for ward nurses

1. Office of the Chief Nursing Officer
www.health.qld.gov.au/ocno
Review of the Nurse Unit Manager Role
Final report
September 2008

3. Review of the Nurse Unit Manager Role
Final report
September 2008
Queensland Health
Office of the Chief Nursing Officer
Review of the Nurse Unit Manager Role
Final report
September 2008
ISBN 978-1-921447-47-1
©The State of Queensland 2008.
Copyright protects this publication. However the Queensland
Government has no objection to this material being reproduced
with acknowledgement, except for commercial purposes.
Permission to reproduce for commercial purposes should be
sought from:
Senior Administration Officer
Policy Branch
Queensland Health
PO Box 48
Brisbane 4001
Preferred citation:
Queensland Government 2008
Review of the Nurse Unit Manager Role
Final report
September 2008
Queensland Government, Brisbane
An electronic version of this ddocument is available at:
www.health.qld.gov.au/ocno/documents/numreport.pdf

4. Contents
Terms and abbreviations used 3
Executive summary 4
Key issues 6
Recommendations 7
Introducton 12
Methodology 16
Review findings 18
Discussion summary 24
Conclusion 30
Appendicies 31
Acknowledgements
I would like to acknowledge Sue Hawes, Principle Project Manager and
Helena Harrison, Project Officer from the ‘Take the Lead’ project from the
Nursing and Midwifery Office New South Wales Health for their support,
guidance and assistance with formatting the Consultation process and
sharing their work.
Undertaking this project involved many Nurse Unit Managers and ‘acting’
Nurse Unit Managers and I wish to acknowledge their contribution to this
project and the time spent meeting me.
Kaye Hewson
Project Officer
Office of the Chief Nursing Officer

5. Terms and abbreviations used
ACIRRT Australian Centre for Industrial
Relations, Research and Training
ADON Assistant Director of Nursing
CN Clinical Nurse
DON Director of Nursing
EB6 Enterprise Bargaining Six
FAMMIS Financial and Materials Management Information
System
HR Human Resources
HPPD Hours Per Patient Day
NIBBIG Nurses Interest Based Bargaining Implementation
Group. The negotiating team made up of nursing
representatives, Queensland Nursing Officials and
Human resource branch who coordinate the
implementation of EB6
NUM Nurse Unit Manager
OCNO Office of the Chief Nursing Officer
QH Queensland Health
PAD Performance Appraisal Development
QNU Queensland Nurses Union

6. Executive summary
This report details the findings from the Nurse Unit Manager (NUM) Project undertaken and
resourced by the Office of the Chief Nursing Officer (OCNO) from December 2007 - May
2008. The project was jointly sponsored by OCNO and the Nursing Interest Based Bargaining
Implementation Group (NIBBIG).
The impetus for the review of the NUM role arose from the recognition that the scope of the NUM
role has increased significantly over the last ten years. The resulting workload significantly impacts
on recruitment and retention, succession planning and job satisfaction. This is evident by The
Workforce Recruitment and Retention Report (NIBBIG 2007) where one of the key deliverables
described as a project should be undertaken to redefine the scope of the NUM role. The report also
suggested strategies be identified to support the position in order to provide career success.
The Australian Centre for Industrial Relations, Research and Training identified 15 factors
referred to as ‘Drivers for Excellence’ for workplaces. The above mentioned report recommended
that the project indicators for success should include these drivers when reviewing the NUM role.
This review sets out to explore the workload and work value of the NUM role in line with the
previous reports recommendations.
Information and data from NUM consultation groups and surveys provided information
consistent with the factors ACIRRT (2003) identified for success in work places. This report
identifies their perceptions on the scope of the current role, and the barriers and enablers to
performing the role to their own satisfaction which subsequently impacts on the success of the
clinical unit and organisation as a whole. Identification of desirable skills and attributes they
regarded as necessary to the role confirmed limited opportunity for learning and development
inhibit the full potential of this middle management nursing leadership role.
The NUMs consultation groups identified a number of key issues in their role. There was a strong
desire to return the role to primarily focusing on clinical leadership. The definition of clinical
leadership provided by the NUMs was ‘driving standards of nursing care and improving patient
outcomes’. However NUMs reported feeling role conflict. Core values of wanting to make a
difference to patient care included developing an effective team with the right nursing skill mix.
The increase in administration work to maintain the service limits the effectiveness of the NUM
to maintain a clinical presence.
From the discussion groups in engaging with the NUMs, the general feeling was one of low
morale, and most felt they were crisis managing from day to day with little opportunity to plan,
implement or evaluate their patient service and or their own performance. From the sample NUM
population surveyed (n= 154), 37% of NUMs stated they would like to leave the position. 98% felt
they did not have the time to complete their workload adequately.
1
IBB: nursing. Nursing Interest Based Bargaining Implementation Group.
http://qheps.health.qld.gov.au/ebb/ibb/Nursing/nibbig.htm
2
Queensland Health Queensland Nurses Union. 2007. Nursing Interest Based Bargaining (NIBB) Project Report.
Workforce Recruitment and Retention.
http://qheps.health.qld.gov.au/eb6/ibb/Nursing/Recruitment%20and%20Retention%20Final%20Report%2004.07.07.pdf
3
ACCIRRT. 2003. Simply the Best Workplaces in Australia, Working Paper 88, University of Sydney.

7. The aim of this report is to highlight the vital role of the NUM with the aim of strengthening the
enablers that support the work of the Nursing and Midwifery Unit Managers across Queensland.
The author suggests that this can be achieved by:
• providing clarity around the responsibilities and accountabilities of the NUM role;
• enhancing the capabilities of staff in the NUM role;
• improving the potential for work life balance within the role of the NUM
This document provides recommendations for NIBBIG to address key issues in the correct role and
refocus the NUM role on clinical leadership which is both an effective application, provides job
satisfaction and is sustainable.
There have been similar bodies of work across several jurisdictions interstate with the same key
themes and issues highlighted for the NUM role. The recommendations are consistent with these
findings.

8. Key issues
The following issues were identified by NUMs who took part in the consultation groups across the
state. These are discussed in more detail in the report:
• NUMs workload is perceived to be inequitable to other Grade 7 positions (Clinical Nurse
Consultants, Nurse Managers, and Nurse Educators) in terms of responsibilities and
accountabilities and workload.
• The core responsibility and accountabilities of the NUM role are no longer clear to
individuals within the roles.
• NUMs want to maintain a clinical focus in order to add value to the role that they play
across Queensland Health to improve care and access for patients in the areas they are
employed in. The burden of administration tasks means they are finding it increasingly
difficult to maintain this presence.
• Lack of access to information technology in clinical area inhibits mobility of NUM to
maintain clinical presence.
• Disparity of upper management styles (nursing and broader) across the state vary from
little contact to total control resulting in NUMs being held to account with no ability to
make decisions or strategically influence.
• Where there is no strong professional relationship with the line manager NUMs self report
no coaching to develop advanced critical thinking and problem solving skills.
• Insufficient collaboration in decision making between financial managers and NUMs in
budget allocation when NUMS are held accountable for insufficient resources. This is a
reactive management rather than proactive management style.
• In the absence of targeted training for NUMs Queensland Health current data systems are
not fully utilised by this group as a tool for efficiency in the management of people, patients
and resources.
• There is no current consistent orientation into the role.
• Development into the role currently occurs via an adhoc process with no structured process
of assessing and developing the skills and competencies for individuals to reach their full
potential in the role.
• No formal medium exists to access suitably trained mentors within Queensland Health to
grow future nurse leaders and assist the NUM to face the challenges of contemporary
nursing practice and patient care.
• NUMs self report feeling professionally isolated from their peers through recurrent health
system restructuring and organisation.
• There is no defined succession planning mechanism to enable Clinical Nurses to access
suitable courses and professional development activities to develop into future NUM roles.
• The role is not perceived to be attractive to Clinical Nurses to ‘act into’ the position as they
are often financially disadvantaged when they are not working shift work.
• NUMs self report that they carry a heavy workload. This is a disincentive to succession
planning and individual NUMs feel powerless to address this.

9. Recommendations for NUM role
Funding will need to be sourced for the implementation of the following recommendations
addressing the key issues identified above:
Recommendation 1:
That Queensland Health addresses the inequity of the work level standards of the Grade 7 roles by:
• Reviewing the Nursing and Midwifery Classification Structure HR Policy B74 that define the
core purpose of the position.
• Reviewing the descriptors for work span, impact of the position, the diversity,
integration and complexity of work performed, autonomy and typical responsibilities found
at the level are agreed upon by all stakeholders.
• Defining and developing a career pathway for each of the four streams of Grade 7: clinical,
management, education and research across the state.
Recommendation 2:
2.0 That the role of the Nurse Unit Manager is evaluated through a Job evaluation System5
which is a method of assessing the work value of the role to address the inequity in current
workloads between NUMs. The work value will then determine a difference within the NUM
classification level. Work level differentiation is determined by the following variables:
• Full time Equivalent numbers versus headcount of total number of staff.
• Staff mix
• Reporting structures
• Support networks and infrastructures
• Hours of operation of service
• Ward unit geography (within organisation or isolated)
• Ward Unit complexity, acuity of patient presentation and unpredictability.
Bands within the grade 7 are assigned according to allocated level of responsibility. Three
bandswithin the NUM role should reflect the degree of responsibility and work value of individual
NUMs contribute to resolving the inequity within the role that currently exists.
2.1 That job classification analysis provides definitions of skills, competencies and formal
qualifications to fulfil the contemporary role of the NUM.
2.2 That the core business and responsibilities of the NUM is defined and agreed upon and form
a platform upon which all role descriptions are based in the future.
4Queensland Health. 2008. Nursing and Midwifery Classification Structure HR Policy B7
http://www.health.qld.gov.au/hrpolicies/resourcing/b_7.pdf
5
Mercer Human Resource Group. 2000. Nurse Unit Manager Classification Review

10. Recommendation 3:
That by reviewing the role of the NUM it is recognised that this will have an impact on other
grades within the Nursing and Midwifery Classification Structure and that further consideration
should be given to developing career pathways. Within the classification structure other
jurisdictions such as Victoria and the Australian Capitol Territory (ACT) have established roles
for the four streams of clinical, management, education and research which articulate into career
pathways through the defined stream. For example the Associate NUM role aligns with the NUM
role, the Clinical Nurse Specialist aligns with the Clinical Nurse Consultant.
Risk to QH of non implementation of recommendations 1-3:
• Current difficulties of recruiting into NUM role and retention of experienced staff in
NUM roles will reach critical levels.
• Attrition rates from NUM role will continue as other Grade 7 roles appear more attractive
in comparison.
Recommendation 4:
That the core responsibility of the NUM role will be recognised and supported as clinical
leadership. This is enabled by the following:
• NUM needs to support evolving models of care by being accessible, visible and leading the
clinical coordination of clinical care including nursing, medical and allied health members
to providing the service and good patient outcomes.
• The NUMs role will be standardised across the state to not be included into the nursing
Hours Per Patient Day (HPPD). The Business Planning Framework (BPF) methodology has
enabled this recommendation for some time and the revised BPF will further support this
recommendation. Clinical leadership is enabled by flexibility within the role to drive the
service model and workforce mix.
• NUM receive (formal and informal) constructive supervision as part of a NUMs PAD by their
line manger via coaching to confidently problem solve and think critically.
Risk to QH of not implementing Recommendation 4
• That if not utilised effectively the potential of this highly skilled nurse leader to affect
good patient outcomes and quality of service is not realised when evidence based
practice supports this recommendation.
Recommendation 5:
That identification of administration tasks that do not require the specialist skill set of the
NUM are assigned to an administration officer. It is expected that the above mentioned
recommendations will result in resource allocation to support nurse leaders with administration
tasks.

11. Recommendation 6: – Identify key issues
That the NUMs clinical leadership role is supported by mobile technological support for greater
access to information management allowing them to analyse and support decision making whilst
maintaining a clinical presence.
• Handheld Blackberry or devices or similar service the needs of the Rural and remote NUM to
align their phone and internet access with their on call needs.
• Notebooks (CV5) or similar for larger metropolitan and regional organisations.
As supported by the E- Nursing strategy (QH 2008, Goal 3) as a recommendation for effective
practice.
Risk to QH of not implementing recommendations 5 and 6:
• That Nurse Unit Managers continue to be overwhelmed by administration tasks which do
not require the unique skill set of the NUM.
• That unavailability of Information technology (IT) that supports contemporary
nurse practices adds to inefficient work practices, data collection and duplication of
information.
Recommendation 7:
That preparation for aspiring NUMs is standardised and consistently applied across the
organisation by:
• Provision of a comprehensive orientation and ongoing training in QH systems as a
prerequisite to commencing work as a NUM. The recommended time period is supported by
the BPF as up to 11 days.
• A Manager Orientation/Resource Guide developed to assist orientation into the role. Helpful
information encompassing human resource, financial (includes targeted training in BPF);
material and clinical governance and information management would be included.
• Every new NUM linked to a formal mentoring program for a period of six months to develop
leadership and people management skills. Development of a Mentoring Framework across
Queensland with supported access through IT technology to reach rural and remote NUMS
should be included.
• Access to the Clinicians Development Education Service (CDES) (partnership between
University of Queensland, Med-E-Serv and QH) for CNs and NUMs to acquire the essential
skill set for the NUM role available on line. Financial support and backfill to complete and
build up a portfolio of credits to achieve baseline knowledge of management and business
processes through to post raduate qualifications needs to be forthcoming.
g

12. • Registered Nurses Grade 5 and 6 identified through Performance Assessment and
Development Process (PAD) as interested in relieving the NUM for periods of leave or
secondment being given the opportunity for work shadowing and formal training into the
role of the NUM.
Risk to QH of not implementing recommendation 7:
• That the lack of succession planning and support to develop into the NUM role is a
disincentive for recruitment.
• Sustainability of leadership development for the professional of the future not realised.
• That NUMs will continue to have only base qualifications of Registered Nurse training or
Bachelor of Nursing for role which requires further development and enhanced skill set
to maximise potential for effective patient outcomes and service delivery.
The following recommendations do not need additional funding and can be implemented at a
local level immediately
Recommendation 8:
That formal network of discussion groups are enabled by the organisation so NUMS can meet
regularly for peer supervision, support and problem solving for example. NUMS working in
isolation videoconference monthly with regional centre NUMs and are supported to visit regional
or metropolitan facilities twice a year.
Risk to QH of not implementing recommendation 8
• That NUMs remain in isolation professionally inhibiting their ability to develop support
networks and act collectively to provide proactive leadership for the health care facility.
Recommendation 9:
That the NUMs are able to:
• Work self managed hours for work life balance and family friendly rostering including eight
or nine day fortnights.
• Enter into job share work practices. This is especially attractive for NUMs nearing the end
of nursing careers, returning from maternity leave and with family and study commitments.
10

13. Risk to QH of not implementing recommendation 9:
• That the inflexibility of work practices makes a significant impact on work life
balance of NUM and creates disincentive to recruit into NUM role.
• Not catering to mature age nurses needs increases the skill drain from the nursing
workforce.
This recommendation has implications for EB7
Recommendation 10:
Single on call allowance should be changed to an hourly rate to recognise the on call workload
of Rural and Remote NUMs.
Risk to QH of not implementing recommendation 10:
That non-recognition of on call workload acts as a disincentive to recruitment and retention of
Rural and Remote NUMs.
This report maps out the breadth of the role of the NUM across
Queensland. This is articulated through consultation with NUMs
from rural, regional and metropolitan health service locations.
Currently there is great variability in the role.
From the consultation process, returning the core function to
clinical leadership is essential.
The recommendations are a way forward to enable the role to
achieve this focus in the future.
11

14. 2.0 Introduction
2.1 Background to project
This report details the outcomes of a six month project conducted and funded by the Office of
the Chief Nursing Officer reviewing the role of the NUM (December 2007 – May 2008) to make
recommendations on the future scope of the role.
The Nurses (Queensland Health) Certified Agreement (EB6) identified the development and
implementation of a nursing recruitment strategy as one of the five priority areas. One of the key
deliverable from the Workforce Recruitment and Retention Report 2007 was for QH to undertake
a project to define the current scope of the NUM role and provide strategies to support the
position and ensure career success.
The Nursing and Midwifery Classification Structure (HR Policy B7)4 defines the Nurse Unit
Manager as a registered nurse who is accountable at an advanced practice level for the
coordination of clinical practice and the provision of human and material resources in a specific
patient/client area and who:
• has ability to lead a nursing team in multi disciplinary environment utilising the principles
of contemporary human, material and financial resource management;
• demonstrates sound knowledge of contemporary nursing practice and theory;
• participates directly or indirectly in the delivery of clinical care to groups/individuals/
groups;
• ensures clinical practice is evidence based to facilitate positive patient outcomes; and
• has sound knowledge and the ability to apply relevant legislation, guidelines and standards.’
The Workforce Recruitment and Retention Report2 (NIBBIG 2007) identifies the NUM role as at
risk of work overload and loss of clarity around the perceived expectation of the role by the
NUMS themselves and others in the organisation. Consequently, in comparison to other Grade
7 roles which have more defined areas of responsibility, it now appears a less attractive role for
career progression.
This subsequent report recognises the impact the NUM role has on the workforce and
organisation. Recent changes in the health care service have resulted in a demand for efficiency
and patient outcomes. In response to this, restructuring has resulted in expanded areas of
responsibility for the NUM requiring a broad range of skills and an increased work load. It is
2
Queensland Health Queensland Nurses Union.2007. Nursing Interest Based Bargaining (NIBB) Project Report.
Workforce Recruitment and Retention.
http://qheps.health.qld.gov.au/eb6/ibb/Nursing/Recruitment%20and%20Retention%20Final%20Report%2004.07.07.pdf
4
Queensland Health. 2008. Nursing and Midwifery Classification Structure HR Policy B7.
http://www.health.qld.goau/hrpolicies/resourcing/b_7.pdf
12

15. widely acknowledged Queensland Health2 is experiencing difficulty in recruiting and retaining
NUMs when their job satisfaction is reported as very low. Clinical nurses do not embrace the
opportunity to ‘act up’ in the role for professional development due to their perception of the
role.
The ACIRRT (2003)3 identified 15 factors which they called ‘Drivers for Successful Workplaces’.
The Recruitment and Retention Project Report (2007)2 recommended the 15 key drivers of
successful workplaces should be included as project indicators for the NUM review. These include:
• Quality working relationships – how people relate to each other in the workplace including
friends, colleague and co-workers in supporting each other and getting the job done.
• Workplace leadership – the focus being on leadership and energy not management and
administration.
• Having a say – participating in decision making which affects workplace business.
• Clear values – people share the same values and attitude to work.
• Pay and conditions – level of income and working environment needs are met to a standard
acceptable to workers.
• Getting feedback – always knowing what people think of each other, their contribution and
success to the workplace. Individual performance feedback.
• Learning – being able to learn on the job, acquire skills and knowledge and develop an
understanding of the whole work place.
• Autonomy and uniqueness – the capacity of the organisation to tolerate and encourage
individuals to be creative and different which develop excellent workplaces.
• Sense of ownership and identity – being seen to be different through and special, taking
pride in workplace, knowing your business well.
• Passion – having energy and commitment to the workplace.
• Having fun – workplaces which are psychologically secure so people may relax with each
other and enjoy social interaction.
• Community and connections – being part of the local community, feeling as though the
workplace is a valuable to the community.
2
Queensland Health Queensland Nurses Union. 2007. Nursing Interest Based Bargaining (NIBB) Project Report.
Workforce Recruitment and Retention.
http://qheps.health.qld.gov.au/eb6/ibb/Nursing/Recruitment%20and%20Retention%20Final%20Report%2004.07.07.pdf
ACCIRRT. 2003. Simply the Best Workplaces in Australia, Working Paper 88, University of Sydney.
3
13

16. The Queensland Health report ‘better workplaces’ Staff Opinion Survey (2007)6 also recognises
psychological factors effect staff performance so that staff will be happier when experiencing or
having access to a better quality of life at work, improved workplace morale, adequate supervisor
support, be participative in decision making, professional growth, develop role clarity and
establish peer support.
This document provides a narrative around the findings of a project which aimed to explore and
describe the current context of the NUM role within the clinical ward/unit. It maps the skills
and attributes NUMs perceive they require to fulfil the role and also identifies the enablers and
barriers to maximise the effectiveness of the role and for personal satisfaction.
Identification of key issues for the NUM role informs the recommendations that have been
proposed in this report. The implementation of these recommendations will ensure the role
of the NUM is reinvigorated and centred on clinical leadership. It would further ensure that a
foundation is put in place to sustain the NUM role for the future.
2.2 Project overview
The project was conducted in three phases
Phase one:
• Development of a framework for the project
• Literature review
• State wide and interstate exploration of research completed or in progress around the NUM
role.
Phase two:
• Development of questionnaire
• Consultation groups planned and conducted
Phase three:
• Draft report circulated to relevant stakeholders
• Final report including findings and recommendations
6
University of Southern Queensland. 2007. Report of ‘better workplaces’ Queensland Health Staff Opinion Survey.
http://qheps.health.qld.gov.au/central/workforce/casu_final_wct.pdf
14

17. 2.3 Project limitations
The project is relatively modest in its aims and scope.
Data to support the definitive number of NUMs in positions in Queensland and vacancy rates
was hard to determine. Lattice does not provide information with descriptor of the nursing
classification Grade 7 allowing for differentiation between the roles at this level.
The new Queensland Health Human Resource data base system Panorama has the capability to
provide this information but as yet it is not available. Based on district information supplied it
is estimated there are approximately 600 NUMs in our nursing workforce. Vacancies can only be
determined as L4 at 102.9FTE across all NO4 and above positions with a 3.0FTE critical. Critical
is determined as unfilled, temporarily filled and unbackfiled long term leave.
It is recognised there is variability on the application of the middle manager classification.
Some facilities have Clinical Nurse Consultants that manage a clinical cost centre and therefore
although the project is limited to NUMs the same issues may apply.
It is also recognised within the methodology that the collection and analysis of statistical
information was not the intent of the questionnaire but rather as a mechanism to engage the
NUMs and facilitate discussion around their perceptions of the role. However some interesting
themes and trends emerged which was consistent with the literature review and the research
project ‘Take the Lead, Strengthening the role of the Nursing and Midwifery Unit Managers across
New South Wales’ (Hawes 2008)8. Convergence of themes in the data and through these mediums
strengthens the overall findings.
8
Hawes, S.2008. ‘Take the Lead’. Strengthening the role of the Nursing Midwifery Unit Managers across NSW.
New South Wales, Nursing Midwifery Office, NSW Health.
http://www.health.nsw.gov.au/nursing/pdf/nmforum_take_lead_pres_apr08.pdf
15

18. 3.0 Methodology
1. Literature review of international, inter state and state wide research and peer reviewed
articles on middle management nursing leadership roles.
2. A review of Position descriptions for the NUM role interstate and state wide.
3. A survey of NUMs acting and permanently appointed to role was conducted.
4. Consultation groups made up of acting and permanently appointed NUMS.
5. Consultation with stakeholders in OCNO, Corporate Office Human Resource representative
and Queensland Nurses Union (QNU).
6. A review of current education/professional development opportunities for NUM within
Queensland Health.
3.1 Literature Review
The aim of the literature review was to identify research and relevant information on the Nurse
Unit Manager role, as well as matters relating to recruitment and retention, and job satisfaction.
The literature review was developed through database searches using search engines and
academic databases such as the QHEPS, Google, Proquest, Informit, and EBSCO to identify a
range of online journals, policy documents, enterprise bargaining agreements and government
reports. The literature review included international and Australian academic literature,
government reports and research data. This provided valuable information into the value of the
NUM role in providing leadership, the development of skills and attributes that are considered
necessary for the role and the responsibility attached by the role.
3.2 Information Collection
3.2.1 Surveys
The purpose of the questionnaire was to develop a broad understanding of the attitudes and
difficulties that NUMs currently experience in their workplace and asked to signal what changes
would enhance their ability to do the role. The questions were formulated in consultation with
senior nursing colleagues. Principally the questionnaire was used to elicit engagement with the
NUMS rather than collect a large range of data. However some interesting data resulted.
16

19. 3.2.2 Consultation Groups
17 Groups consisting of 5-15 acting and permanently appointed NUMs met across the state and
took part in 2-3 hour workshops. Consultations groups involved over 160 NUMS in total.
Sites visited included Cairns Base, Townsville, Mt Isa, Toowoomba (Included Toowoomba Base
and Ballie Henderson Hospitals), Dalby, Redlands, Logan, The Gold Coast, Robina, The Sunshine
Coast, Redcliffe, The Prince Charles Hospital, The Royal Brisbane and Women’s Hospital and the
Princess Alexandra Hospital. In Cairns NUMs travelled from Atherton and Mareeba and Yarrabah
to be part of a consultation group. In Townsville a NUM travelled from Palm Island. In Dalby
NUMs travelled from Miles and Chinchilla to be part of the consultation group. Within Districts
representatives came from community health and schools and mental health was represented
community wise and by specific hospital. Midwifery Nurse Unit Managers also took part and
attended from those sites which offered midwifery services.
Engaging NUMS was viewed as essential to the process of successful review. Consistent
information was gathered through this approach. NUMS were very receptive to the opportunity to
meet and contribute to the project.
Vignettes from NUMS
‘There is light at the end of the tunnel but a the moment it is a
train coming’
‘It seems like the paperwork is taking over’
‘When I first started I only found out how to do things by making
mistakes’
‘I didn’t have choice I was the last Clinical Nurse on the ward’
‘The buck stops with the NUM, hit from below, hit from above!’
17

20. 4.0 Review findings
4.1 Themes emerging from the consultation groups
The key themes which emerged from questionnaires and consultation groups are structured into
three key areas which support the end discussion which centred on what an ideal role will look
like:
• The breadth of the current role with regard to responsibilities, accountabilities and reporting.
• Identifying skills and attributes seen as essential to the role.
• Barriers and enablers to performing the role to the NUMS satisfaction and for an effective
and efficient clinical service.
4.2 Current Role
In exploring and describing the current context of the NUM role within the clinical ward/unit this
document provides a narrative around the findings.
The following areas of responsibility are broadly summarized as follows:
Leadership of Clinical area
• Patient flow
• Standard of care
• Driver of model of care
• Patient and family advocate
• Discharge planning
General management of
• Human resource and staff
• Budgeting
• Unit equipment and maintenance
• Communicating with others
Clinical governance
• Occupational health and safety
• Quality projects, research
• Audits
• Complaints and incident investigation
• Incident management and monitoring
• Risk and hazard identification
• Accreditation
Leadership
• Role modelling behaviour
18

21. • Leading the team
• Professional development
• Change management
Other (mainly rural and remote but not limited to these facilities)
• Travel, accommodation arrangements for staff/patients
• Escorting patients via ambulance
• Overseeing vehicle maintenance and control
• Counselling of staff
• On-call
• Public relations
• X-ray operator
(See appendix 1 for full description from NUM groups and of what NUMs perceive their role entails)
4.3 Skills and Attributes
Skills are defined as things learnt or possessed to enable them to effectively manage the job, and
attributes are characteristics which they possess which make them suited to the position.
Skills and attributes include but are not limited to:
Skills Attributes
Problem solving Trustworthy, honest
Critical thinking Compassionate
Leadership and vision Fair/balanced
Political astuteness Energetic/motivated
Interpersonal skills Resilient
Advanced communication Patient/tolerant
Active listening Calm
IT/Data management Commonsense
Financial management Advocate for staff and patients
Clinical credibility Sense of humour
Conflict resolution Discrete
(See Appendix 2 for NUM brainstorm of skills and attributes)
4.4 Barriers and Enablers
4.4.1 Barriers
• Barriers are described as things which inhibit the ability of the individual NUM to perform
the job to the level of their own satisfaction. These include but are not limited to:
• Lack of understanding and expectation of the role by:
– Self
– Organisation (includes nursing staff, medical, allied health and executive management
team)
19

22. • Inconsistencies in the role across QH
• Lack of staff:
– Recruitment processes are long and time consuming
– Shortage of and temporary positions.
– Skill mix limiting opportunity for succession planing/requiring constant presence in
clinical unit of Clinical Nurses and NUM.
– NUMs counted into clinical hours.
• Lack of resources and ability to influence budget.
• QH processes for rostering, payroll, financial management, reporting.
• Professional development within role:
– Limited to adhoc courses/workshops.
– Tertiary study within own time
(See appendix 3 for NUM brainstorm of barriers).
4.4.2 Enablers
Enablers are defined as factors which enhance the ability of the NUM to perform their job to their
own satisfaction. These include but are not limited to the following:
• Support and respect from nursing executive and senior management.
• Support from own team and being part of a team.
• Support and opportunity to meet peers.
• Staffing
– Adequate staffing
– Adequate skill mix for acuity of patients
• Communication
– Access to information
– Opportunity to contribute an opinion
• Structured education and professional development for role with allocated time
– People management
– Financial management
– Mentoring relationships
• Resources
– Budget
– Equipment
– Support roles (administration, education, operations staff)
(See appendix 4 for brainstorm of perceived Enablers from NUM consultation groups).
20

23. 4.5 Questionnaire results
Questionnaires were completed at a return rate of 96% (n= 154).
Of the 154 responses, 32 (21%) indicated they were in ‘acting’ NUM roles. 12 of this cohort
indicated they would not apply for the position should it be advertised and 20 indicated they
would apply.
Graph 1: Respondents in ‘acting’ positions were asked would they apply for the position if the
position became vacant. n=32
Acting NUM’s responses to whether they would apply for the position.
Yes
No
38%
62%
Three people had been in ‘acting’ positions for 3 years or more. Of this small sample, two
indicated they would apply for the position should it become vacant.
34% of the “acting” NUM sample indicated they had taken on the role due to their perception
there was no one else, however approximately 46% of this cohort considered that the reason for
taking the position was also an opportunity for professional development purposes. For a small
sample those who had taken on the position for professional development felt hindered in this
because they were expected to ‘care take’ in the role and not develop the area per se.
Reasons for not applying for permanent NUM positions were working under constant pressure
and feeling inadequately prepared for the role. Effective orientation and supportive professional
relationships from the CNCs and Clinical Nurse Teachers were stated as desirable but currently
not effective.
Of the 122 permanently appointed NUMs 44 (36%) stated they frequently considered leaving
the position. Whereas 64% indicated they would not consider leaving. These figures are slightly
higher than the workforce survey (2007) figure of 31.8% of employees who consider leaving
Queensland Health.
21

24. Graph 2: The respondent sample was asked to list number of years in the NUM role.
25
20
15 Yes respondents to leaving to
No respondents to leaving
10
5
0
12 months 1-2 years 3-5 years 6-10 years 10 years
Some of the reasons given for considering leaving included a perceived lack of executive
management (nursing and district) constructive supervision combined with not being given
decision making authority and directives to achieve deliverables without a commensurate
resource allocation. There was ambiguity about role expectation and the scope of the role that
were factors for other ‘yes’ respondents. The NUMs also indicated they perceived a higher level
responsibility and accountability than other grade 7 positions specifically the CNC and that their
pay did not reflect this.
Graph 3: The respondents were asked what they considered the barriers to performing the role to
their own satisfaction.
100%
80%
60%
Agreed
98%
40%
54% 54%
45%
20% 37%
0%
Lack of time Lack of Workforce Lack of Lack of
dedicated shortages support training
administration
time
‘Lack of time’ to complete workload had 98% response rate as a barrier to performing the role to
the standard NUMs desire.
When asked what changes would the NUMs require to consider staying or enhancing their
ability to do the role: 57.3% stated clinical support, 53% business support, 53% information
management, 47% human resource support, and 31.9% quality and safety support. Additional
comments included a need for Work- Life balance strategies and role clarity. Administration
support was also stated as highly desirable.
22

25. NUMs were asked to indicate what was the highest level of education they had obtained, and
if they had found that education beneficial. Most had attended a variety of workshops and
short courses but few indicated whether they found them useful. The majority of respondents
who had completed the Graduate Certificate in Health Management found it useful.
Limitations in the questionnaire design describing the exact educational requirements within
this middle management nursing group prevented further analysis.
NUM Vignettes
‘You won’t get me to stay!’
‘To be heard and listened to!’
‘If you look like you’re coping you’re right!’
‘What has stopped me leaving is a dynamic and supportive
Nursing director!’
‘More autonomy and less blaming’
23

26. Discussion summary
It was evident through comments made in consultation groups that for the majority of the
participants, morale and job satisfaction were very low.
Current role
The NUMS felt conflicted in their role as there are no clear delineation between management of
a cost centre and leading a clinical ward/unit. The NUMs have taken on roles and responsibilities
they consider to be outside of their role description. However the culture of the organisation is
such that they feel they are unable to say no without being made to feel they are not up to the
job9. ‘Role ambiguity’10 causes confusion as to where the main focus of the role should be. Role
clarity is therefore clearly desirable8,9.
Administration duties reportedly consume most of their time. NUMs are a finite highly skilled
resource and would be more efficiently utilised to refocus the role if the clinical leadership was
focussed. All NUMs identified this as the desired focus of the position. All groups identified
additional administration support as highly desirable to support refocusing their role on clinical
leadership. This is further supported by the recommendations arising from the NIBBIG Work Life
Balance report 200712.
Paliadelis, Cruickshank and Sheridan (2007)13 in a study of 20 NUMs in Australia found they were
not educated to cope with their increased responsibility around administrative and managerial
requirements. Instead NUMs feel they are unable to support clinical outcomes and staff
sufficiently10,13. NUMs describe themselves as ‘drowning in paper work’ as work stacks up and
there are ever increasing competing priorities.
NUMs who have seen their role expand in responsibility and undergone several name changes
over the last ten years regret the loss of their clinical expertise and patient contact. Other similar
grade roles appear more attractive to the NUM. The Clinical Nurse Consultant, as an example is
a clinical specialist who works across units providing clinical expertise and guidance with no
human resource, financial or material management responsibilities4.
4
Queensland Health. 2008. Nursing and Midwifery Classification Structure IRM 4.8-2.
http://www.health.qld.gov.au/hrpolicies/resourcing/b_7.pdf
8
Hawes, S.2008. ‘Take the Lead’. Strengthening the role of the Nursing and Midwifery Unit Managers across NSW.
New South Wales, Nursing and Midwifery Office, NSW Health.
http://www.health.nsw.gov.au/nursing/pdf/nmforum_take_lead_pres_apr08.pdf
9
Duffield, C., Kearin, M., Johnston, J., and Leonard.2007. The impact of hospital structure and restructuring on the
nursing workforce. Australian Journal of Advanced Nursing, 24(3): 42-46.
10
Stanley, D. 2006. Role conflict: leaders and managers. Nursing Management, 13(5): 31-37.
12
Queensland Health and Queensland Nurses Union. 2007. Nursing Interest Based Bargaining (NIBB) Project report.
Work Life Balance
http://www.health.qld.gov.au/eb/nursing_ibb/work_life_bal.pdf
13
Paliadelis, P., Cruickshrank, M. and Sheridan, A. 2007. Caring for each other: how do nurse managers ‘manage’
their role? Journal of Nursing Management, 15: 830-837.
24

27. There is a strong argument for optimising the role of the NUM by making better use of the skills
of the NUM to affect patient care. This can be achieved by maintaining a clinical presence on
the ward. Due to the dual roles of management and leadership it is not possible for the NUM
to remain a clinical expert however a clinical supervision role is highly desirable. The NUM
currently provides a consistent presence on the ward/unit when the majority of the work force
work shift work and many are part-time. Trends in the nursing workforce such as an aging
workforce and desire for work life balance in the labour market suggest this will continue.
The benefits to the clinical unit/ward are the NUM provides a standard of professional practice
and improved patient care by role modelling behaviours and improving communication across
patient care. This is achieved by being the consistent presence on the ward. Managing stressful
situations and providing support to staff improves retention and job satisfaction for staff14. The
NUM remains credible to staff by working alongside them and earning their trust. Redefining
roles and matching them against skills can improve patient care, reduce waste, and improve
working lives and reducing mistakes and errors15.
Transformational leadership qualities are associated with effective change management,
empowering work conditions, influencing staff and policy and job satisfaction. There is growing
evidence from research state wide, interstate and internationally into the positive impact that
middle management nursing leadership roles have on improving patient outcomes and service
provision16,17. In one Queensland hospital, a new model of care had been adopted as the result
of a two year ‘Professional Practice Partnerships’ Skill mix Research Project18. Within this model
the NUM is required to remain as a complementary figure driving clinical standards of care and
role modelling behaviours until 12:30pm daily. The evaluation shows proven patient outcomes
including reduced patient falls, pressure areas and medication errors. Scheduling of meetings
and administration tasks are left for the afternoon when clinical activity is reduced and double
staffing of nurses occurs. NUMs involved report improved job satisfaction through the ability to
provide clinical leadership with organisational support.
14
Chiarella, M. 2007. Redesigning models of patient care delivery and organisation: building collegial generosity in
response to workplace challenges. Australian Health Review, 31(S1): S109-s115.
NHS Modernisation Agency. 2004. 10 High Impact Changes for service Improvement and Delivery. A guide for
15
NHS leaders.
16
Newman, S. 2005. The impact of health reform on nurse managers and their management of nursing services:
a study of the Australian Context. Paper presented at 6th Annual Interdisciplinary Research Conference, Trinity
College, Dublin.
17
Kramer, M. Maguire, P., Brewer, B. et al .2007. Nurse Manager Support. What is it? Structures and Practices That
Promote it. Nursing Administration Quarterly 31, (4), 325-340.
18
Jones, J., Lowe, M., Burns, C. Donaldson, P., Abbey, J. Abbey, B. 2008. Practice Partnership Model: An
innovative approach for nursing at The Prince Charles Hospital (TPCH). Final Report of the Skillmix Research
Project. QH and QUT.
25

28. The opportunity to network and derive support from meeting their peers formally was provided
through the consultation groups. NUMs all expressed their regret of not having this opportunity
regularly where they had experienced it in the past before restructuring into department
meetings. In rural and remote areas all of these issues are compounded by the isolation of the
role from peer support.
For the rural and remote NUM the transient nature of the workforce means they have the added
pressure of being on call and may be the only person able to perform advanced clinical skills
such as x-ray taking. Remuneration provided hourly for on call hours allocated would recognise
the significant percentage of time rural and remote NUMs spend on call and would reinforce the
value of the NUM role within the rural and remote health care system.
NUMs generally feel undervalued by the organisation. Research by Day, Minichiello and Madison
(2006,p517)19 reveals that low morale is linked to intrinsic factors such as ‘professional worth
and respect, opportunity and skill development, work group relationships and patient care’
and extrinsic factors such as ‘organisational structures, operational issues, leadership traits and
management styles, communication and staffing’. The NUM role is affected by these factors and
equally their job satisfaction impacts on the rest of the nursing staff under their leadership.
Similar issues have been identified in other jurisdictions who have implemented solutions in a
number of ways. The Australian Capital Territory, Victoria and Western Australia have provided
clear career pathways within the nursing classification structure across clinical, management
education and research. This has implications for the adjacent nursing grades within the
classification structure before and after but provides a direct career pathway for nurses entering
the clinical arena and allowing direction through performance appraisals and professional
development.
There is a strong argument from the NUMs themselves in that this allows the roles to line up
to support each other rather than working independently of each other across the organisation.
Having direction will increase retention amongst all staff especially the generation ‘Y’ that thrives
on opportunity and strong leadership20.
NUMs self reported that there is inequity of work value within the role. The Mercer Group 20035
has undertaken a Job Classification Evaluation of the NUM role in both Victoria and Northern
Territory with a resulting banding of streams around the key work value descriptors of full time
equivalent (FTE) numbers (or head count), skill mix, reporting structures, support networks and
infrastructure, hours of operation, ward unit geography, ward unit type and ward unit complexity
and unpredictability. Remuneration is awarded in band for level of the work value determined by
expertise, judgement and accountability. Applying work values addresses the inequity
5
Mercer Human Resource Group. 2000. Nurse Unit Manager Classification Review.
19
Day, G.E., Minichiello, V. and Madison, J. 2006. Nursing Morale: what does the literature reveal? Australian Health
Review, 30 (4), 516-524.
20
Walker, K. 2007. Fast-track for fast times: Catching and keeping Generation Y in the nursing workforce.
Contemporary Nurse, 24(2): 147-158.
26

29. experienced within the NUM role across Queensland Health currently where a NUM who has a
small staff and works office hours is payed the same as the NUM providing leadership to a large
acute care unit with a large volume of staff.
(Recommendations 1, 2 3, 4, 5, 8, 10)
Skills and Attributes
Currently Queensland Health role descriptions state no more than base line qualifications,
Bachelor of Nursing or Registered Nurse Training as mandatory. A Job Evaluation Analysis5 of
the role would provide definitions of skills, competencies and qualifications seen as desirable for
the contemporary NUM role.
In identifying skills and attributes felt necessary for the role the NUMs frequently expressed
frustration over the limited orientation provided for the role. Negotiating the complex Queensland
Health system, especially HR and FAMMIS, and receiving inconsistent advice from officers from
these departments means a learning process of trial and error. Changes to the systems would be
welcome but previous experience with new data systems for rostering and patient acuity mean
NUMs view them with suspicion and dread.
NUMs feel ineffective in fighting for resources as many identified they did not have the
knowledge to manage the business side of the ward/unit. The Business planning framework
was seen as a useful tool for some but many who had received no real training into the process
were left feeling impotent in trying to fight for resources when invited to participate in budget
workups.
The NUMS identified that leadership workshops and courses were helpful but translating and
sustaining this in the workplace was difficult. The literature supports the correlation between
effective leadership and high quality nursing care (Jarman 2007)21. A mentoring process would
support the personal growth of the NUM and provide a support network22. Every consultation
group expressed the view that lack of mentoring relationships limited their potential for growth
within the role. Mentoring has also been identified as important to developing future nurse
leaders in facilitating new learning experiences and guiding career decisions23.
Lack of articulated or supported education in the role also affects succession planning. NUMs
suggested work shadowing and a formal course provided by their organisation would assist this
process. The literature supports this approach. Wolf, Bradle, and Greenhouse24 found through their
research Nurse Unit Managers frequently feel unprepared for the challenges within the role.
5
Mercer Human Resource Group. 2000. Nurse Unit Manager Classification Review.
21
Jarman, H. 2007. Consultant nurses as clinical leaders. Nursing Management, 14(3): 22-26.
22
Gallo, K. 2007. The New Nurse Manager: A Leadership Development Program Paves the Road to Success. Nurse
Leader, 5(5): 28-32.
23
Redman, R.W. 2006. Leadership Succession Planning. The Journal of Nursing Administration, 36(6): 292-297.
Wolf, G.A., Bradle, J. Greenhouse, P. 2006. Investment in the Future. A 3-Level Approach for developing the
24
Health care Leaders of Tomorrow. The Journal of Nursing Administration, 36(6): 331-336.
27

30. Strategies need to be put in place to ensure NUMs develop the business knowledge and other
essential skills for the role25.
One potential solution for NUM could be through utilisation of the Clinicians Development
Education Service offered by the partnership between the University of Queensland, Med-E-Serv
and Queensland Health will offer Quality and Safety, Education and Workforce Development,
Health Services Management and Innovation and Change modules for health professionals to
access online. There are no semesters or time limits set on individuals and the student can build
up to a full credit for post graduate qualifications or sample subjects which are of interest. Access
to such programs for NUMs will provide access, opportunity and the potential for personal
growth within the role.
(Recommendation 7)
Barriers and Enablers
The nature of the workforce means the NUM has taken on a nurturing role caring for the
general welfare of all the nursing staff in their area. NUMs felt the generation Y expectations
of the workforce forced the need for a nurturing role; words used to describe themselves were
‘counsellor’, ‘agony aunt’, ‘mother figure’. They found this rewarding but time consuming and felt
torn with competing priorities. Some NUMs shared offices and consequently found maintaining
confidentiality during performance management challenging.
Critical thinking and problem solving were identified as desirable skills for the NUM by the
groups. Yet the NUMs often complained of lack of constructive supervision by ADONs, DONs16.
This was also true of the District Managers in the more regional and remote areas. Direct
correlation between effective supervisor support and coaching and the positive attitude of
NUMs to their role. It was very obvious when this level of support was afforded to the NUM
by the positiveness of their attitude and belief in themselves. NUMs who had been coached by
the ADONs felt empowered to make decisions and contribute to budget and other decisions.
Organisational support has the proven benefit of developing transformational leader behaviour
and ensuring greater communication with supervisors26.
Succession planning was identified as extremely difficult to achieve in the current environment.
NUMs felt powerless to influence this due to the workload. It was identified in every group a
clinical nurse could earn more money with shift work penalties and working fewer hours than the
business hours the NUM worked. NUMs report arriving early and leaving late. Time to orientate
and develop CNs into the acting NUM role was seen as lacking. NUMs voiced frustration over
dealing with a workload left by acting NUM who backfiled them whilst they were on leave.
16
Newman, S. 2005. The impact of health reform on nurse managers and their management of nursing services:
a study of the Australian Context. Paper presented at 6th Annual Interdisciplinary Research Conference, Trinity
College, Dublin.
25
Kleinams, C.S. 2003. Leadership Roles, Competencies, and Education. How Prepared Are Our Nurse Managers?
Journal of Nurse Administration, 33(9): 451-455.
26
Laschinger, H. Wong, C. 2007. A profile of the Structure and Impact of Nursing Management in Canadian
Hospitals. Final Report for CHSRF Open Grants Competition project # RC1-0964-06.
28

31. NUMs who had worked in other states/territories suggested an Associate NUM role which would
assist with both workload and succession planning. Currently the ‘Path of Chance’27 remains
dominant as evidenced by the ‘No one else’ in the responses from the survey.
Flexible work arrangements enable NUMs to a better work life balance. NUMs who work a nine
day fortnight report improvement in their mental well-being, although in compensation other
days often extend over ten hours. The NIBBIG Work Life Balance report 200712 supports the
NUMS need for flexible self managed work hours and the opportunity to job share. Mature aged
NUMs expressed a desire to job share and identified it as a way of nurturing and supporting
senior staff with families or back from maternity leave to consider senior nursing roles.
(Recommendation 2, 9)
The ideal role
The Consultation groups ended with a discussion centred on what an ideal role could look like.
The consensus was to refocus the role on clinical leadership and provide support in the form of
administration work. The NUMs felt that better preparation and skilled development for the role
would make the NUM position more attractive. This requires redefining the position and gaining
agreement across the nursing profession on the core functions of the NUM role. The other grade
7 roles would then line up and provide more effective professional relationships which ultimately
ensure better patient care.
(See Appendix 5/6)
12
Queensland Health and Queensland Nurses Union. 2007. Nursing Interest Based Bargaining (NIBB) Project report.
Work Life Balance.
http://www.health.qld.gov.au/eb/nursing_ibb/work_life_bal.pdf
27
Bondas, T. 2006. Paths to nursing leadership. Journal of Nursing Management, 14: 332-339.
29

32. Conclusion
The NUM role has expanded in scope to the degree it is now recognised as being difficult to
recruit and retain highly skilled nursing staff into this position. The NUM project has identified
key issues within the role to address to avert a potentially worsening workforce crisis.
There are strong arguments for Queensland Health to implement a framework with core
responsibilities for the NUM role. This can be used to provide consistency within the role across
the state. Other grade 7 roles can then be aligned alongside to ensure a career pathway for future
nurse leaders within the streams of management, clinical, education and research. The framework
would also provide consistency within the role for core responsibilities, qualification and skills
development.
Queensland Health is going through rapid change with systems and process being put in place
which should ultimately enable the NUM to realise more efficient and effective work practices.
However, without the right training and mentoring, NUMs will view them with suspicion and
sceptic. The Nurse Unit Manager has the ability to provide strong leadership when provided with
opportunities to develop the right skill set. Optimising the role ensures effective use of this finite
resource. Providing administrative and reorganising work practices will support the role, improve
job satisfaction and assist with succession planning.
Recommendations address the key issues which impact on recruitment and retention, succession
planning and job satisfaction. Outcomes from implementation of the recommendations will result
in the development of highly skilled and knowledgeable NUMs who provide proactive strong
leadership and positively affect patient outcomes and service provision.
30

33. Appendix 1: A full description of the perceived current responsibilities
of the NUM
Clinical leadership Clinical governance Education and research
Clinical coordinator Change management Transition program governance
Patient flow/discharge planning Coordinator of quality activities New graduate interviews and program
Driving models of care/ Audits overseer
Ward rounds with medical staff Risk management Project manager
Coordinator of patient information Infection control monitor Mentor
Case manager Waste management monitor Orientation of staff including junior
Supervision Accreditation coordinator medical staff and students
Case conferencing Ministerial correspondence Staff aware of unit protocols
Manager of waiting lists Policy and procedure coordinator Own professional development
Crisis management daily Professional practice coordinator needs-attend workshops, conferences,
Works clinically to cover sick leave, Incident reporting networks for clinical area
skill mix issues, support heavy workload Complaints management
periods Work Place Health and safety
Driving evidence based clinical care coordinator
Monitor clinical indicators
Leading and managing people Business management Materials management
Rostering-input, planning, meets award Workforce planning Equipment purchasing – incudes
requirements Service planning and service getting quotes
Pay enquiries profile report Repairs and maintenance
Management of leave – annual, sick, Budget build-up contribution Mediation level management
maternity, study – BPF and Scorecards Meetings with Sales Reps
Professional development allowance Performance indicator reporting IT technician, photocopier/fax
and leave. Daily data management – Hours
Movement forms and Position per patient day/FTE
Occupancy status Business case writing
Performance Appraisals DSS and FAMMIS, Lattice, ESP,
Grievance, debriefings, staff support HBSICS
Recruitment including writing Job Patient Acuity systems
descriptions, interviews, panels, Filing/emails/correspondence
Selection reports, referee checks and Meetings/Minute writing
informing employees Capital works and redevelopment
Maintain skill mix levels to ensure safe involvement
patient care
Succession planning
Coordinate and chair ward meetings,
write up minutes
Maintain QLD registration and annual
practising cert
Extras
Patient and staff counsellor
Accommodation and travel organiser
Car maintenance/transport
Debriefing
Coordinating multi disciplinary team
Escorting patients
On call public holidays
31

34. Appendix 2: Desirable skills and attributes (formal and informal)
Personal characteristics Formal qualifications Orientation Acquired skills
Trustworthy Bachelor of Nursing or RN Supernumery period Business management (BPF
Honest, approachable, training (Hospital) Orientation/Resource training)
positive Post Graduate management/ Manual Service planning
Leader leadership course Mentorship Conflict resolution
Vision Political astuteness
Role model IT training/data management
Good listener Risk analysis/Incident
Tolerance, resilience, management
patience People management
Advocate for staff/ Counselling/active listening
patients Networking
Problem solver Research training
Motivated, creative
sense of humour
Flexibility
Ethical
32

35. Appendix 3: Barriers and Enablers to performing role
Barriers
No specific orientation to role, Lack of staff /skill mix
Complex information systems – lattice, Transient nature of staff (agency rural and remote)
FAMMIS, QHEPS hard to navigate to find things Lack of support from other grade7 roles, Clinical educator,
No A/O support Clinical nurse
Hospital rules, culture, structure Consultant
Lack of HR support (inconsistent information) Magnet status is more work
Office space (sharing) Generation x, y needs, less flexible rostering
IT knowledge Equipment shortage/Clinical supply practices
Interruptions (phone calls, people demanding attention) (inappropriate supplies and not timely)
Expected to manage projects redevelopment in with every
thing else
Enablers
Good staff/team work Patient compliments
Autonomy Task transfer of administration to AO
Peer support
Time to do projects/redevelopment off line
Educational support
IT support/internet access/mobile technology
HR and Business support
Access to study leave
Diversity of job/challenges
33

36. Appendix 4:
Nurse Unit Manager Project questionnaire – pre consultation groups
This questionnaire is designed to form the basis of discussion for the consultation groups discussing the
role of the Nurse Unit Manager as part of the recommendations for EB6. This work is the foundation for
future workforce planning and Industrial Relations negotiations. Please complete the questionnaire prior to
attending the group.
1. Why did you become a Nurse Unit Manager? (please ).
Professional development Make a difference to patient care
There was no one else Other (please state)
2. Are you appointed to the role? (please )
Permanent Acting in the role
3. How long have you been employed as a NUM? (please )
12 months 1-2 years 3-5 years 6-10 years 10 years
4. Have you undertaken any education to assist in this role? Please state the highest level of
education you have attained and the name of the course? (please )
Workshop
Short course
Hospital certificate
Graduate certificate
Graduate Diploma
Masters Degree
PhD
Was the course provided through QH or outside the organisation? Was it beneficial?
What do you consider the barriers to performing the role to the standard you would like? (please )
Lack of time to complete work Lack of dedicated office/admin time
Work force shortage Lack of training
Lack of support (please elaborate) Other (please state)
5. Are you seriously thinking about leaving this role? (please )
Yes No If yes indicate why.
6. What changes need to be made to make you stay or enhance your ability to perform the role?
(Please key areas for consideration and comment)
Clinical Support Human resource responsibilities
Information management Quality and safety responsibilities
Business responsibilities Other (please state)
Contact person: Kaye Hewson, Project officer, Office of the Chief Nursing Officer, QH ext 3234 1035
kaye_hewson@health.qld.gov.au
34

37. Appendix 5: Ideal role – ideas from consultation groups
Clinical Succession planning/education Resources
• Not included in numbers • Remuneration – shift differentials • CNC support
• Model of care driver • Mentorship • Career structure to support Assistant
• Not expert but clinically • Work shadowing NUM role
competent • Business management/cost centre • Administration support
• Clinical leader/credible management • Where Workforce Units exist they pick
• Visible • BPF training up more of the paper work associated
• Constructive professional • NUM prep course with recruitment
relationship with Nursing • Development plan for succession • Peer support network
Director planning • Blackberry/Notebook
• Structured career pathway • Clinical education support
• IT training
• People management
Other responsibilities Other Work Life Balance
• Off line time for specific • Time to look at bigger picture • Flexible work hours – 9 day fortnight/
projects/redevelopment • Hourly on-call rate job share
• Meetings scheduled to fit in • IT access/turnaround/service • Remote access
with clinical business agreement more efficient • Union support for performance
• PAD process streamline • Job description rewrite/ formal role management for management
evaluation • Recognition of time spent at work with
• On call public holidays shared across managing toil
all grade 7 roles • Autonomy
35

38. Appendix 6: Core purpose of NUM role
Core purpose of NUM role
Statement
of role
purpose
Conceptual
Framework
Clinical leadership
Clinical Business
governance Leadership Management
Professional Human, physical
profession of advocacy and financial
Operational
Nursing resource
requirements Midwifery Enabling management
facilitating:
Quality and Safety - change Continuous
Occupational - development performance
Health and safety 0f others improvement
Individual position Position Description reflect core functions of
descriptions role
Note: acknowledgement given to ‘Take the Lead’ Project NSW, NSW Health
36

39. References
1. IBB: nursing. Nursing Interest Based Bargaining Implementation Group.
http://qheps.health.qld.gov.au/ebb/ibb/Nursing/nibbig.htm
2. Queensland Health Queensland Nurses Union. 2007. Nursing Interest Based Bargaining
(NIBB) Project Report. Workforce Recruitment and Retention.
http://qheps.health.qld.gov.au/eb6/ibb/Nursing/Recruitment%20and%20Retention%20Final%20
Report%2004.07.07.pdf
3. ACCIRRT. 2003. Simply the Best Workplaces in Australia, Working Paper 88, University of
Sydney.
4. Queensland Health. 2008. Nursing and Midwifery Classification Structure HR Policy B7.
http://www.health.qld.gov.au/hrpolicies/resourcing/b_7.pdf
5. Mercer Human Resource Group. 2000. Nurse Unit Manager Classification Review.
6. University of Southern Queensland. 2007. Report of ‘better workplaces’ Queensland Health
Staff Opinion Survey
http://qheps.health.qld.gov.au/central/workforce/casu_final_wct.pdf
7. Queensland Health. 2007. Nursing Labour Workforce Survey.
http://qheps.health.qld.gov.au/waru/docs/nurses_lfs_2007.pdf
8. Hawes, S. 2008. ‘Take the Lead’. Strengthening the role of the Nursing and Midwifery
Unit Managers across NSW. New South Wales, Nursing and Midwifery Office, NSW Health.
http://www.health.nsw.gov.au/nursing/pdf/nmforum_take_lead_pres_apr08.pdf
9. Duffield, C., Kearin, M., Johnston, J., and Leonard. 2007. The impact of hospital structure and
restructuring on the nursing workforce. Australian Journal of Advanced Nursing, 24(3): 42-46
10. Stanley, D. 2006. Role conflict: leaders and managers. Nursing Management, 13(5): 31-37.
11. Paliadelis, P. 2005. Rural nursing unit managers: education and support for the role. Rural
and Remote Health 5: 325. (on line)
12. Queensland Health and Queensland Nurses Union. 2007. Nursing Interest Based Bargaining
(NIBB) Project report. Work Life Balance
http://www.health.qld.gov.au/eb/nursing_ibb/work_life_bal.pdf
13. Paliadelis, P., Cruickshrank, M. Sheridan, A. 2007. Caring for each other: how do nurse
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