be performed for the shift. Regular

team huddles are also a way for the team to communicate

their progress in the shift plan.

Managing conflict

It is not unusual to have conflict in the workplace and

appropriate systems are required to manage it. When

nurses work in a patient allocation model they often do not

have to work together closely with other nurses. In a CNM

team members need to have the skills to approach other

members who are ‘not pulling their weight’. In the event

that conflict occurs in teams there should be a standard

mechanism for dealing with it. The actions to be taken

WOW Resource Package NSW HealtH PaGe 11

when a team member’s behavior diverges from the

group values should have been discussed in the values

clarification exercise.

Check to see if your organisation has a policy for managing

conflict. You might need to draw staff’s attention to this

policy and why it is important in a CNM. One of the key

things to remember is that teams require time to develop.

Do not expect smooth sailing especially when a CNM is

first introduced. Follow the link below to a sample conflict

resolution flow chart which you might consider using if

you do not have one.

Link to view a conflict resolution flowchart

PaGe 12 NSW HealtH WOW Resource Package

TeamRoles

RoleoftheRN

Competencies for entry RN practice in Australia have been

developed. It has been identified through the WOW Project

that not all nursing team members are familiar with these

competencies and it would be beneficial for all staff to

review them in the CNM Project planning stage.

Link to The National Competency Standards for the Registered Nurse can be found on the following web page: http://www.nursingmidwiferyboard.gov.au/Codes-and-Guidelines.aspx

The RN competencies are grouped under four major

domains as set out in the table below. RNs are required

to meet these in order to register. First year RNs will take

time to consolidate these competencies and the specialty

skills required as a new member of staff on the ward/unit.

The first year RN is supported by the CNM to attain

these skills in a supportive learning environment.

Table 4 

The National Competency Standards for the RN – Domains

Professional practicen Practices in accordance with legislation affecting nursing practice and health care.n Practices within a professional and ethical nursing framework.

Critical thinking and analysisn Practices within an evidence-based framework.n Participates in ongoing professional development of self and others.

Provision and coordination of caren Conducts a comprehensive and systematic nursing assessment.n Plans nursing care in consultation with individuals/groups, significant others and the interdisciplinary health care team.n Provides comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes.n Evaluates progress towards expected individual/group health outcomes in consultation with individuals/groups, significant

others and interdisciplinary health care teams.

Collaboration and therapeutic practicen Establishes, maintains and appropriately concludes therapeutic relationships.n Collaborates with the interdisciplinary health care team to provide comprehensive nursing care.

WOW Resource Package NSW HealtH PaGe 13

There are at least five standards listed in the competency

document that have important significance to a CNM.

These standards have been extracted and highlighted

in Table 5.

Table 5

Standards CNM skills

2.7 Recognises the differences in accountability and responsibility between RNs, ENs and unlicensed care workers. Delegation

4.3 Contributes to the professional development of others. Clinical teaching and coachingSupervision

7.5 Delegates aspects of care to others according to their competence and scope of practice.

Clinical teaching and coaching:SupervisionDelegation

7.6 Provides effective and timely direction and supervision to ensure that delegated care is provided safely and accurately. Delegation

10.3 Facilitates coordination of care to achieve agreed health outcomes. Leadership and collaboration

Delegation, clinical teaching and coaching, supervision,

leadership and collaboration are areas which might need

development in the RNs who work on the ward/unit.

The skills will be required to work effectively as a team

member and as a team leader. To support RNs in

achieving skills in these areas you might direct your

nurses to educational opportunities through the LHD or

other education providers, eg The College of Nursing.

NaMO is also examining other resources to assist nurses

in the acquisition of these skills.

All roles within the team should have a position description

developed incorporating the specific responsibilities and

competencies required for the role.

Roleoftheteamleader

All teams have a designated team leader. Put simply:

The team leader coordinates a small group of nurses

to provide care for a group of patients for the shift.

All efforts should be made to roster a proficient/expert

RN in the team leader role. Some teams might be made

up of more than one RN and negotiation needs to occur

for the opportunity to take on the lead role for the shift

or to accept delegations as a member of the team.

There are specific skills and knowledge required by the

team leader and these are listed in Table 6.

PaGe 14 NSW HealtH WOW Resource Package

Table 6

The Team Leader

n Is familiar with the ward/unit routines

n Is knowledgeable and skilled in care provision for the specific patient group

n Is familiar with the condition and needs of all patients assigned for the team and assists in planning the individualised care for each patient

n Possesses critical decision- making skills

n Is a coach and clinical teacher, skilled in giving feedback

n Encourages a cooperative environment

n Delegates and assigns care according to scope of practice of team members

n Processes good communication skills and maintains clear communication among all team members including convening regular team huddles to communicate progress toward meeting the shift goals

n Is able to use his/her initiative.

As already highlighted, some of the attributes listed above

might not be skills that all RNs in the ward/unit currently

possess. RNs will need support to develop these important

attributes to enable them to function to their full scope and

practice as an RN.

RoleoftheEN

The enrolled nurse is an associate to the registered

nurse who demonstrates competence in the provision

of patient-centred care as specified by the registering

authority’s license to practice, educational preparation

and context of care.

(EN Competency Standards, 2002)

Somebackground

ENs comprise about 14% of the public sector nursing

workforce in NSW. With changes to workforce patterns

and models of care delivery there has been a renewed

interest in the EN position and ENs have been introduced

into a number of acute health care facilities. Recent changes

to National Law have resulted in no endorsement for

medicine administration by ENs as all ENs practicing in

Australia will as part of their education program; have

undertaken the relevant units of study enabling them to

administer medications safely (Nursing & Midwifery Board

Australia, 2010).

In July 2009 there was a major change to the education

model for ENs in NSW with a move to a pre-service course.

Previously, ENs were educated in an apprentice model;

whereby they were employed by their Area Health Service

for 12 months and attended lectures at Technical and

Further Education (TAFE) for 15 weeks. In the new model

EN education continues to be provided by TAFE NSW and

clinical experience is gained from clinical placements in a

variety of health facilities as well as in clinical simulation

laboratories. These changes bring NSW in line with other

Australian States and Territories and provide a more

supportive learning environment for the students as they

are no longer relied on as part of the nursing workforce.

WOW Resource Package NSW HealtH PaGe 15

In general, the role and functions of the enrolled nurse

are not clearly recognised by managers, RNs and ENs

themselves. This has led to the inconsistent application of

the role and functions of the ENs across the public health

sector. There are wards/units where ENs do not work to

their full scope of practice ie they are performing less

functions than the EN is legislated or trained to do and In

some instances ENs are working in advanced roles without

the necessary education and governance to support them.

Changing skill mix and workforce issues require the effective

utilisation of ENs as part of a CNM. Discussions must be

conducted regarding the roles and functions of the EN

within the team before the CNM Project begins. Ambiguity

in roles could lead to conflict between the team members

and this should be avoided if clear roles are established.

Link to The National Competency Standards for the Enrolled Nurse can be found on the following web page: http://www.nursingmidwiferyboard.gov.au/Codes-and-Guidelines.aspx

Link to Australian Nursing Federation Competency Standards for the Advanced Enrolled Nurse are found at: http://www.anf.org.au/pdf/Competency_Standards_Advanced_EN.pdf

RoleoftheAIN

NSW Health released a policy directive in 2010 which

supports the introduction of AINs into acute care units/wards.

The purpose of this policy is to facilitate uniform practices

for employing, expanding and developing the AIN role.

The policy outlines the education, qualification or

equivalency, scope of practice and skills recognition

processes to be applied to those in this employment

category. The policy also refers employers to assessment

processes for identifying the appropriate clinical

environments for AIN allocation in acute care.

Link to Visit the NSW Health Working with AINs Website http://www.health.nsw.gov.au/training/ain/workingwithains.asp for the following documents

n Health Service Implementation Package: Working with

Assistants in Nursing in the acute care environmentn Position Description for Assistant in Nursing –

Acute Caren Delegation and Supervision Guidelines.

Project Checkpoint Two

Is Practice Development methodology being used? 3Are regular meetings scheduled? 3Have the team roles been defined and are staff aware of them? 3Is the allocation board ready? 3Is there a team communication system? 3Has conflict resolution been discussed with staff? 3Are education supports in place? 3Is the implementation plan in place? 3Has a start date been established? – Go for it. 3

PAGE 16 NSW HEAltH WOW Resource Package

Once the CNM has been implemented on the ward/unit

it is time to evaluate what difference it has made, what

further changes need to occur and how you can go

about sustaining the CNM as everyday practice.

Re-evaluating your efforts

As highlighted earlier in the WOW Resource, it is very

important to re-evaluate your efforts to determine whether

the CNM project has resulted in positive outcomes for the

nurses and the patients. A CNM will not ‘fix’ everything

and there might be areas which require further discussion

and action which will not be directly related to the CNM.

Reevaluation should occur around six months to give the

nurses time to settle into the new CNM. The same strategies

should be used as for the initial evaluation so that the

results can be compared. After adding the new data for

the Nursing Teamwork Survey and Nursing Workforce

Satisfaction Survey you will be able to open Sheet 3

where you will find the data has been converted to graphs.

The graphs will compare the outcomes from the first and

second surveys.

You might like to compare your outcomes across the

different wards/units in the hospital. Or perhaps more

importantly showcase your achievements and share

your lessons learnt.

Sustaining the work

There are lots of changes in health and there are lots of

projects that commence and when the initial enthusiasm

dies down so does the action and everyone goes back to

the way it was. For a CNM, like any other initiative to be

sustained, it needs to become part of the culture or the

norm – the way things are done around here. This is

perhaps the hardest part of the project.

Not only have the process and outcome changed,

but the thinking and attitudes behind them are

fundamentally altered and the systems surrounding

them are transformed as well. In other words the

change has become an integrated or mainstream

way of working rather than something ‘added on’.

As a result, when you look at the process or outcome

one year from now or longer, you can see that at a

minimum it has not reverted to the old way or old

level of performance. Further, it has been able to

withstand challenge and variation; it has evolved

alongside other changes and perhaps has continued

to improve over time. Sustainability means holding

the gains and evolving as required – definitely not

going back.

NHS Institute for Innovation and Improvement (2005)

Link to www.institute.nhs.uk/sustainability

The Clinical Excellence Commission (CEC) suggests that

there are a number of key activities which can assist in

ensuring the sustainability of a project. As you read the

list you will realise that a lot of these activities have already

been instigated within the project if a Practice Development

approach is being used.

Implementing a CNM – What have we done?

SECTION 4

WOW Resource Package NSW HEAltH PAGE 17

Table 7

Activities to promote sustainability include:

n Adequate resources

n Building and sharing a clear vision

n Strong executive commitment and day-to-day leadership

n Embedding the change via policy, standard practice etc

n Identification and training of key messengers who communicate to others

n Formally assigning people to clear roles

n Providing adequate training and support

n Using data to highlight benefits of change

n Rewarding good practice

n Developing the organisation’s capacity

n Creating a learning organisation

n Anchoring change, so it becomes standard and accepted practice

(Clinical Excellence Commission, 2008)

Project Checkpoint Three

Is Practice Development methodology being used? 3Are regular meetings scheduled? 3Has re-evaluation occurred? 3Have changes to the CNM been made as required? 3Are sustaining strategies in place? 3Have you shared the lessons learnt from the project with others? 3

Then it is time to celebrate your achievements with all ward/unit nurses –

well done!!!

Link to http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0017/135701/spread-and-sustainability.pdf

If it all goes to plan, the CNM should be established on your ward/unit.

Take the time to reflect on the project and identify your key learnings.

What went well and what things would you do differently next time you introduce a change?

PaGe 18 NSW HealtH WOW Resource Package

Accountability: means that nurses must be prepared to

answer to others, such as health care consumers, their

nursing regulatory authority, employers and the public for

their decisions, actions, behaviours and the responsibilities

that are inherent in their roles. Accountability cannot be

delegated. The registered nurse who delegates an activity

to another person is accountable, not only for their

delegation decision, but also for monitoring the standard

of performance of the activity by the other person, and for

evaluating the outcomes of the delegation. Enrolled nurses

are accountable for making decisions about their own

practice and about what is within their own capacity and

scope of practice. See NMBA Decision-making Framework

for further information.

Allocation or assignment: involves asking another person

to care for one or more consumers on the assumption that

the required activities of consumer care are normally within

that person’s responsibility and scope of practice. Many of

the same factors regarding competence assessment and

supervision that are relevant to delegation also need to

be considered in relation to allocation/assignment.

Coaching: focuses on the skills and competencies required

for optimum performance to meet expectations. Coaching

approaches are predominantly facilitating in style using

challenging questions to enable the coachee to ‘grow’

from the experience.

Collaboration: is a process where two or more people

work together to realise shared goals. Collaborative

problem solving relies on sharing knowledge, learning,

and building consensus.

Competency: is the combination of skills, knowledge,

attitudes, values and abilities that underpin effective and/or

superior performance in a profession/occupational area.

Delegation: A delegation relationship exists when one

nurse delegates aspects of patient care, which they are

competent to perform and which they would normally

perform themselves, to a less experienced nurse.

The delegator retains accountability for the decision to

delegate and for monitoring outcomes. Delegation may be

either the: transfer of authority to a competent person to

perform a specific activity in a specific context or conferring

of authority to perform a specific activity in a specific

context on a competent person who does not have

autonomous authority to perform the activity.

Delegation is a two-way, multi-level activity, requiring a

rational decision-making and risk assessment process, and

the end point of delegation may come only after teaching

and competence assessment. To maintain a high standard

of care when delegating activities, the professional’s

responsibilities include: teaching, competence assessment,

providing guidance, assistance, support and clinically-

focussed supervision ensuring that the person to whom the

delegation is being made understands their accountability

and is willing to accept the delegation evaluation of

outcomes reflection on practice. See Decision Making

Framework.

Experience: as it is used in this resource, does not

necessarily refer to the length of time in a position, rather

it refers to a very active process of refining and changing

preconceived theories, notions and ideas when confronted

with actual situations (Benner, 1984). Some nurses will

progress to an expert in a relatively short period of time

while others may spend ten years on a ward without being

classified as expert. In addition, you do not need to be an

RN to be seen as an experienced nurse.

Responsibility: in nursing is the state of being answerable

for one’s performance according to the terms of reference

of the Code of Professional Conduct.

Supervision: in the CNM context is direct. Direct

supervision is when the supervisor is actually present and

personally observes, works with, guides and directs the

person who is being supervised.

APPENDIx 1

Glossary of terms

WOW Resource Package NSW HealtH PaGe 19

FurtherHelp

The following references which are available through CIAP

or assessable on the internet might be helpful in providing

some more information around CNMs. There are some

hospitals/wards/units in NSW where a CNM is working

well and you might like to seek out one of these areas

for support.

Teamwork

Biech, E. ed. (2008). The Pfeiffer Book of Successful Team-

building Tools, second edition. Pfeiffer: San Francisco.

Hansten R (2009) Field evidence for a bundle of best

bedside practices. The Health Care Manager 28(2) 11-116.

Kalisch, B.J., Weaver, S.J. & Salas, E. (2009). What does

nursing teamwork look like? A qualitative study.

Journal of Nursing Care Quality, Oct-Dec, 298-307.

Kalisch, B.J. & Lee, H. (2009). Nursing teamwork,

staff characteristics, work schedules and staffing.

Health Care Management Review, 34(4) 323-333.

Kalisch, B.J., Curley, M. & Stefanov, S. (2007).

An intervention to enhance nursing staff teamwork

and engagement. Journal of Nursing Administration,

37(2) 77-84.

Kalisch, B.J. & Begeny, S.M. (2005). Improving nursing

unit teamwork. Journal of Nursing Administration,

35(12) 550-556.

NHS Institute for Innovation and Improvement &

The Royal College of Nursing. (2007). Developing

and sustaining effective teams – Guides 1-8. Royal

College of Nursing: London.

DelegationandDecisionMaking

Nursing and Midwifery Board of Australia (2007).National

Framework for the Development of Decision-Making Tools

for Nursing and Midwifery Practice (2007). Available at:

http://www.anmc.org.au/userfiles/file/DMF%20

Framework%20Final+watermark.pdf

Nursing and Midwifery Board of Australia (2007).

Nursing Practice Decisions Summary Guide. Available at:

http://www.nursingmidwiferyboard.gov.au/Codes-and-

Guidelines.aspx

Hansten, R. & Washburn, M. (1996). Why don’t nurses

delegate? Journal of Nursing Administration, 26(12) 24-28.

Phoenix Bittner, N. & Gravlin, G. (2009). Critical thinking,

delegation and missed care in nursing practice.

Journal of Nursing Administration, 39(3) 142-146.

Standing, T.S. & Anthony, M.J. (2008). Delegation: what

it means to acute care nurses. Applied Nursing Research,

21(1) 8-14.

General

Benner, P. (1984). From novice to expert: excellence

and power in clinical nursing practice. Menlo Park:

Addison-Wesley.

NSW Health (2008) Profile of the nurses and midwives

workforce in NSW. Available at:

http://www.health.nsw.gov.au/pubs/2009/pdf/nursing_08.pdf

APPENDIx 2

Useful reading and references

PaGe 20 NSW HealtH WOW Resource Package

TeamRoles

Albani, R., Camp, C. & Culver, A. (2006) Celebrating

a partnership of enrolled nurse education and training

in NSW. (1986–2006). Sydney: TAFE NSW.

Nursing and Midwifery Board of Australia. National

Competency Standards for the Enrolled Nurse, (2002).

Available at: http://www.nursingmidwiferyboard.gov.au/

Codes-and-Guidelines.aspx

Nursing and Midwifery Board of Australia. National

Competency Standards for the Registered Nurse, (2006)

Available at: http://www.nursingmidwiferyboard.gov.au/

Codes-and-Guidelines.aspx

Australian Nursing Federation Competency Standards

for the Advanced Enrolled Nurse. Available at:

http://www.anf.org.au/pdf/Competency_Standards_

Advanced_EN.pdf

Blay, N. & Donoghue, J. (2007) Enrolled nurse skill

extension: metropolitan myth or rural reality?

Australian Journal of Advanced Nursing 24(3) 38-42.

Chaboyer, W., Wallis, M., Duffield, C., Courtney, M.,

Seaton, P., Holzhauser, K., Schluter, J. & Bost, N. (2008)

A comparison of activities undertaken by enrolled and

registered nurses on medical wards in Australia: an

observational study. International Journal of Nursing

Studies. 45 1274-1284.

Eagar, S., Cowin, L., Gregory, L. & Firtko, A. (2010)

Scope of practice conflict in nursing: a new war or just

the same battle? Contemporary Nurse 36(1-2) 86-95.

Gibson, T. & Heartfield, M. (2005) Australian enrolled

nurses have their say – Part 2: Scope of practice.

Contemporary Nurse 19(1-2) 126-136.

Milson-Hawke, S. & Higgins, I. (2004) The scope of

enrolled nurse practice: a grounded theory study.

Contemporary Nurse 17(1-2) 44-62.

NSW Health, 2010, PD 2010_059. Employment of

Assistants in Nursing (AIN) in NSW Health Acute Care.

Available at: http://www.health.nsw.gov.au/policies/

pd/2010/pdf/PD2010_059.pdf

NSW Health (2010) Assistants in Nursing working

in the acute care environment health service Health

Service Implementation Package. Available at:

http://www.health.nsw.gov.au/pubs/2010/pdf/ain_

acute_care.pdf

NSW Health Nursing and Midwifery Office (2009)

Enrolled Nurse – Critical Care Units Project Report.

Available at: http://www.health.nsw.gov.au/resources/

nursing/pdf/eval_report_april09_1.pdf

Queensland Health (2010) Enrolled Nurse (Advanced

Practice). Available at: http://www.health.qld.gov.au/

nursing/enrolled_advanced.asp

Sutherland-Fraser, S. (2007) PEPEN: Developing an

educational pathway for the enrolled nurse instrument

nurse in New South Wales. ACORN 20(1) 17-21.

Tranter, S., Westgarth, F. & White, G. (2010). The Scope

of Practice of the Haemodialysis Enrolled Nurse in NSW

Report. Available at http://www.health.nsw.gov.au/

resources/gmct/renal/pdf/moc_report_2009.pdf

WOW

Chavasse, J. (1981). From task assignment to patient

allocation a change evaluation. Journal of Advanced

Nursing, 6 137-145.

Cioffi, J. & Ferguson, L. (2009). Team nursing in acute

care settings; nurses’ experiences. Contemporary Nurse,

33(1) 2-12.

Fairbrother, G., Jones, A. & Rivas, K. (2010). Changing

model of nursing care from individual patient allocation

to team nursing in the acute inpatient environment.

Contemporary Nurse, 35(2) 202-220.

Fowler, J., Hardy, J. & Howarth, T. (2006). Trialing

collaborative nursing models of care: the impact of change.

Australian Journal of Advanced Nursing, 23(4) 40-46.

Gullick, J., Shepherd, M. & Ronald, T. (2004). The effects

of an organisational model on the standard of care.

Nursing Times, 100(10) 36-39.

Hayman, B., Wilkes, L. & Cioffi, J. (2008) Change process

during redesign of a model of nursing practice in a surgical

ward. Journal of Nursing Management, 16 257-265.

WOW Resource Package NSW HealtH PaGe 21

Makinen, A., Kivimaki, M., Elovanio, M. & Virtanen, M.

(2003). Organization of nursing care and stressful work

characteristics. Journal of Advanced Nursing, 43(2) 197-205.

Thomas, J. & Herrin, D. (2009). Care model transformation:

a necessity, not an option. Journal of Nursing Administration,

39(11) 453-456.

O’Connell, B., Duke, M., Bennett, P., Crawford, S. &

Korfiatis, V. (2006). Trials and tribulations of team-nursing.

Collegian, 13 (3) 11-17.

Tiederman, M.E., & Lockinland, S. (2004). Traditional

models of care delivery; what have we learned?

Journal of Nursing Administration, 34(6), 291-297.

Zinsmeister, LB. & Schafer, D. (2009) The exploration

of the lived experience of the graduate nurse making

the transition to registered nurse during the first year of

practice. Journal for Nurses in Staff Development.

25(1) 28-34.

EvaluationandProjectManagement

Aiken, LH., Clarke, SP., & Sloane, DM. (2002) Hospital

staffing, organization, and quality of care: cross-national

findings. Int J Qual Health Care 14:5-13.

Aiken, LH., Clarke, SP., Sloane, DM., Lake, E. & Cheney, T.

(2008) Effects of hospital care environment on patient

mortality and nurse outcomes. Journal of Nursing

Administration 38(5) 223-229.

Amos, M.A., Hu, J. & Herrick, C.A. (2005). The impact of

team building on communication and job satisfaction of

nursing staff. Journal for Nurses in Staff Development,

21(1) 10-16.

Bartram, T., Joiner, T. & Stanton, P. (2004) Factors affecting

the job stress and job satisfaction of Australian nurses:

implications for recruitment and retention. Contemporary

Nurse,17(3) 293-304.

Bureau of Health Information. (2010). Insights into care:

patients’ perspectives on NSW Public Hospitals. Available at:

http://www.bhi.nsw.gov.au/publications/iic-report

Cioffi, J. & Ferguson, L. (2009). Team nursing in acute care

settings; nurses’ experiences. Contemporary Nurse, 33(1) 2-12.

Clinical Excellence Commission (CEC) (2008). Enhancing

project spread and sustainability – A companion to the

‘Easy guide to clinical practice improvement. Sydney: CEC.

Available at: http://www.cec.health.nsw.gov.au/__data/

assets/pdf_file/0017/135701/spread-and-sustainability.pdf

Dougherty, M.B. & Larson, E.L. (2010). The Nurse-Nurse

Collaboration Scale. Journal of nursing Administration,

40(1) 17-25.

Duddle, M. & Boughton, M. Intraprofessional relations

in nursing. Journal of Advanced Nursing 59 (1) 29-37.

Fairbrother, G. (2010). Team-based versus patient

allocation systems in nursing: a comparative evaluation

and socio-cultural discussion. Unpublished thesis.

Fairbrother, G., Jones, A. & Rivas, K. (2009). Development

and validation of the Nursing Workplace Satisfaction

Questionnaire (NWSQ). Contemporary Nurse, 34(1) 10-18.

Kalisch, B.J., Lee, H. & Salas, E. (2010). The Development

and testing of the Nursing Teamwork Survey.

Nursing Research, 59(1) 42-50.

Kalisch, B.J (2009). Nurse and nurse assistant perceptions

of missed nursing care. Journal of Nursing Administration,

39(11) 485-493.

Heinemann, D., Lengacher, C.A., Vancott, M., Mabe,

P. & Swymer, S. (1996). Partners in patient care: measuring

the effects on patient satisfaction and other quality

indicators. Nursing Economics, 14(5) 276-285.

Makinen, A., Kivimaki, M., Elovainio., M, Virtanen,

M. & Bond, S. (2003). Organisation of nursing care as a

determinant of job satisfaction among hospital nurses.

Journal of Nursing Management, 11, 299-306.

NHS Institute for Innovation and Improvement, (2005)

Sustainability model and guide. Available at:

www.institute.nhs.uk/sustainability

Montalvo, I. (2007) The National Database of Nursing

Quality Indicators (NDNQI). The Online Journal of

Issues in Nursing 12(3) 1-11. Available at:

http://www.nursingworld.org/MainMenuCategories/

ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/

Volume122007/No3Sept07/NursingQualityIndicators.aspx

PaGe 22 NSW HealtH WOW Resource Package

Urden, L.D. & Roode, J.I. (1997). Work sampling: a decision

making tool for determining resource and work design.

Journal of Nursing Administration, 27(9) 34-41.

Vancott, M., Lengacher, C.A., Heinemann, D., Mabe, P.,

Swymer, S. & Bistritz, D. (1997). The use of focus groups to

assist in the design and implementation of a new nursing

practice model. Journal of Nursing Staff Development,

13(2) 83-87.

Walker, K., Donoghue, J. & Mitten-Lewis, S. (2007).

Measuring the impact of a team model of nursing

practice using work sampling. Australian Health Review,

13(1) p98-107.

Wu, M., Courtney, M. & Berger, G. (2000).

Models of nursing care: a comparative study of patient

satisfaction on two orthopaedic wards in Brisbane.

Australian Journal of Advanced Nursing, 17(4) 29-34.

PracticeDevelopment

Dewing J. (2008). Implications for nursing managers

from a systematic review of practice development.

Journal of Nursing Management, 2008, 16, 134–140.

Manley, K., McCormack, B. & Wilson, V. (editors) (2008)

International Practice Development in Nursing and

Healthcare. Blackwell.

McCormack, B. & McCance, TV. (2006). Development

of a framework for person-centred nursing. Journal of

Advanced Nursing 56(5): 472-9.

Pryor, J. & Buzio, A. (2010) Enhancing inpatient

rehabilitation through the engagement of patients

and nurses. Journal of Advanced Nursing 66(5),

978–987.

Tranter, S., Burns, T., Dobson, S., Graf, E., Ng, W. &

Martinez, Y. (2007). Practice Development in the

hospital haemodialysis unit: improving calcium and

phosphate management. Renal Society of Australasia

Journal 3(2) 61-64. Available at:

http://findarticles.com/p/articles/mi_6859/is_2_3/ai_

n28558883/?tag=content;col1

SHPN (NM) 110125