Adding unregulated nursing support workers to ward staffing: Exploration of a natural experiment

Journal article


Christine Duffield, Michael Roche, Di Twigg, Anne Williams, Samantha Rowbotham and Sean Clarke. (2018). Adding unregulated nursing support workers to ward staffing: Exploration of a natural experiment. Journal of Clinical Nursing. 27(19-20), pp. 3768-3779. https://doi.org/10.1111/jocn.14632
AuthorsChristine Duffield, Michael Roche, Di Twigg, Anne Williams, Samantha Rowbotham and Sean Clarke
Abstract

Aims and objectives
To explore the impact of an initiative to add unregulated nursing support workers to wards in acute care hospitals.

Background
Adding nursing support workers to existing nurse staffing may be one solution to reduce nursing workloads and improve outcomes. However, the effects of this addition on nurse, patient and system outcomes are not well documented. In one state of Australia, a trial deployment of nursing support workers to wards across the public health system provided opportunity for the exploration of their impact in a natural, real‐world, environment.

Design
Cross‐sectional study.

Methods
A sample of five wards where nursing support workers had been added matched to a group of five wards where there were no nursing support workers. Data were collected via patient survey (n = 141) and nurse survey (n = 154). Analysis was comparative with regression models constructed for the different ward types.

Results
Nursing leadership, staffing and resources, and nurse experience were linked to outcomes on both ward types. Instability was a significant predictor of reduced quality of care and increased turnover intention on wards where support workers were added.

Conclusion
Adding nursing support workers to ward staffing did not lead to improvements in patient care. Findings suggest that staffing a nursing ward is a complex activity and that a simple approach to staffing is unlikely to be successful. Future research should explore the process of implementation and the conditions under which this strategy is likely to be successful.

Relevance to clinical practice
Ward‐level factors are key in making appropriate staffing and skill mix choices to limit instability and to consequently avoid negative patient, staff and system outcomes. Consideration of the ward context, alongside effective delegation processes and integration into the care team are imperative when adding nursing support workers.

Keywordsmodel of care; nurse outcomes; patient outcomes; system outcomes; unregulated nursing support workers
Year2018
JournalJournal of Clinical Nursing
Journal citation27 (19-20), pp. 3768-3779
PublisherWiley-Blackwell
ISSN0962-1067
Digital Object Identifier (DOI)https://doi.org/10.1111/jocn.14632
Scopus EID2-s2.0-85052634290
Publisher's version
File Access Level
Controlled
Publication process dates
Deposited09 May 2021
Permalink -

https://acuresearchbank.acu.edu.au/item/8vzww/adding-unregulated-nursing-support-workers-to-ward-staffing-exploration-of-a-natural-experiment

Restricted files

Publisher's version

  • 58
    total views
  • 0
    total downloads
  • 2
    views this month
  • 0
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

Mental health nurses' resilience in the context of emotional labour : An interpretive qualitative study
Delgado, Cynthia, Evans, Alicia, Roche, Michael and Foster, Kim. (2022). Mental health nurses' resilience in the context of emotional labour : An interpretive qualitative study. International Journal of Mental Health Nursing. 31(5), pp. 1260-1275. https://doi.org/10.1111/inm.13037
Datasets to support workforce planning in nursing : A scoping review
Weller-Newton, Jennifer M., Phillips, Craig, Roche, Michael A., McGillion, Anthony, Mapes, Jo, Dufty, Tania, Schlieff, Jo, Boyd, Leanne, Geary, Alanna and Haines, Stephanie. (2021). Datasets to support workforce planning in nursing : A scoping review. Collegian. 28(3), pp. 324-332. https://doi.org/10.1016/j.colegn.2020.09.001
Mental health matters : A cross-sectional study of mental health nurses’ health-related quality of life and work-related stressors
Foster, Kim, Roche, Michael, Giandinoto, Jo-Ann, Platania-Phung, Chris and Furness, Trentham. (2020). Mental health matters : A cross-sectional study of mental health nurses’ health-related quality of life and work-related stressors. International Journal of Mental Health Nursing. 30(3), pp. 624-634. https://doi.org/10.1111/inm.12823
Workplace stressors, psychological well-being, resilience, and caring behaviours of mental health nurses : A descriptive correlational study"
Foster, Kim, Roche, Michael, Giandinoto, Jo-Ann and Furness, Trentham. (2020). Workplace stressors, psychological well-being, resilience, and caring behaviours of mental health nurses : A descriptive correlational study". International Journal of Mental Health Nursing. 29(1), pp. 56-68. https://doi.org/10.1111/inm.12610
Workplace resilience and emotional labour of Australian mental health nurses : Results of a national survey
Delgado, Cynthia, Roche, Michael, Fethney, Judith and Foster, Kim. (2020). Workplace resilience and emotional labour of Australian mental health nurses : Results of a national survey. International Journal of Mental Health Nursing. 29(1), pp. 35-46. https://doi.org/10.1111/inm.12598
Clarifying workforce flexibility from a division of labor perspective : A mixed methods study of an emergency department team
Wise, Sarah, Duffield, Christine, Fry, Margaret and Roche, Michael. (2020). Clarifying workforce flexibility from a division of labor perspective : A mixed methods study of an emergency department team. Human Resources for Health. 18(1), p. 17. https://doi.org/10.1186/s12960-020-0460-7
Care planning and nonpharmacological interventions in a metropolitan inpatient dual diagnosis service : A retrospective exploratory study
MacLeay, Euan, Fry, Margaret, Roche, Michael Anthony and Montilla, Tim. (2020). Care planning and nonpharmacological interventions in a metropolitan inpatient dual diagnosis service : A retrospective exploratory study. International Journal of Mental Health Nursing. 29(5), pp. 856-867. https://doi.org/10.1111/inm.12719
Uncovering the disconnect between nursing workforce policy intentions, implementation, and outcomes : Lessons learned from the addition of a nursing assistant role
Duffield, Christine, Twigg, Di, Roche, Michael, Williams, Anne and Wise, Sarah. (2019). Uncovering the disconnect between nursing workforce policy intentions, implementation, and outcomes : Lessons learned from the addition of a nursing assistant role. Policy Politics and Nursing Practice. 20(4), pp. 228-238. https://doi.org/10.1177/1527154419877571
Dynamics of nurses’ authority in the inpatient care of adolescent consumers with anorexia nervosa : A qualitative study of nursing perspectives
Zugai, Joel Sebastian, Stein-Parbury, Jane and Roche, Michael. (2019). Dynamics of nurses’ authority in the inpatient care of adolescent consumers with anorexia nervosa : A qualitative study of nursing perspectives. International Journal of Mental Health Nursing. 28(4), pp. 940-949. https://doi.org/10.1111/inm.12595
Resilience and mental health nursing: An integrative review of international literature
Foster, Kim, Roche, Michael, Delgado, Cynthia, Cuzzillo, Celeste, Giandinoto, Jo-Ann and Furness, Trentham. (2019). Resilience and mental health nursing: An integrative review of international literature. International Journal of Mental Health Nursing. 28(1), pp. 71 - 85. https://doi.org/10.1111/inm.12548
The nature of the therapeutic alliance between nurses and consumers with anorexia nervosa in the inpatient setting: A mixed‐methods study
Zugai, Joel S., Stein-Parbury, Jane and Roche, Michael. (2018). The nature of the therapeutic alliance between nurses and consumers with anorexia nervosa in the inpatient setting: A mixed‐methods study. Journal of Clinical Nursing. 27(43862), pp. 416 - 426. https://doi.org/10.1111/jocn.13944
Therapeutic alliance, anorexia nervosa, and the inpatient setting: A mixed methods study
Zugai, Joel S., Stein-Parbury, Jane and Roche, Michael. (2018). Therapeutic alliance, anorexia nervosa, and the inpatient setting: A mixed methods study. Journal of Advanced Nursing. 74(2), pp. 443 - 453. https://doi.org/10.1111/jan.13410
On PAR: A feasibility study of the Promoting Adult Resilience programme with mental health nurses
Foster, Kim, Shochet, Ian, Wurfl, Astrid, Roche, Michael, Maybery, Darryl, Shakespeare-Finch, Jane and Furness, Trentham. (2018). On PAR: A feasibility study of the Promoting Adult Resilience programme with mental health nurses. International Journal of Mental Health Nursing. 27(5), pp. 1470 - 1480. https://doi.org/10.1111/inm.12447
When parenting does not ‘come naturally’ : Providers’ perspectives on parenting education for incarcerated mothers and fathers
Fowler, Cathrine, Dawson, Angela, Rossiter, Chris, Jackson, Debra, Power, Tamara and Roche, Michael. (2018). When parenting does not ‘come naturally’ : Providers’ perspectives on parenting education for incarcerated mothers and fathers. Studies in Continuing Education. 40(1), pp. 98-114. https://doi.org/10.1080/0158037X.2017.1396449
User compliance with documenting on a track and trigger-based observation and response chart: A two-phase multi-site audit study
Elliott, Doug, Allen, Emily, McKinley, Sharon, Perry, Lin, Duffield, Christine, Fry, Margaret, Gallagher, Robyn, Iedema, Rick and Roche, Michael. (2017). User compliance with documenting on a track and trigger-based observation and response chart: A two-phase multi-site audit study. Journal of Advanced Nursing. 73(12), pp. 2892 - 2902. https://doi.org/10.1111/jan.13302
A comparison of nursing tasks undertaken by regulated nurses and nursing support workers: A work sampling study
Roche, Michael A., Friedman, Sarah, Duffield, Christine, Twigg, Diane E. and Cook, Rebecca. (2017). A comparison of nursing tasks undertaken by regulated nurses and nursing support workers: A work sampling study. Journal of Advanced Nursing. 73(6), pp. 1421 - 1432. https://doi.org/10.1111/jan.13224
The impact of evidence-based sepsis guidelines on emergency department clinical practice : A pre-post medical record audit
Romero, Bernadine, Fry, Margaret and Roche, Michael. (2017). The impact of evidence-based sepsis guidelines on emergency department clinical practice : A pre-post medical record audit. Journal of Clinical Nursing. 26(21-22), pp. 3588-3596. https://doi.org/10.1111/jocn.13728
Intrahospital transfers and the impact on nursing workload
Blay, Nicole, Roche, Michael A., Duffield, Christine and Gallagher, Robyn. (2017). Intrahospital transfers and the impact on nursing workload. Journal of Clinical Nursing. 26(23-24), pp. 4822-4829. https://doi.org/10.1111/jocn.13838
Intrahospital transfers and adverse patient outcomes: An analysis of administrative health data
Blay, Nicole, Roche, Michael, Duffield, Christine and Xu, Xiaoyue. (2017). Intrahospital transfers and adverse patient outcomes: An analysis of administrative health data. Journal of Clinical Nursing. 26(23-24), pp. 4927 - 4935. https://doi.org/10.1111/jocn.13976
Learning to become a better man: Insights from a prison fathering program for incarcerated Indigenous men
Rossiter, Chris, Power, Tamara, Fowler, Cathrine, Jackson, Debra, Roche, Michael and Dawson, Angela. (2017). Learning to become a better man: Insights from a prison fathering program for incarcerated Indigenous men. Australian Journal of Social Issues. 52(1), pp. 13 - 31. https://doi.org/10.1002/ajs4.4
Workforce flexibility: In defence of professional healthcare work
Wise, Sarah, Duffield, Christine, Fry, Margaret and Roche, Michael. (2017). Workforce flexibility: In defence of professional healthcare work. Journal of Health, Organization and Management. 31(4), pp. 503 - 516. https://doi.org/10.1108/JHOM-01-2017-0009
Regulated and unregulated nurses in the acute hospital setting: Tasks performed, delayed or not completed
Roche, Michael Anthony, Duffield, Christine and Friedman, Sarah. (2016). Regulated and unregulated nurses in the acute hospital setting: Tasks performed, delayed or not completed. Journal of Clinical Nursing. 25(1-2), pp. 153 - 162. https://doi.org/10.1111/jocn.13118
A protocol to assess the impact of adding nursing support workers to ward staffing
Duffield, Christine, Roche, Michael Anthony, Twigg, Di, Williams, Anne and Clarke, Sean. (2016). A protocol to assess the impact of adding nursing support workers to ward staffing. Journal of Advanced Nursing. 72(9), pp. 2218 - 2225. https://doi.org/10.1111/jan.12965
The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data
Twigg, Diane E., Myers, Helen, Duffield, Christine, Pugh, Judith D., Gelder, Lucy and Roche, Michael Anthony. (2016). The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data. International Journal of Nursing Studies. 63(November), pp. 189 - 200. https://doi.org/10.1016/j.ijnurstu.2016.09.008
Changes to nurses' practice environment over time
Roche, Michael Anthony, Duffield, Christine, Friedman, Sarah and Twigg, Di. (2016). Changes to nurses' practice environment over time. Journal of Nursing Management. 24(5), pp. 666 - 675. https://doi.org/10.1111/jonm.12371
Testing the nursing worklife model in Canada and Australia: A multi-group comparison study
Roche, Michael Anthony, Spence Laschinger, Heather K. and Duffield, Christine. (2015). Testing the nursing worklife model in Canada and Australia: A multi-group comparison study. International Journal of Nursing Studies. 52(2), pp. 525 - 534. https://doi.org/10.1016/j.ijnurstu.2014.10.016
Nurses' perspectives of the impact of the older person on nursing resources in the emergency department and their profile: A mixed methods study
Gallagher, Robyn, Gallagher, Peter, Roche, Michael Anthony and Fry, Margaret. (2015). Nurses' perspectives of the impact of the older person on nursing resources in the emergency department and their profile: A mixed methods study. International Emergency Nursing. 23(4), pp. 312 - 316. https://doi.org/10.1016/j.ienj.2015.03.006
Therapeutic alliance in mental health nursing: An evolutionary concept analysis
Zugai, Joel Sebastian, Stein-Parbury, Jane and Roche, Michael Anthony. (2015). Therapeutic alliance in mental health nursing: An evolutionary concept analysis. Issues in Mental Health Nursing. 36(4), pp. 249 - 257. https://doi.org/10.3109/01612840.2014.969795
Instability in patient and nurse characteristics, unit complexity and patient and system outcomes
Duffield, Christine M., Roche, Michael Anthony, Dimitrelis, Sofia and Homer, Caroline S.. (2015). Instability in patient and nurse characteristics, unit complexity and patient and system outcomes. Journal of Advanced Nursing. 71(6), pp. 1288 - 1298. https://doi.org/10.1111/jan.12597
The rate and cost of nurse turnover in Australia
Roche, Michael Anthony, Duffield, Christine M., Homer, Caroline S. and Buchan, James. (2015). The rate and cost of nurse turnover in Australia. Collegian. 22(4), pp. 353 - 358. https://doi.org/10.1016/j.colegn.2014.05.002
A comparative review of nurse turnover rates and costs across countries
Duffield, Christine M., Roche, Michael Anthony, Homer, Caroline S., Buchan, James and Dimitrelis, Sofia. (2014). A comparative review of nurse turnover rates and costs across countries. Journal of Advanced Nursing. 70(12), pp. 2703 - 2712. https://doi.org/10.1111/jan.12483
The use of unregulated staff: Time for regulation?
Duffield, Christine M., Twigg, Di E., Pugh, Judith D., Evans, Gemma, Dimitrelis, Sofia and Roche, Michael Anthony. (2014). The use of unregulated staff: Time for regulation? Policy Politics and Nursing Practice. 15(1-2), pp. 42 - 48. https://doi.org/10.1177/1527154414529337
Disparities in treatment of people with mental disorder in non-psychiatric hospitals: A review of the literature
Mather, Brad and Roche, Michael Anthony. (2014). Disparities in treatment of people with mental disorder in non-psychiatric hospitals: A review of the literature. Archives of Psychiatric Nursing. 28(2), pp. 80 - 86. https://doi.org/10.1016/j.apnu.2013.10.009
A four month prospective descriptive exploratory study of patients receiving antibiotics in one Emergency Department
Fry, Margaret, Horvat, Leanne and Roche, Michael Anthony. (2013). A four month prospective descriptive exploratory study of patients receiving antibiotics in one Emergency Department. International Emergency Nursing. 21(3), pp. 163 - 167. https://doi.org/10.1016/j.ienj.2012.07.004
Domains of practice and advanced practice nursing in Australia
Roche, Michael Anthony and Duffield, Christine. (2013). Domains of practice and advanced practice nursing in Australia. Nursing and Health Sciences. 15(4), pp. 497 - 503. https://doi.org/10.1111/nhs.12062
Nursing work directions in Australia: Does evidence drive the policy?
Roche, Michael Anthony and Duffield, Christine. (2012). Nursing work directions in Australia: Does evidence drive the policy? Collegian. 19(4), pp. 231 - 238. https://doi.org/10.1016/j.colegn.2012.03.006
The prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital
Fry, Margaret, Horvat, Leanne and Roche, Michael Anthony. (2012). The prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital. Australasian Emergency Nursing Journal. 15(3), pp. 127 - 132. https://doi.org/10.1016/j.aenj.2012.06.001
Nursing unit managers, staff retention and the work environment
Duffield, Christine M. and Roche, Michael Anthony. (2011). Nursing unit managers, staff retention and the work environment. Journal of Clinical Nursing. 20(1-2), pp. 23 - 33. https://doi.org/10.1111/j.1365-2702.2010.03478.x
Factors in the practice environment of nurses working in inpatient mental health: A partial least squares path modeling approach
Roche, Michael Anthony, Duffield, Christine and White, Edward. (2011). Factors in the practice environment of nurses working in inpatient mental health: A partial least squares path modeling approach. International Journal of Nursing Studies. 48(12), pp. 1475 - 1486. https://doi.org/10.1016/j.ijnurstu.2011.07.001
The consequences of executive turnover
Duffield, Christine and Roche, Michael Anthony. (2011). The consequences of executive turnover. Journal of Research in Nursing. 16(6), pp. 503 - 514. https://doi.org/10.1177/1744987111422419
A comparison of the nursing practice environment in mental health and medical-surgical settings
Roche, Michael A. and Duffield, Christine M.. (2010). A comparison of the nursing practice environment in mental health and medical-surgical settings. Journal of Nursing Scholarship. 42(2), pp. 195-206. https://doi.org/10.1111/j.1547-5069.2010.01348.x
Staffing, skill mix and the model of care
Duffield, Christine, Roche, Michael, Diers, Donna, Catling-Paull, Christine and Blay, Nicole. (2010). Staffing, skill mix and the model of care. Journal of Clinical Nursing. 19(15-16), pp. 2242 - 2251. https://doi.org/10.1111/j.1365-2702.2010.03225.x
Violence toward nurses, the work environment, and patient outcomes
Roche, Michael, Diers, Donna, Duffield, Christine and Catling-Paull, Christine. (2010). Violence toward nurses, the work environment, and patient outcomes. Journal of Nursing Scholarship. 42(1), pp. 13 - 22. https://doi.org/10.1111/j.1547-5069.2009.01321.x
Staff satisfaction and retention and the role of the Nursing Unit Manager
Duffield, Christine, Roche, Michael, Pallas, Linda O'Brien, Catling-Paull, Christine and King, Madeleine. (2009). Staff satisfaction and retention and the role of the Nursing Unit Manager. Collegian. 16(1), pp. 11 - 17. https://doi.org/10.1016/j.colegn.2008.12.004
The implications of staff 'churn' for nurse managers, staff, and patients
Duffield, Christine, Roche, Michael, O'Brien Pallas, Linda and Catling-Paull, Christine. (2009). The implications of staff 'churn' for nurse managers, staff, and patients. Nursing Economics.
Churn: Patient turnover and mix
Duffield, Christine, Diers, Donna, Aisbett, Chris and Roche, Michael. (2009). Churn: Patient turnover and mix. Nursing Economics.
Issues and challenges in the mental health workforce development
Roche, Michael and Duffield, Christine. (2007). Issues and challenges in the mental health workforce development. Contemporary Nurse. 25(43862), pp. 94 - 103. https://doi.org/10.5172/conu.2007.25.1-2.94
A selective review of mental health nursing in New South Wales, Australia, in relation to clinical supervision
White, Edward and Roche, Michael. (2006). A selective review of mental health nursing in New South Wales, Australia, in relation to clinical supervision. International Journal of Mental Health Nursing. 15(3), pp. 209-219. https://doi.org/10.1111/j.1447-0349.2006.00424.x
Methods of measuring nursing workload in Australia.
Duffield, Christine, Roche, Michael and Merrick, Eamon Thomas. (2006). Methods of measuring nursing workload in Australia. Collegian. 13(1), pp. 16 - 22. https://doi.org/10.1016/S1322-7696(08)60512-0
Recruitment of nurses working outside nursing
Duffield, Christine, Pallas, Linda O'Brien, Aitken, Leanne M., Roche, Michael and Merrick, Eamon Thomas. (2006). Recruitment of nurses working outside nursing. Journal of Nursing Administration. 36(2), pp. 58 - 62. https://doi.org/10.1097/00005110-200602000-00002