Office of the Chief Nursing Officerwww.health.qld.gov.au/ocno

Final reportSeptember 2008

Review of the Nurse Unit Manager Role

Review of the Nurse Unit Manager RoleFinal reportSeptember 2008

Queensland Health Office of the Chief Nursing Officer Review of the Nurse Unit Manager Role Final report September 2008 ISBN 978-1-921447-47-1

©The State of Queensland 2008.

Copyright protects this publication. However the Queensland Government has no objection to this material being reproduced with acknowledgement, except for commercial purposes.

Permission to reproduce for commercial purposes should be sought from: Senior Administration Officer Policy Branch Queensland Health PO Box 48 Brisbane 4001

Preferred citation: Queensland Government 2008 Review of the Nurse Unit Manager Role Final report September 2008 Queensland Government, Brisbane

An electronic version of this ddocument is available at: www.health.qld.gov.au/ocno/documents/numreport.pdf

2

Terms and abbreviations used 3

Executive summary 4

Key issues 6

Recommendations 7

Introducton 12

Methodology 16

Review findings 18

Discussion summary 24

Conclusion 30

Appendicies 31

Acknowledgements

I would like to acknowledge Sue Hawes, Principle Project Manager and Helena Harrison, Project Officer from the ‘Take the Lead’ project from the Nursing and Midwifery Office New South Wales Health for their support, guidance and assistance with formatting the Consultation process and sharing their work.

Undertaking this project involved many Nurse Unit Managers and ‘acting’ Nurse Unit Managers and I wish to acknowledge their contribution to this project and the time spent meeting me.

Kaye Hewson

Project Officer

Office of the Chief Nursing Officer

Contents

3

ACIRRT Australian Centre for Industrial Relations, Research and Training

ADON Assistant Director of Nursing

CN Clinical Nurse

DON Director of Nursing

EB6 Enterprise Bargaining Six

FAMMIS Financial and Materials Management Information System

HR Human Resources

HPPD Hours Per Patient Day

NIBBIG Nurses Interest Based Bargaining Implementation Group. The negotiating team made up of nursing representatives, Queensland Nursing Officials and Human resource branch who coordinate the implementation of EB6

NUM Nurse Unit Manager

OCNO Office of the Chief Nursing Officer

QH Queensland Health

PAD Performance Appraisal & Development

QNU Queensland Nurses Union

Terms and abbreviations used

4

This report details the findings from the Nurse Unit Manager (NUM) Project undertaken and resourced by the Office of the Chief Nursing Officer (OCNO) from December 2007 - May 2008. The project was jointly sponsored by OCNO and the Nursing Interest Based Bargaining Implementation Group (NIBBIG)1.

The impetus for the review of the NUM role arose from the recognition that the scope of the NUM role has increased significantly over the last ten years. The resulting workload significantly impacts on recruitment and retention, succession planning and job satisfaction. This is evident by The Workforce Recruitment and Retention Report (NIBBIG 2007)2 where one of the key deliverables described as a project should be undertaken to redefine the scope of the NUM role. The report also suggested strategies be identified to support the position in order to provide career success.

The Australian Centre for Industrial Relations, Research and Training3 identified 15 factors referred to as ‘Drivers for Excellence’ for workplaces. The above mentioned report recommended that the project indicators for success should include these drivers when reviewing the NUM role. This review sets out to explore the workload and work value of the NUM role in line with the previous reports recommendations.

Information and data from NUM consultation groups and surveys provided information consistent with the factors ACIRRT (2003) identified for success in work places. This report identifies their perceptions on the scope of the current role, and the barriers and enablers to performing the role to their own satisfaction which subsequently impacts on the success of the clinical unit and organisation as a whole. Identification of desirable skills and attributes they regarded as necessary to the role confirmed limited opportunity for learning and development inhibit the full potential of this middle management nursing leadership role.

The NUMs consultation groups identified a number of key issues in their role. There was a strong desire to return the role to primarily focusing on clinical leadership. The definition of clinical leadership provided by the NUMs was ‘driving standards of nursing care and improving patient outcomes’. However NUMs reported feeling role conflict. Core values of wanting to make a difference to patient care included developing an effective team with the right nursing skill mix. The increase in administration work to maintain the service limits the effectiveness of the NUM to maintain a clinical presence.

From the discussion groups in engaging with the NUMs, the general feeling was one of low morale, and most felt they were crisis managing from day to day with little opportunity to plan, implement or evaluate their patient service and or their own performance. From the sample NUM population surveyed (n= 154), 37% of NUMs stated they would like to leave the position. 98% felt they did not have the time to complete their workload adequately.

1IBB: nursing. Nursing Interest Based Bargaining Implementation Group. http://qheps.health.qld.gov.au/ebb/ibb/Nursing/nibbig.htm

2Queensland Health & Queensland Nurses Union. 2007. Nursing Interest Based Bargaining (NIBB) Project Report. Workforce Recruitment and Retention. http://qheps.health.qld.gov.au/eb6/ibb/Nursing/Recruitment%20and%20Retention%20Final%20Report%2004.07.07.pdf

3ACCIRRT. 2003. Simply the Best Workplaces in Australia, Working Paper 88, University of Sydney.

Executive summary

5

The aim of this report is to highlight the vital role of the NUM with the aim of strengthening the enablers that support the work of the Nursing and Midwifery Unit Managers across Queensland. The author suggests that this can be achieved by:

• providing clarity around the responsibilities and accountabilities of the NUM role; • enhancing the capabilities of staff in the NUM role; • improving the potential for work life balance within the role of the NUM

This document provides recommendations for NIBBIG to address key issues in the correct role and refocus the NUM role on clinical leadership which is both an effective application, provides job satisfaction and is sustainable.

There have been similar bodies of work across several jurisdictions interstate with the same key themes and issues highlighted for the NUM role. The recommendations are consistent with these findings.

6

The following issues were identified by NUMs who took part in the consultation groups across the state. These are discussed in more detail in the report:

• NUMs workload is perceived to be inequitable to other Grade 7 positions (Clinical Nurse Consultants, Nurse Managers, and Nurse Educators) in terms of responsibilities and accountabilities and workload.

• The core responsibility and accountabilities of the NUM role are no longer clear to individuals within the roles.

• NUMs want to maintain a clinical focus in order to add value to the role that they play across Queensland Health to improve care and access for patients in the areas they are employed in. The burden of administration tasks means they are finding it increasingly difficult to maintain this presence.

• Lack of access to information technology in clinical area inhibits mobility of NUM to maintain clinical presence.

• Disparity of upper management styles (nursing and broader) across the state vary from little contact to total control resulting in NUMs being held to account with no ability to make decisions or strategically influence.

• Where there is no strong professional relationship with the line manager NUMs self report no coaching to develop advanced critical thinking and problem solving skills.

• Insufficient collaboration in decision making between financial managers and NUMs in budget allocation when NUMS are held accountable for insufficient resources. This is a reactive management rather than proactive management style.

• In the absence of targeted training for NUMs Queensland Health current data systems are not fully utilised by this group as a tool for efficiency in the management of people, patients and resources.

• There is no current consistent orientation into the role. • Development into the role currently occurs via an adhoc process with no structured process

of assessing and developing the skills and competencies for individuals to reach their full potential in the role.

• No formal medium exists to access suitably trained mentors within Queensland Health to grow future nurse leaders and assist the NUM to face the challenges of contemporary nursing practice and patient care.

• NUMs self report feeling professionally isolated from their peers through recurrent health system restructuring and organisation.

• There is no defined succession planning mechanism to enable Clinical Nurses to access suitable courses and professional development activities to develop into future NUM roles.

• The role is not perceived to be attractive to Clinical Nurses to ‘act into’ the position as they are often financially disadvantaged when they are not working shift work.

• NUMs self report that they carry a heavy workload. This is a disincentive to succession planning and individual NUMs feel powerless to address this.

Key issues

7

Funding will need to be sourced for the implementation of the following recommendations addressing the key issues identified above:

Recommendation 1:That Queensland Health addresses the inequity of the work level standards of the Grade 7 roles by:

• Reviewing the Nursing and Midwifery Classification Structure HR Policy B74 that define the core purpose of the position.

• Reviewing the descriptors for work span, impact of the position, the diversity, integration and complexity of work performed, autonomy and typical responsibilities found at the level are agreed upon by all stakeholders.

• Defining and developing a career pathway for each of the four streams of Grade 7: clinical, management, education and research across the state.

Recommendation 2: 2.0 That the role of the Nurse Unit Manager is evaluated through a Job evaluation System5

which is a method of assessing the work value of the role to address the inequity in current workloads between NUMs. The work value will then determine a difference within the NUM classification level. Work level differentiation is determined by the following variables:

• Full time Equivalent numbers versus headcount of total number of staff. • Staff mix • Reporting structures • Support networks and infrastructures • Hours of operation of service • Ward unit geography (within organisation or isolated) • Ward Unit complexity, acuity of patient presentation and unpredictability.

Bands within the grade 7 are assigned according to allocated level of responsibility. Three bandswithin the NUM role should reflect the degree of responsibility and work value of individual NUMs contribute to resolving the inequity within the role that currently exists.

2.1 That job classification analysis provides definitions of skills, competencies and formal qualifications to fulfil the contemporary role of the NUM.

2.2 That the core business and responsibilities of the NUM is defined and agreed upon and form a platform upon which all role descriptions are based in the future.

Recommendations for NUM role

4Queensland Health. 2008. Nursing and Midwifery Classification Structure HR Policy B7 http://www.health.qld.gov.au/hrpolicies/resourcing/b_7.pdf

5Mercer Human Resource Group. 2000. Nurse Unit Manager Classification Review

8

Recommendation 3:That by reviewing the role of the NUM it is recognised that this will have an impact on other grades within the Nursing and Midwifery Classification Structure and that further consideration should be given to developing career pathways. Within the classification structure other jurisdictions such as Victoria and the Australian Capitol Territory (ACT) have established roles for the four streams of clinical, management, education and research which articulate into career pathways through the defined stream. For example the Associate NUM role aligns with the NUM role, the Clinical Nurse Specialist aligns with the Clinical Nurse Consultant.

Risk to QH of non implementation of recommendations 1-3: • Current difficulties of recruiting into NUM role and retention of experienced staff in

NUM roles will reach critical levels. • Attrition rates from NUM role will continue as other Grade 7 roles appear more attractive

in comparison.

Recommendation 4:That the core responsibility of the NUM role will be recognised and supported as clinical leadership. This is enabled by the following:

• NUM needs to support evolving models of care by being accessible, visible and leading the clinical coordination of clinical care including nursing, medical and allied health members to providing the service and good patient outcomes.

• The NUMs role will be standardised across the state to not be included into the nursing Hours Per Patient Day (HPPD). The Business Planning Framework (BPF) methodology has enabled this recommendation for some time and the revised BPF will further support this recommendation. Clinical leadership is enabled by flexibility within the role to drive the service model and workforce mix.

• NUM receive (formal and informal) constructive supervision as part of a NUMs PAD by their line manger via coaching to confidently problem solve and think critically.

Risk to QH of not implementing Recommendation 4 • That if not utilised effectively the potential of this highly skilled nurse leader to affect

good patient outcomes and quality of service is not realised when evidence based practice supports this recommendation.

Recommendation 5:That identification of administration tasks that do not require the specialist skill set of the NUM are assigned to an administration officer. It is expected that the above mentioned recommendations will result in resource allocation to support nurse leaders with administration tasks.

9

Recommendation 6: – Identify key issuesThat the NUMs clinical leadership role is supported by mobile technological support for greater access to information management allowing them to analyse and support decision making whilst maintaining a clinical presence.

• Handheld Blackberry or devices or similar service the needs of the Rural and remote NUM to align their phone and internet access with their on call needs.

• Notebooks (CV5) or similar for larger metropolitan and regional organisations.

As supported by the E- Nursing strategy (QH 2008, Goal 3) as a recommendation for effective practice.

Risk to QH of not implementing recommendations 5 and 6: • That Nurse Unit Managers continue to be overwhelmed by administration tasks which do

not require the unique skill set of the NUM. • That unavailability of Information technology (IT) that supports contemporary

nurse practices adds to inefficient work practices, data collection and duplication of information.

Recommendation 7:That preparation for aspiring NUMs is standardised and consistently applied across the organisation by:

• Provision of a comprehensive orientation and ongoing training in QH systems as a prerequisite to commencing work as a NUM. The recommended time period is supported by the BPF as up to 11 days.

• A Manager Orientation/Resource Guide developed to assist orientation into the role. Helpful information encompassing human resource, financial (includes targeted training in BPF); material and clinical governance and information management would be included.

• Every new NUM linked to a formal mentoring program for a period of six months to develop leadership and people management skills. Development of a Mentoring Framework across Queensland with supported access through IT technology to reach rural and remote NUMS should be included.

• Access to the Clinicians Development Education Service (CDES) (partnership between University of Queensland, Med-E-Serv and QH) for CNs and NUMs to acquire the essential skill set for the NUM role available on line. Financial support and backfill to complete and build up a portfolio of credits to achieve baseline knowledge of management and business processes through to post graduate qualifications needs to be forthcoming.

10

• Registered Nurses Grade 5 and 6 identified through Performance Assessment and Development Process (PAD) as interested in relieving the NUM for periods of leave or secondment being given the opportunity for work shadowing and formal training into the role of the NUM.

Risk to QH of not implementing recommendation 7:

• That the lack of succession planning and support to develop into the NUM role is a disincentive for recruitment.

• Sustainability of leadership development for the professional of the future not realised. • That NUMs will continue to have only base qualifications of Registered Nurse training or

Bachelor of Nursing for role which requires further development and enhanced skill set to maximise potential for effective patient outcomes and service delivery.

The following recommendations do not need additional funding and can be implemented at a local level immediately

Recommendation 8:That formal network of discussion groups are enabled by the organisation so NUMS can meet regularly for peer supervision, support and problem solving for example. NUMS working in isolation videoconference monthly with regional centre NUMs and are supported to visit regional or metropolitan facilities twice a year.

Risk to QH of not implementing recommendation 8 • That NUMs remain in isolation professionally inhibiting their ability to develop support

networks and act collectively to provide proactive leadership for the health care facility.

Recommendation 9:That the NUMs are able to:

• Work self managed hours for work life balance and family friendly rostering including eight or nine day fortnights.

• Enter into job share work practices. This is especially attractive for NUMs nearing the end of nursing careers, returning from maternity leave and with family and study commitments.

11

Risk to QH of not implementing recommendation 9: • That the inflexibility of work practices makes a significant impact on work life

balance of NUM and creates disincentive to recruit into NUM role. • Not catering to mature age nurses needs increases the skill drain from the nursing

workforce.

This recommendation has implications for EB7

Recommendation 10:Single on call allowance should be changed to an hourly rate to recognise the on call workload of Rural and Remote NUMs.

Risk to QH of not implementing recommendation 10: That non-recognition of on call workload acts as a disincentive to recruitment and retention of Rural and Remote NUMs.

This report maps out the breadth of the role of the NUM across Queensland. This is articulated through consultation with NUMs from rural, regional and metropolitan health service locations. Currently there is great variability in the role.

From the consultation process, returning the core function to clinical leadership is essential.

The recommendations are a way forward to enable the role to achieve this focus in the future.

12

2.1 Background to projectThis report details the outcomes of a six month project conducted and funded by the Office of the Chief Nursing Officer reviewing the role of the NUM (December 2007 – May 2008) to make recommendations on the future scope of the role.

The Nurses (Queensland Health) Certified Agreement (EB6) identified the development and implementation of a nursing recruitment strategy as one of the five priority areas. One of the key deliverable from the Workforce Recruitment and Retention Report 2007 was for QH to undertake a project to define the current scope of the NUM role and provide strategies to support the position and ensure career success.

The Nursing and Midwifery Classification Structure (HR Policy B7)4 defines the Nurse Unit Manager as a registered nurse who is accountable at an advanced practice level for the coordination of clinical practice and the provision of human and material resources in a specific patient/client area and who:

• has ability to lead a nursing team in multi disciplinary environment utilising the principles of contemporary human, material and financial resource management;

• demonstrates sound knowledge of contemporary nursing practice and theory; • participates directly or indirectly in the delivery of clinical care to groups/individuals/

groups; • ensures clinical practice is evidence based to facilitate positive patient outcomes; and • has sound knowledge and the ability to apply relevant legislation, guidelines and standards.’

The Workforce Recruitment and Retention Report2 (NIBBIG 2007) identifies the NUM role as at risk of work overload and loss of clarity around the perceived expectation of the role by the NUMS themselves and others in the organisation. Consequently, in comparison to other Grade 7 roles which have more defined areas of responsibility, it now appears a less attractive role for career progression.

This subsequent report recognises the impact the NUM role has on the workforce and organisation. Recent changes in the health care service have resulted in a demand for efficiency and patient outcomes. In response to this, restructuring has resulted in expanded areas of responsibility for the NUM requiring a broad range of skills and an increased work load. It is

2Queensland Health & Queensland Nurses Union.2007. Nursing Interest Based Bargaining (NIBB) Project Report. Workforce Recruitment and Retention. http://qheps.health.qld.gov.au/eb6/ibb/Nursing/Recruitment%20and%20Retention%20Final%20Report%2004.07.07.pdf

4Queensland Health. 2008. Nursing and Midwifery Classification Structure HR Policy B7. http://www.health.qld.goau/hrpolicies/resourcing/b_7.pdf

2.0 Introduction

13

widely acknowledged Queensland Health2 is experiencing difficulty in recruiting and retaining NUMs when their job satisfaction is reported as very low. Clinical nurses do not embrace the opportunity to ‘act up’ in the role for professional development due to their perception of the role.

The ACIRRT (2003)3 identified 15 factors which they called ‘Drivers for Successful Workplaces’. The Recruitment and Retention Project Report (2007)2 recommended the 15 key drivers of successful workplaces should be included as project indicators for the NUM review. These include:

• Quality working relationships – how people relate to each other in the workplace including friends, colleague and co-workers in supporting each other and getting the job done.

• Workplace leadership – the focus being on leadership and energy not management and administration.

• Having a say – participating in decision making which affects workplace business. • Clear values – people share the same values and attitude to work. • Pay and conditions – level of income and working environment needs are met to a standard

acceptable to workers. • Getting feedback – always knowing what people think of each other, their contribution and

success to the workplace. Individual performance feedback. • Learning – being able to learn on the job, acquire skills and knowledge and develop an

understanding of the whole work place. • Autonomy and uniqueness – the capacity of the organisation to tolerate and encourage

individuals to be creative and different which develop excellent workplaces. • Sense of ownership and identity – being seen to be different through and special, taking

pride in workplace, knowing your business well. • Passion – having energy and commitment to the workplace. • Having fun – workplaces which are psychologically secure so people may relax with each

other and enjoy social interaction. • Community and connections – being part of the local community, feeling as though the

workplace is a valuable to the community.

2Queensland Health & Queensland Nurses Union. 2007. Nursing Interest Based Bargaining (NIBB) Project Report. Workforce Recruitment and Retention. http://qheps.health.qld.gov.au/eb6/ibb/Nursing/Recruitment%20and%20Retention%20Final%20Report%2004.07.07.pdf

3ACCIRRT. 2003. Simply the Best Workplaces in Australia, Working Paper 88, University of Sydney.

14

The Queensland Health report ‘better workplaces’ Staff Opinion Survey (2007)6 also recognises psychological factors effect staff performance so that staff will be happier when experiencing or having access to a better quality of life at work, improved workplace morale, adequate supervisor support, be participative in decision making, professional growth, develop role clarity and establish peer support.

This document provides a narrative around the findings of a project which aimed to explore and describe the current context of the NUM role within the clinical ward/unit. It maps the skills and attributes NUMs perceive they require to fulfil the role and also identifies the enablers and barriers to maximise the effectiveness of the role and for personal satisfaction.

Identification of key issues for the NUM role informs the recommendations that have been proposed in this report. The implementation of these recommendations will ensure the role of the NUM is reinvigorated and centred on clinical leadership. It would further ensure that a foundation is put in place to sustain the NUM role for the future.

2.2 Project overviewThe project was conducted in three phases

Phase one: • Development of a framework for the project • Literature review • State wide and interstate exploration of research completed or in progress around the NUM

role.

Phase two: • Development of questionnaire • Consultation groups planned and conducted

Phase three: • Draft report circulated to relevant stakeholders • Final report including findings and recommendations

6University of Southern Queensland. 2007. Report of ‘better workplaces’ Queensland Health Staff Opinion Survey. http://qheps.health.qld.gov.au/central/workforce/casu_final_wct.pdf

15

2.3 Project limitationsThe project is relatively modest in its aims and scope.

Data to support the definitive number of NUMs in positions in Queensland and vacancy rates was hard to determine. Lattice does not provide information with descriptor of the nursing classification Grade 7 allowing for differentiation between the roles at this level.

The new Queensland Health Human Resource data base system Panorama has the capability to provide this information but as yet it is not available. Based on district information supplied it is estimated there are approximately 600 NUMs in our nursing workforce. Vacancies can only be determined as L>4 at 102.9FTE across all NO4 and above positions with a 3.0FTE critical. Critical is determined as unfilled, temporarily filled and unbackfiled long term leave.

It is recognised there is variability on the application of the middle manager classification. Some facilities have Clinical Nurse Consultants that manage a clinical cost centre and therefore although the project is limited to NUMs the same issues may apply.

It is also recognised within the methodology that the collection and analysis of statistical information was not the intent of the questionnaire but rather as a mechanism to engage the NUMs and facilitate discussion around their perceptions of the role. However some interesting themes and trends emerged which was consistent with the literature review and the research project ‘Take the Lead, Strengthening the role of the Nursing and Midwifery Unit Managers across New South Wales’ (Hawes 2008)8. Convergence of themes in the data and through these mediums strengthens the overall findings.

8Hawes, S.2008. ‘Take the Lead’. Strengthening the role of the Nursing & Midwifery Unit Managers across NSW. New South Wales, Nursing & Midwifery Office, NSW Health. http://www.health.nsw.gov.au/nursing/pdf/nmforum_take_lead_pres_apr08.pdf

16

1. Literature review of international, inter state and state wide research and peer reviewed articles on middle management nursing leadership roles.

2. A review of Position descriptions for the NUM role interstate and state wide.

3. A survey of NUMs acting and permanently appointed to role was conducted.

4. Consultation groups made up of acting and permanently appointed NUMS.

5. Consultation with stakeholders in OCNO, Corporate Office Human Resource representative and Queensland Nurses Union (QNU).

6. A review of current education/professional development opportunities for NUM within Queensland Health.

3.1 Literature ReviewThe aim of the literature review was to identify research and relevant information on the Nurse Unit Manager role, as well as matters relating to recruitment and retention, and job satisfaction.

The literature review was developed through database searches using search engines and academic databases such as the QHEPS, Google, Proquest, Informit, and EBSCO to identify a range of online journals, policy documents, enterprise bargaining agreements and government reports. The literature review included international and Australian academic literature, government reports and research data. This provided valuable information into the value of the NUM role in providing leadership, the development of skills and attributes that are considered necessary for the role and the responsibility attached by the role.

3.2 Information Collection

3.2.1 SurveysThe purpose of the questionnaire was to develop a broad understanding of the attitudes and difficulties that NUMs currently experience in their workplace and asked to signal what changes would enhance their ability to do the role. The questions were formulated in consultation with senior nursing colleagues. Principally the questionnaire was used to elicit engagement with the NUMS rather than collect a large range of data. However some interesting data resulted.

3.0 Methodology

17

3.2.2 Consultation Groups17 Groups consisting of 5-15 acting and permanently appointed NUMs met across the state and took part in 2-3 hour workshops. Consultations groups involved over 160 NUMS in total.

Sites visited included Cairns Base, Townsville, Mt Isa, Toowoomba (Included Toowoomba Base and Ballie Henderson Hospitals), Dalby, Redlands, Logan, The Gold Coast, Robina, The Sunshine Coast, Redcliffe, The Prince Charles Hospital, The Royal Brisbane and Women’s Hospital and the Princess Alexandra Hospital. In Cairns NUMs travelled from Atherton and Mareeba and Yarrabah to be part of a consultation group. In Townsville a NUM travelled from Palm Island. In Dalby NUMs travelled from Miles and Chinchilla to be part of the consultation group. Within Districts representatives came from community health and schools and mental health was represented community wise and by specific hospital. Midwifery Nurse Unit Managers also took part and attended from those sites which offered midwifery services.

Engaging NUMS was viewed as essential to the process of successful review. Consistent information was gathered through this approach. NUMS were very receptive to the opportunity to meet and contribute to the project.

Vignettes from NUMS ‘There is light at the end of the tunnel but a the moment it is a train coming’

‘It seems like the paperwork is taking over’

‘When I first started I only found out how to do things by making mistakes’

‘I didn’t have choice I was the last Clinical Nurse on the ward’

‘The buck stops with the NUM, hit from below, hit from above!’

18

4.1 Themes emerging from the consultation groupsThe key themes which emerged from questionnaires and consultation groups are structured into three key areas which support the end discussion which centred on what an ideal role will look like:

• The breadth of the current role with regard to responsibilities, accountabilities and reporting. • Identifying skills and attributes seen as essential to the role. • Barriers and enablers to performing the role to the NUMS satisfaction and for an effective

and efficient clinical service.

4.2 Current RoleIn exploring and describing the current context of the NUM role within the clinical ward/unit this document provides a narrative around the findings.

The following areas of responsibility are broadly summarized as follows:

Leadership of Clinical area • Patient flow • Standard of care • Driver of model of care • Patient and family advocate • Discharge planning

General management of • Human resource and staff • Budgeting • Unit equipment and maintenance • Communicating with others

Clinical governance • Occupational health and safety • Quality projects, research • Audits • Complaints and incident investigation • Incident management and monitoring • Risk and hazard identification • Accreditation

Leadership • Role modelling behaviour

4.0 Reviewfindings

19

• Leading the team • Professional development • Change management

Other (mainly rural and remote but not limited to these facilities) • Travel, accommodation arrangements for staff/patients • Escorting patients via ambulance • Overseeing vehicle maintenance and control • Counselling of staff • On-call • Public relations • X-ray operator

(See appendix 1 for full description from NUM groups and of what NUMs perceive their role entails)

4.3 Skills and AttributesSkills are defined as things learnt or possessed to enable them to effectively manage the job, and attributes are characteristics which they possess which make them suited to the position.

Skills and attributes include but are not limited to:

(See Appendix 2 for NUM brainstorm of skills and attributes)

4.4 Barriers and Enablers

4.4.1 Barriers • Barriers are described as things which inhibit the ability of the individual NUM to perform

the job to the level of their own satisfaction. These include but are not limited to: • Lack of understanding and expectation of the role by: – Self – Organisation (includes nursing staff, medical, allied health and executive management

team)

Skills AttributesProblem solvingCritical thinkingLeadership and visionPolitical astutenessInterpersonal skillsAdvanced communicationActive listeningIT/Data managementFinancial managementClinical credibilityConflict resolution

Trustworthy, honestCompassionateFair/balancedEnergetic/motivatedResilientPatient/tolerantCalmCommonsenseAdvocate for staff and patientsSense of humourDiscrete

20

• Inconsistencies in the role across QH

• Lack of staff: – Recruitment processes are long and time consuming – Shortage of and temporary positions. – Skill mix limiting opportunity for succession planing/requiring constant presence in

clinical unit of Clinical Nurses and NUM. – NUMs counted into clinical hours. • Lack of resources and ability to influence budget. • QH processes for rostering, payroll, financial management, reporting. • Professional development within role: – Limited to adhoc courses/workshops. – Tertiary study within own time

(See appendix 3 for NUM brainstorm of barriers).

4.4.2 EnablersEnablers are defined as factors which enhance the ability of the NUM to perform their job to their own satisfaction. These include but are not limited to the following: • Support and respect from nursing executive and senior management. • Support from own team and being part of a team. • Support and opportunity to meet peers. • Staffing – Adequate staffing – Adequate skill mix for acuity of patients • Communication – Access to information – Opportunity to contribute an opinion • Structured education and professional development for role with allocated time – People management – Financial management – Mentoring relationships • Resources – Budget – Equipment – Support roles (administration, education, operations staff)

(See appendix 4 for brainstorm of perceived Enablers from NUM consultation groups).

21

4.5 Questionnaire resultsQuestionnaires were completed at a return rate of 96% (n= 154).

Of the 154 responses, 32 (21%) indicated they were in ‘acting’ NUM roles. 12 of this cohort indicated they would not apply for the position should it be advertised and 20 indicated they would apply.

Graph 1: Respondents in ‘acting’ positions were asked would they apply for the position if the position became vacant. n=32

Three people had been in ‘acting’ positions for 3 years or more. Of this small sample, two indicated they would apply for the position should it become vacant.

34% of the “acting” NUM sample indicated they had taken on the role due to their perception there was no one else, however approximately 46% of this cohort considered that the reason for taking the position was also an opportunity for professional development purposes. For a small sample those who had taken on the position for professional development felt hindered in this because they were expected to ‘care take’ in the role and not develop the area per se.

Reasons for not applying for permanent NUM positions were working under constant pressure and feeling inadequately prepared for the role. Effective orientation and supportive professional relationships from the CNCs and Clinical Nurse Teachers were stated as desirable but currently not effective.

Of the 122 permanently appointed NUMs 44 (36%) stated they frequently considered leaving the position. Whereas 64% indicated they would not consider leaving. These figures are slightly higher than the workforce survey (2007) figure of 31.8% of employees who consider leaving Queensland Health.

ActingNUM’sresponsestowhethertheywouldapplyfortheposition.

38%62%

Yes

No

22

Graph 2: The respondent sample was asked to list number of years in the NUM role.

Some of the reasons given for considering leaving included a perceived lack of executive management (nursing and district) constructive supervision combined with not being given decision making authority and directives to achieve deliverables without a commensurate resource allocation. There was ambiguity about role expectation and the scope of the role that were factors for other ‘yes’ respondents. The NUMs also indicated they perceived a higher level responsibility and accountability than other grade 7 positions specifically the CNC and that their pay did not reflect this.

Graph 3: The respondents were asked what they considered the barriers to performing the role to their own satisfaction.

‘Lack of time’ to complete workload had 98% response rate as a barrier to performing the role to the standard NUMs desire.

When asked what changes would the NUMs require to consider staying or enhancing their ability to do the role: 57.3% stated clinical support, 53% business support, 53% information management, 47% human resource support, and 31.9% quality and safety support. Additional comments included a need for Work- Life balance strategies and role clarity. Administration support was also stated as highly desirable.

Yes respondents to leaving to

No respondents to leaving

< 12 months 1-2 years 3-5 years 6-10 years > 10 years

20

25

15

10

5

0

Lack of time Lack of dedicated

administration time

Workforce shortages

Lack of support

100%

80%

60%

40%

20%

0%

Agreed98%

54% 54%45%

37%

Lack of training

23

NUMs were asked to indicate what was the highest level of education they had obtained, and if they had found that education beneficial. Most had attended a variety of workshops and short courses but few indicated whether they found them useful. The majority of respondents who had completed the Graduate Certificate in Health Management found it useful. Limitations in the questionnaire design describing the exact educational requirements within this middle management nursing group prevented further analysis.

NUM Vignettes

‘You won’t get me to stay!’

‘To be heard and listened to!’

‘If you look like you’re coping you’re right!’

‘What has stopped me leaving is a dynamic and supportive Nursing director!’

‘More autonomy and less blaming’

24

It was evident through comments made in consultation groups that for the majority of the participants, morale and job satisfaction were very low.

Current roleThe NUMS felt conflicted in their role as there are no clear delineation between management of a cost centre and leading a clinical ward/unit. The NUMs have taken on roles and responsibilities they consider to be outside of their role description. However the culture of the organisation is such that they feel they are unable to say no without being made to feel they are not up to the job9. ‘Role ambiguity’10 causes confusion as to where the main focus of the role should be. Role clarity is therefore clearly desirable8,9.

Administration duties reportedly consume most of their time. NUMs are a finite highly skilled resource and would be more efficiently utilised to refocus the role if the clinical leadership was focussed. All NUMs identified this as the desired focus of the position. All groups identified additional administration support as highly desirable to support refocusing their role on clinical leadership. This is further supported by the recommendations arising from the NIBBIG Work Life Balance report 200712.

Paliadelis, Cruickshank and Sheridan (2007)13 in a study of 20 NUMs in Australia found they were not educated to cope with their increased responsibility around administrative and managerial requirements. Instead NUMs feel they are unable to support clinical outcomes and staff sufficiently10,13. NUMs describe themselves as ‘drowning in paper work’ as work stacks up and there are ever increasing competing priorities.

NUMs who have seen their role expand in responsibility and undergone several name changes over the last ten years regret the loss of their clinical expertise and patient contact. Other similar grade roles appear more attractive to the NUM. The Clinical Nurse Consultant, as an example is a clinical specialist who works across units providing clinical expertise and guidance with no human resource, financial or material management responsibilities4.

Discussion summary

4Queensland Health. 2008. Nursing and Midwifery Classification Structure IRM 4.8-2. http://www.health.qld.gov.au/hrpolicies/resourcing/b_7.pdf

8Hawes, S.2008. ‘Take the Lead’. Strengthening the role of the Nursing and Midwifery Unit Managers across NSW. New South Wales, Nursing and Midwifery Office, NSW Health. http://www.health.nsw.gov.au/nursing/pdf/nmforum_take_lead_pres_apr08.pdf

9Duffield, C., Kearin, M., Johnston, J., and Leonard.2007. The impact of hospital structure and restructuring on the nursing workforce. Australian Journal of Advanced Nursing, 24(3): 42-46.

10Stanley, D. 2006. Role conflict: leaders and managers. Nursing Management, 13(5): 31-37.

12Queensland Health and Queensland Nurses Union. 2007. Nursing Interest Based Bargaining (NIBB) Project report. Work Life Balance http://www.health.qld.gov.au/eb/nursing_ibb/work_life_bal.pdf

13Paliadelis, P., Cruickshrank, M. and Sheridan, A. 2007. Caring for each other: how do nurse managers ‘manage’ their role? Journal of Nursing Management, 15: 830-837.

25

There is a strong argument for optimising the role of the NUM by making better use of the skills of the NUM to affect patient care. This can be achieved by maintaining a clinical presence on the ward. Due to the dual roles of management and leadership it is not possible for the NUM to remain a clinical expert however a clinical supervision role is highly desirable. The NUM currently provides a consistent presence on the ward/unit when the majority of the work force work shift work and many are part-time. Trends in the nursing workforce such as an aging workforce and desire for work life balance in the labour market suggest this will continue.

The benefits to the clinical unit/ward are the NUM provides a standard of professional practice and improved patient care by role modelling behaviours and improving communication across patient care. This is achieved by being the consistent presence on the ward. Managing stressful situations and providing support to staff improves retention and job satisfaction for staff14. The NUM remains credible to staff by working alongside them and earning their trust. Redefining roles and matching them against skills can improve patient care, reduce waste, and improve working lives and reducing mistakes and errors15.

Transformational leadership qualities are associated with effective change management, empowering work conditions, influencing staff and policy and job satisfaction. There is growing evidence from research state wide, interstate and internationally into the positive impact that middle management nursing leadership roles have on improving patient outcomes and service provision16,17. In one Queensland hospital, a new model of care had been adopted as the result of a two year ‘Professional Practice Partnerships’ Skill mix Research Project18. Within this model the NUM is required to remain as a complementary figure driving clinical standards of care and role modelling behaviours until 12:30pm daily. The evaluation shows proven patient outcomes including reduced patient falls, pressure areas and medication errors. Scheduling of meetings and administration tasks are left for the afternoon when clinical activity is reduced and double staffing of nurses occurs. NUMs involved report improved job satisfaction through the ability to provide clinical leadership with organisational support.

14Chiarella, M. 2007. Redesigning models of patient care delivery and organisation: building collegial generosity in response to workplace challenges. Australian Health Review, 31(S1): S109-s115.

15NHS Modernisation Agency. 2004. 10 High Impact Changes for service Improvement and Delivery. A guide for NHS leaders.

16Newman, S. 2005. The impact of health reform on nurse managers and their management of nursing services: a study of the Australian Context. Paper presented at 6th Annual Interdisciplinary Research Conference, Trinity College, Dublin.

17Kramer, M. Maguire, P., Brewer, B. et al .2007. Nurse Manager Support. What is it? Structures and Practices That Promote it. Nursing Administration Quarterly 31, (4), 325-340.

18Jones, J., Lowe, M., Burns, C. Donaldson, P., Abbey, J. & Abbey, B. 2008. Practice Partnership Model: An innovative approach for nursing at The Prince Charles Hospital (TPCH). Final Report of the Skillmix Research Project. QH and QUT.

26

The opportunity to network and derive support from meeting their peers formally was provided through the consultation groups. NUMs all expressed their regret of not having this opportunity regularly where they had experienced it in the past before restructuring into department meetings. In rural and remote areas all of these issues are compounded by the isolation of the role from peer support.

For the rural and remote NUM the transient nature of the workforce means they have the added pressure of being on call and may be the only person able to perform advanced clinical skills such as x-ray taking. Remuneration provided hourly for on call hours allocated would recognise the significant percentage of time rural and remote NUMs spend on call and would reinforce the value of the NUM role within the rural and remote health care system.

NUMs generally feel undervalued by the organisation. Research by Day, Minichiello and Madison (2006,p517)19 reveals that low morale is linked to intrinsic factors such as ‘professional worth and respect, opportunity and skill development, work group relationships and patient care’ and extrinsic factors such as ‘organisational structures, operational issues, leadership traits and management styles, communication and staffing’. The NUM role is affected by these factors and equally their job satisfaction impacts on the rest of the nursing staff under their leadership.

Similar issues have been identified in other jurisdictions who have implemented solutions in a number of ways. The Australian Capital Territory, Victoria and Western Australia have provided clear career pathways within the nursing classification structure across clinical, management education and research. This has implications for the adjacent nursing grades within the classification structure before and after but provides a direct career pathway for nurses entering the clinical arena and allowing direction through performance appraisals and professional development.

There is a strong argument from the NUMs themselves in that this allows the roles to line up to support each other rather than working independently of each other across the organisation. Having direction will increase retention amongst all staff especially the generation ‘Y’ that thrives on opportunity and strong leadership20.

NUMs self reported that there is inequity of work value within the role. The Mercer Group 20035 has undertaken a Job Classification Evaluation of the NUM role in both Victoria and Northern Territory with a resulting banding of streams around the key work value descriptors of full time equivalent (FTE) numbers (or head count), skill mix, reporting structures, support networks and infrastructure, hours of operation, ward unit geography, ward unit type and ward unit complexity and unpredictability. Remuneration is awarded in band for level of the work value determined by expertise, judgement and accountability. Applying work values addresses the inequity

5Mercer Human Resource Group. 2000. Nurse Unit Manager Classification Review.

19Day, G.E., Minichiello, V. and Madison, J. 2006. Nursing Morale: what does the literature reveal? Australian Health Review, 30 (4), 516-524.

20Walker, K. 2007. Fast-track for fast times: Catching and keeping Generation Y in the nursing workforce. Contemporary Nurse, 24(2): 147-158.

27

experienced within the NUM role across Queensland Health currently where a NUM who has a small staff and works office hours is payed the same as the NUM providing leadership to a large acute care unit with a large volume of staff.

(Recommendations 1, 2 3, 4, 5, 8, 10)

Skills and AttributesCurrently Queensland Health role descriptions state no more than base line qualifications, Bachelor of Nursing or Registered Nurse Training as mandatory. A Job Evaluation Analysis5 of the role would provide definitions of skills, competencies and qualifications seen as desirable for the contemporary NUM role.

In identifying skills and attributes felt necessary for the role the NUMs frequently expressed frustration over the limited orientation provided for the role. Negotiating the complex Queensland Health system, especially HR and FAMMIS, and receiving inconsistent advice from officers from these departments means a learning process of trial and error. Changes to the systems would be welcome but previous experience with new data systems for rostering and patient acuity mean NUMs view them with suspicion and dread.

NUMs feel ineffective in fighting for resources as many identified they did not have the knowledge to manage the business side of the ward/unit. The Business planning framework was seen as a useful tool for some but many who had received no real training into the process were left feeling impotent in trying to fight for resources when invited to participate in budget workups.

The NUMS identified that leadership workshops and courses were helpful but translating and sustaining this in the workplace was difficult. The literature supports the correlation between effective leadership and high quality nursing care (Jarman 2007)21. A mentoring process would support the personal growth of the NUM and provide a support network22. Every consultation group expressed the view that lack of mentoring relationships limited their potential for growth within the role. Mentoring has also been identified as important to developing future nurse leaders in facilitating new learning experiences and guiding career decisions23.

Lack of articulated or supported education in the role also affects succession planning. NUMs suggested work shadowing and a formal course provided by their organisation would assist this process. The literature supports this approach. Wolf, Bradle, and Greenhouse24 found through their research Nurse Unit Managers frequently feel unprepared for the challenges within the role.

5Mercer Human Resource Group. 2000. Nurse Unit Manager Classification Review.

21Jarman, H. 2007. Consultant nurses as clinical leaders. Nursing Management, 14(3): 22-26.

22Gallo, K. 2007. The New Nurse Manager: A Leadership Development Program Paves the Road to Success. Nurse Leader, 5(5): 28-32.

23Redman, R.W. 2006. Leadership Succession Planning. The Journal of Nursing Administration, 36(6): 292-297.

24Wolf, G.A., Bradle, J. & Greenhouse, P. 2006. Investment in the Future. A 3-Level Approach for developing the Health care Leaders of Tomorrow. The Journal of Nursing Administration, 36(6): 331-336.

28

Strategies need to be put in place to ensure NUMs develop the business knowledge and other essential skills for the role25.

One potential solution for NUM could be through utilisation of the Clinicians Development Education Service offered by the partnership between the University of Queensland, Med-E-Serv and Queensland Health will offer Quality and Safety, Education and Workforce Development, Health Services Management and Innovation and Change modules for health professionals to access online. There are no semesters or time limits set on individuals and the student can build up to a full credit for post graduate qualifications or sample subjects which are of interest. Access to such programs for NUMs will provide access, opportunity and the potential for personal growth within the role.

(Recommendation 7)

Barriers and EnablersThe nature of the workforce means the NUM has taken on a nurturing role caring for the general welfare of all the nursing staff in their area. NUMs felt the generation Y expectations of the workforce forced the need for a nurturing role; words used to describe themselves were ‘counsellor’, ‘agony aunt’, ‘mother figure’. They found this rewarding but time consuming and felt torn with competing priorities. Some NUMs shared offices and consequently found maintaining confidentiality during performance management challenging.

Critical thinking and problem solving were identified as desirable skills for the NUM by the groups. Yet the NUMs often complained of lack of constructive supervision by ADONs, DONs16. This was also true of the District Managers in the more regional and remote areas. Direct correlation between effective supervisor support and coaching and the positive attitude of NUMs to their role. It was very obvious when this level of support was afforded to the NUM by the positiveness of their attitude and belief in themselves. NUMs who had been coached by the ADONs felt empowered to make decisions and contribute to budget and other decisions. Organisational support has the proven benefit of developing transformational leader behaviour and ensuring greater communication with supervisors26.

Succession planning was identified as extremely difficult to achieve in the current environment. NUMs felt powerless to influence this due to the workload. It was identified in every group a clinical nurse could earn more money with shift work penalties and working fewer hours than the business hours the NUM worked. NUMs report arriving early and leaving late. Time to orientate and develop CNs into the acting NUM role was seen as lacking. NUMs voiced frustration over dealing with a workload left by acting NUM who backfiled them whilst they were on leave.

16Newman, S. 2005. The impact of health reform on nurse managers and their management of nursing services: a study of the Australian Context. Paper presented at 6th Annual Interdisciplinary Research Conference, Trinity College, Dublin.

25Kleinams, C.S. 2003. Leadership Roles, Competencies, and Education. How Prepared Are Our Nurse Managers? Journal of Nurse Administration, 33(9): 451-455.

26Laschinger, H. & Wong, C. 2007. A profile of the Structure and Impact of Nursing Management in Canadian Hospitals. Final Report for CHSRF Open Grants Competition project # RC1-0964-06.

29

NUMs who had worked in other states/territories suggested an Associate NUM role which would assist with both workload and succession planning. Currently the ‘Path of Chance’27 remains dominant as evidenced by the ‘No one else’ in the responses from the survey.

Flexible work arrangements enable NUMs to a better work life balance. NUMs who work a nine day fortnight report improvement in their mental well-being, although in compensation other days often extend over ten hours. The NIBBIG Work Life Balance report 200712 supports the NUMS need for flexible self managed work hours and the opportunity to job share. Mature aged NUMs expressed a desire to job share and identified it as a way of nurturing and supporting senior staff with families or back from maternity leave to consider senior nursing roles.

(Recommendation 2, 9)

The ideal roleThe Consultation groups ended with a discussion centred on what an ideal role could look like. The consensus was to refocus the role on clinical leadership and provide support in the form of administration work. The NUMs felt that better preparation and skilled development for the role would make the NUM position more attractive. This requires redefining the position and gaining agreement across the nursing profession on the core functions of the NUM role. The other grade 7 roles would then line up and provide more effective professional relationships which ultimately ensure better patient care.

(See Appendix 5/6)

12Queensland Health and Queensland Nurses Union. 2007. Nursing Interest Based Bargaining (NIBB) Project report. Work Life Balance. http://www.health.qld.gov.au/eb/nursing_ibb/work_life_bal.pdf

27Bondas, T. 2006. Paths to nursing leadership. Journal of Nursing Management, 14: 332-339.

30

The NUM role has expanded in scope to the degree it is now recognised as being difficult to recruit and retain highly skilled nursing staff into this position. The NUM project has identified key issues within the role to address to avert a potentially worsening workforce crisis.

There are strong arguments for Queensland Health to implement a framework with core responsibilities for the NUM role. This can be used to provide consistency within the role across the state. Other grade 7 roles can then be aligned alongside to ensure a career pathway for future nurse leaders within the streams of management, clinical, education and research. The framework would also provide consistency within the role for core responsibilities, qualification and skills development.

Queensland Health is going through rapid change with systems and process being put in place which should ultimately enable the NUM to realise more efficient and effective work practices. However, without the right training and mentoring, NUMs will view them with suspicion and sceptic. The Nurse Unit Manager has the ability to provide strong leadership when provided with opportunities to develop the right skill set. Optimising the role ensures effective use of this finite resource. Providing administrative and reorganising work practices will support the role, improve job satisfaction and assist with succession planning.

Recommendations address the key issues which impact on recruitment and retention, succession planning and job satisfaction. Outcomes from implementation of the recommendations will result in the development of highly skilled and knowledgeable NUMs who provide proactive strong leadership and positively affect patient outcomes and service provision.

Conclusion

31

Clinical leadershipClinical coordinatorPatient flow/discharge planningDriving models of care/Ward rounds with medical staffCoordinator of patient informationCase managerSupervisionCase conferencingManager of waiting listsCrisis management dailyWorks clinically to cover sick leave, skill mix issues, support heavy workload periodsDriving evidence based clinical careMonitor clinical indicators

Clinical governanceChange managementCoordinator of quality activitiesAuditsRisk managementInfection control monitorWaste management monitorAccreditation coordinatorMinisterial correspondencePolicy and procedure coordinatorProfessional practice coordinatorIncident reportingComplaints managementWork Place Health and safety coordinator

Education and researchTransition program governanceNew graduate interviews and program overseerProject managerMentorOrientation of staff including junior medical staff and studentsStaff aware of unit protocolsOwn professional development needs-attend workshops, conferences, networks for clinical area

Leading and managing peopleRostering-input, planning, meets award requirementsPay enquiriesManagement of leave – annual, sick, maternity, studyProfessional development allowance and leave.Movement forms and Position Occupancy statusPerformance AppraisalsGrievance, debriefings, staff supportRecruitment including writing Job descriptions, interviews, panels,Selection reports, referee checks and informing employeesMaintain skill mix levels to ensure safe patient care Succession planningCoordinate and chair ward meetings, write up minutesMaintain QLD registration and annual practising cert

Business managementWorkforce planningService planning and service profile reportBudget build-up contribution – BPF and Scorecards Performance indicator reportingDaily data management – Hours per patient day/FTEBusiness case writingDSS and FAMMIS, Lattice, ESP, HBSICSPatient Acuity systemsFiling/emails/correspondenceMeetings/Minute writingCapital works and redevelopment involvement

Materials managementEquipment purchasing – incudes getting quotesRepairs and maintenanceMediation level managementMeetings with Sales RepsIT technician, photocopier/fax

ExtrasPatient and staff counsellorAccommodation and travel organiserCar maintenance/transportDebriefingCoordinating multi disciplinary teamEscorting patientsOn call public holidays

Appendix 1: A full description of the perceived current responsibilities of the NUM

32

Personal characteristics Formal qualifications Orientation Acquired skills

Trustworthy Honest, approachable, positiveLeaderVisionRole modelGood listenerTolerance, resilience, patienceAdvocate for staff/patientsProblem solverMotivated, creativesense of humourFlexibility Ethical

Bachelor of Nursing or RN training (Hospital)Post Graduate management/ leadership course

Supernumery periodOrientation/Resource ManualMentorship

Business management (BPF training)Service planningConflict resolutionPolitical astutenessIT training/data managementRisk analysis/Incident managementPeople managementCounselling/active listeningNetworkingResearch training

Appendix 2: Desirable skills and attributes (formal and informal)

33

Barriers No specific orientation to role,Complex information systems – lattice, FAMMIS, QHEPS hard to navigate to find thingsNo A/O supportHospital rules, culture, structureLack of HR support (inconsistent information)Office space (sharing)IT knowledgeInterruptions (phone calls, people demanding attention)

Lack of staff /skill mixTransient nature of staff (agency rural and remote)Lack of support from other grade7 roles, Clinical educator, Clinical nurse ConsultantMagnet status is more workGeneration x, y needs, less flexible rosteringEquipment shortage/Clinical supply practices (inappropriate supplies and not timely)Expected to manage projects redevelopment in with every thing else

EnablersGood staff/team work AutonomyPeer supportTime to do projects/redevelopment off lineEducational supportIT support/internet access/mobile technologyHR and Business supportAccess to study leaveDiversity of job/challenges

Patient complimentsTask transfer of administration to AO

Appendix 3: Barriers and Enablers to performing role

34

Nurse Unit Manager Project questionnaire – pre consultation groupsThis questionnaire is designed to form the basis of discussion for the consultation groups discussing the role of the Nurse Unit Manager as part of the recommendations for EB6. This work is the foundation for future workforce planning and Industrial Relations negotiations. Please complete the questionnaire prior to attending the group.

1. WhydidyoubecomeaNurseUnitManager?(please). Professional development Make a difference to patient care There was no one else Other (please state)

2. Are you appointed to the role? (please ) Permanent Acting in the role

3. How long have you been employed as a NUM? (please ) < 12 months 1-2 years 3-5 years 6-10 years >10 years

4. Have you undertaken any education to assist in this role? Please state the highest level of education you have attained and the name of the course? (please )

Workshop Short course Hospitalcertificate Graduatecertificate Graduate Diploma Masters Degree PhD WasthecourseprovidedthroughQHoroutsidetheorganisation? Wasitbeneficial?

What do you consider the barriers to performing the role to the standard you would like? (please ) Lackoftimetocompletework Lackofdedicatedoffice/admintime Work force shortage Lack of training Lack of support (please elaborate) Other (please state)

5. Are you seriously thinking about leaving this role? (please ) Yes No If yes indicate why.

6. What changes need to be made to make you stay or enhance your ability to perform the role? (Please key areas for consideration and comment) Clinical Support Human resource responsibilities Information management Quality and safety responsibilities Business responsibilities Other (please state)

Contact person: Kaye Hewson, Project officer, Office of the Chief Nursing Officer, QH ext 3234 1035 kaye_hewson@health.qld.gov.au

Appendix 4:

35

Appendix 5: Idealrole–ideasfromconsultationgroups

Clinical Succession planning/education Resources

• Not included in numbers• Model of care driver• Not expert but clinically

competent• Clinical leader/credible• Visible• Constructive professional

relationship with Nursing Director

• Remuneration – shift differentials• Mentorship• Work shadowing• Business management/cost centre

management• BPF training• NUM prep course• Development plan for succession

planning• Structured career pathway• IT training• People management

• CNC support• Career structure to support Assistant

NUM role• Administration support• Where Workforce Units exist they pick

up more of the paper work associated with recruitment

• Peer support network• Blackberry/Notebook• Clinical education support

Other responsibilities Other Work Life Balance

• Off line time for specific projects/redevelopment

• Meetings scheduled to fit in with clinical business

• PAD process streamline

• Time to look at bigger picture• Hourly on-call rate• IT access/turnaround/service

agreement more efficient• Job description rewrite/ formal role

evaluation• On call public holidays shared across

all grade 7 roles

• Flexible work hours – 9 day fortnight/job share

• Remote access• Union support for performance

management for management• Recognition of time spent at work with

managing toil• Autonomy

36

Core purpose of NUM role

Appendix 6: Core purpose of NUM role

Statement of role

purpose

Clinical leadership

Clinical governance Leadership

Business Management

Conceptual Framework

Operational requirements

Individual position descriptions

Note:acknowledgementgivento‘TaketheLead’ProjectNSW,NSWHealth

profession of Nursing & Midwifery

Quality and Safety Occupational

Health and safety

Professional advocacy

Enabling & facilitating:- change- development

0f others

Continuous performance improvement

Human,physical andfinancial resource management

PositionDescriptionreflectcorefunctionsofrole

37

References1. IBB: nursing. Nursing Interest Based Bargaining Implementation Group. http://qheps.health.qld.gov.au/ebb/ibb/Nursing/nibbig.htm

2. Queensland Health & Queensland Nurses Union. 2007. Nursing Interest Based Bargaining (NIBB) Project Report. Workforce Recruitment and Retention. http://qheps.health.qld.gov.au/eb6/ibb/Nursing/Recruitment%20and%20Retention%20Final%20 Report%2004.07.07.pdf

3. ACCIRRT. 2003. Simply the Best Workplaces in Australia, Working Paper 88, University of Sydney.

4. Queensland Health. 2008. Nursing and Midwifery Classification Structure HR Policy B7. http://www.health.qld.gov.au/hrpolicies/resourcing/b_7.pdf

5. Mercer Human Resource Group. 2000. Nurse Unit Manager Classification Review.

6. University of Southern Queensland. 2007. Report of ‘better workplaces’ Queensland Health Staff Opinion Survey http://qheps.health.qld.gov.au/central/workforce/casu_final_wct.pdf

7. Queensland Health. 2007. Nursing Labour Workforce Survey. http://qheps.health.qld.gov.au/waru/docs/nurses_lfs_2007.pdf

8. Hawes, S. 2008. ‘Take the Lead’. Strengthening the role of the Nursing and Midwifery Unit Managers across NSW. New South Wales, Nursing and Midwifery Office, NSW Health. http://www.health.nsw.gov.au/nursing/pdf/nmforum_take_lead_pres_apr08.pdf

9. Duffield, C., Kearin, M., Johnston, J., and Leonard. 2007. The impact of hospital structure and restructuring on the nursing workforce. Australian Journal of Advanced Nursing, 24(3): 42-46

10. Stanley, D. 2006. Role conflict: leaders and managers. Nursing Management, 13(5): 31-37.

11. Paliadelis, P. 2005. Rural nursing unit managers: education and support for the role. Rural and Remote Health 5: 325. (on line)

12. Queensland Health and Queensland Nurses Union. 2007. Nursing Interest Based Bargaining (NIBB) Project report. Work Life Balance http://www.health.qld.gov.au/eb/nursing_ibb/work_life_bal.pdf

13. Paliadelis, P., Cruickshrank, M. & Sheridan, A. 2007. Caring for each other: how do nurse managers ‘manage’ their role? Journal of Nursing Management, 15: 830- 837.

14. Chiarella, M. 2007. Redesigning models of patient care delivery and organisation: building collegial generosity in response to workplace challenges. Australian Health Review, 31(S1): S109-s115.

15. NHS Modernisation Agency. 2004. 10 High Impact Changes for service Improvement and Delivery. A guide for NHS leaders.

16. Newman, S. 2005. The impact of health reform on nurse managers and their management of nursing services: a study of the Australian Context. Paper presented at 6th Annual Interdisciplinary Research Conference, Trinity College, Dublin.

38

17. Kramer, M. Maguire, P., Brewer, B. et al. 2007. Nurse Manager Support. What is it? Structures and Practices That Promote it. Nursing Administration Quarterly 31, (4), 325-340.

18. Jones, J., Lowe, M., Burns, C. Donaldson, P., Abbey, J. & Abbey, B. 2008. Practice Partnership Model: An innovative approach for nursing at The Prince Charles Hospital (TPCH). Final Report of the Skillmix Research Project. QH and QUT.

19. Day, G.E., Minichiello, V. and Madison, J. 2006. Nursing Morale: what does the literature reveal? Australian Health Review, 30 (4), 516-524.

20. Walker, K. 2007. Fast-track for fast times: Catching and keeping Generation Y in the nursing workforce. Contemporary Nurse, 24(2): 147-158.

21. Jarman, H. 2007. Consultant nurses as clinical leaders. Nursing Management, 14(3): 22-26

22. Gallo, K. 2007. The New Nurse Manager: A Leadership Development Program Paves the Road to Success. Nurse Leader, 5(5): 28-32.

23. Redman, R.W. 2006. Leadership Succession Planning. The Journal of Nursing Administration, 36(6): 292-297.

24. Wolf, G.A., Bradle, J. & Greenhouse, P. 2006. Investment in the Future. A 3-Level Approach for developing the Health care Leaders of Tomorrow. The Journal of Nursing Administration, 36(6): 331-336.

25. Kleinams, C.S. 2003. Leadership Roles, Competencies, and Education. How Prepared Are Our Nurse Managers? Journal of Nurse Administration, 33(9): 451-455.

26. Laschinger, H. & Wong, C. 2007. A profile of the Structure and Impact of Nursing Management in Canadian Hospitals. Final Report for CHSRF Open Grants Competition project # RC1-0964-06.

27. Bondas, T. 2006. Paths to nursing leadership. Journal of Nursing Management, 14: 332-339.

39

Bibliography• Qld Health Business planning framework: a tool for nursing workload management (4th

edition) Resource manual.

• ACT Health Nursing & Midwifery Work Level Standards, June 2007 JUMCC.

• MED-E-SERV 2008, Health Services Workforce Development Programs, Clinicians Development Education Service.

• Nurses (Victorian Public Health Sector) 2007 Multiple Business Agreement, 2007-2011.