Quality of Nursing Leadership - Force 1 - Magnet Application for

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					FORCE 1


1
 princess alexandra hospital    application for redesignation                                                                                force 1



                                                        Table of Contents

                                     Force 1: Quality of Nursing Leadership

 Number           Title                                                                                                                       Page

 Quality of Nursing Leadership
 	                Definition
 	                Expectations	of 		the	Magnet	Organisation
 	                Components ...................................................................................................................79

 1.1	             Describe	how	the	mission,	vision,	values	and	philosophy	and	
 	                strategic	plan	of 	nursing	services	are	congruent	with	those	
 	                aspects	of 	the	organisation. .........................................................................................80

 1.2	             Describe	how	the	EDNS	includes	nurses	who	work	in	areas	




                                                                    1
 	                other	than	nursing	services	in	activities	and	decision-making	regarding	
 	                nursing	care. ...................................................................................................................83

 1.3	             Give	examples	from	different	nursing	units,	of 	advocacy	by	the	
 	                EDNS	on	behalf 	of 	the	staff,	such	as	requests	for	additional	FTE,	
 	                systems,	equipment,	personnel	support,	and	so	forth. ............................................85

 1.4	             Provide	examples	of 	how	nurses	at	all	levels	are	leading	and	
 	                participating	in	professional	nursing	organisations	and	activities	at	
 	                the	local,	state,	national	and/or	international	levels.		Include	examples	
 	                of 	how	this	benefits	the	practice	setting	and	the	nursing	community. .................87

 1.5	             Describe	the	involvement	of 	nurses	at	all	levels	in	the	budget	
 	                development	process.....................................................................................................94

 1.6	             Provide	evidence	of 	data-driven	decision-making	regarding	budget	
 	                formulation,	implementation,	monitoring	and	evaluation. .....................................96




   quality of
 1.7	             Provide	specific	examples	of 	ways	nurses	at	all	levels	have	identified	
 	                and	advocated	for	additional	nursing	resources	to	support	unit	goals. ................98

 1.8	             Provide	nurse	satisfaction	data	for	a	four	year	period.	Describe	how	



  nursing
 	                nurse	satisfaction	data	are	tracked	and	analysed	and	how	action	plans	
 	                are	developed	and	evaluated	based	on	data.	Address	how	direct	




leadership
 	                care	nurses	are	involved	in	the	process. ....................................................................100
 princess alexandra hospital     application for redesignation                                                                                       force 1



 Number           Title                                                                                                                               Page


 Force 1 Graphs

 10	              PAHHSD	Cardiothoracic	Surgery	Unit	(3C)	Cultural	Shift ..................................101

 11	              PAHHSD	Average	Scores	of 	Workplace	Morale ....................................................103



 References       .........................................................................................................................................104




   quality of
  nursing
leadership
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 princess alexandra hospital   application for redesignation                                    force 1



 Quality of Nursing Leadership

 Nursing	leaders	are	perceived	as	knowledgeable,	strong	risk-takers	who	follow	an	articulated	
 philosophy	in	day-to-day	operations	of 	the	nursing	department.	Nursing	leaders	also	convey	a	
 strong	sense	of 	advocacy	and	support	on	behalf 	of 	the	staff.




 Expectations of the Magnet Organisation

 Knowledgeable,	strong,	risk-taking	nurse	leaders	follow	a	well	articulated,	strategic,	and	visionary	
 philosophy	in	the	day–to–day	operations	of 	the	nursing	services.	Nursing	leaders,	at	all	levels	of 	
 the	organisation,	convey	a	strong	sense	of 	advocacy	and	support	for	the	staff 	and	for	the	patient.	
 (The	results	of 	quality	leadership	are	evident	in	nursing	practice	at	the	patient’s	side.)




                                                           1
 Components

 1.	 Competency,	skill,	and	educational	advancement	are	valued	attributes	of 	nurses	at	all	levels.	
     Individuals	are	encouraged	and	supported	in	making	progressive	gains	in	these	areas.

 2.	 There	is	congruence	between	the	mission,	vision,	values,	philosophy,	and	strategic	plan	of 	
     nursing	services	and	those	aspects	of 	the	organisation.

 3.	 The	EDNS	is	accurately	perceived	by	all	employees	as	representing	all	nurses	in	the	
     organisation	at	the	highest	governing	body	and	in	matters	arising	from	or	impacting	the	
     practice	of 	nursing	or	the	environment	in	which	it	is	practiced.

 4.	 The	EDNS	and	other	nurse	administrators	are	able	to	secure	adequate	fiscal	and	human	
     resources	to	support	nursing	practice.




   quality of
 5.	 Nurse	satisfaction	is	measured	using	valid	data	collection	tools/methods.	Direct	care	nurses	
     participate	in	decision-making	relative	to	planning	changes	based	on	the	data.




  nursing
 6.	 Nurses	from	a	variety	of 	roles	(direct	care,	advanced	practice,	management,	executive,	etc.)	
     are	involved	in	decision-making	bodies	in	the	organisation.




leadership
 7.	 Direct	care	nurses	are	routinely	involved	in	formal	and	informal	work	groups	within	the	
     organisation.




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 1.1            Describe how the mission, vision, values, philosophy and strategic plan of
                nursing services are congruent with those aspects of the organisation.




 PAHHSD	is	one	of 	many	hospitals	governed	by	QH	and	therefore	PAHHSD	practices	within	
 the	overarching	mission,	values	and	strategic	directions	of 	QHealth,	which	nursing	services	have	
 articulated	into	the	Nursing	Division	Strategic	Directions	Statement	2006	–	2009	(Appendix 37).
 This	narrative	describes	the	QH	mission,	values	and	strategic	directions	and	demonstrates	how	
 nursing	services	are	aligned	with	these	overarching	beliefs	and	strategies.

 QH’s	mission	is	“to	create	dependable	health	care	and	better	health	for	all	Queenslanders”.	The	
 four	core	underpinning	values	are	important	in	building	trust	and	fulfilling	the	mission,	which	




                                                           1
 are	caring	for	people,	leadership,	respect	and	integrity.	QH	strategic	directions	are	found	in	a	
 number	of 	strategic	directions	documents	(as	discussed	in	the	organisational	overview),	and	are	
 summarised	below:

       	Working	with	communities	to	improve	health
       	Creating	a	patient	focused	health	system
       	Responding	justly	and	fairly	to	need
       	Working	together
       	Making	Queensland	Health	a	good	place	to	work
       	Building	the	next	generation	of 	health	workers,	ideas	and	health	services
       	Promoting	a	problem	solving	approach	to	reform	Queensland	Health
       	Better	manage	performance	of 	systems	assets	and	information	

 The	PAHHSD	Nursing	Division	Strategic	Directions	Statement	2006	–	2009,	identifies	five	
 priority	areas	for	nursing	at	PAHHSD	that	are	congruent	with	QH	mission,	values	and	strategic	
 directions.	They	are	collaborative	and	safe	nursing	care,	leadership	and	development,	practice	




   quality of
 development	through	continuous	improvement,	workforce	development,	and	financial	and	
 resource	management.	It	is	also	acknowledged	that	the	document	was	developed	in	line	with	
 existing	strategic	directions	set	by	PAHHSD.




  nursing
 The	PAHHSD	Nursing	Division	Strategic	Directions	Statement	2006	–	2009	have	been	
 prioritised	and	the	following	examples	detail	how	the	priorities	have	been	operationalised.	




leadership
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 Priority 1.	Collaborative	and	safe	care	is	based	on	strengthening	nursing	practice	through	
 collaborative,	innovative	models	of 	care	and	using	evidence	and	best	practice	to	underpin	safe	
 care.	Priority	1	is	also	based	on	building	relationships	with	other	health	care	workers,	internal	and	
 external	to	the	organisation.	Examples	include	initiatives	such	as	the	Patient	Operational	Access	
 Committee	which	promotes	interdisciplinary	collaboration,	and	system	and	process	review	aimed	
 at	positive	patient	outcomes.	Further	examples	include	review	and	changes	to	models	of 	care,	
 in	the	Spinal	Injuries	Unit	(SIU)	and	the	Internal	Medicine	Units	(as	discussed	in	Force	5).	In	
 both	examples	nurses	have	identified	areas	of 	improvement	and,	by	using	an	evidenced	based	
 approach,	have	developed	new	models	of 	care.	

 Priority 2.	Leadership	and	development	is	about	building	leadership	capacity	at	both	senior	
 management	and	clinical	unit	levels.	In	this	priority	development	of 	nurses	across	the	span	of 	




                                                           1
 their	career	is	identified	in	conjunction	with	what	professional	development,	education	and	
 skills	the	service	will	require.	For	example,	senior	nursing	leaders	have	been	participating	in	the	
 QH	Leadership	program	‘Inspiring	Leadership’	where	the	program	is	aligned	to	QH’s	mission,	
 values	and	strategic	direction	and	aims	to	instil	the	values	to	each	participant.	Each	nursing	
 staff 	member	participates	in	the	PAD	process,	discussed	in	Force	4.	Nurses	identify	learning	
 and	development	needs,	and	a	plan	is	formulated	to	support	the	nurse	to	attain	the	required	
 knowledge	and	skills. (Appendix 85).

 Priority 3.	Practice	development	through	continuous	improvement	supports	an	environment	
 that	encourages	and	actively	participates	in	research,	benchmarking	activities,	implementation	
 of 	best	practice,	continuous	review	of 	practice	and	maintenance	of 	Magnet	status.	Evidence	
 of 	the	implementation	of 	the	strategy	can	be	seen	in	the	establishment	of 	the	Professional	
 Practice	–	Medication	Project,	where	an	interdisciplinary	group	reviews	risk	management	and	
 best	practice	in	medication	management.	The	NPDU	has	developed	a	draft	action	plan	further	
 articulating	the	direction	for	nurse	education	at	PAHHSD	(Appendix 86).	Further	evidence	is	
 demonstrated	through	the	Nursing	Research	Register	which	identifies	nursing	research	activities	




   quality of
 being	undertaken	(Appendix 87).




  nursing
leadership
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 Priority 4.	Workforce	development	focuses	on	the	attraction,	recruitment	and	retention	of 	
 staff.	This	takes	into	account	appropriately	qualified	nurses	to	meet	current	and	future	needs	
 of 	both	the	organisation	and	the	staff,	including	work	life	balance	and	staff 	satisfaction.	
 Examples	of 	implementation	of 	the	strategy	include	the	PAHHSD	Workforce	Plan	2006	–	2008	
 (Appendix 88).	The	District	Multidisciplinary	Workforce	Committee	sponsored	by	the	EDNS,	
 operationalises	this	plan	which	links	directly	with	the	nursing	workforce	plan,	currently	under	
 development	(Appendix 89).	Feedback	from	the	BPA	survey	is	also	utilised	to	inform	workforce	
 development.

 Priority 5.	Financial	and	resource	management	focuses	on	ensuring	that	financial,	human	and	
 physical	resources	are	efficiently	and	effectively	managed	across	the	PAHHSD,	and	includes	
 appropriate	information	systems	that	support	decision	making	at	all	levels.	For	example,	the	




                                                           1
 Nursing	Scorecard	is	analysed	on	a	monthly	basis	to	identify	resources	used	and	required,	trends	
 in	areas	such	as	nurse	sensitive	indicators,	and	to	monitor	overall	labour	and	non	labour	costs.	

 The	Nursing	Division	Strategic	Directions	Statement	2006	–	2009	can	be	shown	to	be	aligned	
 with	QH	vision,	mission	and	strategic	direction	as	demonstrated	with	the	above	examples.




   quality of
  nursing
leadership
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 1.2           Describe how the EDNS includes nurses who work in areas other than
               nursing services in activities and decision-making regarding nursing care.



 There	are	a	number	of 	nurses	working	outside	the	traditional	nursing	field	of 	direct	patient	care,	
 in	areas	such	as	administration,	recruitment,	and	the	Clinical	Governance	Unit.	Nurses	who	work	
 in	these	roles	report	operationally	to	their	line	managers,	and	professionally	to	the	EDNS.	Line	
 management	may	be	delegated	by	the	EDNS	to	appropriate	nursing	executive	members.	Many	
 of 	these	roles	provide	support	to	the	clinical	areas	and	are	members	of 	key	committees	and	
 working	parties	within	PAHHSD.	These	roles	include	Patient	Safety	Officers;	Medication	Safety	
 Officer;	Quality	Coordinator;	Disaster	and	Emergency	Response	Coordinator;	Clinical	Product	
 Coordinator	Nurse	Manager,	Central	Clinical	Resource	Unit	(CCRU);	and	Nursing	Employment	




                                                           1
 Nurse	Manager.	This	narrative	will	provide	examples	of 	the	activities	and	involvement	in	decision	
 making	by	the	Patient	Safety	Officers,	Medication	Safety	Officer	and	the	Disaster	and	Emergency	
 Response	Coordinator	.	

 PAHHSD	employ	three	Patient	Safety	Officers	(PSOs),	part	of 	their	role	is	to	review	critical	
 incidents	that	occur	in	the	hospital.	As	part	of 	the	process	the	PSOs	coordinate	teams	to	
 discuss	process,	system	or	human	error	in	relation	to	critical	incidents.	An	action	plan	is	then	
 formulated	by	the	reviewing	team	and	the	PSO,	as	a	member	of 	the	District	Safety	and	Quality	
 Committee,	presents	the	findings	and	recommendations	to	the	committee	for	endorsement.	
 Recommendations	may	range	from	changing	policy,	purchasing	new	equipment,	or	establishing	
 new	resources	to	prevent	further	incidents.	The	PSOs	also	provide	training	to	the	organisation,	
 on	the	management	and	detection	of 	errors	in	the	form	of 	the	HEAPS	training.	Many	nurses	
 as	well	as	other	specialty	groups	across	the	organisation	have	now	completed	this	course,	which	
 aims	to	improve	patient	outcomes	through	a	team	approach	to	care	and	responsibility.	




   quality of
  nursing
leadership
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 The	PSOs	closely	monitor	PRIME	incidents	(discussed	in	Force	7)	and	assist	to	investigate	these	
 incidents	with	nursing	staff 	and	other	members	of 	the	team.	Incident	or	‘near	miss’	trends	are	
 identified	and	monitored	across	the	organisation	(Appendix 90, 91). This	information	is	then	
 highlighted	and	actioned	through	committees	such	as	the	District	Safety	and	Quality	Committee,	
 Medication	Safety	Committee,	and	Drugs	&	Therapeutics	Committee,	with	feedback	to	Clinical	
 Council.	The	Medication	Safety	Officer	in	the	Clinical	Governance	Unit	works	alongside	nursing	
 staff 	and	pharmacists	to	monitor	and	improve	the	medication	safety	processes	within	the	
 PAHHSD.	The	Clinical	Governance	Unit	reports	to	the	Executive	Director	of 	Medical	Services	
 (EDMS)	however	the	EDNS	has	close	links	to	this	unit	through	the	Nursing	Governance	and	
 professional	responsibilities.	

 An	example	of 	the	EDNS	including	nurses	working	in	areas	other	than	nursing	services	was	the	




                                                           1
 alteration	in	labelling	of 	3%	Saline	infusion	flasks,	on	the	recommendation	of 	nurses	from	the	
 Medication	Safety	Unit.	A	patient	incident	regarding	3%	Saline	resulted	in	a	review	of 	the	ED	
 store	room	and	Intra-	Venous	(IV)	storage	processes.	It	was	found	that	3%	Saline	was	being	
 delivered	to	the	ED	storeroom	instead	of 	the	ED	pharmacy	room.	Despite	ED	and	Pharmacy	
 having	established	delivery	and	storage	procedures,	where	three	bags	of 	3%	Saline	were	delivered	
 to	the	pharmacy	room	into	a	specially	marked	area	away	from	the	regular	IV	stores,	3%	Saline	
 continued	to	be	found	in	the	storeroom.	As	3%	Saline	has	the	potential	to	cause	death	or	
 significant	harm	by	disrupting	the	electrolyte	balance,	through	the	EDNS,	nurses	working	with	
 the	Medication	Safety	Unit	sought	further	action	with	various	groups	including	Medication	
 Safety,	Quality,	and	Patient	Safety	Officers.

 The	Pharmacy	Department	made	arrangements	for	interim	identification	of 	the	3%	Saline	bags	
 (Appendix 92). The	EDNS	sought	and	gained	the	support	of 	the	Clinical	Council	to	progress	
 recommendations.	With	the	support	and	action	of 	the	EDNS,	nurse’s	recommendations	to	
 request	the	manufacturer	to	amend	the	labels	of 	3%	Saline	bags	to	make	the	contents	more	
 visible	were	progressed	and	the	labelling	was	suitably	amended.	




   quality of
 The	Disaster	and	Emergency	Response	Coordinator	is	a	senior	nurse	working	in	an	area	other	
 than	nursing	services,	ensuring	processes	are	in	place	to	assist	in	the	management	of 	emergency	




  nursing
 situations	affecting	the	PAHHSD	(see	further	information	regarding	this	role	in	Force	12).	The	
 ENDS	and	Clinical	Council	worked	closely	with	the	nurse	on	receipt	of 	recommendations	




leadership
 from	the	nurse	regarding	planning	and	training	for	Pandemic	and	fit	testing.	The	Disaster	and	
 Emergency	Response	Coordinator	was	instrumental	in	decision	making	for	the	PAHHSD,	and	
 developed	a	plan	and	educational	program	to	meet	the	needs	of 	the	organisation.	The	plan	was	
 discussed	and	endorsed	at	the	District	Safety	and	Quality	meeting.


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 1.3           Give examples from different nursing units, of advocacy by the EDNS behalf
               of the staff, such as requests for additional FTEs, systems, equipment,
               personnel support, and so forth.



 As	a	member	of 	the	Finance	Board,	the	EDNS	is	able	to	advocate	on	behalf 	of 	nursing	staff 	to	
 directly	influence	the	budget	across	the	entire	organisation.	This	narrative	will	provide	examples	
 demonstrating	where	the	EDNS	has	advocated	for	resources	such	as	additional	FTEs	in	the	
 permanent	pool,	funding	for	the	Mental	Health	service,	the	ED	and	the	CCRU.

 An	extremely	good	example	of 	how	the	EDNS	has	secured	additional	nursing	resources	can	be	
 illustrated	through	the	introduction	of 	the	permanent	nursing	pool.	The	EDNS	has	had	direct	
 impact	on	increasing	FTE	nursing	staff 	in	the	hospital	through	her	advocacy	for	and	support	




                                                           1
 of 	the	development	of 	a	Permanent	Pool	of 	Nursing	staff.	In	2007	the	EDNS	presented	the	
 case	for	a	Permanent	Pool	of 	Nursing	Staff 	at	Clinical	Council	and	highlighted	the	benefits.	The	
 benefits	are	patient	safety	requirements,	continuity	of 	care,	and	a	decrease	in	agency	nursing	
 costs.	The	proposal	for	a	permanent	nursing	pool	was	supported	to	the	level	of 	eighty	(80)	FTE.	
 This	has	been	an	extremely	positive	and	worthwhile	achievement	for	the	organisation	and	its	
 nursing	staff,	and	a	number	of 	nurses	have	elected	to	join	the	permanent	pool	versus	the	casual	
 pool,	which	remains	as	a	long	standing	arrangement	in	the	hospital.	The	permanent	pool	secures	
 shift	flexibility,	annual	leave,	sick	leave	and	the	professional	development	allowance	for	staff 	that	
 wish	to	work	on	the	permanent	pool,	increasing	staff 	satisfaction.

 In	conjunction	with	the	ND	of 	Mental	Health,	the	EDNS	demonstrated	the	under	funding	
 of 	the	Mental	Health	Service	in	the	PAHHSD	through	various	methods	including	showcasing	
 the	large	number	of 	recorded	PRIME	incidents	related	to	patient	service	delivery.	The	number	
 of 	significant	high	risk	patient	incidents	involving	death	or	permanent	disability,	listed	as	SAC	
 1	incidents,	were	of 	concern	to	the	EDNS	and	Mental	Health	Services.	This	information	was	




   quality of
 used	to	advocate	for	an	increase	in	staffing	for	the	Mental	Health	Service	at	PAHHSD.	The	
 new	Mental	Health	Unit	was	opened	in	2006	with	a	concurrent	increase	in	mental	health	nurses.	
 New	Clinical	NE	positions	were	included	to	enhance	and	facilitate	the	provision	of 	training	and	




  nursing
 education	for	our	existing	mental	health	nurses,	undergraduates,	and	new	postgraduates.	

 A	further	example	of 	the	EDNS	advocacy	by	the	EDNS	for	mental	health	nursing	resources	was	



leadership
 the	Emergency	Mental	Health	Service.	A	business	case	which	was	supported	by	the	EDNS	with	
 PAHHSD	Executive,	Mental	Health	and	the	ED	resulted	in	the	expansion	of 	the	Emergency	




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 Mental	Health	Service	in	the	ED.	A	new	model	of 	care	was	implemented	which	included	the	
 recovery	model	of 	health,	where	intensive	mental	health	support	is	provided	in	the	home.	The	
 EDNS	also	supported	increasing	affiliations	with	the	Australian	College	of 	Mental	Health	Nurses	
 and	the	university	sector	to	provide	professional	development	opportunities	for	mental	health	
 nurses.

 The	EDNS	has	successfully	advocated	for	an	increase	in	senior	nursing	staff 	in	the	Emergency	
 Department,	to	provide	clinical	expertise,	supervision	and	support	to	nurses.	An	ADON	ED	
 has	been	established,	and	an	increase	of 	three	CNCs	and	a	NM	was	achieved	during	2007.	
 The	EDNS	lobbied	for	these	positions	on	behalf 	of 	emergency	department	nurses	who	
 had	demonstrated	an	increase	in	demand	for	services,	an	increase	in	the	number	of 	patient	
 presentations,	and	a	higher	level	of 	patient	acuity.	Nursing	staff 	were	supported	by	the	EDNS	




                                                           1
 and	the	Emergency	Network,	which	resulted	in	the	addition	of 	expert	emergency	department	
 nurses	to	the	team.	Many	of 	these	new	positions	operate	after	hours	when	demand	have	proven	
 to	be	highest.	The	Southern	Area	Health	Service	(SAHS)	funded	two	(2)	of 	the	three	(3)	CNC	
 positions.	The	support	of 	the	EDNS	ensured	PAHHSD	funding	was	procured	to	fund	the	third	
 position (Appendix 93).

 The	EDNS	has	supported	the	need	for	increased	equipment	and	was	successful	in	gaining	one	
 million	two	hundred	thousand	dollars	($1,200,000)	towards	acquisitions	for	CCRU	during	the	
 2006	–	2007	financial	year	(Appendix 94). Nurses	in	every	unit	of 	the	PAHHSD	have	benefited	
 with	the	purchase	of 	equipment	such	as:	electrocardiogram	machines	and	ten	(10)	carts;	five	
 hundred	(500)	intravenous	poles;	one	hundred	and	twenty	(120)	hoist	slings	for	patient	handling;	
 twenty	six	(26)	syringe	pumps	for	infusions;	two	(2)	bariatric	equipment	shower	trolleys	and	two	
 (2)	shower	chairs.	This	support	has	benefited	direct	care	nurses	and	NUMs,	as	the	CCRU	now	
 procures,	supplies	and	maintains	patient	care	equipment.

 Car	parking	and	child	care	facilities	were	identified	by	the	BPA	staff 	satisfaction	survey	data	as	




   quality of
 areas	of 	concern	for	nurses.	The	EDNS	was	part	of 	the	executive	team	who	successfully	lobbied	
 the	government	for	these	facilities	based	on	the	data.	The	multi	storey	staff 	car	park	opened	
 during	2008	and	has	provided	over	five	hundred	(500)	additional,	secure	parks	for	nurses	and	




  nursing
 PAHHSD	staff.	The	implementation	of 	the	PA	Lifestyle	Program	was	another	outcome	of 	the	
 BPA	survey,	which	offers	classes	on	meditation	and	yoga,	and	at	a	small	cost,	a	massage	therapist.	




leadership
 Further	examples	of 	EDNS	advocacy	for	resourcing	nursing	services	include	the	establishment	
 of 	a	NM	position	in	the	DOR,	the	development	of 	the	Nursing	Workforce	and	Patient	Flow	
 Unit,	and	the	introduction	of 	the	ESU	in	the	DOS	(Appendix 95).



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 1.4           Provide examples of how nurses at all levels are leading and participating in
               professional nursing organisations and activities at the local, state, national
               and/or international levels. Include examples of how this benefits the
               practice setting and the nursing community.




 Nurses	at	all	levels	of 	the	organisation	not	only	participate	in,	but	play	a	leading	role	in	
 professional	nursing	organisations	and	activities	in	a	variety	of 	settings.	Nursing	involvement	
 in	professional	nursing	organisations	at	the	local,	state,	national	and	international	level	benefits	
 the	organisation	with	access	to	developments	in	healthcare,	maintenance	of 	currency,	and	the	
 contribution	to	professional	practise	and	standards.	Nursing	participation	benefits	the	practice	
 setting	and	nursing	community	with	the	opportunity	to	network	and	foster	an	environment	of 	




                                                           1
 continuous	improvement	through	sharing	knowledge.	

 The	following	examples	illustrate	how	PAHHSD	nurses	participate	and	lead	professional	nursing	
 organisations	at	a	PAHHSD	level,	within	the	SAHS,	Queensland	state,	and	Australia	wide	in	a	
 variety	of 	specialties.	This	narrative	will	discuss	the	benefits	participation	in	professional	nursing	
 organisations	has	for	nursing	practice	and	patient	care,	and	include	nursing	participation	in	
 Clinical	Networks,	Queensland	Nurses	Union	(QNU),	QNC,	Royal	College	of 	Nursing	Australia	
 (RCNA),	the	Association	of 	Queensland	Nurse	Leaders	and	a	variety	of 	speciality	nursing	
 organisations.	

 A	QH	Clinical	Network	is	a	formally	recognised	group,	principally	comprised	of 	clinicians,	
 established	to	address	problems	in	quality	and/or	efficiency	of 	health	care,	and	are	established	
 around	a	particular	speciality (Appendix 96). The	combined	knowledge	and	expertise	of 	
 clinicians	who	are	members	of 	clinical	networks	is	used	to	improve	quality	of 	care	for	patients	
 and	service	planning.	




   quality of
 Each	clinical	network	provides	policy	advice	for	their	clinical	speciality,	budget	priorities,	
 service	planning,	and	specific	issue	review	and	advice.	A	number	of 	PAHHSD	nurses	are	
 actively	involved	in	clinical	networks,	many	leading	sub	groups	within	the	networks.	The	current	




  nursing
 networks	involving	PAHHSD	staff 	are	Cardiac,	Emergency,	Palliative	Care,	Renal	Services,	
 Surgical	Services,	Intensive	Care	Services,	Aged	Care	and	Rehabilitation,	Cancer	Care	and	Mental	




leadership
 Health.	The	following	examples	identify	benefits	to	PAHHSD	from	nurse	participation	in	these	
 groups.




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 The	PAHHSD	cardiology	NUM	participates	in	the	Cardiac	Network.	In	addition,	the	CNC	Heart	
 Failure	(Heart	Failure	Sub	Committee),	CNC	Cardiac	Rehabilitation	(Cardiac	Rehabilitation	Sub	
 Committee)	and	Cardiology	NE	(Education	and	Training	group)	are	active	members	and	support	
 subcommittees	within	the	network.	A	benefit	of 	participation	has	been	the;	provision	of 	funding	
 from	the	network	for	a	project	reviewing	cardiac	competencies	across	the	SAHS,	and	making	
 recommendations	for	standardising	cardiac	nursing	competencies.	As	a	result	a	further	project	
 has	been	endorsed	to	start	working	on	a	standardisation	strategy	using	competencies	based	on	
 best	practice	principals	which	will	not	only	increase	the	practice	standards	at	PAHHSD	but	
 throughout	the	SAHS.

 The	NUM	ED	is	a	member	of 	the	Emergency	Network	and	member	of 	the	Expert	Panel	(senior	
 medical	and	nursing	representatives	from	each	of 	the	hospitals	in	the	SAHS).	Appendix 97	is	




                                                           1
 an	example	of 	the	discussion	points	at	the	SAHS	ED	Clinical	Network	expert	panel	meeting.	A	
 number	of 	ED	nurses	from	PAHHSD	participated	in	three	(3)	subcommittees	of 	the	network.	
 The	NUM	chairs	the	nursing	subcommittee	and	with	other	senior	nurses	involved.	There	is	an	
 education	subcommittee	with	Acting	Nurse	Educator	ED	involved	and	a	research	subcommittee	
 with	Nurse	Researcher	and	Research	Assistant	SAHS	involved:	both	of 	these	research	
 incumbents	are	nursing	employees	of 	PAHHSD	with	direct	links	in	ED	either	through	direct	
 clinical	care	and/or	research.	The	Emergency	Network	has	funding	for	a	number	of 	projects,	
 including	a	clinical	nurse	from	PAHHSD	to	standardise	clinical	guidelines	across	the	SAHS	to	
 improve	patient	outcomes	and	decrease	adverse	incidents	(Appendix 98).

 The	Palliative	Care	NUM	is	an	active	member	of 	the	Palliative	Care	Network	and	has	participated	
 in	establishing	medication	guidelines	for	domiciliary	nursing	services.	This	is	designed	to	support	
 both	the	nurses	and	the	carers	of 	patients	who	require	palliative	care	in	this	state.	In	addition	the	
 network	has	established	learning	tools	for	aged	care	facilities	throughout	the	state	on	the	use	of 	
 Grasby	infusion	pumps.




   quality of
 Eighty	Nine	Percent	(89%)	of 	PAHHSD	nurses	are	members	of 	the	QNU.	This	organisation	
 helps	review	standards	of 	nursing	practice,	negotiates	for	improved	conditions	for	nurses	
 throughout	the	state,	and	provides	professional	advice	and	training	in	professional	and	industrial	




  nursing
 issues.	QNU	is	the	state	organisation	and	the	Australian	Nursing	Federation	(ANF)	is	the	
 national	union	body	for	nursing	at	a	national	level.	




leadership
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 Three	PAHHSD	nurses	are	QNU	councillors,	two	senior	nurses	are	councillors	for	both	QNU	
 and	ANF,	and	one	(1)	CN	is	a	councillor	with	QNU.	Two	(2)	of 	these	nurses	work	in	ED	and	the	
 third	works	in	the	Infectious	Diseases	Unit.	There	are	six	(6)	PAHHSD	QNU	nursing	delegates.	
 The	QNU	annual	conference	was	held	16	–	19	July,	2008	and	all	nine	(9)	delegates	attended.	This	
 is	the	opportunity	for	the	interests	of 	PAHHSD	nurses	to	be	represented.	The	branch	delegates	
 are	invited	to	present	resolutions	to	be	voted	on	that	may	influence	the	course	of 	the	QNU	
 during	the	year	ahead.	

 The	EDNS	is	a	member	of 	the	QNC	which	is	the	independent	statutory	body	that	regulates	
 nursing	and	midwifery	in	Queensland.	The	Council	meets	on	the	first	Friday	of 	each	month	to	
 establish	the	objectives	and	policies	for	the	regulation	of 	nursing	in	Queensland,	in	accordance	
 with	the	Nursing Act 1992 (can	be	veiwed	on	site).	Consideration	and	decisions	that	influence	




                                                           1
 nursing	practice,	regulation	and	public	safety	in	Queensland	is	also	undertaken	at	Council	
 meetings.	Decisions	of 	Council	are	made	in	the	public	interest	with	an	understanding	of 	the	
 profession	and	the	settings	in	which	nursing	is	practised.

 The	EDNS	actively	supports	nursing	professional	organisations	and	activities,	which	can	be	
 evidenced	with	the	approval	of 	secondments.	For	example,	a	clinical	nurse	was	approved	for	
 secondment	to	the	QNC	to	participate	in	a	project	looking	at	practice	standards	in	2007.	This	
 will	directly	benefit	PAHHSD	in	the	future	by	influencing	the	level	of 	clinical	standards	across	
 the	hospital	and	throughout	the	state	as	a	tertiary	facility	and	service	provider.

 The	EDNS	has	a	vital	role	in	influencing	nursing	strategic	direction	through	participation	in,	
 and	leading	various	groups	which	influence	the	practice	and	direction	of 	nursing	at	PAHHSD,	
 Queensland	and	Australia	level.	Nurses	throughout	the	organisation	are	encouraged	by	the	
 EDNS	to	join	various	bodies	of 	nursing	such	as	the	RCNA	and	the	Association	of 	Queensland	
 Nurse	Leaders,	of 	which	the	EDNS	is	a	member.




   quality of
  nursing
leadership
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 The	ED	NUM	is	the	Executive	Director	of 	the	College	of 	Emergency	Nursing	Australasia	Ltd	
 (CENA)	and	has	served	two	terms	in	this	position.	In	addition,	30%	of 	the	emergency	nurses	
 at	PAHHSD	belong	to	this	professional	organisation	and	participate	in	different	capacities.	
 CENA	was	commenced	after	amalgamating	the	six	Australian	states	Emergency	Nurses	
 Associations	(ENA)	in	order	to	have	a	combined	national	college	of 	emergency	nursing.	The	
 aim	of 	amalgamation	was	to	have	a	united	voice	for	emergency	nursing	in	Australia.	The	NUM	
 was	instrumental	in	bringing	all	the	ENAs	to	the	table	and	to	commit	to	the	development	of 	the	
 college.	The	organisation	is	now	the	peak	national	nursing	specialty	organisation	representing	
 emergency	nurses	in	this	country,	has	over	twelve	hundred	(1200)	members	and	is	growing	at	
 a	steady	rate.	CENA	is	representative	of 	all	emergency	nurses	across	the	country	at	a	state	and	
 national	level	in	specific	areas	eg.	state	health	department	groups,	disaster	planning,	organ	and	
 tissue	donation	and	transplantation,	and	Standards	Australia,	and	is	able	to	influence	and	respond	




                                                           1
 to	recommendations.	

 The	NUM	is	the	CENA	representative	on	the	QH	Disaster	Collaborative,	an	invited	member	
 on	the	Queensland	Trauma	Registry	(QTR)	Governance	Committee	(Appendix 99)	and	
 a	committee	member	on	the	Cognate	Committee	on	Organ	and	Tissue	Donation	and	
 Transplantation	which	reports	directly	to	the	Australian	Health	Ministers	Advisory	Committee	
 (Appendix 100). The	committee	is	chaired	by	the	Chief 	Medical	Officer	and	is	the	oversight	
 committee	tasked	with	responsibility	for	advising	the	Commonwealth	on	all	issues	related	to	the	
 changes	to	the	process	of 	organ	and	tissue	donation	and	transplantation	in	Australia,	announced	
 in	July	by	the	Prime	Minister	(Appendix 101).

 One	of 	the	NUM’s	recent	achievements,	as	President	of 	CENA	Qld	Branch	in	2007,	was	to	
 lobby	the	Queensland	Premier,	QH	Minister,	the	Director-General	of 	Health	and	the	Chief 	
 Nurse	for	progression	of 	a	staffing	model	for	emergency	nurses	in	Queensland	that	recognised	
 their	workload	issues.	The	NUM	has	been	a	member	of 	the	Australian	Defence	Force	for	
 twenty	eight	(28)	years	and	is	a	Lieutenant	Colonel,	Deputy	Head	of 	Corps	General	Reserve,	




   quality of
 Royal	Australian	Army	Nursing	Corps.	She	has	received	an	Order	of 	Australia	Medal	in	the	
 Queens’	Birthday	Honours	in	2000	for	services	to	nursing	particularly	in	the	area	of 	accident	and	




  nursing
 emergency	care	and	community.	

 The	Acting	ND	Research	of 	the	NPDU,	also	a	senior	research	fellow	with	Griffith	University,	




leadership
 is	actively	involved	in	improving	professional	standards	for	emergency	nurses	nationally	and	
 at	a	state	level.	She	holds	several	positions	within	CENA.	These	include	Director	of 	CENA,	
 President	of 	the	Queensland	Branch,	Chair	of 	the	Research	Sub	Committee,	and	Member	of 	the	
 Website	Sub	Committee.	This	same	nurse	was	invited	to	participate	in	the	NICS,	an	institute	of 	
 the	National	Health	&	Medical	Research	Council	(NHMRC)	(Appendix 102).
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 The	NHMRC	is	Australia’s	peak	body	for	supporting	health	and	medical	research;	for	developing	
 health	advice	for	the	Australian	community,	health	professionals	and	governments;	and	for	
 providing	advice	on	ethical	behaviour	in	health	care	and	in	the	conduct	of 	health	and	medical	
 research	(Appendix 103). NICS	works	to	improve	healthcare	by	utilising	the	best	available	
 evidence	from	medical	research	and	to	assist	clinicians	to	make	this	evidence	part	of 	their	
 everyday	practice.	Six	million	(6,000,000)	presentations	in	2007	were	seen	through	our	Australian	
 emergency	departments	and	NICS	has	been	working	with	ED’s	to	utilise	evidence	to	improve	
 care	and	outcomes	for	our	patients (Appendix 104, 105, 106).

 The	Emergency	Care	Communities	of 	Practice	(EC	CoP)	Pain	Initiative	is	a	working	group	
 of 	NHMRC-NICS,	of 	which	Acting	ND	Research	of 	the	NPDU	is	an	emergency	care	expert	
 member.	The	aim	of 	this	initiative	is	to	improve	emergency	department	pain	management	




                                                           1
 by	implementing	the	recommendations	of 	the	NHMRC.	A	research	initiative	engaging	
 emergency	departments	nationally	is	in	process	of 	implementation	by	this	group	over	two	
 years	commencing	June	2008.	One	of 	the	Acting	CNC	in	the	ED	is	the	project	leader	for	the	
 PAHHSD	involvement	in	this	project.	PAHHSD	ED	was	successful	in	its	nomination	to	become	
 part	of 	this	initiative,	and	will	be	involved	in	a	later	wave	of 	involvement	commencing	in	2009	
 (Appendix 107a, 107b).

 Numerous	nurses	throughout	the	organisation	and	at	various	levels	are	involved	in	specialist	
 groups.	This	interaction	brings	with	it	the	knowledge	that	each	nurse	is	contributing	to	improving	
 patient	outcomes	through	the	provision	of 	evidence	based	up	to	date	information	gather	from	
 networking.	The	following	list	provides	examples	of 	such	nurses	and	groups.	Evidence	of 	this	
 involvement	will	be	available	during	the	site	visit.

    	Oncology	Nurses	Group	(	Queensland	Cancer	Council)	–	nurses	throughout	cancer	
        services	at	all	levels
    	Cancer	Nurses	Society	of 	Australia	(CNSA)	–	nurses	throughout	cancer	services	at	all	




   quality of
        levels,	NUM	Oncology	it	is	a	national	committee	member	of 	the	CSNA	–	education	group
    	Trans	Tasman	Radiation	Oncology	Group	(TROG)	–	NUM	Oncology
    	Ci-Scat	New	South	Wales	reference	group	for	radiation	oncology	–	NUM	Oncology	




  nursing
    	Australian	College	of 	Critical	Care	Nurses	(ACCCN)	–	nurses	from	Intensive	Care	Unit	
        (ICU),	ED,	Coronary	Care	Unit	(CCU)	of 	all	levels	are	members	of 	this	College.	Among	




leadership
        the	PAHHSD	membership	is	the	Queensland	Branch	treasurer,	a	peer	reviewer	for	the	
        journal	of 	Australian	Critical	Care	distributed	nationally	and	honorary	lifetime	membership	
        in	recognition	of 	years	of 	service	to	ACCCN




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    	Australian	Nurses	Hypertension	and	Cardiovascular	Association	(ANCHA)	–	the	NO	4	&	
        a	RN	in	the	Hypertension	Unit,	and	are	also	members	of 	the	Executive	Committee
    	National	Blood	Pressure	and	Vascular	Disease	Advisory	Committee	which	is	a	sub	
        committee	of 	the	National	Heart	Foundation	(NHF)	–	NO4	is	a	committee	member.	This	
        committee	developed	guidelines	based	on	recent	literature	and	best	practice	for	patients	
        with	hypertension.	The	guidelines	are	designed	for	General	Practitioners	(GP)	and	Health	
        Professionals
    	Queensland	Cardiac	Rehabilitation	Association	(QCRA)	–	CNC	and	NO2	of 	cardiac	
        rehabilitation,	NO2	is	membership	secretary
    	Australian	Cardiovascular	Health	and	Rehabilitation	Association	(ACRA)	–	CNC	and	NO2	
        of 	cardiac	rehabilitation
    	Cardiac	Society	of 	Australia	and	New	Zealand	(	CSANZ)	–	various	members	of 	staff 	from	




                                                           1
        NUM,	NE,	CNC,	CN,	and	RN	from	Heart	Failure,	CCU,	Cardiology,	Cardiac	Outpatients	
        and	Cardiac	Catheter	Lab	are	affiliate	members
    	Cardiovascular	Nurses	working	group	–	sub	group	within	CSANZ
    	Australasian	Cardiovascular	Nursing	College	(ACNC)	–	NUM,	CNC,	NE,	CN	and	RNs	
        from	Heart	Failure,	CCU,	Cardiology,	Cardiac	Outpatients	and	Cardiac	Catheter	Lab.	The	
        CN	of 	Electrophysiology	and	Pacing	(a	unique	position	in	Australia)	has	presented	topics	
        at	each	annual	meeting	so	far	held	by	the	College
    	Australian	Nurse	Practitioner	Association	(ANPA)	–	NP	and	NP	candidates	
    	European	Dialysis	Transplant	Nurses	Association	(EDTNA)	–	nurses	from	the	renal	unit
    	Renal	Society	of 	Australasia	(RSA)	Nurse	Educator	is	on	the	QLD	education	board.	Many	
        papers	have	been	presented	by	the	Renal	Unit	nursing	staff 	at	the	national	conference,	the	
        latest	being	at	the	2007	conference	in	Perth.	This	presentation	was	nominated	for	an	RSA	
        award,	judged	annually	at	the	conference
    	Queensland	Nephrology	Nurses	Network	–	a	Nurse	Practitioner	in	CKD
    	Transplant	Nurses	Association	–	NM,	CNs	and	RNs	in	the	transplant	ward:	with	one	staff 	




   quality of
        member	in	the	role	of 	Qld	branch	president	and	secretary
    	Australasian	Neurosurgical	Nurses	Association	–	state	delegate	and	members:	RN,	CN,	
        NM



  nursing
    	Australasian	Rehabilitation	Nurses	Association	(ARNA),	is	the	peak	specialist	organisation	
        for	rehabilitation	nurses	throughout	Australasia.	Nurses	working	within	the	rehabilitation	




leadership
        settings	at	PAHHSD	are	encouraged	to	be	members.	A	number	of 	PAHHSD	nursing	
        staff 	sit	on	the	ARNA	Queensland	state	chapter	and	hold	national	committee	positions	
        and	portfolios.	ARNA	Queensland	Chapter	has	eight	(8)	executive	positions	and	five	
        (5)	of 	these	are	held	by	PAHHSD	staff,	they	are	the	Vice	president,	Treasurer	and	three	
        Committee	members
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 The	Queensland	Chapter	Vice	President	and	ARNA	member	has	been	representing	
 Rehabilitation	nurses	on	the	Community	Rehabilitation	Workforce	Project	–	Assistant	Project	
 Reference	group	for	eighteen	(18)	months.	Nursing	representation	on	this	group	has	ensured	
 that	the	new	undergraduate	curriculum	for	Certificate	IV	Community	Rehabilitation	Assistance	
 training	offered	through	TAFE	includes	a	nursing	component.	Previously	this	training	has	been	
 allied	health	and	discipline	specific	and	excluded	nurses	as	being	part	of 	community	rehabilitation	
 teams.	A	comprehensive	curriculum	will	ensure	that	the	Community	Rehabilitation	Assistant	
 workforce	will	be	prepared	and	value	the	concept	of 	working	alongside	the	nursing	staff 	on	these	
 teams.

 In	late	2004	ARNA	released	its	evidence	based	Competency	Standards	for	Registered	Nurses.	
 A	number	of 	PAHHSD	nurses	were	involved	in	the	study	that	informed	the	standards.	The	




                                                           1
 competency	standards	provide	a	framework	of 	the	‘how’	and	‘the	what’	of 	rehabilitation	nursing.	
 The	DOR	has	been	working	on	translating	these	standards	into	practice.




   quality of
  nursing
leadership
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 1.5           Describe the involvement of nurses at all levels in the budget development
               process.




 All	direct	care	nursing	staff 	at	PAHHSD	are	encouraged	to	have	input	into	the	development	of 	
 budgets	relevant	to	their	work	units.	The	senior	nursing	staff 	are	then	responsible	for	validating	
 and	lobbying	for	appropriate	resources	across	their	divisions	and	for	nursing	resources	across	the	
 PAHHSD,	this	includes	nursing	roles	that	support	the	divisions.	This	narrative	will	discuss	how	
 nurses	at	all	levels	are	involved	in	budget	development	for	PAHHSD.	

 As	discussed	in	the	organisational	overview	section	15,	the	BPF	(Appendix 48)	is	the	framework	
 used	to	review	and	analyse	resources	and	budget	allocation	for	nursing.	The	tool	is	a	framework	




                                                           1
 that	provides	nurses	with	a	business	planning	process	to	assist	in	determining	appropriate	nursing	
 staff 	to	meet	service	requirements	and	in	addition	evaluate	the	performance	of 	the	nursing	
 service.	

 Senior	nurses	have	had	training	in	the	principles	and	application	of 	the	BPF	to	ensure	
 understanding	of 	the	process.	The	initial	process	incorporates	the	development	of 	a	service	
 profile	for	each	individual	unit,	for	example	the	Division	of 	Rehabilitation	Service	Profile	–	SIU	
 2008/2009	(Appendix 108). The	service	profile	takes	into	account	the	core	business	of 	the	unit,	
 unit	objectives,	describing	the	service,	analysing	the	environment	and	reviewing	the	strengths,	
 weaknesses,	opportunities	and	threats	to	the	service	(SWOT	analysis).	At	this	point	all	unit	based	
 staff 	will	have	the	opportunity	to	input	into	the	process	and	particularly	the	SWOT	analysis.	
 The	NHPPD	recommended	for	each	unit	are	negotiated	between	NUMs	and	nursing	executive	
 following	completion	of 	the	service	profile.	

 The	Divisions	review	all	service	plans	to	ensure	they	remain	consistent	with	PAHHSD	strategic	
 direction,	and	divisional	priorities.	Nursing	executive	within	the	divisions	are	responsible	for	




   quality of
 lobbying	Clinical	Council	for	appropriate	resource	allocation.	Each	unit	has	developed	a	nursing	
 scorecard (Appendix 78),	to	monitor	resource	utilisation	and	meet	monthly	to	analyse	data	and	
 review	service	targets.	Scorecards	are	discussed	at	unit	meetings	and	staff 	are	given	opportunity	




  nursing
 to	comment	on	the	progress	and	any	changes	required.	




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 Senior	nursing	members	also	have	opportunities,	as	members	of 	clinical	networks,	to	lobby	for	
 extra	resources	from	the	allocated	network	funding.	This	may	be	in	the	form	of 	one	off 	funding	
 for	project	work,	or	recurrent	funding	to	establish	new	positions	within	particular	services.	For	
 example,	SAHS	ED	Network	provided	recurrent	funding	for	two	of 	the	three	new	CNC/	Shift	
 Coordinator	positions	for	the	ED	at	PAHHSD.	

 New	positions	have	also	been	approved	within	PAHHSD,	through	either	formal	business	cases	
 or	data	collection	in	combination	with	an	identified	need	to	improve	our	practices	and	outcomes	
 for	patients.	Such	positions	as	Renal	Rover,	streamers,	Clinical	Care	Coordinators	and	a	number	
 of 	Mental	Health	positions	have	come	about	this	way.	Business	cases	are	presented	to	the	
 financial	board	and	as	a	member	on	the	financial	board,	the	EDNS	lobbies	for	resources	for	
 nursing	and	service	enhancement.	




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 1.6           Provide evidence of data-driven decision making regarding budget
               formulation, implementation, monitoring and evaluation.




 PAHHSD	utilises	a	variety	of 	data	to	support	decision	making	in	the	development,	
 implementation,	monitoring	and	evaluation	of 	budgets.	PAHHSD	takes	a	balanced	approach	to	
 ensuring	appropriate	resources	are	available.	Data	sources	to	be	discussed	in	this	narrative	include	
 feedback	from	the	BPA	survey,	human	resource	indicators,	nursing	scorecard,	nurse	sensitive	
 indicators,	labour	and	non	labour	costs.	

 Feedback	was	received	through	BPA	surveys,	HRM,	and	QH,	showing	that	staff 	were	unhappy	
 about	the	three	(3)	‘Cs’	–	Carparking,	Childcare	&	the	Cafeteria.	The	hospital	executive	needed	to	




                                                           1
 address	these	issues	as	a	priority.

 Funds	were	obtained	by	lobbying	QH	and	Capital	works	and	the	three	(3)	Cs	were	approved	for	
 construction.	This	was	a	big	step	towards	improving	morale	of 	staff.	The	result	of 	the	lobbying	
 has	been	that	the	car	park	was	opened	in	2008	and	both	the	new	cafeteria	and	child	care	centre	
 will	be	opened	later	in	2008.	

 PAHHSD	uses	a	DDW	tool	to	capture	actual	nursing	hours	to	measure	actuals	against	planned	
 hours.	DDW	captures	this	information	which	is	used	to	manage	and	organise	nursing	hours	
 more	effectively	and	efficiently.	It	helps	inform	budget	preparation	requirements	each	financial	
 year	and	also	aids	in	analysing	nursing	trends,	user	manual	can	be	see	on	site	visit.	Trends,	for	
 example,	include	external	staff 	utilisation	for	sick	leave	and	NHPPD	requirements.	

 The	ND	collaborate	with	BMs,	ADON,	NUMs,	NMs	and	CNCs	to	develop	the	nursing	labour	
 budget	for	each	financial	year.	In	accordance	with	the	nursing	industrial	award,	the	BPF	is	the	
 framework	under	which	nursing	workloads	and	nursing	resource	management	planning	and	
 evaluation	must	be	approached.




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 In	order	to	inform	decision	making	the	nursing	divisions	have	developed	unit	specific	nursing	
 scorecards	that	have	a	range	of 	data	collected	into	an	easy	to	read	document.	The	scorecard	
 data	is	used	in	conjunction	with	the	Roster	Coster	tool	to	better	inform	budget	preparation	and	
 planning.	The	Roster	Coster	tool	can	be	completed	on	a	roster	or	annual	basis	dependent	on	
 need	to	identify	and	manage	labour	costs	(Appendix 79). The	individual	unit	Nursing	Scorecards	
 are	reviewed	monthly,	issues	identified	then	have	strategies	developed	to	minimise	their	impact.	
 Strategies	are	review	each	month	to	evaluate	effectiveness.	Data	collected	on	the	scorecards	
 include:

 	Patient	numbers	for	the	month
 	Bed	occupancy	data	(budget	versus	actual)
 	Occupied	bed	days	(budgeted	versus	actual)




                                                           1
 	Direct	and	indirect	nursing	hours	(variance	identified)
 	FTE	(budgeted	versus	actual)
 	Unit	FTE	nursing	vacancies
 	Sick	leave	FTE
 	Clinical	indicators	(Hospital	acquired	pressure	ulcers,	Patient	falls,	Patient	medication	
    incidents)
 	Financial	indicators	(Nursing	Labour	Variance,	Clinical	supplies	variance,	Total	Budget	
    Variance)

 The	BM	has	a	clear	role	within	the	Divisions	in	the	development	of 	the	yearly	budget.	The	
 BM	works	collaboratively	with	Nursing	Executive,	ADONs,	NUMs	and	the	NMs	to	build	up	
 appropriate	nursing	budgets	for	individual	units.	Key	priorities	and	plans	are	considered	and	built	
 into	the	budget,	based	on	the	best	available	evidence.	




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 1.7           Provide specific examples of ways nurses at all levels have identified and
               advocated for additional nursing resources to support unit goals.




 Nursing	staff 	at	all	levels	contribute	to	service	planning	for	their	units.	In	this	process	staff 	utilise	
 data	to	assist	decision	making	in	relation	to	required	resources.	Using	the	principles	of 	the	BPF,	
 as	discussed	previously,	enables	nurses	at	every	level	to	identify	and	advocate	for	extra	nursing	
 resources.	This	narrative	will	provide	example	of 	how	this	has	occurred	in	the	Cardiology	unit,	
 After	Hours	Managers	Unit,	SIU	and	BIRU.

 In	2006	the	direct	care	nurses	in	the	Cardiology	unit	lodged	a	number	of 	Nursing	Workload	
 Forms	(Grievance	Forms)	regarding	their	increasing	workload	between	the	hours	of 	1300	–	2130.	




                                                           1
 This	involved	multiple	admissions	and	discharges	during	the	weekdays.	The	Nursing	Workload	
 forms	are	designed	for	nurses	to	report	issues	related	to	increased	workloads,	staff 	shortages	
 and	any	concerns	they	have	in	relation	staffing	issues,	further	discussed	in	force	4.	Workload	
 grievance	forms	were	completed	by	RNs,	CNs	and	EENs,	and	reported	to	the	NUM.	

 On	investigation	and	in	collaboration	with	the	nurses	of 	the	unit,	the	NUM	found	nursing	time	
 would	be	saved	with	the	addition	of 	an	AIN	after	hours	to	help	with	bed	washing	and	patient	
 movements,	and	a	nursing	team	leader	without	a	patient	load	to	coordinate	activities.	These	
 suggestions	were	discussed	with	the	ADON	and	ND,	DOM	and	subsequently	EDNS.	The	result	
 was	an	allocation	of 	four	hours	AIN	per	shift	and	a	readjustment	of 	rostering	practices	to	allow	
 for	a	senior	nurse	without	a	patient	load	to	be	introduced	on	this	shift.	This	occurred	through	the	
 commitment	of 	direct	care	nurses	in	documenting	their	concerns	and	demonstrating	the	need	for	
 more	resources.	

 Another	example	of 	the	identification	for	the	need	to	increase	resources	to	meet	unit	goals	
 was	the	introduction	of 	after	hours	administration	officers	to	support	the	after	hours	nurse	




   quality of
 managers	for	sixteen	hours	per	day.	The	additional	support	has	enabled	the	after	hours	hospital	
 manager	to	focus	on	the	management	of 	the	organisation	after	hours,	without	the	distraction	
 of 	administrative	duties.	This	was	supported	at	executive	level	with	EDNS	endorsement.	The	




  nursing
 additional	resources	which	were	identified	and	provided	to	the	after	hours	NMs’	Unit	has	
 resulted	in	a	positive	effect	on	morale	for	the	after	hours	nurse	managers,	and	a	benefit	to	patient	




leadership
 outcomes	as	the	senior	nurse	was	able	to	act	as	a	resource	and	was	available	where	needed.




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 A	further	example	is	that	of 	the	ND	in	the	DOR	advocating	for	the	establishment	of 	a	NM	
 for	the	division	and	a	NE	for	the	QSCIS.	The	division	was	established	in	early	2006	with	no	
 identified	nursing	infrastructure	to	support.	A	business	case	was	developed	highlighting	the	
 deficits	within	the	division,	the	ND	lobbied	the	EDNS	for	support	when	the	business	case	was	
 presented	to	the	financial	board.	The	outcome	was	successful	and	the	position	was	permanently	
 established.	

 The	final	example	provided	is	that	of 	the	BIRU.	Through	a	review	of 	the	model	of 	care	
 delivered	in	the	unit,	a	collective	decision	was	made	to	adjust	the	skill	mix	in	the	unit	to	allow	for	
 the	establishment	of 	a	CNC.	A	business	cases	was	developed	and	tabled	at	the	finance	board	for	
 approval.	This	was	also	successful	and	the	position	was	established	in	May	2008.	




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 1.8           Provide nurse satisfaction data for a four year period. Describe how nurse
               satisfaction data are tracked and analysed and how action plans are developed
               and evaluated based on data. Address how direct care nurses are involved in
               the process.




 BPA	is	a	privately	owned	research	company	based	in	Brisbane	which	has	bi-annually	conducted	a	
 Best	Practice	Employee	survey	since	the	initial	benchmark	survey	was	completed	at	PAHHSD	in	
 2000.	BPA	has	conducted	surveys	in	over	four	hundred	(400)	organisations	and	the	tool	has	been	
 successfully	validated (Appendix 109, 110).

 The	most	recent	BPA	survey	was	conducted	in	September	2006.	This	was	the	fourth	such	survey	




                                                           1
 conducted	involving	nursing	staff,	and	due	to	the	success	of 	previous	surveys	it	was	rolled	out	to	
 all	hospital	staff 	by	the	CCEO.	The	information	gained	in	the	survey	was	presented	at	Clinical	
 Council,	and	disseminated	to	the	individual	units/services	for	review	and	action.	Action	plans	
 were	initiated	and	implemented	when	an	area	identified	a	need	for	improvement	based	on	the	
 survey	results.	

 An	example	of 	an	action	plan	was	developed,	implemented	and	evaluated	was	in	Ward	3C	in	the	
 DOS.	Ward	3C,	the	Cardiac	Surgery	Unit	was	identified	through	the	BPA	survey	and	governance	
 meetings	to	have	high	turn	over,	low	staff 	morale,	increased	labour	costs	due	to	agency	usage,	
 however	there	was	high	patient	satisfaction.	The	NUM	3C,	who	was	a	reasonably	new	NUM	
 in	a	busy	area,	worked	with	the	ADON	and	ND	to	develop	an	action	plan	to	address	issues	
 identified.	An	action	plan	was	then	developed	which	set	goals	and	objectives	aimed	at	improving	
 in	all	these	areas	of 	deficit.	The	action	plan	was	agreed	to	by	the	NUM,	ADON	and	ND	in	
 consultation	with	3C	staff 	members.	The	NUM,	on	self 	reflection,	looked	at	his	own	part	in	
 the	culture	of 	3C	and	decided	that	he	wanted	to	be	able	to	contribute	significantly	to	changing	
 the	culture	in	the	unit.	The	NUM	enrolled	in	a	Graduate	Certificate	in	Health	Management	to	




   quality of
 assist	in	enabling	him	to	lead	change	for	the	positive	in	the	unit.	From	these	beginnings	the	ward	
 culture,	behaviour,	and	structure	was	reviewed	and	revised.	




  nursing
 The	senior	nursing	staff 	were	made	accountable	for	their	portfolios	and	for	the	nurses	
 working	with	them	in	their	portfolios.	All	nurses	were	involved	in	a	process	of 	reviewing	their	




leadership
 performance	through	the	PAD	process.	Lack	of 	education	for	the	nursing	staff 	was	shown	to	be	
 a	factor	in	the	high	turn	over	rates	of 	the	staff.	More	resources	were	concentrated	on	education	
 and	resulted	in	either	the	review	or	development	of 	learning	modules	to	improve	the	knowledge	
 and	skills	of 	the	staff,	their	practice	and	also	their	satisfaction.	


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 Staffing	levels	were	reviewed	and	there	were	changes	made	to	the	skill	mix	that	involved	
 the	employment	of 	EENs	which	was	a	significant	shift	in	culture.	There	were	difficulties	
 employing	registered	nurses,	however	the	changing	skill	mix	with	EENs	provided	a	consistent	
 workforce,	keen	to	grow	and	develop	their	knowledge	and	skills,	and	who	wanted	to	work	in	3C.	
 Information	was	sourced	from	exit	interviews	through	the	ADON,	and	information	fed	back	to	
 the	NUM	and	senior	staff 	regarding	reasons	why	staff 	were	leaving	–	which	then	helped	inform	
 changes	that	were	likely	to	be	required	in	the	unit.	Exit	Interview	Reports	are	available	to	identify	
 any	potential	or	current	issues	that	may	affect	Recruitment	and	Retention	(Appendix 111).

 The	NUM	was	keen	to	develop	new	knowledge	and	skills	and	to	grow	through	the	process	
 and	sought	the	support	of 	a	mentor.	The	change	that	occurred	in	3C	was	a	positive	change	
 that	refocused	the	staff,	encouraged	them	to	be	change	agents	in	this	process	and	the	unit	was	




                                                           1
 supported	through	the	changes	that	occurred.	The	BPA	culture	survey	results	the	following	year	
 demonstrated	a	positive	cultural	shift	towards	consolidation	and	ambition,	from	a	culture	of 	
 blame	(see	graph	10	below).

 Graph 10
 PAHHSD Cardiothoracic Surgery Unit (3C) Cultural Shift




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 PAHHSD,	as	part	of 	QH,	also	participate	in	the	Better	Health	Staff 	Opinion	Survey	(Appendix
 54).	The	survey	is	conducted	biannually	across	QH	facilities	enabling	benchmarking	with	other	
 districts,	and	internally	amongst	divisions.	The	tool	utilised	in	the	survey	is	the	Quick	Psycho	
 Affective	Symptoms	Scan	(QPASS).	The	QPASS	tool	is	not	the	same	tool	used	in	the	BPA	survey	
 however	a	number	of 	the	predictors	utilised	are	similar.	

 The	QPASS	measures	incorporated	into	the	Better	Health	Staff 	Opinion	Survey	are:	(1)	the	
 Psychological	Outcomes	scales	(Quality	of 	Work	Life,	Individual	Morale,	and	Individual	Distress)	
 that	measure	how	employees	feel	about,	or	at	work;	and	(2)	the	Organisational	Climate	scales	
 (Workplace	Morale,	Workplace	Distress,	Supportive	Leadership,	Participative	Decision-Making,	
 Role	Clarity,	Professional	Interaction,	Appraisal	and	Recognition,	Professional	Growth,	Goal	
 Congruence,	and	Excessive	Work	Demands)	that	measure	the	way	in	which	things	are	done	at	




                                                           1
 work	(eg.,	how	decisions	are	made)	(Hart,	Griffin,	Wearing,	&	Cooper,	1996).

 Additional	survey	sections	have	been	designed	to	address	many	of 	the	issues	confronted	by	staff 	
 in	QH.	Additions	reflect	the	importance	of 	staff 	opinion	about	topics	including	organisational	
 management	practices,	intention	to	leave,	working	in	a	clinical	environment,	teamwork,	workplace	
 health	and	safety	and	trust	in	leadership.	

 The	validity	and	reliability	of 	the	tool	was	tested	firstly	by	Robinson,	Perryman,	&	Hayday	in	
 2004	in	fourteen	(14)	organisations	in	the	National	Health	Service	(NHS)	(10,024	completed).	
 Secondly,	the	trust	measures	were	tested	and	modified	and	have	been	found	to	reflect	the	domain	
 as	identified	in	the	literature	(content	validity)	With	regards	to	predictive	validity,	University	of 	
 Southern	Queensland	(USQ)	is	currently	investigating	the	relationship	of 	trust	and	employee	
 engagement.	Trust	in	immediate	supervisor	is	also	directly	correlated	with	Supportive	Leadership	
 in	QPASS,	which	establishes	concurrent	validity.	No	other	studies	have	been	reported.

 Positive	outcomes	from	the	September	2007	survey	indicate	that	PAHHSD	staff 	are	generally	
 moderately	satisfied	with	their	jobs,	this	was	indicated	by	low	individual	stress	and	moderate	




   quality of
 morale	scores.	The	graph	below	indicates	the	average	scores	of 	workplace	moral	across	each	
 of 	the	divisions	at	PAHHSD.	The	blue	boxed	line	represents	PAHHSD	scores	while	the	green	




  nursing
 triangle	line	represents	QH	comparative	data.	




leadership
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 princess alexandra hospital           application for redesignation                                                                                                              force 1



 Graph 11
 PAHHSD Average Scores of Workplace Morale
                           100%



                            90%



                            80%



                            70%



                            60%



                            50%



                            40%



                            30%



                            20%



                            10%



                             0%
                                   Division of   Division of   Division of   Division of    Division of    Division of    Division of     Division of   Executive   Executive
                                    Cancer        Clinical     Corporate     Medicine      Mental Health   Radiology     Rehabilitation    Surgery      Director    Director of
                                    Services      Support       Services                                                                                 Medical     Nursing
                                                  Services                                                                                              Services    Services




                                                                                           1
                Workplace Morale      60.7          61.6          52.5          57.9           48.3           51.6           58.7            58.3         56.8         55.2
                September 2007        52.8          52.8          52.8          52.8           52.8           52.8           52.8            52.8         52.8         52.8
                QH Comparative        50.8          50.8          50.8          50.8           50.8           50.8           50.8            50.8         50.8         50.8




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 References




 1.	    American	Nurses	Credentialing	Center.	2004.	Magnet	Recognition	Program	Recognizing	
        Excellence	in	Nursing	Services	Application	Manual	2005.	Maryland.	ANCC.

 2.	    Hart,	P.M,	Griffin,	M.A.,	Wearing,	A.J.,	&	Cooper,	C.L.	(1996).	Manual	for	the	QPASS	
        survey.	PAHHSD.	2006.	Princess Alexandra Hospital Health Service District – Nursing Division
        Strategic Direction Statement 2006-2009.	Brisbane.	PAHHSD.

 3.	    Queensland	Government.	2007.	Queensland Health Strategic Plan 2007-2012, Brisbane.	
        Queensland	Government.




                                                           1
 4.	    Queensland	Government.	2007.	Queensland	Statewide	Health	Service	Plan	2007-2012.	
        Brisbane.	Queensland	Government.	

 5.	    Queensland	Health.	2008.	Business Planning Framework – a tool for nursing workload management
        Resource manual 4th edition.	Brisbane.	Queensland	Health,

 6.	    University	of 	Southern	Queensland.	2007.	Report	of 	“better workplaces” Queensland Health
        Staff Opinion Survey September 2007. Brisbane.	Community	and	Organisational	Research	
        Unit.	University	of 	Southern	Queensland.




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  nursing
leadership
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