strengthening the nursing/midwifery unit manager role ... · pdf filepage 4 nsw health...

"take the lead"Strengthening the Nursing/Midwifery Unit Manager role across NSW

Report Phase One: August 2008

NSW DEPARTMENT OF HEALTH

73 Miller Street

NORTH SYDNEY NSW 2060

Tel. (02) 9391 9000

Fax. (02) 9391 9101

TTY. (02) 9391 9900

www.health.nsw.gov.au

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

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

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

purposes other than those indicated above requires written permission from

the NSW Department of Health.

© NSW Department of Health 2009

SHPN (NAMO) 090041

ISBN 978-1-74187-433-4

For further copies of this document please contact:

Better Health Centre – Publications Warehouse

PO Box 672

North Ryde BC, NSW 2113

Tel. (02) 9887 5450

Fax. (02) 9887 5452

Further copies of this document can be downloaded from the

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

May 2009

Compiled by:Sue HawesProject Manager Nursing and Midwifery Office

Statistical and thematic analysis by:Dr Donna WatersThe College of Nursing

I would like to acknowledge each and every Nursing and Midwifery Unit Manager that participated in this project.

Your commitment to patient/client care through safe nursing/midwifery practice is inspiring.

Thank you for sharing your experiences with such sincerity and integrity. It is these experiences and other ideas that

create the platform for this report.

I would like to also acknowledge the editorial support given by Helena Harrison, Project Officer and Adjunct Professor

Debra Thoms, Chief Nursing and Midwifery Officer NSW.

Sue Hawes

Registered Nurse

Project Manager "take the lead"

"We must become the change we want to see"Mahatma Ghandi

NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

Many people who come into contact with the public

health system are admitted to a ward or unit. It is here

that the professional capabilities of the Nursing or

Midwifery Unit Manager have considerable influence

and contribution to the experiences of these patients,

their families and carers as well as other members of the

health care team.

There are many challenges for Nursing and Midwifery

Unit Managers in today’s health care environment. They

are expected to provide not only clinical leadership within

their units but also deal with an increasing number of

organisational and administrative requirements and at the

same time ensure the maintenance of high standards of

nursing and midwifery care.

These challenges are not unique to New South Wales or

indeed Australia. Throughout the course of this project

we have come into contact with similar work being

undertaken in Queensland, Scotland and Wales.

This Report provides feedback on the first phase of

the "take the lead" project. The work undertaken in

this phase of the project has provided valuable insights

into the challenges faced by Nursing and Midwifery

Unit Managers and has provided a firm basis for the

development of the strategies which make up the next

phase of work in the project.

Three streams of work have been identified as a result of

the information gathered in this first phase, as outlined

in the executive summary.

The leadership provided by Sue Hawes as the Project

Manager and Helena Harrison who has worked with Sue

over the past months has been critical to the success of

the project.

The willingness and enthusiasm with which Nursing and

Midwifery Unit Managers have engaged with the project

has also been an essential element. It is clear from the

interactions with Nursing and Midwifery Unit Managers

during the course of this project that they maintain

a deep commitment to ensuring that nursing and

midwifery practice make a positive contribution to the

outcomes of care for those members of the community

that come into contact with the NSW public health

system. It is a key aim of this project to support and

enable them in achieving that goal.

Adjunct Professor Debra Thoms,

Chief Nursing and Midwifery Officer

NSW Health

Foreword

NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 3

Contents

Executive Summary ...........................................4

Background and literature review .....................5

Assessing and determining the issues .............7

1 Methodology ................................................ 8

1.1 N/MUM workshops .....................................8

1.2 One page questionnaire ...............................8

1.3 N/MUM Forum Day .....................................9

1.4 Other stakeholders ......................................9

2 Results ........................................................ 10

2.1 N/MUM workshops ...................................10

2.1.1 The Current N/MUM role ..........................10

2.1.1a General management functions ........ 10

Staff and human resource management .......... 11

Communication ............................................... 11

Budgeting ........................................................ 13

Unit maintenance and equipment .................... 13

2.1.1b Patient Care Activities ...................13

2.1.1c Quality and Safety Management ......14

2.1.1d Leadership ...................................15

2.1.2 Skills and Attributes .................................16

2.1.3 Barriers and Enablers ...............................16

2.1.4 The Ideal N/MUM role ..............................17

2.2 One page questionnaire .............................18

2.3 N/MUM Forum Day ...................................19

2.4 Other stakeholders ....................................19

Conclusion and next steps ............................. 21

References ....................................................... 22

Appendices

1 N/MUM Workshops, Clinical areas ....................24

2 N/MUM Workshops, Hospitals ..........................25

3 Workshop Format ..............................................26

4 N/MUM Questionnaire .......................................27

5 N/MUM Forum Day Agenda ..............................28

6 Key Pad Summary Results ................................29

7 N/MUM Workshop Management Functions ......35


Executive Summary

In 2007 a collaborative project between the Nursing

and Midwifery Office (NaMO) and the Health Service

Improvement Branch (HSIB) at NSW Health was

initiated by Adjunct Professor Debra Thoms, Chief

Nursing and Midwifery Officer NSW and Professor

Katherine McGrath, the then Deputy Director General

Health System Performance. This was in response to

patient and carer feedback and anecdotal information

about Nursing/Midwifery Unit Managers (N/MUMs)

experiences.

For many years it has been acknowledged that the

N/MUM is the central and pivotal role in managing

and co-ordinating patient care activities at the unit/

ward level. For the purpose of this report N/MUMs

are defined as the Registered Nurse/Midwife that has

responsibility for leading clinical care and managing the

business aspects of a unit/ward.

The project called “take the lead” aims to facilitate

the role of the N/MUM in order to provide highly

co-ordinated care at the unit level and thereby

improve the patient journey and the patient and carer

experiences. In addition the project aims to identify

strategies to support N/MUMs in achieving this

role, recognising the pivotal part the N/MUM has in

co-ordinating patient care.

Through a range of strategies conducted between

August 2007 and February 2008 the current experiences

of N/MUMs and the expectations of others of the role

were explored.

Data collected identified the current activities

undertaken by N/MUMs, the barriers and enablers

to their role, the skills and attributes required for the

role and what the ideal N/MUM role would be. Other

stakeholders were asked to outline their expectations of

the N/MUM role as well as the behaviours they observe

in a successful N/MUM.

The key findings identified were:

n There is extensive breadth, depth and variability

in the accountability, responsibilities and functions

performed by N/MUMs.

n 60% of N/MUM activities involve general management

tasks and tend to be predominantly transactional

in nature. The remaining 40% of N/MUM activities

include quality and safety, patient care activities and

leadership.

n There are a variety of educational levels among N/MUMs

with over 40% identifying their nursing entry level

qualification as their highest level of education.

n The availability of appropriate professional

development and education that specifically meets the

needs of this role is variable and at times limited.

n Standardised reports and information to support the

N/MUM in fulfilling their role were limited in their

availability.

As a result of the consultation processes and data analysis

three work streams have been identified. These are:

n Defining and seeking agreement on the purpose and

core functions of the N/MUM role across NSW.

n Identifying strategies to address the education and

professional development required to support and

strengthen the N/MUM role.

n Outlining strategies to address the number of

transactional (administrative) tasks N/MUMs currently

undertake that do not align with the purpose and

core functions of the role.

These work streams aim to address the key issues identified

and will be progressed in the next phase of the project.


Background and Literature Review

In NSW there are three classifications of

Nursing/Midwifery Unit Managers (N/MUMs) as defined

by the NSW Public Health System Nurses’ & Midwives’

(State) Award. They are defined in the Award as N/

MUM Level 1, 2 or 3 and have responsibility for the

co-ordination of patient services, unit management,

and nursing staff management. For the purpose of this

report a N/MUM refers to the “registered nurse in charge

of a ward or unit or group of wards or units in a public

hospital or health service or public health organisation”

(NSW Health, 2008, p.7).

Patient and Carer Experiences

Responsiveness, patient centredness, safety and

effectiveness form the pillars of the NSW State Health

Plan (NSW Health 2007). The role of the N/MUM lies at

the core of these values, and is critical to the delivery of

quality healthcare in line with State objectives.

The N/MUM occupies a frontline management position

and their skills and performance is critically important to

health service outcomes (Duffield et al 2007a; Duffield

et al 2007b).

Over the past 20 years, there has been a steady growth

in research, nationally and internationally, related to

nurses working in frontline management positions.

There is consistent evidence indicating that these

frontline management positions are a key factor in the

delivery of high quality care and are vital links in the

patient and carers experience (Baumann 2007; Casida

2007; Duffield et al 2007b, ICN/FNIF 2006; Read et al

2004; The Scottish Government 2008).

Results from the 2007 NSW Patient Survey revealed

that one of the top priorities for patients is the ability

to access appropriate staff to adequately discuss their

treatment and concerns. Similarly, international studies

identify that patients expect the unit/ward manager to

be easily identified, have a visible presence on the ward/

unit and be approachable (Baumann 2007; Baumann et

al 2001; The Scottish Government 2008). The literature

further highlights the key role nursing leaders play in

determining the context and culture of care, which

influence the quality of care and the patient and carer

experience (Baumann 2007; Casida 2007; Laschinger &

Wong 2007b; McGuire & Kennerly 2006).

The N/MUM role

Results from a review of the N/MUM role in NSW,

as part of the "take the lead” project, identified that

there is considerable disparity in responsibility and

accountability of the N/MUM role. In addition there is

limited agreed understanding of what the purpose and

core functions of the N/MUM role are.

A recent review by Queensland Health of their

comparable role revealed identical issues (Queensland

Health 2008). The literature recognises the N/MUM role

as complex and multifaceted, including its continued

expansion of responsibility over the last 20 years

(Duffield 1991; Duffield et al 2007a; Duffield & Franks

2001). Reviews of similar roles in Scotland, United

Kingdom and Canada found corresponding results

(Laschinger & Wong 2007a; Read et al 2004; The

Scottish Government 2008).

NSW Health is comprised of eight Area Health Services

(AHS) and two public health organisations (The Children’s

Hospital at Westmead and Justice Health). To facilitate

the management and business administration workflows

some corporate service functions are retained locally,

while others have become centralised following the

establishment of Health Support Services. Health

Support Services provide centralised co-ordination of

such activities as information technology support for

AHS, payroll and human resource management support.

N/MUMs participating in workshops as part of the “take

the lead” project identified that a significant proportion

of disparate administrative tasks have been delegated

to their role over many years and following recent

restructuring. The impact of organisational restructures

is well documented in studies conducted in Australia and


overseas. They include such things as role ineffectiveness

due to broadened responsibilities and functions; greater

complexity, time and financial constraints; lack of clarity

of role accountability; and the distortion of escalation

procedures (Duffield et al 2007a; Duffield et al 2007b;

ICN/FNIF 2006; Laschinger & Wong 2007b; Read et al

2004; The Scottish Government 2008).

Nursing shortages, increasing patient volumes and

financial pressures also contribute to the complexity and

ability of N/MUMs to effectively manage their changing

environments (Duffield et al 2007b). In the past five

years, the flow of patients between wards has increased

in NSW. Patients will on average move at least twice

during their inpatient stay, and the average number

of patients moving through a ward is 1.25% greater

than the number of beds open. This “churn” (Duffield

et al 2007b) has created an increasingly complex ward

environment, particularly when recognising that the

casemix split of patients on wards has increased year

on year since 2001 – as many as 250 DRG groups may

pass through a ward, each with different care/treatment

plans and pharmacology requirements (Duffield et al

2007b). The need for a co-ordinated approach to patient

care at a ward/unit level is critical.

Leadership capacity and capability

National and international research identifies leadership

development for front line nursing and midwifery

managers as critical to ensure they are able to manage

the complex challenges within a constantly changing

health care system and enact positive sustainable change

(Duffield et al 2007b; ICN/FNIF 2006; Laschinger &

Wong 2007a, Read et al 2004; The Scottish Government

2008). Transformational leadership has been linked to

better overall organisational outcomes and is essential

in achieving and maintaining the organisational

effectiveness of acute care hospitals (Casida 2007;

McGuire & Kennerly 2006; RNAO 2006).

Notably, evidence also suggests that the higher the

educational qualifications and professional status

amongst nurses providing care, the better the patient

outcomes (Aitken et al 2007). Therefore the capacity

and capability of those in the N/MUM role is crucial if

they are to influence organisational culture, clinical and

financial outcomes, retention and sustainability of the

health care team.

Australian studies have highlighted the lack of

experience, educational preparation and support

mechanisms for N/MUMs (Duffield 1989, 1994, 1995;

Duffield et al 2001; Duffield et al 1996; Duffield &

Franks 2001; Paliadelis 2005). Further to this, succession

planning is generally absent and support structures such

as mentoring and supervision are not well accessed

or designed (Buchan & Calman 2005; ICN/FNIF 2006;

Moran et al 2002; NSW Health 2006). Together these

impact on the ability of organisations to recruit and

retain nurses in the N/MUM role and result in adverse

patient events, poor business management practices,

and significant financial liabilities (Buchan & Calman

2005; ICN/FNIF 2006; Laschinger & Wong 2007a; Moran

et al 2002).

The International Council of Nurses (ICN) (2006) believes

that leadership development is a critical aspect for

positive and sustainable change. Nurses in key leadership

and management positions need to be prepared to

manage rapid change in a globalised and technologically

driven world with limited financial and human resources

(ICN 2006).


Assessing and Determining the Issues

Four key activities were undertaken over 12 months to

determine and assess the issues that prevail across NSW

relating to the N/MUM role.

These were as follows:

1. Workshops: attended by N/MUMs where data was collected in

response to a series of questions.

2. Completion of a questionnaire: N/MUMs who attended the workshops were invited

to complete a one page demographic questionnaire.

3. N/MUM Forum Day: data collected at the workshops was validated and

further exploration of issues were conducted through

workshops.

4. Engagement of other stakeholders: workshops, focus groups and one-on-one interviews

were conducted.

Approximately 70 workshops, small focus groups and

one-on-one interviews were conducted between August

2007 and February 2008. The N/MUMs Forum Day held

in March 2008, involved 170 N/MUMs – 44% (n = 75)

of those attending had not been to a workshop prior to

coming to the Forum.

A total of 870 health staff (Table 1) from metropolitan,

rural and remote health facilities located across NSW

participated in workshops and interviews. Health staff

worked in all eight NSW Area Health Services (AHS);

Northern Sydney Central Coast (NSCCAHS), Sydney

South West (SSWAHS), Hunter New England (HNEAHS),

South Eastern Sydney Illawarra (SESIAHS), Sydney West

(SWAHS), Greater Western (GWAHS), North Coast

(NCAHS), and Greater Southern (GSAHS).

Staff from The Children's Hospital at Westmead (CHW)

and Justice Health (JH) were also represented. Those

participants identified as ‘other’ represent sessions held

with health staff at state wide meetings at NSW Health.

Table 2 (below) identifies N/MUMs, both in permanent

positions and in acting roles, which made up 71%

(n = 619) of the total sample of workshop and interview

participants. Stakeholders other than N/MUMs made up

the remaining 29% (n = 251) of workshop and interview

participants.

Table 1: Number of Participants by Area Health Service

NSCC AHS

SESI AHS

SSW AHS

SW AHS

GS AHS

GW AHS

HNE AHS

NC AHS

JH CHW OTHER TOTAL

No. of workshops 4 7 4 6 5 11 10 9 2 2 10 70

Metro 35 136 67 135 – – – – – – – 373

Rural/Remote – – – – 64 66 86 152 – – – 368

Other – – – – – – – – 24 12 93 129

TOTAL 35 136 67 135 64 66 86 152 24 12 93 870

Table 2: Nursing and Midwifery Unit Managers by Area Health Service

NSCC AHS

SESI AHS

SSW AHS

SW AHS

GS AHS

GW AHS

HNE AHS

NC AHS

JH CHW OTHER TOTAL

N/MUM 28 77 60 121 25 41 53 85 24 12 35 561

N/MUM (Acting) 4 16 7 12 6 12 1 – – – 58

TOTAL – – – – – – – – – – – 619

Appendix One lists the clinical areas of the N/MUMs that attended the workshop, Appendix Two lists the hospitals that N/MUMs came from.


One of the objectives of this project was to identify and

describe the depth and breadth of the current N/MUM

role in NSW. All the data was statistically and thematically

analysed by an independent research consultant. The

analysis aimed to offer a full description of the range of

the N/MUM functions identified through workshops and

interviews.

1.1 N/MUM workshops

Each AHS was invited to host as many workshops as

they thought necessary for as long as they thought

appropriate for N/MUMs.

A total of 63 workshops were held for N/MUMs across

NSW. Workshops varied from two to five hours in

length depending on the time allocated by the AHS.

Participants were N/MUMs permanently appointed or

acting in the role.

The workshop format (Appendix 3) included an

introduction and overview of the project. Picture

postcards were used as a tool to introduce participants

and share “why they liked being a N/MUM”. The larger

group was divided into four smaller groups to explore a

particular topic.

The topics and the related questions were:

n Current N/MUM role – identify all the things that

you currently do as a N/MUM.

n Skills and attributes – identify the skills and

attributes you need to have as a N/MUM. This can be

what you currently have or what you think you need.

n Barriers and enablers – identify the barriers and

enablers to your role. What allows you to get on and

do your job and what stops or blocks you from doing

your job?

n The ideal N/MUM role – If you could stop what

you are doing tomorrow and work in your ideal world,

what would that look like and feel like?

Each smaller group explored only one of these topics.

Participants were given blank ‘post-it’ notes where

they could record their individual responses and then

place them onto a large sheet of butcher’s paper. A

representative from the group fed back to the larger

group where the information was validated, clarified and

added to if needed.

To conclude the workshops, an evaluation was done

where each participant was asked to identify the one

thing “they liked least about the workshop” and “they

liked the most about the workshop”. Their responses

were recorded by the facilitator.

Following the workshops, the ‘post-it’ notes from

each session were grouped into common themes and

transcribed verbatim onto excel spreadsheets. The final

dataset comprised the typed verbatim comments from

each workshop participant organised under themes of

response to each of the broad questions.

Further analysis consisted mainly of identifying the

frequency of responses within each of the themes to

highlight areas of commonality or consensus among the

workshop and interview participants.

Frequency counts presented in figures and graphs in

the findings represent the number of times the same or

similar comments were expressed by the sample. Direct

quotes (noted by italics and quotation marks) are also

used to illustrate some major points.

1.2 One page questionnaire

All the N/MUMs that attended workshops were invited

to complete a one page questionnaire (Appendix 4) at

the end of the workshops. The questionnaire aimed

to collect some demographic data about N/MUM

participants.

The demographic data collected from workshop

attendees were analysed using standard descriptive

techniques by an independent research consultant.

Methodology


1.3 N/MUM Forum Day

A Forum Day (Appendix 5) for N/MUMs across the

state was hosted on the 27th March 2008 at Australian

Technology Park in Sydney.

N/MUMs were invited to attend through their AHS, Area

Directors of Nursing and Midwifery. AHS were invited

to send 20 participants from metropolitan AHS and 10

from rural AHS, as well as 10 each from The Children’s

Hospital at Westmead and Justice Health.

It was requested that as a minimum, half of the AHS

participants be those who had previously attended a

workshop in their AHS for the “take the lead” project.

The aim of the day was to validate the thematic analysis

that had been undertaken of the workshop data

collected. Each participant at the forum was issued with

a 'keypad' to use to answer questions posed throughout

a presentation given by the Project Manager. Using the

key pad to answer questions was not compulsory, so

results do not add to 100% of the participants. “Turning

Point” software counted the responses and graphed the

results (Appendix 6).

Role plays were also used to present a visual

representation of the findings on current and ideal

N/MUM role analysis. After viewing the role plays,

participants confirmed that these represented a true

reflection of their current and ideal role, further

validating the findings.

1.4 Other stakeholders

Workshops, small group discussions, one-on-one meetings

and phone interviews were conducted with other

stakeholders to explore and discover their expectations

of the N/MUM role. Other stakeholders included nursing

staff at all levels, other health professionals, consumers,

industrial organisations, professional organisations and

non clinical staff. Other stakeholders were also asked

to describe the behaviours they saw of a N/MUM who

worked effectively in their role and the behaviours where a

N/MUM had limited capability in fulfilling the role.

All responses were recorded on ‘post-it’ notes by participants

in workshops, otherwise the information was recorded in

notes taken by the interviewer. This data/ information was

transcribed into an excel spreadsheet for analysis.

All the data was statistically and thematically analysed by

an independent research consultant.


2.1 N/MUM workshops

At the beginning of each workshop N/MUMs were

asked to select (from a collection of picture postcards)

a card that would help them articulate why they liked

being a N/MUM. Individuals then used the card they

had selected to tell the group why they liked their job.

Responses were many and varied as evident in Figure 1,

but the idea of ‘making a difference’ to people’s lives,

accounting for 14% (n = 86) of the total number of

responses, was the most common theme. N/MUMs

reported being motivated by ‘empowering’ their staff

and being able to support and grow their team. This

made up 11% (n = 69) of the total responses.

‘Teamwork’ or being part of a team was an equally

important aspect of why participants liked being a

N/MUM, with a further 11% (n = 67) of responses

relating to ‘having a happy cohesive team’ and being

‘valued and supported by the team’ towards the common

goal of patient care. Other aspects of why participants

liked being a N/MUM are identified in Figure 1.

Figure 1: Reasons I like being a N/MUM as a percentage of all responses (n = 614)

14

1111

10

9 9

8 8

7

5

3 32

Mak

e a

diffe

renc

e

Team

wor

k

Dive

rsity

Lead

ersh

ip

Chal

leng

e

Pass

ion

Wor

k w

ith p

eopl

e

Poss

ibili

ties

Prob

lem

sol

ving

Life

styl

e

Lear

ning

Excit

ing

Empo

wer

sta

ff

2.1.1 The Current N/MUM role

Workshop participants were invited to identify and discuss

all the things they currently do as part of their role as a

Nursing or Midwifery Unit Manager. General management

of the nursing/midwifery unit was identified as the major

function of a N/MUM role across all workshops.

The tasks associated with general management and

the relative weight given to this function is given in

Table 3. Expressed as a percentage of all responses

relating to the current functions of the N/MUM role,

64% (n = 1944) of responses related directly to general

management tasks.

Other major aspects of the role nominated by participants

were attending to patient care activities (accounting for 16%

of all responses), the maintenance of quality and safety (14%

of responses), and demonstrating leadership and maintaining

professional standards (6% of all responses).

Table 3: Major functions and tasks of N/MUMs (n = 3036)

MAJOR FUNCTIONS ASSOCIATED TASKS

% OF TOTAL RESPONSES

WITHIN CATEGORY

1. General management

n Staffing and human resource management

n Communication

n Budgeting

n Unit equipment and maintenance

64% (n = 1944)

2. Patient care activities

n Case and care management

n Direct patient care

n Patient flow and co-ordination (admission, transfer and discharge)

n Patient and family advocacy

16% (n = 497)

3. Quality, safety and risk management

n Occupational health and safety

n Quality projects, research and audits

n Complaint and incident investigation

n Incident monitoring and management

n Risk and hazard identification

n Accreditation

14% (n = 429)

4. Leadership n Maintain professional standards

n Lead a team

n Professional development

6% (n = 166)

Results


2.1.1a General management functions

N/MUMs acknowledge that an important part of their

role includes management responsibilities and activities;

however it is to what extent they are required to do

such tasks, which inevitably takes them away from

directing and co-ordinating patient care.

The general management functions identified by N/MUMs

were many and varied. While some of this variance can

be explained by the size, location and clinical focus of

the various facilities in which the N/MUMs work, it is

difficult to reconcile an ‘official’ N/MUM role description

with some of the roles actually identified by workshop

participants (listed in Appendix 7) such as events

management, fundraising, student careers advisor,

cleaner, caterer, clerk, travel agent, fleet manager and

community liaison.

General management functions can be further

categorised into specific tasks as identified by the

workshop participants. This includes staff and human

resource management, budgeting, unit maintenance and

equipment and, communicating with others (Table 3).

Staff and human resource management

Staffing and human resource (HR) functions form a major

part of the NSW N/MUM role. Staffing and HR functions

can be further divided into four main categories (Table 4).

The management of leave (annual and sick leave) including

the organisation of staff return to work under Work Cover

agreements is nominated as a major part of staff and HR

management functions. In addition to annual performance

reviews, performance management, and dealing with staff

and family conflict, the N/MUM also frequently acts as a

personal counsellor (staff bereavements and relationship

problems), often describing themselves as ‘staff social

workers’ during the workshops.

Ensuring the unit is adequately staffed is an important

part of the N/MUM role. This function includes completing

and managing rosters and dealing with payroll systems

Table 4: Staffing and human resource management related N/MUM functions

STAFFING AND HUMAN RESOURCE MANAGEMENT INCLUDES AS A % OF RESPONSES

WITHIN CATEGORY

AS A % OF ALL NOMINATED STAFFING AND HR

FUNCTIONS

Managing staff

Leave & injury (Work Cover, annual, sick) 19% (51) –

Counselling (personal) 13% (35) –

Performance management 13% (34) –

Performance appraisals 12% (31) –

Supervision & support 11% (30) –

Conflict management 9% (24) –

Allied health & support staff 6% (17) –

Other (grievance, debrief, discipline) 17% (47) –

Total responses 100% (269) 36%

Staffing the unit

Rosters & rostering systems 42% (74) –

Finding staff (new and leave replacement) 24% (43) –

Staff allocation 15% (28) –

Skill mix & workload 10% (17) –

Audit & report 9% (16) –


Staff education and development

Plan, organise & conduct staff education 50% (79) –

Orientation new staff (nursing and other) 26% (41) –

Mandatory training 8% (13) –

Other (supervise, mentor, succession plan) 16% (25) –


Human resource administration

Recruitment & selection 65% (91) –

Managing workforce (staffing, succession) 18% (26) –

Payroll & timesheets 13% (18) –

Staff health (immunisation) 4% (6) –



such as Proact™ and Kronos™. The actual ‘finding’

of new staff and staff for coverage (for meal breaks,

leave, overtime and ‘on call’) was frequently raised

by workshop participants and clearly constitutes a

major part of the work associated with staffing the

unit. This has significant implications for the N/MUM

role in maintaining a safe workload for staff, and an

appropriate skill mix.

The organisation of staff education and professional

development was identified as another important aspect

of staff and HR management functions (Table 4). The

selection and training of facilitators, mentors, preceptors

and educators was also identified as a significant part of

managing new graduates, trainees and students.

As human resource managers (Table 4), N/MUMs spend

much time in recruitment and selection processes.

Their HR role can include everything from sending

letters to applicants, getting selection panels together

and organising rooms and times, through to reference

checking and other processes required to maintain

compliance with HR policy and procedures. Many

participants commented on the amount of time involved

in this process, not only in completing necessary

recruitment and selection functions, but also in ‘chasing

up’ people and paperwork. In general, a lag time of

around three months was given for the commencement

of new staff.

In addition to common staffing and HR functions

identified by workshop participants in Table 4, there

were a range of other activities that can occur around

managing staff. Many of these are listed in Appendix

7, but include tasks such as coordinating hospital

volunteers, being the staff social director, organising

team building events, monitoring staff security and

being either officially (rostered) or unofficially on call for

staff at any time.

Communication

As a central point of contact within the ward or unit,

the N/MUM’s ability to liaise and network with others

is clearly an important aspect of their role. N/MUMs

identified themselves as the interface between their

staff, patients and families, other health professions, the

executive and management, other departments, police

and ambulance, emergency services, visiting medical

officers, general practitioners and the community.

Answering telephones, mobiles and pagers, returning

calls, teleconferencing and faxing make up much of

the activities that N/MUMs participate in. Sending and

replying to emails was also identified as a significant

part of communicating with others, as was dealing with

general enquires from the public.

The ‘paperwork’ described by workshop participants

ranged from the simple to the complex and

encompassed:

n The dissemination of information to staff, patients

and others

n The writing of memos, briefs and reports to senior

management

n Writing proposals for funding equipment or services

n Briefs to ministers (in three of the AHS)

n Preparing media releases (one AHS)

n Writing a story for the local newspaper (one AHS)

n Preparing submissions for the Health Care Complaints

Commission (one AHS).

A further analysis of the kind of ‘paperwork’ N/MUMs

are dealing with shows that the majority can be more

accurately described as ‘data entry’ and ‘report’ writing

(Figure 2). N/MUMs also identified the need to be

proficient in accessing and using a number of databases

such as DOHRS, CHIME, PIMS, IIMS, MHOAT, ANZICS,

NAOPPPS, CAPS, EDRS, Supero and OST

Audits and reports, such as monthly activity statistics

and the measurement of performance against Key

Performance Indicators, form a large part of the

N/MUMs paperwork load.

Data analysis was identified by 12% (n = 14) of

workshop participants as part of the background

preparation for these reports. N/MUMs identified that

they sometimes become the IT resource for others

(denoted by IT systems 3%, n = 4, in Figure 2).

Attendance at meetings is another major component of

the N/MUM general management role. In addition to

the more than 30 meetings identified and attended by

workshop participants, many N/MUMs have additional

responsibilities such as arranging the meeting schedules

and booking rooms, sending agendas and recording

minutes. Travel is also a significant component of

meeting attendance for many N/MUMs working

in satellite facilities or remote locations with some

spending a whole day travelling for compulsory meeting

attendance.


Figure 2: The ‘paperwork’ of N/MUMs

23 23

18

1312

54

20

5

10

15

20

25

30

Dat

a En

try

Aud

its

Pay

syst

ems

Dat

a A

naly

sis

Wor

kloa

d to

ol

IT s

yste

ms

Not

ifica

tions

Repo

rts

Budgeting

Budgeting is another major management function

of N/MUM (Table 3). Apart from building an annual

budget and managing and reporting against this

budget, workshop participants identified a number of

other associated finance functions. These commonly

included the monitoring of revenue targets, eg private

bed utilization, revenue collecting, eg salary packaging

targets, and fundraising to support and promote the

needs of their unit (also see Appendix 7).

While the need to manage relevant financial aspects

of the role is recognised many workshop participants

identified that they are held to account for things they

feel that they have no control over, such as pathology

and medication utilisation and costs.

Unit maintenance and equipment

The general management function of the N/MUM

includes responsibility for the stores and equipment

within their ward or unit and the maintenance of same.

The degree to which N/MUMs are involved in this

process varies with the size and type of unit, as well

as the geographic location and access to resources for

maintaining and purchasing. A wide range of functions

are apparent with N/MUMs commenting particularly on

the many levels of ‘sign-off’ required for apparently basic

items such as garbage bags.

Workshop participants detailed steps in the process of

ordering non-stock or replacement equipment for which

they are responsible:

n Finding a supplier

n Getting product information and quotes

n Making the submission for funding

n Dealing with company representatives

n Ensuring product complies with occupational health

and safety and infection control guidelines

n Equipment risk assessment

n Gaining approval for purchase

n Monitoring and variation adjustments after delivery

n Tracking and maintenance.

Maintenance of unit equipment can involve a similar

complex process with N/MUMs highlighting the individual

time-consuming tasks contributing to this function. For

example they need to find repairers, get quotes, replace

equipment while it is being repaired, track equipment

location and ensure its timely return to unit.

As illustrated in Appendix 7, the N/MUM role can

also include the maintenance of car fleets with the

management of service logs, safety checks and car

washes all part of the mix. Some N/MUMs have

responsibility for up to 30 cars as part of the fleet.

In some areas, N/MUMs are directly responsible for

the refurbishment of their units, undertaking direct

negotiation with local councils and contractors as part

of their role.

2.1.1b Patient Care Activities

The nursing knowledge and clinical experience that

N/MUMs bring to their role is vitally important to ensure

safe nursing and midwifery practice and high quality

patient care.

Patient care activities were identified by workshop

participants as one of the four major functions of the

N/MUM role (refer Table 3). Almost half of N/MUMs

returning their questionnaire indicated that they are

responsible for a clinical or patient load, in addition to

their unit management and coordination responsibilities.

Figure 3 (page 14) details the major functions identified

during the workshops as part of the N/MUM patient


care activities. Particularly in rural AHS, N/MUMs’

rostered hours to perform clinical work often outnumber

the administration hours available to them. In these

situations, options for completing management tasks

identified by N/MUMs include working paid overtime,

working for unpaid time-in-lieu or working for ‘love’

(unpaid and unrecognised).

Workshop feedback also indicates that N/MUM

are frequently covering staff absences (during meal

breaks, sick leave and night duty), filling Clinical Nurse

Consultant (CNC) roles and working double shifts,

on-call and overtime to cover short falls in their staffing.

Figure 3: N/MUM role and patient care activities (n = 497)

39% patient care activities

26 % Direct patient care

21 % Patient �ow

8 % Advocacy

6 % Other

When not undertaking the broader task of case

and patient care coordination, other service gaps

filled by N/MUM included scrubbing and scouting in

operating theatre, doing medication rounds, giving out

and collecting bedpans, answering patient buzzers,

‘specialling’ patients (one-on-one care), escorting

patients during transport or transfer, showering patients,

making and cleaning beds, assisting with meal service

and feeding, emptying linen and rubbish bins and

mopping the floors.

As N/MUMs are often experienced clinical nurses, they

are also frequently consulted as a ‘clinical expert’ in their

specialty area and act as a resource person for other

units or wards.

NUMs in aged care settings indicated that they were

shopping, banking and running errands for residents.

In smaller communities, the N/MUM role also includes

community outreach and the performance of activities

such as delivering medications from the hospital to the

patient or following patients’ progress on discharge.

Other tasks identified as part of the patient care and

coordination role of N/MUM were weapon screening

and dealing with mental health emergencies and sieges.

2.1.1c Quality and Safety Management

The third major function of the N/MUM (Table 3) is overall

responsibility for unit quality and safety. Again, workshop

participants identified a broad range of tasks within this

category which are grouped in Figure 4. The conduct of

quality audits and projects (16%, n = 53); conducting

investigations such as Root Cause Analyses and case

reviews (15%, n = 50); writing, updating and ensuring

compliance with policies and procedures (14%, n = 44)

and; monitoring and managing incidents (12%, n = 40)

assume approximately equal weight among the N/MUMs

activities within this category.

Staff occupational health and safety (OH&S) is an

associated component of unit quality and safety but is

considered as a separate item in this analysis. For OH&S,

specific audits and staff training are required (such as

manual handling, hazard, fire training and safe work

practices) and most training is mandatory. When added

to the overall functions of the N/MUM role (in Table 3),

OH&S accounts for 20% (n = 63) of quality and safety

monitoring.

Figure 4: N/MUMs role in monitoring quality and safety

(n = 328)

8% Accredition

5% Reporting

2% Infection control

20% OH&S

17% Audits & projects

15% Investigations

14% Policies & procedures

12% Incident monitor/manage

8% Indentify risks

The monitoring of quality and safety is clearly a

continuous process for all N/MUMs, however, there are

also specific tasks associated with accreditation such

as documentation and visits from quality assessors

(8%, n = 27, of responses in Figure 4). Risk and hazard

identification (8%, n = 27) and monthly or annual

reporting against quality benchmarks and performance

indicators (5%, n = 16) is also part of the N/MUM role in

monitoring quality and safety within the unit.

2.1.1d Leadership

A final but equally important major function identified

as part of the N/MUM role (from Table 3) is related to

leadership of the ward or unit team. N/MUMs across

NSW have high expectations for their own personal and

professional development in terms of career progression,


maintaining currency and undertaking further education

to develop their leadership potential and to manage a

competent and professional service.

While monitoring compliance with policy and

procedure can be regarded as part of quality and safety

management, there is also a requirement to monitor

and maintain the professional standards of the staff and

unit. In identifying all the things N/MUMs do as part of

their role, workshop participants identified the following

common leadership skills:

1. People-skills: listening, communicating, empowering

2. Mediation

3. Problem-solving

4. Delegation

5. Mentoring

Other leadership and management skills identified at the

workshops included having a positive attitude and being

flexible, being a role model, having clear boundaries,

being accountable and able to manage conflict.

2.1.2 Skills and Attributes

Workshop participants were asked to identify the skills

and attributes they believe are necessary for the

N/MUM role. These could be either the skills or attributes

participants believed they already possessed or what they

believe is necessary for the role. While the distinction

between a skill and an attribute is somewhat arbitrary,

for this report a skill has been defined as an ability that

can be acquired by training, whereas an attribute is a

characteristic or quality that is demonstrated by a person.

In Figure 5 eight different skill sets or themes identified

by workshop participants are grouped and presented as

a percentage of the total number of responses. It can be

seen from Figure 5 that workshop participants believe

that skills in ‘management’ are most important. In this

context, management skills included functions such as

budgeting, performance managing, delegation, policy

and procedure development and ‘knowledge’. This

‘knowledge’ related to understanding how things work

– understanding the system, understanding the staff,

understanding the organisation.

‘People skills’ incorporates the advocacy and support

functions of the N/MUM as well as conflict resolution,

mediation and facilitation. Leadership was also rated

as important. While leadership can be both a skill

(learnt) and an attribute (personal quality), workshop

participants named role modelling and mentorship

among the necessary leadership skills.

Figure 5: Necessary skills for N/MUMs (n = 739)

Lead

er

IT &

dat

a

Peop

le s

kills

Reso

urce

Com

mun

icato

r

Inno

vato

r

Man

agem

ent s

kills

Clin

ical s

kill

5%

10%

15%

20%

25%

30%

35%

Being a good ‘communicator’ was also identified as

an important skill for N/MUMs. Across all areas, it

was deemed necessary that a N/MUM has the ability

to listen, to think critically, to interpret and to share

information and knowledge with their staff.

As an ‘innovator’, the N/MUM should possess skills in

motivation, particularly with respect to initiating and

managing change. The N/MUM should also have relevant

‘clinical skills’ for the area in which they work and be a

‘resource’ person, educator and guide to their staff.

Skills in information technology and data (‘IT & data’)

relate to the N/MUM’s ability to use and manage data

for audits and reports.

In Figure 6 (page 16), eight attributes or themes

identified by workshop participants are grouped and

presented as a percentage of the total number of

attribute responses. Across all AHS there is a clear

and distinct expectation that a N/MUM should be ‘fair

and balanced’. This category includes the attributes

of empathy, acceptance, respect, patience and being

approachable.

Being ‘flexible’ or amenable to change, reliable and

‘committed’ to the role as well as having ‘integrity’


or being honest and trustworthy (Figure 6), are all

attributes identified as important to a N/MUM. The

notion of having insight into oneself and others,

maintaining a holistic approach and generally keeping

a commonsense perspective were grouped under the

‘reflective’ attribute. Pragmatism is also valued, with

many workshop participants identifying being ‘calm

and confident’ as an attribute, and noting the need for

resilience to withstand daily pressures.

Having a ‘positive’, optimistic attitude and maintaining

a ‘sense of humour’ and fun were also identified as

important and necessary attributes for a N/MUM.

Figure 6: Necessary attributes of N/MUMs (n = 352)

Fair/

bala

nced

Refle

ctiv

e

Posit

ive

Sens

e of

hum

our

Calm

& c

onfid

ent

Com

mitt

ed

Inte

grity

Flex

ible

5%

10%

15%

20%

25%

30%

35%

2.1.3 Barriers and Enablers

During each workshop, participants were asked to

identify the people (roles), resources or systems that

enable or facilitate their role, as well as those that create

barriers to the performance of their role as a N/MUM.

A large range of enablers and barriers were identified

and these are clearly impacted upon by environmental

factors such as staff availability and geographic location.

1. Enablers

Despite small differences the majority of workshop

participants in both metropolitan and rural locations

identified the following as the most important enablers

of the N/MUM role:

a) Support

Support from unit staff, peers and colleagues as well as

from senior management. Clinical Nurse Consultants,

Clinical Nurse Educators and Nurse Educators were

specifically identified as part of the N/MUM's own

support network.

b) Adequate staffing

Adequate staffing levels and appropriate skill mix.

Adequate staffing extended to clerical, allied health

and other administrative and human resource roles that

support the current functions of the N/MUM.

c) Resources

Adequate resourcing of the unit including office space,

an appropriate budget allocation, and functioning

equipment. Access and training in information

technology (computers) was one of the most frequently

cited enablers of the N/MUM role.

d) Education and development

Access and opportunities for professional development

and education to ensure the ability to undertake the role

effectively and efficiently.

e) Effective communication

Adequate and timely access to information necessary to

perform the N/MUM role effectively and appropriately.

Other common enablers of the N/MUM role identified

were the capacity of staff and management to be

receptive and adaptive to change, the support of allied

health and medical staff, autonomy, flexibility, and the

ability to contribute to decisions about the ward or unit.

Guidance from organisational systems and processes

such as policies and procedures was also seen as a major

enabler to the role. There were minimal differences

between the metropolitan and rural areas, although

N/MUMs from rural AHS were more likely to choose

education and development among their role enablers.

Many workshop participants commented on the

importance of a happy workplace with enthusiastic,

motivated staff. Self-care, mentoring, clinical supervision

and the support of family were also identified as

significant role enablers, as was feeling valued and

respected by staff, patients and their families.

‘Time-out’ enabled the more indirect aspects of the role

such as organising staff development or succession planning.


2. Barriers

There was a clear identification of barriers to the

N/MUM role and a larger number of overall responses

within this category. Almost without exception, lack of

appropriate resources to fulfil the N/MUM role ranked

among the three most common responses of workshop

participants across metropolitan and rural AHS. The most

common shortfall in resources was access to information

technology and to the kind of IT support services required

to use computers and programs effectively.

The non-replacement of broken equipment and

shortages of stock and stores was also raised frequently

within this category. Across NSW, the following were

identified as important barriers to the N/MUM role:

a) Lack of resources and equipment

Responses ranged from a lack of basic equipment

such as faxes and photocopiers, limited access to IT

equipment and expertise, through to issues with the

physical work environment.

b) Lack of staff

Barriers included the long lag-time between recruitment

and commencement, inadequate or inappropriately trained

staff, and shortage within clinical specialties. Vacant, acting

and non-permanent positions in executive and management

were also seen as a barrier to the N/MUM role.

c) Poor understanding of the N/MUM role by others

N/MUMs are aware that inconsistencies, lack of role

clarity and position descriptions impact upon how others

communicate and interact with them. There is also a

perceived lack of insight into how the role of N/MUM can

be further developed within specific specialties or locations.

d) Unrealistic expectations

The N/MUM role is made more difficult by expectations

to provide what many believe is an unrealistically high

level of service. They feel this comes at the same time

as demands for increased performance, efficiency and

reporting within an existing resource base.

e) Prevailing workplace culture

N/MUMs perceive the current workplace culture as one

that is not always supportive of them in their role.

2.1.4 The Ideal N/MUM role

During the workshops, participants were invited to offer

their vision of the ideal N/MUM role – both how it might

look and how it might work.

The following six top features of the ideal N/MUM role

emerged (Table 5). The prioritisation of these responses

was reasonably consistent across all AHS with ‘adequate

support’ appearing among the top five most frequent

responses of all areas.

Table 5: Top six features of the ideal N/MUM role

THE IDEAL ROLE OF THE UNIT MANAGER IS ONE THAT:

Has adequate support Appropriate resources, equipment and staff.

Has autonomy To make decisions about their ward or unit.

Coordinates patient care By focussing the team on the patient.

Has management training

To prepare for the role and improve management skill.

Develops staff Through leadership, mentorship and role modelling.

Has appropriate staffing Appropriate allocation and skill mix for the care setting.

N/MUMs expressed that there was a lack of clarity

around expectations of the management versus the

clinical or nursing aspects of their role. They felt that this

has contributed to the perception of N/MUMs as ‘the

jack of all trades and master of none’ and has cemented

their post as one which offers the promise of ‘all things

to all people’. This is presumably what has led many

N/MUMs attending the workshops to identify the need

for specific management training for the role (Table 5),

a large component of which is the management of

conflicting roles and interests.

N/MUMs described the "ideal" role for a N/MUM as one

where:

n The N/MUM is prepared through succession planning

and mentoring into the role,

n There is autonomy and authority with accountability

and responsibility,

n There is clarity of what the purpose and core functions

of the N/MUM role is and executive, management and

colleagues understand and respect this,

n Meeting and other forms of communication are

efficient and effective,


n There is support for the N/MUM especially for the

large number of transactional tasks that N/MUMs

undertake,

n The N/MUM is involved in decisions that effect the

service they lead and manage,

n The N/MUM has physical space and time to participate

in transformational activities such as service planning,

improvement projects and staff development plans,

n The N/MUM works in collaboration with business

managers to monitor and manage the financial aspects

of the ward/unit,

n The N/MUM coordinates and manages patient care

with a focus on the patient/family, best practice and

appropriate models of care,

n N/MUMs have time to talk to patients,

n N/MUMs work an eight hour day with a lunch break,

n N/MUMs have the opportunity to participate in

education and professional development,

n N/MUMs lead, mentor and develop staff to provide

patient centred care.

2.2 One page questionnaire

Workshop participants who identified themselves as

Nursing or Midwifery Unit Managers (n = 619 in Table 2)

were invited to complete a more detailed demographic

questionnaire following their workshop session

(Appendix 4).

91% (n = 564) participants returned their questionnaires.

Of these, 72% (n = 409) were female and 11% (n = 62)

were male. The gender of a further 93 participants who

elected to anonymously return a survey is unknown.

An average of 66 N/MUMs from each AHS returned a

questionnaire (Table 6).

94% (n = 531) of respondents were in full time

employment with 6% (n = 33) working part-time.

Table 6 outlines the demographic profile of current

N/MUMs working in NSW who responded to the

questionnaire. Not all respondents answered every

question, therefore, some rows do not add to 100%.

While the majority of respondents were being paid

at the award rate of N/MUM Level 2, 39% (n = 15)

respondents were working under other professional

awards. 27% (n = 154) had been working in a N/MUM

role for between three and five years, although there

were equal proportions who were both new to the role

(19%, n = 105, had worked as N/MUM less than 12

months) and who were more experienced (18%, n = 104,

had worked as N/MUM for more than 10 years).

Approximately equal proportions of NSW N/MUMs

nominated their highest educational qualification as a

bachelor degree in nursing (25%, n = 143), a hospital

certificate (21%, n = 121) and a graduate certificate

(21%, n = 116). 13% (n = 74) of N/MUMs had a Masters

level qualification.

All but one survey respondent had access to a computer

in their workplace and 81% (n = 457) of those with

computer access also had an internet connection.

While the majority of N/MUMs (80%, n = 453) worked

to a known position description, a further 14% (n = 78)

of respondents indicated that they did not have a

position description and a further 3% (n = 16) were

unsure. Almost half of all respondents (46%, n = 253)

had a patient load in addition to their N/MUM duties;

however, as shown in Figure 7, this was more likely to

occur in rural-based AHS and in Justice Health.

Figure 7: Percentage of N/MUMs per Area Health

Service with patient load (n = 553)

11

NSC

CAHS

CHW

HNEA

HS

SESI

AHS

CSW

AHS

NCA

HS

GSA

HS

SSW

AHS

GW

AHS

Just

ice H

ealth

32 33 36 3844

52

60

83 87


2.3 N/MUM Forum Day

A total of 173 N/MUMs from across NSW attended

the Forum. Of these, 80% (n = 138) responded to the

question asked about who had attended a "take the

lead" workshop in their AHS. Participants represented

57% (n = 78) who had attended a workshop and 44%

(n = 60) who had not.

A didactic presentation outlining the main themes

and three sub-themes emerging from the data was

delivered to the audience by the Project Manager. The

themes reflected content explored during the N/MUM

workshops and were as follows:

1. Reasons why N/MUMs like their role,

2. Main functions of the current N/MUM role:

a. General management

b. Coordination of patient care

c. Quality and safety

d. Leadership,

3. The skills and attributes required for the role,

4. Enablers to the N/MUM role,

5. Barriers to the N/MUM role,

6. What an ideal N/MUM role looks like.

During the presentation N/MUMs were presented with

a series of questions which were used to validate the

results found within each of the above themes.

An affirmative response rate of between 94% – 100%

was achieved for each theme or sub theme, with an

average rate of agreement of 98% (refer Appendix 6).

Table 6: Demographic profile of N/MUMs (n = 564)

NSW UNIT MANAGERS NUMBER PERCENTAGE

Female: Male 409:62 72:11

Fulltime: Part time 531:33 94:6

Permanent: Acting in Role 445:117 79:21

Award classification Nursing Unit Manager Level 1 164 29

Nursing Unit Manager Level 2 306 54

Nursing Unit Manager Level 3 76 13

Other 15 2

Length of service as a N/MUM Less than 12 months 105 19

1 – 2 years 93 17

3 – 5 years 154 27

6 – 10 years 105 19

More than 10 years 104 18

Highest education qualification Bachelors Degree 143 25

Hospital Certificate 121 21

Diploma/Associate Diploma 43 8

Graduate Certificate 116 21

Graduate Diploma 65 12

Masters Degree 74 13


2.4 Other stakeholders

More than 200 other health service staff across NSW

attended workshops, focus groups, or one on one

interviews. These were Directors of Nursing and

Midwifery; nursing or midwifery managers or educators;

service directors; service managers; human resource and

finance staff; clinical nurses and midwives as well as

allied health staff; doctors; bed managers; network and

clinical practice managers; after-hours managers; union

representatives and members of the N/MUM Society.

These stakeholders (other than N/MUMs) were asked to

comment on their expectations of the N/MUM role and

also whether they could identify attributes that differentiate

between a successful and less successful N/MUM role.

Nurses and Midwives expect N/MUMs to:

n Go on rounds with staff, coordinate patient care and

generally manage the unit and staff and to use Clinical

Nurse Consultants (CNC) and Clinical Nurse Specialists

(CNS) to coordinate clinical care.

n Be a ‘clinical leader’ who is ‘a nurse’ and is an

‘advocate for patients and staff’.

n Have a ‘good work ethic’ and be ‘reliable and punctual’.

n ‘Control their environment’, ‘lead and direct change’

and maintain ‘high standards’ of patient care.

n ‘Direct the traffic’.

n ‘Take on a clinical role when it’s busy’ while others

firmly believe that N/MUM should be letting go

of their ‘clinical and collegial role’ and ‘moving to

management and leadership’.

n Have clinical knowledge but not expertise.

n Be ‘in control’ and know the difference between

leadership and management.

Health service personnel expect N/MUMs to:

n Have skills in ‘small business management’.

n Have knowledge of all aspects of service delivery.

n Have a presence and visibility on the ward.

n Be a role model.

n Undertake human resource functions.

n Successfully instigate and manage change as well as

maintain contact (‘talking’) with patients.

n ‘I need them to do what I ask them to do’.

n Be financially prudent because they are ‘managing part

of a multi-million dollar business’.

n ‘Know what drives the business’.

n ‘We expect them to know who is in bed 6 and why

the budget is over’.

Stakeholders’ perceptions of a successful or less successful N/MUM

Only 24% (n = 29) of the 120 stakeholders other than

N/MUMs attempted to identify the characteristics of a

successful N/MUM, while only five attempted to identify

those attributes that contribute to the N/MUM who is

less successful. This is a small group whose analysis of

the attributes will necessarily be based on their own

experience. This information was therefore not included

in this report.


Conclusion and Next Steps

It is acknowledged that N/MUMs have a pivotal role in

managing and co-ordinating patient care activities at the

ward/unit level. As a result of the diagnostic phase of

the “take the lead” project, it is clear that the N/MUMs

role and related responsibilities and accountabilities vary

across the state and are often dependant on the context

in which they work and the tasks others expect them to

perform.

It has been identified that more than 60% of activities

N/MUMs participate in are transactional in nature

related to managing the business aspects of the ward/

unit. The remaining 40% of activities relate to quality

and safety, patient care activities and leadership. Other

key stakeholders interviewed agreed that N/MUMs are

loaded with administrative tasks that could be done

by others. Key stakeholders were also clear in their

expectations that N/MUMs should be co-ordinating,

directing and leading care within the ward/unit.

National and international research identifies leadership

development for front line nursing managers as critical to

ensure they are able to manage the complex challenges

within a constantly changing health care system and

enact positive sustainable change (Duffield et al 2007b;

ICN/FNIF 2006; Laschinger & Wong 2007a; Read et al

2004; The Scotland Government 2008).

Information collected from workshops with N/MUMs

identified that they often feel ill equipped to perform

their diverse role, and the availability of appropriate

professional development and education that specifically

meets the needs of this role is variable and at times

limited. From the questionnaire responses of 564

N/MUMs it was also identified that 43% (n=264)

apparently have their entry level nursing qualification as

the highest level of formal education.

As a result of the consultation processes and data

analysis three work streams have been identified.

These are:

n Defining and seeking agreement on the purpose and

core functions of the N/MUM role across NSW,

n Identifying strategies to address the education and

professional development required to support and

strengthen the N/MUM role,

n Outlining strategies to address the number of

transactional (administrative) tasks N/MUMs currently

undertake.


Aiken, L., Clarke, S.P., Sloane, D.M., Sochalski, J. & Silber,

J.H. (2002). Hospital nurse staffing and patient mortality,

nurse burnout, and job dissatisfaction. Journal of the

American Medical Association, 288, 1987-1993.

Baumann, A, (2007). Positive Practice Environments:

quality workplaces = Quality patient care. Information

and Action Tool Kit. International Council of Nurses

(ICN), Geneva Switzerland.

Baumann, A., O'Brien-Pallas, L., Armstrong-Stassen, M.,

Blythe, J., Bourbonnais, R., Cameron, Doran, D.I, Kerr,

M., McGillis-Hall, L., Vezina, M., Butt, M., & Ryan, L.

(2001). Commitment and care: The benefits of a healthy

workplace for nurses, their patients and the system.

Canadian Health Services Research Foundation, Ottawa,

Ontario, Canada.

Buchan, J., Calman, L. (2005). The Global Shortage

of Registered Nurses: An Overview of Issues and

Actions. International Council of Nurses (ICN), Geneva

Switzerland.

Casida, J.M. (2007). The relationship of nurse managers

leadership styles and nursing unit organisational culture

in acute care hospitals in New Jersey. PhD thesis, Seaton

Hall, New Jersey, USA.

Duffield, C.M. (1989). The Competencies Expected Of

First-line Nursing Managers - An Australian Context.

Journal of Advanced Nursing, 14(12), 997-1001.

Duffield, C.M. (1991). First-line nurse managers: Issues

in the Literature. Journal of Advanced Nursing, 16(1),

55-62.

Duffield, C.M. (1994). Role Competencies of First-line

Managers. Nursing Management, 23(6), 49-52.

Duffield, C.M. (1995). Future Responsibility and

Requirements for First-Line Nurse Managers in New

South Wales. Journal of Nursing scholarship, 24(1), 9-43.

Duffield, C.M., Donoghue, J.M., Pelletier, D.S. & Adams,

A.F. (1993). First-line nurse managers in NSW: perceived

role competencies (Part II). Contemporary Nurse 2(3),

110-117.

Duffield, C. M. & Franks, H. (2001). The role and

preparation of first-line nurse managers in Australia:

where are we going and how do we get there? Journal

of Nursing Management, 9(0), 87-91.

Duffield, C., Kearin, M., Johnston, J., & Leonard, (2007a).

The impact of hospital structure and restructuring on

the nursing workforce. Australian Journal of Advanced

Nursing, 24(3), 42-46.

Duffield, C.M., Moran, P., Beutel, J., Bunt, S., Thornton,

A., Wills, J., Cahill, P. & Franks, H. (2001). Profile of first-

line managers in NSW, Australia in the 1990's, Journal of

Advanced Nursing, 36, 785-793.

Duffield, C.M., Roche, M.A., O'Brien-Pallas, L., Diers,

D., Aisbett, C., King, M.T., Aisbett, K., Hall, J.P. (2007b).

Glueing it together: nurses, their work environment and

patient safety, Centre for Health Services Management,

UTS, Sydney, 1-243.

Queensland Health. (2008). Review of the Nurse Unit

Manager Role. Office of the Chief Nurse, Queensland

Health. (unpublished at present)

ICN/FNIF, (2006). Global Nursing Shortage: Priority Areas

for Intervention: A Report from International Council

of Nurses (ICN)/ Florence Nightingale International

Foundation (FNIF), Geneva Switzerland.

Laschinger, H. & Wong, C. (2007a). A profile of the

Structure and Impact of Nursing Management in

Canadian Hospitals. Final Report for Canadian Health

Services Research Foundation (CHSRF) Ottawa, Ontario,

Canada.

References


Laschinger, H. & Wong, C. (2007b). Canadian Nursing

Leadership Study Invitational Symposium: Final Report 26

Canadian Health Services Research Foundation, Ottawa,

Ontario, Canada

McGuire, E. & Kennerly. S. M. (2006) Nurse Managers

as Transformational and Transactional Leaders. Nursing

Economics 24(4), 179-184)

Moran, P. Duffield, C.M. Beutel, J., Bunt, S., Thornton,

A., Wills, J., Cahill, P. & Franks, H. (2002). Nurse

Managers in Australia: Mentoring, leadership and Career

Progression. Canadian Journal of Nursing Leadership,

15(2), 14-20.

NSW Health (2000) A new direction for NSW State

Health Plan-Toward 2010, NSW Health

NSW Health (2006). Profile of the Nursing Workforce in

NSW. An overview of information from the 2006 Labour

Force Survey, Workforce Development and Leadership

Branch, NSW Health.

NSW Health (2007) NSW Health Patient Survey 2007

Statewide Report

NSW Health (2008) The NSW Public Health System

Nurse’ & Midwives’ (State) Award.

Paliadelis, P. 2005. Rural nursing unit managers:

education and support for the role. Rural and Remote

Health 5(325)

Read, S., Ashman, M., Scott, C., Savage, J. (2004).

Evaluation of the modern matron role in a sample of

NHS trusts, Final Report to the Department of Health.

The Royal College of Nursing Institute and the University

of Sheffield School of Nursing and Midwifery.

RNAO Registered Nurses’ Association of Ontario, (2006).

Developing and Sustaining Nursing Leadership. Toronto,

Canada: Registered Nurses’ Association of Ontario.

The Scottish Government (2008). Leading Better Care:

Report of the Senior Charge Nurse Review and Clinical

Quality Indicators Project, The Scottish Government,

Edinburgh, Scotland.


Aged Care Assessment Team

Acute Geriatric

Acute Medical

Adolescent Health

Adolescent Mental Health

Adult Correction Centre

Aged Care

Aged Care Psychiatry

Aged Care Rehabilitation

Aged Care/Community Health

Aged Care/Dementia

Aged Day Care Community

Ambulatory Care

Anesthesia/Recovery

Antenatal/Gynecology

Birth Unit

Brain Injury Rehab

Breast Cancer Oncology

Burns Unit

Cancer Services

Cardiology

Cardiothoracic

Child and Family Health

Colorectal

Community Health

Critical Care Unit

Day Surgery

Drug and Alcohol Services

ED/HDU

Emergency

Endoscopy

General Medicine

Geriatric Medicine

Gl Surgery

Gosford ED

GP Casualty

Hematology

HIV Aids Dementia & Psych

ICU

Maternity

Medical

Mental Health

Midwifery

Midwifery Aboriginal Health

Neonatal Intensive Care

Nephrology/Gastro

Neural Trauma High Dependency

Neuroscience

Newborn Care

Oncology

Operating Theatre

Operating Theatre/Recovery

Opioid Treatment Services

Ophthalmology

Orthalmology

Paediatric

Palliative Care

Preoperative Services

Postnatal/Antenatal/Gynecology

Primary Care Health

Psycho Geriatrics

Radiology

Rehabilitation

Renal

Residential Aged Care

Respiratory Medicine

Sexual Health

Spinal Cord Injury

Stroke Unit

Surgical Ward

Transitional Care Unit

Tresillian Child and Family Health

Tuberculosis/Chest

Upper GI and Gastro

Urology

Women's Health

Appendix 1 – N/MUM Workshops, Clinical Areas

Clinical areas represented in N/MUM workshops


Appendix 2 – N/MUM Workshops, Hospitals

Hospitals/Health Services represented in N/MUM workshops

Albury Base Hospital

Armidale Hospital

Auburn Hospital

Ballina Hospital

Barkala Aged (Acute) TSH

Bathurst Base Hospital

Bathurst Comm Mental Health

Bega Hospital

Bellingen Hospital

Belmont Hospital

Blacktown Hospital

Bloomfield Hospital

Blue Mountains Hospital

Bourke Health Service

Broken Hill Base Hospital

Bulli Hospital

Calvary Hospital

Canterbury Hospital

Casino & Corak Hospital

Cessnock Hospital

The Children's Hospital at Westmead

Coffs Harbour Hospital

Coledale Hospital

Collarenebn Health Service

Concord Hospital

Coonabarabran Health Service

Coonamble Health Service

Cowra Health Service

Croucester Soldiers Memorial Hospital

Dubbo Health Service

Eloura West Shellharbour Hospital

Eurobodalla - Moruya Health Service

Forbes Health Service

Garrawarra Hospital

Gosford Hospital

Grenfell Multi Purpose Service

Hawkesbury Hospital

Hoxton Park Community Health Centre

John Hunter Children's Hospital

John Hunter Hospital

Kaleidoscope Child & Family Nursing

Kempsey District Hospital

Kyogle Memorial Hospital

Lismore Base Hospital

Lithgow Hospital

Liverpool Hospital

Macarthur Health Service

Maclean Hospital

Maitland Hospital

Manning Base Hospital

Merrylands Hospital

Moruya Hospital

Mt Druitt Hospital

Mudgee Health Service

Mullumbimby Hospital

Murwillumbah Hospital

Nepean Hospital

Nowra Community Health Centre

Orange Base Hospital

Parkes Communityy Mental Health

Parramatta Community Hospital

Port Kembla Hospital

Port Macquarie Base Hospital

Prince of Wales Hospital

Riverlands Hospital

Royal North Shore Hospital

Royal Newcastle Centre

Royal Prince Alferd Hospital

Sacred Heart Hospice

Sydney Children's Hospital

Shellharbour Hospital

Shoalhaven Hospital

Singleton Hospital

St George Hospital

St Vincent's Hospital

St Heliers Hospital

St Joseph Hospital

Sydney Hospital

Tamworth Base Hospital

The Tweed Hospital

Trundle Multi Purpose Service

Tullamore Multi Purpose Service

Tweed Byron Community Health

Tweed Byron Mental Health

Urbenville Health Service

Wagga Base Hospital

Walgett Health Service

Wallsend Aged Care Facility

War Memorial Hospital

Warren Multi Purpose Service

Wauchope Hospital

Wingham Hospital

Westmead Hospital

Wollongong Hospital

Wyong Hospital

Yarrabee TSH

Yass Hospital


Appendix 3 – Workshop Format

Date:

Venue:

Facilitator: Sue Hawes, Project Manager – CSRP / The NUM Role

TIME MODULE ACTIVITY RESOURCES WHO

Welcome and Introduction n SH to introduce herself and the project concept and what the aim of the workshop is

Computer and data projector

SH

Warm up activity n Participants to introduce themselves and what they hope to get out of the session

n N/MUM identify why they like being a N/MUM

Post cards

Explore the type of activities NUMs currently do

Explore the skills and attributes needed for the N/MUM role

Explore the enablers and barriers to the N/MUM role

Explore what the “ideal” N/MUM role would look like and work like

n Divide the group into smaller groups

n Each group to take one topic

n Feedback to the group and discussion

Butchers paper and pens

'Post it notes’

White board

SH

Sum up and evaluation n Sum up the agenda and what we did

n Check if their expectations were met

n Any interest in future involvement

n Workshop evaluation – ‘liked most /liked least activity’

Butchers paper SH

"take the lead"

Strengthening the Nursing/Midwifery Unit Manager role across NSW

Workshop agenda with N/MUMs


Appendix 4 – N/MUM Questionnaire

"take the lead"

Specialty area currently working in _________________________________________________________________________

What is your position called (e.g. N/MUM, Clinical Co-ordinator etc) _____________________________________________

1. Are you ? (Please √) Full time o Part time o

2. Are you ?

Permanent in the role o Acting in the role o Other o

3. Are you paid as a ?

NUM 1 o NUM 2 o NUM 3 o Other o

4. How long have you been a N/MUM?

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

5. Do you have a copy of your position description?

Yes o No o Unsure o

6. What is the highest level of education you have attained (Please √ only one box):

Hospital Certificate o Associate Diploma o Diploma o Bachelor's Degree o

Graduate Certificate o Graduate Diploma o Master's Degree o PhD o

7. Do you have access to a computer at work ?

Yes o No o Comment:________________________________________________________________________

8. Do you have access to the Internet at work ?

Yes o No o Comment:________________________________________________________________________

9. Do you have a clinical (patient) load in your day-to-day duties? Yes o No o

If “yes” (Please √):

Part of my Position Description o

OR

Rarely o Sometimes (2-4 shifts per month) o Often (twice per week) o

10. Would you be interested in becoming involved with activities related to this project?

Yes, please contact me with more information o No o

Name:__________________________________________________________________________________________________

Email:__________________________________________________ Telephone Number: ______________________________


Appendix 5 – N/MUM Forum Day Agenda

Nursing & Midwifery Unit Manager Forum

0830 Coffee and Registration

0900 Overview and Housekeeping Sue Hawes, Project Manager NaMO NSW Health Department

0920 Keynote Welcome Professor Debora Picone AM, Director General

NSW Health Department

0930 NUM/MUM Data feedback and validation Sue Hawes

1045 Morning Tea

1115 Where are we now? Theatrical Presentation

1145 Where could we go? Theatrical Presentation

1215 Lunch

1300 NUM/MUM Workshops

1530 Regroup and snapshot review Sue Hawes, Project Manager

1545 Closing Remarks Adjunct Professor Debra Thoms,

Chief Nursing and Midwifery Officer

NaMO NSW Health Department


Appendix 6 – Key Pad Summary Results

Turning Graphical Results by Question

Session Name: New Session 3.27.2008 4.27PM.tpz

Created: 3/27/2008 4:29 PM

2) HOW WOULD YOU PREFER TO HEAR ABOUT "TAKE THE LEAD" PROJECT ACTIVITIES ?

RESPONSES

"take the lead" Website 18 14%

Email 74 58%

Regular "take the lead" newsletter 34 26%

From your line manager 3 2%

Don't want to hear anything 0 0%

Totals 129 100%

From your line manager

"take the lead" website

Email

Regular "take the lead" newsletters

PIE 4

"take the lead" newsletter

Email sent by Project Manager

Your line manager

Another N/MUM

Other

1) HOW DID YOU HEAR ABOUT TODAY'S FORUM?

RESPONSES

"take the lead" newsletter 7 5%

Email sent by Project Manager 34 26%

Your line manager 65 50%

Another N/MUM 5 4%

Other 20 15%

Totals 131 100%

3) HOW CONFIDENT ARE YOU THAT ANYTHING WILL CHANGE AS A RESULT OF "TAKE THE LEAD" PROJECT?

RESPONSES

Confident 43 31%

Not confident 42 31%

Unsure 52 38%

Totals 137 100%

Con�dent

Not con�dent

Unsure


4) HOW CONFIDENT ARE YOU THAT "TAKE THE LEAD" WILL MAKE A DIFFERENCE TO ...

RESPONSES

You the N/MUM 10 8%

The team 5 4%

The patients and carers 2 2%

All of the above 46 35%

None of the above 11 8%

Unsure 57 43%

Totals 131 100%

You the N/MUM

The team

The patients and carers

All of the above

None of the above

Unsure

5) ARE YOU ABLE TO HAVE MEANINGFUL CONVERSATIONS WITH YOUR LINE MANAGER ABOUT MAKING CHANGES?

RESPONSES

Yes 90 68%

No 43 32%

Totals 132 100%

Yes

No

6) WHERE DO YOU SEE YOUR BIGGEST OPPORTUNITY FOR CHANGE ? RESPONSES

Recruitment and retention 14 10%

Patient care co-ordination 24 18%

Financial/budget management 6 4%

Developing staff 25 19%

Quality and safety 12 9%

Communication 13 10%

Managing staff 15 11%

Self empowerment 21 16%

Self development 4 3%

Totals 131 100%

Recruitment and retention

Patient care co-ordination

Financial/budget management

Developing sta�

Quality and safety

Communication

Managing sta�

Self empowerment

Self development

7) DID YOU ATTEND A "TAKE THE LEAD" WORKSHOP FACILITATED BY EITHER SUE OR HELENA?

RESPONSES

Yes 78 57%

No 60 43%

Totals 138 100%

Yes

No


9) ARE YOU CURRENTLY ENROLLED IN A TERTIARY PROGRAM THAT IS RELATED TO MANAGEMENT, LEADERSHIP OR BUSINESS ADMINISTRATION ?

RESPONSES

Yes 23 16%

No 118 84%

Totals 141 100%

10) THE EMERGING THEMES DESCRIBED ABOUT WHY YOU LIKE BEING A N/MUM ARE...

RESPONSES

A true reflection 134 98%

Not reflective 3 2%

Totals 137 100%

11) HAVE YOU CHANGED ANYTHING IN YOUR OWN PRACTICE SINCE ATTENDING A "TAKE THE LEAD" WORKSHOP?

RESPONSES

Yes 28 20%

No 47 34%

Did not attend workshop 63 46%

Totals 138 100%

8) SINCE BECOMING A REGISTERED NURSE/MIDWIFE HAVE YOU COMPLETED ANY OF THE FOLLOWING TERTIARY (UNIVERSITY) QUALIFICATIONS? (SELECT THE HIGHEST DEGREE)

RESPONSES

Bachelor of Health Administration 8 6%

Graduate Certificate in Management, Health Management

17 12%

Graduate Diploma in Management, Health Management

14 10%

Masters in Management, Health Management

14 10%

PHD 1 1%


Totals 140 100%

Bachelor of Health AdministrationGraduate Certi�cate in Management,Health Management

Graduate Diploma in Management, Health Management

Masters in Management, Health Management

PHDNone of the above

Yes

No

A true re�ection

Not re�ective

Yes

No

Did not attend a workshop


15) THE EMERGING THEMES DESCRIBED ABOUT THE LEADERSHIP ASPECTS OF YOUR ROLE ARE...

RESPONSES

A true reflection of what currently happens

140 99%

Not a true reflection of what currently happens

2 1%

Totals 131 100%

PIE 18

A true re�ection of what currently happens

Not a true re�ection of what currently happens

14) THE EMERGING THEMES DESCRIBED ABOUT THE QUALITY AND SAFETY ASPECTS OF YOUR ROLE ARE...

RESPONSES


142 100%


0 0%

Totals 131 100%

13) THE EMERGING THEMES DESCRIBED ABOUT THE CO-ORDINATION OF PATIENT CARE ASPECTS OF YOUR ROLE ARE...

RESPONSES


134 96%


5 4%

Totals 139 100%

12) THE EMERGING THEMES DESCRIBED ABOUT THE GENERAL MANAGEMENT ASPECTS OF YOUR ROLE ARE...

RESPONSES


132 96%


5 4%

Totals 137 100%

A true re�ection

PIE 21

A true re�ection

Not re�ective

A true re�ection

Not re�ective


PIE 22

A true re�ection of what you want to happen

Not re�ective of what you want to happen

19) THE EMERGING THEMES DESCRIBING THE IDEAL ROLE ARE... RESPONSES

A true reflection of what you want to happen

142 99%

Not reflective of what you want to happen

74 1%

Totals 129 100%

18) THE EMERGING THEMES DESCRIBED ABOUT THE SKILLS AND ATTRIBUTES TO YOUR ROLE ARE...

RESPONSES

A true reflection 142 100%

Not reflective 0 0%

Totals 142 100%

PIE 21

A true re�ection

17) THE EMERGING THEMES DESCRIBED ABOUT WHAT ENABLES YOU TO DO YOUR ROLE ARE...

RESPONSES


131 95%


7 5%

Totals 138 100%

PIE 20



16) THE EMERGING THEMES DESCRIBED ABOUT THE BARRIERS TO YOUR ROLE ARE...

RESPONSES


136 98%


3 2%

Totals 139 100%

PIE 18




20) HOW CONFIDENT ARE YOU THAT ANYTHING WILL CHANGE AS A RESULT OF "TAKE THE LEAD" PROJECT?

RESPONSES

Confident 81 65%

Not confident 43 35%

Totals 124 100%

Con�dent

Not con�dent

21) HOW CONFIDENT ARE YOU THAT "TAKE THE LEAD" WILL MAKE A DIFFERENCE TO ...

RESPONSES

You the N/MUM 24 18%

The team 5 4%

The patients and carers 6 5%

All of the above 73 56%


Totals 131 100%

22) ARE YOU WILLING TO BECOME A "TAKE THE LEAD" CHAMPION, LEADING CHANGES IN YOUR LOCAL FACILITY OR COMMUNITY AREA ?

RESPONSES

Yes 63 53%

No 57 47%

Totals 132 100%

PIE 25

You the NUM/MUM

The team

The patients and carers

All of the above

None of the above

Yes

No


Appendix 7 - N/MUM Workshop General Management Functions

Daily ward administration and management

Photocopy, faxing, filing

Disaster management: plans and audits

Proposals, submissions and reports

Service planning

General ward and theatre cleaning

Car & fleet management and maintenance

Universal problem solving

Project management

Resource person for general and specific health information

Strategic planning

Business cases and plans

Trouble shoot problems

Food service, catering officer

Fundraising in community

Plan social functions, raffle prizes & supplies for fundraising

Security & security management plans

Computer programs & support

Order ward food (tea, coffee), stores and supplies

Monitor and manage change

After hours contact

Change agent

Typing minutes from meetings

Dealing with drug and product reps

Switchboard operation

Mail: collection, sorting, distributing

Building and site manager

Building refurbishment redesign, planning and development

Signing documents

Meeting & monitoring KPI's: medication errors, pressure areas, falls

Events planning, co-ordination and management

Hospital portfolio on top of NUM role

Research

Ward clerking

Manage the barriers

Education and orientation

Feedback

Budget

Be a middle manager as well as a front line manager

Investigate everything before acting

Set the tone of your unit

Keep abreast of technological change and implementation

Crisis management

Arranging agendas for meetings

Keep the notice board up to date

Notification births to Births, Death and Marriages

Update ward brochures

Write and type letters

Creating new ways of doing things

Printing patients labels

Organizing IT access for all staff

Answering the phone

Taking phone enquiries from public patients and health professionals

Public speaking to community groups

Acquisition of health service premises

Access control

Community Liaison

Health promotion

Careers advisor for High School

Clinical redesign

Winter bed strategy

Surge capacity

Bed utilization strategy

Review of other area business plans

General management functions of NSW N/MUMs

The following general functions of the N/MUMs were identified by those attending workshops. The most common general

management functions of a N/MUMs are at the top of the list with less frequent functions towards the bottom of the list.


Appendix 7 (continued)

Ward cleaning: drug fridge and all other equipment

Pest control

Attending to building alarms

Organize funeral for destitute person

Ethics and law officer

Coordinate emergency response

Public relations

Building works - quotes, resource information on building

Time manager and time manager consultant

Public relations officer

Representative face of service

Provide safe harmonious work environment

Travel agent

Spokesperson for unit

Media officer

Police contact

Community Liaison officer - builders

Wash the dog

Audits and overseeing of same e.g. S4 and S8 and files

Manage bed closures staff redeployment

Open door

Donation responses

Take work home

Downtime "lockdown" management

Aboriginal Unit Liaison Programs

Pandemic Plan

Clinical stream management

Investigate & follow up with parents

Angry parent/staff meeting

Ward closures and mergers

Statewide projects

Unpacking stores

Being the middleman between area ideas and ward staff

Housekeeping issues

Policy changes

Monitor and coordinate clinics for VMO

Planning theatre schedules and lists

Hospital management

Keeping the finger on the pulse

Travel between sites

Answer everyone's questions

Manager community service

SHPN (NAMO) 090041

strengthening the nursing/midwifery unit manager role ... · pdf filepage 4 nsw health...

Documents