Compiled by:
Sue Hawes
Project Manager
Nursing and Midwifery Office
Statistical and thematic analysis by:
Dr Donna Waters
The College of Nursing
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

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"

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
PAGE 2 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

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

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.
PAGE 4 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

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
).
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 ).
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
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 5

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.
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).
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.
PAGE 6 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

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.
attended by N/MUMs where data was collected in response to a series of questions.
2.
N/MUMs who attended the workshops were invited to complete a one page demographic questionnaire.
3.
data collected at the workshops was validated and further exploration of issues were conducted through workshops.
4.
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
No. of workshops
Metro
Rural/Remote
Other
TOTAL
NSCC
AHS
4
35
–
–
35
SESI
AHS
7
136
–
–
136
SSW
AHS
4
67
–
–
67
SW
AHS
6
135
–
–
135
GS
AHS
5
–
64
–
64
GW
AHS
11
–
66
–
66
HNE
AHS
10
–
86
–
86
NC
AHS
9
–
152
–
152
Table 2: Nursing and Midwifery Unit Managers by Area Health Service
N/MUM
N/MUM (Acting)
TOTAL
NSCC
AHS
28
4
–
SESI
AHS
77
16
–
SSW
AHS
60
7
–
SW
AHS
121
–
GS
AHS
25
12
–
GW
AHS
41
6
–
HNE
AHS
53
12
–
Appendix One lists the clinical areas of the N/MUMs that attended the workshop,
Appendix Two lists the hospitals that N/MUMs came from.
NC
AHS
85
1
–
JH
24
–
–
JH
24
24
2
–
–
CHW OTHER TOTAL
12
12
2
–
–
10
–
–
93
93
70
373
368
129
870
CHW OTHER TOTAL
12
–
–
35
–
–
561
58
619
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 7

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
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
– identify all the things that you currently do as a N/MUM. n
– 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
– 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
– 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
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.
PAGE 8 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

1.3
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
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.
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 9

2.1
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.
Figu re 1: Reasons I like being a N/MUM as a percentage of all responses (n = 614)
14
11
11
10
9 9
8 8
7
5
3 3
2
2.1.1
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
2. Patient care activities n
Staffing and human resource management n
Communication n
Budgeting n
Unit equipment and maintenance n
Case and care management n
Direct patient care n
Patient flow and co-ordination
(admission, transfer and discharge) n
Patient and family advocacy
64%
(n = 1944)
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
4. Leadership n
Maintain professional standards n
Lead a team n
Professional development
14%
(n = 429)
6%
(n = 166)
PAGE 10 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

Table 4: Staffing and human resource management related N/MUM functions
STAFFING AND HUMAN
RESOURCE MANAGEMENT
Managing staff
Staffing the unit
Staff education and development
Human resource administration
INCLUDES
Leave & injury (Work Cover, annual, sick)
Counselling (personal)
Performance management
Performance appraisals
Supervision & support
Conflict management
Allied health & support staff
Other (grievance, debrief, discipline)
Total responses
Rosters & rostering systems
Finding staff (new and leave replacement)
Staff allocation
Skill mix & workload
Audit & report
Total responses
Plan, organise & conduct staff education
Orientation new staff (nursing and other)
Mandatory training
Other (supervise, mentor, succession plan)
Total responses
Recruitment & selection
Managing workforce (staffing, succession)
Payroll & timesheets
Staff health (immunisation)
Total responses
AS A % OF RESPONSES
WITHIN CATEGORY
19% (51)
13% (35)
13% (34)
12% (31)
11% (30)
9% (24)
6% (17)
17% (47)
100% (269)
42% (74)
24% (43)
15% (28)
10% (17)
9% (16)
100% (178)
50% (79)
26% (41)
8% (13)
16% (25)
100% (158)
65% (91)
18% (26)
13% (18)
4% (6)
100% (141)
AS A % OF ALL NOMINATED
STAFFING AND HR
FUNCTIONS
–
–
–
–
–
–
–
–
36%
21%
–
–
–
–
19%
–
–
–
–
–
–
24%
–
–
–
2.1.1a
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).
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
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 11

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.
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.
PAGE 12 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

Figu
15
10
5
0
30
25
20
23 23
18
13
12
5
4
2
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.
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
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
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 13

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 flow
8 % Advocacy
6 % Other
2.1.1c
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
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.
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
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,
PAGE 14 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

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.
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)
35%
30%
25%
20%
15%
10%
5%
Clinical skill People skills
Communicator
Management skills
2.1.2
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
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’
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 15

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)
35%
30%
25%
20%
15%
10%
5%
Fair/balanced
Sense of humour Calm & confident
2.1.3
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.
PAGE 16 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

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
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
Develops staff
To prepare for the role and improve management skill.
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,
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 17

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.
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)
83
87
2.2
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
11
32 33
36 38
44
52
60
PAGE 18 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

Table 6: Demographic profile of N/MUMs (n = 564)
NSW UNIT MANAGERS
Female: Male
Fulltime: Part time
Permanent: Acting in Role
Award classification
Length of service as a N/MUM
Highest education qualification
Nursing Unit Manager Level 1
Nursing Unit Manager Level 2
Nursing Unit Manager Level 3
Other
Less than 12 months
1 – 2 years
3 – 5 years
6 – 10 years
More than 10 years
Bachelors Degree
Hospital Certificate
Diploma/Associate Diploma
Graduate Certificate
Graduate Diploma
Masters Degree
154
105
104
143
306
76
15
105
93
NUMBER
409:62
531:33
445:117
164
121
43
116
65
74
2.3
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).
PERCENTAGE
72:11
94:6
79:21
29
18
25
27
19
2
19
54
13
17
21
8
21
12
13
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 19

2.4
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.
PAGE 20 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

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.
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 21

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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.
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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.
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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.
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 23

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
PAGE 24 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW
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

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
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 25

Date:
Venue:
Facilitator: Sue Hawes, Project Manager – CSRP / The NUM Role
Welcome and Introduction
n SH to introduce herself and the project concept and what the aim of the workshop is
Warm up activity n
Participants to introduce themselves and what they hope to get out of the session
Computer and data projector
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
Sum up and evaluation n
N/MUM identify why they like being a N/MUM n Divide the group into smaller groups Butchers paper and pens n Each group to take one topic
'Post it notes’ n Feedback to the group and discussion White board 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
SH
SH
PAGE 26 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

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
2. Are you ?
Permanent in the role o
Part time
Acting in the role o 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
If “yes” (Please √ ):
Part of my Position Description o
OR
Rarely o Sometimes (2-4 shifts per month) o Often (twice per week) o
No 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: ______________________________
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 27

0830 Coffee and Registration
0900 Overview and Housekeeping
0920 Keynote Welcome
Sue Hawes, Project Manager
NaMO NSW Health Department
Professor Debora Picone AM, Director General
NSW Health Department
Sue Hawes 0930 NUM/MUM Data feedback and validation
1045 Morning Tea
1115 Where are we now?
1145 Where could we go?
1215 Lunch
1300 NUM/MUM Workshops
1530 Regroup and snapshot review
1545 Closing Remarks
Theatrical Presentation
Theatrical Presentation
Sue Hawes, Project Manager
Adjunct Professor Debra Thoms,
Chief Nursing and Midwifery Officer
NaMO NSW Health Department
PAGE 28 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

Session Name: New Session 3.27.2008 4.27PM.tpz
Created: 3/27/2008 4:29 PM
1) HOW DID YOU HEAR ABOUT
TODAY'S FORUM?
"take the lead" newsletter
Email sent by Project Manager
Your line manager
Another N/MUM
Other
Totals
RESPONSES
7
34
65
5%
26%
50%
5
20
4%
15%
131 100%
2) HOW WOULD YOU PREFER TO HEAR
ABOUT "TAKE THE LEAD" PROJECT
ACTIVITIES ?
"take the lead" Website
Email
Regular "take the lead" newsletter
From your line manager
Don't want to hear anything
Totals
RESPONSES
18
74
34
14%
58%
26%
3 2%
0 0%
129 100%
3) HOW CONFIDENT ARE YOU THAT
ANYTHING WILL CHANGE AS A RESULT
OF "TAKE THE LEAD" PROJECT?
Confident
Not confident
Unsure
Totals
RESPONSES
43
42
31%
31%
52 38%
137 100%
"take the lead" newsletter
Email sent by Project Manager
Your line manager
Another N/MUM
Other
From your line manager
"take the lead" website
Email
Regular "take the lead" newsletters
Confident
Not confident
Unsure
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 29

4) HOW CONFIDENT ARE YOU THAT
"TAKE THE LEAD" WILL MAKE A
DIFFERENCE TO ...
You the N/MUM
The team
The patients and carers
All of the above
None of the above
Unsure
Totals
RESPONSES
10 8%
46
11
5
2
4%
2%
35%
8%
57 43%
131 100%
5) ARE YOU ABLE TO HAVE MEANINGFUL
CONVERSATIONS WITH YOUR LINE
MANAGER ABOUT MAKING CHANGES?
Yes
No
Totals
RESPONSES
90
43
68%
32%
132 100%
6) WHERE DO YOU SEE YOUR BIGGEST
OPPORTUNITY FOR CHANGE ?
Recruitment and retention
Patient care co-ordination
Financial/budget management
Developing staff
Quality and safety
Communication
Managing staff
Self empowerment
Self development
Totals
RESPONSES
12
13
15
21
14
24
6
25
10%
18%
4%
19%
9%
10%
11%
16%
4 3%
131 100%
7) DID YOU ATTEND A "TAKE THE LEAD"
WORKSHOP FACILITATED BY EITHER
SUE OR HELENA?
Yes
No
Totals
RESPONSES
78
60
57%
43%
138 100%
PAGE 30 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW
You the N/MUM
The team
The patients and carers
All of the above
None of the above
Unsure
Yes
No
Recruitment and retention
Patient care co-ordination
Financial/budget management
Developing staff
Quality and safety
Communication
Managing staff
Self empowerment
Self development
Yes
No

8) SINCE BECOMING A REGISTERED
NURSE/MIDWIFE HAVE YOU COMPLETED
ANY OF THE FOLLOWING TERTIARY
(UNIVERSITY) QUALIFICATIONS?
(SELECT THE HIGHEST DEGREE)
Bachelor of Health Administration
Graduate Certificate in Management,
Health Management
Graduate Diploma in Management,
Health Management
Masters in Management,
Health Management
PHD
None of the above
Totals
RESPONSES
8
17
14
14
1
6%
12%
10%
10%
1%
86 61%
140 100%
9) ARE YOU CURRENTLY ENROLLED IN A
TERTIARY PROGRAM THAT IS RELATED
TO MANAGEMENT, LEADERSHIP OR
BUSINESS ADMINISTRATION ?
Yes
No
Totals
RESPONSES
23
118
16%
84%
141 100%
10) THE EMERGING THEMES DESCRIBED
ABOUT WHY YOU LIKE BEING A
N/MUM ARE...
A true reflection
Not reflective
Totals
RESPONSES
134
3
98%
2%
137 100%
11) HAVE YOU CHANGED ANYTHING
IN YOUR OWN PRACTICE SINCE
ATTENDING A "TAKE THE LEAD"
WORKSHOP?
Yes
No
Did not attend workshop
Totals
RESPONSES
28
47
20%
34%
63 46%
138 100%
Bachelor of Health Administration
Graduate Certificate in Management,
Health Management
Graduate Diploma in Management,
Health Management
Masters in Management,
Health Management
PHD
None of the above
Yes
No
A true reflection
Not reflective
Yes
No
Did not attend a workshop
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 31

12) THE EMERGING THEMES DESCRIBED
ABOUT THE GENERAL MANAGEMENT
ASPECTS OF YOUR ROLE ARE...
A true reflection of what currently happens
Not a true reflection of what currently happens
Totals
RESPONSES
132
5
137
96%
4%
100%
13) THE EMERGING THEMES DESCRIBED
ABOUT THE CO-ORDINATION OF
PATIENT CARE ASPECTS OF YOUR
ROLE ARE...
A true reflection of what currently happens
Not a true reflection of what currently happens
Totals
RESPONSES
134
5
139
96%
4%
100%
14) THE EMERGING THEMES DESCRIBED
ABOUT THE QUALITY AND SAFETY
ASPECTS OF YOUR ROLE ARE...
A true reflection of what currently happens
Not a true reflection of what currently happens
Totals
RESPONSES
142
0
131
100%
0%
100%
15) THE EMERGING THEMES DESCRIBED
ABOUT THE LEADERSHIP ASPECTS OF
YOUR ROLE ARE...
A true reflection of what currently happens
Not a true reflection of what currently happens
Totals
RESPONSES
140
2
131
99%
1%
100%
PAGE 32 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW
A true reflection
Not reflective
A true reflection
Not reflective
A true reflection
A true reflection of what currently happens
Not a true reflection of what currently happens

PIE 18
PIE 20
16) THE EMERGING THEMES DESCRIBED
ABOUT THE BARRIERS TO YOUR
ROLE ARE...
A true reflection of what currently happens
Not a true reflection of what currently happens
Totals
RESPONSES
136 98%
3 2%
139 100%
17) THE EMERGING THEMES DESCRIBED
ABOUT WHAT ENABLES YOU TO DO
YOUR ROLE ARE...
A true reflection of what currently happens
Not a true reflection of what currently happens
Totals
RESPONSES
131
7
138
95%
5%
100%
18) THE EMERGING THEMES DESCRIBED
ABOUT THE SKILLS AND ATTRIBUTES
TO YOUR ROLE ARE...
A true reflection
Not reflective
Totals
RESPONSES
142
0
100%
0%
142 100%
19) THE EMERGING THEMES DESCRIBING
THE IDEAL ROLE ARE...
A true reflection of what you want to happen
Not reflective of what you want to happen
Totals
RESPONSES
142
74
129
99%
1%
100%
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 33
A true reflection of what currently happens
Not a true reflection of what currently happens
A true reflection of what currently happens
Not a true reflection of what
currently happens
A true reflection
A true reflection of what you want to happen
Not reflective of what you want to happen

PIE 25
20) HOW CONFIDENT ARE YOU THAT
ANYTHING WILL CHANGE AS A
RESULT OF "TAKE THE LEAD"
PROJECT?
Confident
Not confident
Totals
RESPONSES
81
43
65%
35%
124 100%
21) HOW CONFIDENT ARE YOU THAT
"TAKE THE LEAD" WILL MAKE A
DIFFERENCE TO ...
You the N/MUM
The team
The patients and carers
All of the above
None of the above
Totals
RESPONSES
24
5
6
18%
4%
5%
73 56%
23 17%
131 100%
22) ARE YOU WILLING TO BECOME
A "TAKE THE LEAD" CHAMPION,
LEADING CHANGES IN YOUR LOCAL
FACILITY OR COMMUNITY AREA ?
Yes
No
Totals
RESPONSES
63
57
53%
47%
132 100%
Confident
Not confident
You the NUM/MUM
The team
The patients and carers
All of the above
None of the above
Yes
No
PAGE 34 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

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.
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
NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW PAGE 35

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
PAGE 36 NSW HEAltH "take the lead" Strengthening the Nursing/Midwifery Unit Manager role across NSW

SHPN (NAMO) 090041