Christine Duffield

Christine Duffield
Edith Cowan University · Centre for Nursing, Midwifery and Health Services Research

PhD

About

219
Publications
173,613
Reads
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9,302
Citations
Additional affiliations
January 2011 - present
University of Toronto
January 2011 - present
January 2009 - present
University of Newcastle

Publications

Publications (219)
Article
Background There have been predictions of a significant nursing workforce shortage in Australia and one strategy to address this has been an increase in supply of new graduates. Their rates and hours of work are largely unknown. Aim To explore trends in employment of newly graduate registered nurses in Australia between 2004 and 2019. Methods A r...
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Background To meet the growing needs of a diverse population, it is critical that healthcare service provision is underpinned by innovative, cost-effective, and sustainable services and solutions. The role of the nurse practitioner creates an opportunity to meet the increasing demands of complex care and enables greater access to high quality care....
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Background: Recent research has focused on the potential benefits of physical activity in occupational settings in addition to leisure time. However, occupational physical activity (OPA) differs substantially for occupations that require heavy and repetitive physical work, such as nursing. We explored associations between leisure time and OPA and...
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Aim To describe how nurse coordinators accomplished day-to-day interprofessional coordination in an Australian emergency department team, drawing some lessons for the design of nurse coordinator roles in other settings. Background Previous studies have examined leadership within nursing teams, and there is a growing number of registered nurses emp...
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Objectives To demonstrate how the team mental model concept can broaden our understanding of team effectiveness in health care by exploring the knowledge that underpins it, and the workplace conditions that sustain it in a metropolitan emergency department (ED) in Sydney, Australia. Methods This study draws on accounts of 19 ED clinicians (registe...
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Aims To highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic. Background In acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to det...
Chapter
Nurse managers play a critical role in ensuring an appropriate number and mix of staff are available to ensure safe patient care is provided. When leadership decisions are effective, we see improved patient care outcomes, better staff performance, increased job satisfaction and staff retention. However, when decision making is less effective both p...
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The National Safety and Quality Health Service Standards requires health service compliance by 2013 and covers several areas including governance arrangements, partnerships with consumers and eight key clinical processes. Nurses in Australia comprise 62% of the hospital workforce, are the largest component and hence play a critical role in meeting...
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Aim. To determine the cost effectiveness of increasing nurse staffing or changing the nursing skill mix in adult medical and/or surgical patients? Background. Research has demonstrated that nurse staffing levels and skill mix are associated with patient outcomes in acute care settings. If increased nurse staffing levels or richer skill mix can be s...
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Background Advanced practice nursing is recognised globally as central to meeting this community need. Whilst there is increasing recognition that advanced practice nurses should be educated to at least a master degree level, there is scant evidence on the influence of higher education on the practice profile of advanced practice nursing. Aim To i...
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Background: The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, "flexibility" is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifyin...
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The use of nursing assistants has increased across health systems in the past 20 years, to alleviate licensed nurses' workload and to meet rising health care demands at lower costs. Evidence suggests that, when used as a substitute for licensed nurses, assistants are associated with poorer patient and nurse outcomes. Our multimethods study evaluate...
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Aim 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...
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Aim To develop a critical thinking assessment tool for Australian undergraduate nurses. Background Critical thinking is an important skill but difficult to assess in nursing practice. There are often many responses a nurse can make to a clinical problem or situation. Some responses are more correct than others and these decisions have an impact on...
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Nurses and midwives (nurses) are the principle role models and health educators for the wider population. This study sought to identify the health-related behaviors of the nursing workforce of New South Wales (NSW), Australia, compared to contemporary recommendations for healthy living and to the Australian general population, matched by gender and...
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Aims To investigate hypertension awareness, prevalence and treatment in nurses. Background Nurses are the largest health workforce group, currently facing an ageing demographic and the risk of chronic disease such as hypertension. Little is known about hypertension in nurses despite the potential impact on work productivity. Methods A cross‐secti...
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Aim: To explore the primary healthcare needs and health service use of homeless men in inner Sydney. Background: People experiencing homelessness have greater health needs than the general population and place high demands on tertiary care, which is expensive and may not be the optimum service for their needs. Accessible, approachable and afford...
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Objectives To investigate the influence of work-related characteristics, health, health behaviours and symptoms on ingestible biologically-based Complementary and Alternative Medicine (CAM) use within the Australian nursing and midwifery workforce. Background CAM use is widespread worldwide, but there is little research into nurses’ and midwives’...
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Purpose The desirability of having a more flexible workforce is emphasised across many health systems yet this goal is as ambiguous as it is ubiquitous. In the absence of empirical studies in healthcare that have defined flexibility as an outcome, the purpose of this paper is to draw on classic management and sociological theory to reduce this ambi...
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Aims and objectives: To determine whether there was an association between intra-hospital transfers and adverse outcomes. Background: Transfers between clinical units and between beds on the same unit are routine aspects of an episode of care in acute hospitals. The rate of these transfers per episode has increased in response to high occupancy...
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Aim: To explore the relationship between the practice environment and nurse outcomes in two Intensive Care Unit (ICU) models.Background: Internationally the demand for intensive care is increasing. A large capacity multi-specialty integrated critical care service, the “hot-floor”, is emerging as the preferred organisational model. Benefits include...
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Aim: To use a Delphi panel to determine the relative importance and feasibility of workplace health promotion interventions to promote and support the health of the Australian nursing and midwifery workforce BACKGROUND: The nursing workforce experiences rates of ill health above that of other workforces yet there is little investment in workplace...
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Aim: To examine the quality of life of nurses and midwives in New South Wales, Australia and compare values with those of the Australian general population; to determine the influence of workforce, health and work life characteristics on quality of life and its effect on workforce intention to leave. Background: Few studies have examined nurses'...
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Aims and objectives: To determine the rate of patient moves and the impact on nurses' time. Background: Bed shortages and strategies designed to increase patient flow have led to a global increase in patient transfers between wards. The impact of transferring patients between wards and between beds within a ward on nurses' workload has not previ...
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Aims: To examine user compliance and completeness of documentation with a newly designed Observation and Response Chart and whether a rapid response system call was triggered when clinically indicated. Background: Timely recognition and responses to patient deterioration in hospital general wards remains a challenge for health care systems globa...
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Aim: The aim of this study is to develop an assessment tool to measure the critical thinking ability of nurses. Background: As an increasing number of complex patients are admitted to hospitals, the importance of nurses recognising changes in health status and picking up on deterioration is more important. To detect early signs of complication r...
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Aim: To identify the practice patterns of the Australian registered nurse workforce according to position title and to map these disparate titles across all jurisdictions of the country. Introduction: Effective nursing workforce planning can contribute to improved patient care and increased effectiveness and efficiency of healthcare systems. Ba...
Article
Aim: To identify the personal cancer screening behaviours of nurses and midwives in New South Wales, Australia, and identify factors predictive of cancer screening uptake. Background: The nursing workforce may have a higher risk for some cancers and is ageing. In Australia, more than 40 percent are over 50 years - an age where cancer incidence ri...
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Aim: To examine the workforce, workplace, psychosocial and health characteristics of nurses and midwives in relation to their reported use of sickness absence described as 'mental health days'. Background: The occupational stress associated with the nursing profession is increasingly recognized and nurse/midwifery absenteeism is a significant gl...
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Aims: The aim of this study was to determine which tasks unregulated nursing support staff spend their work time undertaking and to determine differences between the work undertaken by licensed/regulated nurses on units which have nursing support workers and those on units which do not. Background: Acute hospital nursing teams often include nurs...
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Background: There is growing recognition of the influence of the workplace environment on the eating habits of the workforce, which in turn may contribute to increased overweight and obesity. Overweight and obesity exact enormous costs in terms of reduced well-being, worker productivity and increased risk of non-communicable diseases. The workplac...
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Objectives: The aim of this study was to assess the impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes using administrative health data. Design: Logistic regression modelling was used with linked administrative health data to examine the association between seven adverse patient outcomes...
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Open access: http://onlinelibrary.wiley.com/doi/10.1111/jonm.12412/full Aim: To investigate and describe nurses' and midwives' physical health, rates of symptoms and disease, and to determine if these factors contribute to intention to leave. Background: The nursing and midwifery workforce is ageing yet little is known about their physical healt...
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Aims and objectives: To examine user acceptance with a new format of charts for recording observations and as a prompt for responding to episodes of clinical deterioration in adult medical-surgical patients. Background: Improving recognition and response to clinical deterioration remains a challenge for acute healthcare institutions globally. Fi...
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Aim: To assess the impact of adding nursing support workers to ward staffing. Background: Nurses' capacity to provide safe care is compromised by increased workloads and nursing shortages. Use of unregulated workers is an alternative to increasing the number of regulated nurses. The impact of adding nursing support workers on patient, nurse and...
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Objectives: This research investigates the instruments currently available to measure the cancer patient experience of health care. An investigation of the number of instruments, the domains covered by the instruments, and the structure and psychometric performance of instruments is undertaken. Methods: A narrative synthesis approach is used to...
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Aims: To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013. Background: Positive nurse practice environments have been linked to nurse retention and care quality outcomes. Methods: The collection of the Practice En...
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Investigate the number and type of tasks performed, delayed or not completed by regulated and unregulated (assistant) nurses. Assistants in Nursing change the work environment of the nurses with whom they work. As the number of Assistants in Nursing working on acute units grows, it is important to understand how their presence influences nursing ca...
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Background: The size and flexibility of the nursing workforce has positioned nursing as central to the goals of health service improvement. Nursing's response to meeting these goals has resulted in proliferation of advanced practice nursing with a confusing array of practice profiles, titles and roles. Whilst numerous models and definitions of adv...
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Nurses make up the largest component of the health workforce and provide the majority of patient care. Most health education is delivered by nurses, who also serve as healthy living and behavioural role models. Anything that diminishes their health status can impact their credibility as role models, their availability and ability to deliver quality...
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Michael A Roche,1 Christine Duffield,1,2 Sofia Dimitrelis,1 Belinda Frew1 1Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, NSW, 2Clinical Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia Aim: To examine specific elements of nursing le...
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Background: Nursing is an emotionally demanding profession and deficiencies in nurses' mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses' health, the aim of this paper was to describe the mental health status and related...
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To explore the importance of role recognition and relationships between the opportunities for decision-making, social support, and skill development, in a sample of nurses working in general practice in New South Wales, Australia. Understanding how nurses make decisions about patients and their care in general practice will benefit organisations an...
Article
AimExamine metrics and policies regarding nurse workforce across four countries.Background International comparisons informs health policy makers.Methods Data from the OECD were used to compare expenditure, workforce and health in: Australia, Portugal, the United Kingdom (UK) and the United States (US). Workforce policy context was explored.Results...
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To identify factors that motivate older nurses to leave the workforce. As many older nurses are now reaching retirement age and will be eligible for government-funded pensions, governments are concerned about the impending financial burden. To prepare for this scenario, many are looking at increasing the age of retirement to 67 or 70 years. Little...
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Objective: To determine an appropriate survey instrument to evaluate the impact of organizational structures on the work environment of intensive care nurses. Background: Internationally the demand for intensive care is increasing. Solely increasing bed capacity is not sustainable. Large capacity multi-specialty Intensive Care Units are emerging a...
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AimsTo explore key factors related to nursing unit instability, complexity and patient and system outcomes.Background The relationship between nurse staffing and quality of patient outcomes is well known. The nursing unit is an important but different aspect that links to complexity and to system and patient outcomes. The relationship between the i...
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Optimising clinical responses to deteriorating patients is an international indicator of acute healthcare quality. Observation charts incorporating track and trigger systems are an initiative to improve early identification and response to clinical deterioration. A suite of track and trigger 'Observation and Response Charts' were designed in Austra...
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Study aim: To test a model derived from the Nursing Worklife Model linking elements of supportive practice environments to nurses' turnover intentions and behaviours in Canada and Australia. Background: With the worldwide shortage of nurses, retaining nurses within fiscally challenged health care systems is critical to sustaining the future of t...
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Objective To explore the association between patient volume in intensive care units (ICUs) and risk-adjusted mortality. Background Large multi-speciality ICUs are emerging in response to increasing demand for critical care. Consolidation of resources through regionalisation of services aims to contain costs and optimise demand management and opera...
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Objective: To identify the reasons older RNs (≥45 years) remain in the healthcare workforce. Background: Despite predictions of early retirements of older nurses, many continue to work past the age when they can gain access to their retirement funds. Methods: The authors surveyed nurses older than 45 years in New South Wales, Australia. Resul...
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Background: Within Australia nursing unions are pursuing mandated nurse-patient ratios to safeguard patient outcomes and protect their members in healthcare systems where demand perpetually exceeds supply. Establishing ratios for an emergency department is more contentious than for hospital wards. The study's aim was to estimate average staffing l...
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Background Clinical deterioration of adult patients in acute medical-surgical wards continues to occur, despite a range of systems and processes designed to minimize this risk. In Australia, a standardized template for adult observation charts using human factors design principles and decision-support characteristics was developed to improve the de...
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AimsTo compare nurse turnover rates and costs from four studies in four countries (US, Canada, Australia, New Zealand) that have used the same costing methodology; the original Nursing Turnover Cost Calculation Methodology.Background Measuring and comparing the costs and rates of turnover is difficult because of differences in definitions and metho...
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Nurse turnover is a critical issue facing workforce planners across the globe, particularly in light of protracted and continuing workforce shortages. An ageing population coupled with the rise in complex and chronic diseases, have contributed to increased demands placed on the health system and importantly, nurses who themselves are ageing. Costs...
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AimTo critically review the work sampling technique used in nursing workload research.Background Work sampling is a technique frequently used by researchers and managers to explore and measure nursing activities. However, work sampling methods used are diverse making comparisons of results between studies difficult.DesignMethodological integrative...
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Increasing role complexity has intensified the work of managers in supporting healthcare teams. This study examined the influence of front-line managers' characteristics and scope of responsibility on teamwork. Scope of responsibility considers the breadth of the manager's role. A descriptive, correlational design was used to collect cross-sectiona...
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To explore whether or not the context of Australian practice nursing supports collaborative decision-making about organisation and delivery of patient care. Positive patient outcomes depend on Australian practice nurses participating in collaborative and interprofessional services, particularly for patients with chronic disease(s). It is unclear wh...
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This study aimed to reveal nurses' experiences and perceptions of turnover in Australian hospitals and identify strategies to improve retention, performance and job satisfaction. Nursing turnover is a serious issue that can compromise patient safety, increase health care costs and impact on staff morale. A qualitative design was used to analyze res...
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Internationally, shortages in the nursing workforce, escalating patient demands, and financial constraints within the health system have led to the growth of unlicensed nursing support workers. Recently, in relation to the largest publicly funded health system (National Health Service), it was reported that extensive substitution of registered nurs...
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People with mental disorder experience a heavy burden of physical ill-health. This, alongside structural health-system changes, means more people with mental disorder are being cared for in non-psychiatric hospitals. This article reports on 32 studies that have investigated the care and outcomes of people with comorbid mental and physical health pr...
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Patients in hospital are increasingly being moved between clinical units and between bedspaces; however, the impact of patient transfers and bedspace moves on nurses' workload is not known. Time studies are an established observational research method that can be used to determine the duration of time taken to perform an activity or process. This r...
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The purpose was to describe the number, demographic characteristics, work patterns, exit rates, and work perceptions of nurses in Ontario, Canada, in 4 specialty classifications: advanced practice nurse (APN)-clinical nurse specialist (CNS), APN-other, primary healthcare nurse practitioner [RN(extended class [EC])], and registered nurse (RN) with s...
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Background: Bibliometrics are an essential aspect of measuring academic and organizational performance. Aim. This review seeks to describe methods for measuring bibliometrics, identify the strengths and limitations of methodologies, outline strategies for interpretation, summarise evaluation of nursing and midwifery performance, identify implicati...
Article
The National Safety and Quality Health Service Standards requires health service compliance by 2013 and covers several areas including governance arrangements, partnerships with consumers and eight key clinical processes. Nurses in Australia comprise 62% of the hospital workforce, are the largest component and hence play a critical role in meeting...
Article
A key component of workforce reform is the international growth in Advanced Practice Nursing (APN) roles. This study evaluated one APN role in Australia, the Clinical Nurse Consultant (CNC). All 56 CNCs employed in a tertiary hospital in New South Wales took part in the study. Demographic and work activity data were collected by an online questionn...
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Reducing maternal mortality and providing universal access to reproductive health in resource poor settings has been severely constrained by a shortage of health workers required to deliver interventions. The aim of this article is to determine evidence to optimize health worker roles through task shifting/sharing to address Millennium Development...