IntroductionPatient safety is paramount, yet medication management errors are common, including amongst new graduates. Ongoing need exists to examine new graduates’ medication safety preparedness, to better improve preparedness and help them manage medication errors. This cross-sectional and longitudinal qualitative research (LQR) explores new graduates’ medication safety preparedness in nursing, pharmacy and medicine.MethodsUnderpinned by social constructionism, 26 final-year healthcare students at an Australian university participated in three study phases between July 2019 and April 2020: entrance interviews (around degree completion), longitudinal audio-diaries (through approximately the first 12 weeks of work), and exit interviews (after approximately 12 weeks of work). We analyzed interview and audio-diary transcripts, and audio-diary email correspondence using team-based framework analysis, cross-sectionally and longitudinally.ResultsParticipants’ medication safety stories demonstrated mostly unpreparedness, often about developing and implementing medication therapy plans. Medication error narratives revealed errors (of commission or omission) made by new graduates or others. They were rich in emotional talk (mostly negative such as anxiety, anger and sadness talk), illustrating psychosocial impacts on new graduates. However, positive emotional talk was also present in preparedness stories. While the proportion of preparedness stories increased across time at the cohort level, we found more nuanced/complex patterning in participants’ narratives at the individual level including evidence of stability, and positive or negative changes in medication safety preparedness.DiscussionWe offer evidence-based recommendations for student/new graduate learning to help educators better prepare them for medication safety and enable them to cope with the emotional work of safe medication management. Further LQR with longer study durations is now needed on medication safety preparedness.

Research-based theatre (RbT) integrates research findings with performing arts to deliver a performance that informs, translates, and engages learners or audiences. Although not a new concept, RbT is growing in popularity within health professions education (HPE). A scoping review was conducted to map available literature regarding the methods used to inform RbT in HPE activities, as well as how they are used within education, training or curricula. The review followed Arksey and O’Malley’s six-stage framework and the Joanna Briggs Institute methodology. Studies that report on the use of RbT (concept) as an educational intervention (context) among health professionals or students (participants) were included. Multiple databases were searched (CINAHL, MeDLINE, PsycINFO, AMED, ERIC, Scopus, EMBASE, International bibliography of theatre and dance, and Web of Science). A total of 286 studies were retrieved. Following title and abstract screening, 71 studies were retrieved for full text review and 31 were included in the final review. Results were analysed and synthesised narratively. Most RbT interventions were aimed at qualified health professionals (HP) across 13 different professions. Performances were delivered to diverse audiences, including HP students, the public, and were often accompanied by post-performance discussion. Educational impact was widely reported, including increased awareness, empathy, and critical reflection, though learning measurement approaches varied. Research-based theatre has significant potential as an innovative tool for HPE, translating research findings into accessible, engaging educational formats. However, implementation is often obstructed by ambiguous terminology and a lack of transparent methodology available to HP researchers. Addressing these challenges by highlighting sustainable strategies, such as consistent terminology, opportunities for digital dissemination and collaborative design, is vital to maximizing reach and educational impact.

Aim To gain insights into the hip fracture recovery journey with a focus on discharge and follow-up interventions through exploration of the lived experience of people post hip fracture, advanced practice nurses and practice nurses.Design An interpretive descriptive methodology was used to guide this qualitative study, underpinned by the Health Empowerment theoretical framework.Methods Semi-structured interviews were conducted from March to October 2021, eliciting the experiences of recovery from people post-hip fracture, advanced practice nurses, and practice nurses. Interviews were recorded and transcribed. Thematic analysis was applied to the data.Results Thirteen participants comprising people post-hip fracture, advanced practice nurses, and practice nurses were interviewed. Connecting with the Human Spirit was a major theme identified, and the Health Empowerment Conceptual Model was developed to represent the care components highlighted within this theme.Conclusion Connecting with the Human Spirit was an important finding which incorporated acknowledging the trauma of hip fracture and supported open and honest communication to empower people to actively participate in their recovery. The Health Empowerment Conceptual Model draws together important findings, highlighting the care people post-hip fracture and nurses valued, and the support, education and understanding needed to recover underpinned by an empowerment approach.Implications for the Profession and/or Patient Care The Health Empowerment Conceptual Model supports an empowered approach to policy and practice development of nurse-led models of care to effectively manage patients post-hip fracture across the care continuum.Impact This study addressed the recovery experiences post-hip fracture. Connecting with the Human Spirit was a major theme, with care component findings informing the Health Empowerment Conceptual Model to support an empowered recovery. Research supports policy and practice development for nurse-led models for health services, clinicians, and people affected by hip fracture.Reporting Method Consolidated criteria for reporting qualitative research.Patient or Public Contribution The experiences of people post-hip fracture, advanced practice nurses, and practice nurses were elicited in this study.

IntroductionCancer nurse practitioners (CNPs) provide specialized care for patients with complex cancer needs. CNPs undertake advanced assessment, diagnosis, prescribing, and management of treatment-related toxicities and end-of-life care. Beyond clinical care, Nurse Practitioners (NPs) engage in leadership, education, and research. However, many student and novice CNPs report challenges developing confidence and capability across all domains. Structured mentorship may support this transition.MethodsA one-year mentorship program matched novice/student CNPs with experienced CNPs. As part of this program, a self-assessment instrument—the Nurse Practitioner Self-Assessment Tool (NP-SAT)—was developed, validated and piloted to measure participants’ knowledge, skills, and confidence. A mixed-methods design incorporated surveys and semi-structured interviews with student and newly endorsed CNPs (N = 10) and their mentors (N = 10) to identify perceived needs and elicit enablers and barriers to their role transition.ResultsParticipants worked in metropolitan (50%) and regional/rural (50%) settings, with most (80%) in public healthcare. Post-program, there were statistically significant increases in clinical knowledge and research domains. Participants were satisfied and found the program feasible.ConclusionThis study is the first to develop and implement a cancer nurse practitioner mentorship program. The validated tool may inform future CNP workforce and education strategies and be adapted for other NP specialties. Despite reported positive outcomes, and good feasibility and acceptability, due to the limited sample size and absence of a control group, the findings regarding the program’s effectiveness should be regarded as preliminary.

Background Cognitive biases are predictable deviations in judgement occurring when people process and interpret information from their environment. Educational interventions which support healthcare professionals and students to surface cognitive bias, and mitigate negative influences are recommended to prevent serious adverse patient safety events. Co-designing simulation-based education enhances authenticity and offers a platform for sharing lived experiences. Objective To examine how healthcare professionals and students developed their understanding and awareness of cognitive biases through their experiences and reflections following a co-designed simulation activity. Methods Scaffolded upon serious adverse patient safety event data analysis and healthcare staff and consumer interviews, a participatory action research approach was utilised to co-design a simulation-based education intervention with healthcare consumers and professionals. We used a qualitative interpretivist lens to explore healthcare professional and student understanding and awareness of cognitive bias. The debrief of four simulations was audio recorded, transcribed, and analysed using thematic analysis. Results Twenty healthcare professionals, and two nursing students participated in four occurrences of the simulation intervention. Based on the debrief data, five themes were developed: 1) An authentic and meaningful learning experience, 2) Humanness of cognitive bias, 3) Intersection between physical health, mental health, and cognitive bias, 4) Factors contributing to cognitive bias in healthcare, and 5) Strategies to manage cognitive bias. Conclusions Cognitive biases can negatively influence healthcare professional and student decision making. Our co-designed simulation facilitated participant reflection to explore their understanding and awareness of cognitive bias.

AIM:To develop a person-centred nurse-led model of care framework to empower people post hip fracture. DESIGN:Modified e-Delphi study. METHODS:A Modified e-Delphi study seeking expert opinion from people with the lived experience of hip fracture and clinicians was implemented. Content experts consisted of 17 nursing and medical clinicians and four people with the experience of hip fracture. RESULTS:Study found > 70% consensus on all 20 statements rating the importance and feasibility of care components in the Modified e-Delphi survey. Themes developed from content analysis of expert free text responses comprised: Relationships support person-centred care; Value of a Specialist Hip Fracture Nurse; Prioritising is key to positive outcomes. PREPARE-Empowering People Post Hip Fracture: A Conceptual Framework for a nurse-led model of care was developed from study findings, highlighting key principles: person-centred care; evidence-informed practice; Health Empowerment; organisational governance; follow-up and evaluation, constituting this framework. CONCLUSION:This study presents PREPARE-Empowering People Post Hip Fracture: A Conceptual Framework for a nurse-led model of care. PREPARE presents a structured approach to empowering people post hip fracture, outlining the aim and context in which the model of care is intended. It highlights an integrated, shared, coordinated approach to the care of people post hip fracture. Shared care empowers people and their support person to effectively manage their recovery journey and safely remain supported in the community. IMPLICATIONS FOR PRACTICE:PREPARE outlines a structured framework to support nurse leaders in implementing nurse-led models of care for people post hip fracture. There is an opportunity to empower nurse leaders and patients to support the recovery journey through education encompassing this person-centred holistic framework. IMPACT:To our knowledge this is the first study to develop a conceptual framework for a nurse-led model of care to empower people post hip fracture. This model highlights opportunities for an integrated shared, coordinated approach to the care of people post hip fracture. PREPARE-Empowering People Post Hip Fracture: A Conceptual Framework for a nurse-led model of care, offers a structured approach for localised health service development of person-centred nurse-led empowerment models of care. REPORTING METHOD:DELPHISTAR-Delphi studies in social and health sciences-Recommendations for an interdisciplinary standardised reporting. PATIENT OR PUBLIC CONTRIBUTION:The experiences of people post-hip fracture, and clinicians were elicited to inform the PREPARE Conceptual Framework.

BACKGROUND:Emergency Clinical Nurse Specialists (CNS) are experts in treating patients across the lifespan in the dynamic, unpredictable and busy Emergency Department (ED). The aim of this paper was to create a profile of the Emergency CNS role and practice, and assess work satisfaction. METHODS:An online cross-sectional survey based on the College of Emergency Nursing Australasia's Practice Standards for the Specialist Emergency Nurse was conducted in the Australian states of Victoria and New South Wales. RESULTS:There were 59 survey responses. The domains Lawful Practice, Professional Ethics and Communication were rated as practiced with the greatest frequency, and Lawful Practice and Teamwork were rated very important by respondents. 79 % of CNSs planned to continue working in ED, with all CNSs reporting plans to continue working in healthcare. 77 % of CNSs were satisfied in their current role. CONCLUSION:The Practice Standards for the Specialist Emergency Nurse are used regularly and are relevant to CNS practice. CNSs are largely satisfied with their role, which is versatile and multifaceted. However, CNSs face challenges to perform all elements of their role, and reported protected non-clinical time and collaboration with management as enablers to their role.

BACKGROUND:The current nursing shortage is a critical issue facing healthcare systems. Workforce research priorities foremergency nurses are limited.This study aimed to identify, collate, and prioritise areas of workforce research for emergency nursing in Australia. METHODS:This priority-setting study was conducted with ED nurses from September 2022 to August 2023 and comprised: i) an initial survey, ii) face-to-face group discussions, and iii) a prioritisation survey. RESULTS:A total of 318 ED nurses responded to the initial survey. Staffing (n = 245), workload (n = 112), access block (n = 63) and burnout (n = 54) were nominated as workforce concerns. Responses were grouped into three overarching categories: person, department, and organisation. These categories informed the face-to-face group discussions. A total of 30 ED nurses participated in one of three face-to-face group discussions. Sub-themes, including resilience, workload, and well-being emerged. From the prioritisation survey completed by 163 ED nurses, the highest-ranked workforce research priorities pertained to turnover and retention. CONCLUSIONS:The research priorities identified reflect important and contemporary workforce issues for emergency nurses. Efforts to progress research in these priority workforce areas should be encouraged and supported.

Problem: Metastatic breast cancer nurses are integral in providing support to those affected by cancer, while the supervision and mentoring for these roles in the workplace are not always available. Aim: To explore metastatic breast cancer nurses' perspectives on participation in a 12-month clinical supervision intervention. Methods: Clinical supervision was offered to participants as part of a pilot metastatic breast cancer nurse training program. Bi-monthly one-hour clinical supervision sessions were held using a video conferencing platform for a 12-month period. The clinical supervision intervention was evaluated using a mixed methods approach. Participants completed the Manchester Clinical Supervision Scale-26 (c) (MCSS-26 (c)) online, and a semistructured interview at the end of the clinical supervision period. Descriptive statistics and thematic analysis were used to summarise and report the findings. Results: Eight metastatic breast cancer nurses participated in the clinical supervision intervention. All were 'very satisfied' with the supervision (N = 8; 100%). The MCSS subscales which scored highest were 'Reflection' (M = 11.5, SD = 0.7, range 0-12), 'Supervisor advice' (M = 18.9, SD = 1.4, range 0-20), and 'Improve Care/Skills' (M = 14.6, SD = 1.5, range 0-16). Three themes were inductively derived: (i) Learning and growth through clinical supervision, (ii) The shared experience, and (iii) Importance of embedding clinical supervision into practice. Conclusion: Clinical supervision can be used as a learning and support tool for metastatic breast cancer nurses, with peer-to-peer participation being a valuable component. Other specialist cancer nurses may benefit from having clinical supervision embedded into their practice. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of Australian College of Nursing Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

There is little nursing research about process issues in conducting inclusive project advisory groups of people with autism and/or intellectual disability or those who are parents/carers of this cohort. Through a descriptive qualitative design, this article aims to analyze the processes, challenges, and solutions when facilitating these groups for a nursing project in Australia. Reflexive thematic analysis was utilized to analyze field notes and meeting minutes. Results highlight the need for a defined, robust communication process between researchers and advisory groups, skilled facilitators, and careful planning of when in the life of the project the groups can contribute meaningfully. This project offers a proposed framework for the valuable contribution of lived experiences from research advisory groups.

AIM:To explore the experiences of emergency nurses providing end-of-life care during the COVID-19 pandemic. DESIGN:A qualitative descriptive study. METHODS:Data were collected between May and August 2023. Individual, semi-structured interviews were conducted face to face or by videoconferencing with a purposive and snowballed sample of 11 emergency nurses. Data were analysed using thematic analysis. RESULTS:There were four main themes identified: (1) Isolation and loneliness that emergency nurses felt when providing end-of-life care throughout COVID-19. (2) Comparison of Care Relating to Communication; whereby emergency nurses compared the provision of end-of-life care before COVID-19 to end-of-life care provided during the pandemic. (3) Frustration and guilt: emergency nurses felt when providing end-of-life care. (4) Teamwork: participants interviewed explored the meaning of having a supportive team when providing end-of-life care. CONCLUSIONS:This study explores in-depth experiences of emergency nurses providing care to those who were dying during the COVID-19 pandemic. This study identified that emergency nurses were impacted emotionally by providing end-of-life care during the pandemic, and ongoing support is likely to be needed. This study also reinforced the strength of teamwork amongst emergency nurses. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

AIM:Conduct a systematic review to analyse how nursing informatics influence patient safety outcomes in critical care settings. RESEARCH METHODOLOGY/DESIGN:The following database searches were conducted: Ovid MEDLINE, Cochrane library, Cochrane CENTRAL, CINAHL plus, Ovid Emcare, PsycINFO, and Ovid Embase. Two reviewers conducted the data selection and critical appraisal independently, following the JBI evaluation guidelines. Seventeen articles of high quality were included in this review. SETTINGS:This systematic review focused on critical care settings in healthcare facilities, including Emergency Departments, Intensive Care Units, High Dependency Units and Coronary Care Units in public or private hospitals. MAIN OUTCOME MEASURES:The overarching outcomes evaluated were patient safety outcomes (e, g, the development of a pressure injury), patient safety outcome measures (i.e., the application of tools used to measure patient safety outcomes e.g. the frequency with which pressure areas are assessed) and the processes of care (e.g. conducting regular pressure area care to prevent pressure injuries). RESULTS:In critical care settings, nursing informatics were associated with promotion of patient safety and prevention of adverse incidents, including reducing the incidence of pressure ulcers and medication errors; helping control blood glucose levels; decreasing the length of hospital stay; and improving compliance with care bundles and overall screening completion rates for risks of pressure ulcers, falls, substance use and agitation in emergency departments. CONCLUSION:The implementation of nursing informatics in critical care areas has been successful in promoting patient safety. While informatics can be costly to introduce, there is evidence these interventions can reduce costs by preventing adverse events. IMPLICATIONS FOR CRITICAL PRACTICE:Electronic health information record systems, clinical decision support systems and telehealth can increase compliance with screening and delivery of care aligned with guidelines across a range of presentations and critical care contexts. With the growing prevalence of nursing informatics, these systems should be considered for more widespread introduction.

BACKGROUND:Quality improvement activities targeting low-value care are important to ensure that scarce healthcare resources are used responsibly. However, there has been little systematic research into what diagnostic testing is considered by emergency department (ED) clinicians to be at risk of unwarranted variation or potentially low value. OBJECTIVES:This study aimed to determine the views of ED clinicians on which diagnostic tests are highest risk for variation and/or low-value care. METHODS:A voluntary electronic survey was distributed to emergency clinicians across Australia and Aotearoa New Zealand. Respondents were asked to identify which investigations were high risk for unwarranted variation and/or low value. RESULTS:There were 184 responses (75 doctors, 82 nurses, and 27 other) analysed. Investigations identified included D-dimer (42%), venous blood gas (VBG) (39%), C-reactive protein (CRP) (35%), and plain x-rays of the abdomen (35%). Compared to nursing staff, medical staff perceived CRP (51% vs. 24%), urine drug screening (55% vs. 21%), clotting profile (48% vs. 24%), salicylate level (29% vs. 7%), erythrocyte sedimentation rate (41% vs. 10%), and abdominal x-ray (67% vs. 16%) at higher risk. D-dimer and VBG were seen to be high risk by both groups. Routinely ordered tests (e.g., full blood examination) were considered relatively low risk. CONCLUSIONS:Several commonly used investigations are perceived to be at high risk of unwarranted variation or low-value care. These risks are perceived differently by different groups of emergency clinicians. Potential future directions include understanding the reasons for variation and efforts to reduce variation, including audit and feedback.

AIM:To develop and psychometrically test a comprehensive Cancer Nurse Self-Assessment Tool (CaN-SAT). DESIGN:Modified Delphi to assess content validity and cross-sectional survey to assess reliability and validity. METHODS:Phase 1: An expert group developed the tool structure and item content. Phase 2: Through a modified Delphi, cancer nursing experts rated the importance of each element of practice and assessed the relevance and clarity of each item. Content Validation Indexes (CVI) were calculated, and a CVI of ≥ 0.78 was required for items to be included. Phase 3: Cancer nurses participated in a survey to test internal consistency (using Cronbach's alpha coefficients) and known-group validity (through Mann-Whitney U tests). This study was reported using the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) checklist. RESULTS:The CaN-SAT underwent two rounds of Delphi with 24 then 15 cancer nursing experts. All elements of practice were rated as important. Only three items achieved a CVI < 0.78 after round one; however, based on open-ended comments, 26 items were revised and one new item added. After round two, all items received a CVI above 0.78. The final tool consisted of 93 items across 15 elements of practice. Cronbach's alpha coefficients were between 0.92 and 0.98 indicating good reliability. Mann-Whitney U tests demonstrated significant differences between clinical nurses and advanced practice nurses across 13 out of 15 elements of practice. CONCLUSION:The CaN-SAT is a comprehensive, valid and reliable tool that can be used for cancer nurses to self-assess current skill levels, identify their learning needs and inform decisions about educational opportunities to optimise cancer care provision. PATIENT OR PUBLIC CONTRIBUTION:The research team included three patient advocates from Cancer Voices NSW, who were actively involved in all aspects of the study and are listed as authors.

BACKGROUND:Quality improvement partnerships between higher education and healthcare organizations are emerging as a valuable way to engage pre-licensure nursing students in this content. There are no agreed guidelines to assist with the establishment of these partnerships. AIM:To convene key stakeholders with the objective of reaching consensus on the following question: What needs to happen to establish quality improvement education partnerships between higher education and healthcare organizations? METHODS:A nominal group technique was used, adhering to the STROBE guidelines. Participants generated ideas to answer the question individually before sharing and discussing them within the group. Participants then independently voted and ranked the ideas in order of priority to reach consensus. RESULTS:Thirty-nine ideas were generated during the nominal group technique meeting by the five participants. A consensus was reached on ten priority areas required to establish quality improvement education partnerships. CONCLUSION:These priority areas can be used as a starting point for the establishment of quality improvement education partnerships for pre-licensure nursing students. The results can be used internationally to guide pre-licensure nursing and health professions academics towards the inclusion of quality improvement education partnerships in curricula to develop quality improvement knowledge and skills of students which they can apply on entering the workforce.

ABSTRACTAimTo develop and psychometrically test two newly developed Cancer Nurse Self‐Assessment Tools for early and metastatic breast cancer (CaN‐SAT‐eBC and CAN‐SAT‐mBC).DesignInstrument development and psychometric testing of content validity, reliability and construct validity.MethodsA three‐phase procedure was conducted. Phase 1: An expert working group was formed to design and develop each tool using Benner's Model of Clinical Competence. Phase 2: The Content Validation Index (CVI) was used to assess the relevance and clarity of each item on the tools with breast cancer nurse experts and nursing educators. A CVI ≥ 0.78 was required for an item to be included in each tool. Phase 3: The tools were tested for internal consistency using Cronbach's alpha and construct validity using principal component analysis (PCA). The Guidelines for Reporting Reliability and Agreement Studies were followed in reporting this study.ResultsEach tool underwent two rounds of content validation. Ten experts were involved in the content validation for the CaN‐SAT‐eBC and 12 experts involved for CaN‐SAT‐mBC. The final versions comprised 18 (CAN‐SAT‐eBC) and 22 elements (CaN‐SAT‐mBC). All items obtained a satisfactory CVI of 0.83–1.0. Data from 159 and 126 nurses were analysed to evaluate reliability for CaN‐SAT‐eBC and CaN‐SAT‐mBC, respectively. The Cronbach's alpha coefficients for all elements were between 0.83 and 0.98. The PCA supported that each element was unidimensional and composed of internally correlated items, with the exception of the ‘Diagnostics’ element of practice which has a two‐component structure measuring basic and advanced diagnostic tasks.ConclusionsThe two CaN‐SATs are comprehensive, valid and reliable. They can be used for self‐assessment by nurses in relation to breast cancer care and for identifying learning needs for long‐term professional development. The self‐assessment tools can also be used to develop education initiatives for specialised breast cancer nurses.Patient or Public ContributionNo patient or public contribution.

AIM:To explore the pathway of care for people post hip fracture and define what is important for person-centred recovery. DESIGN:Qualitative design using interpretive descriptive methodology, guided by the Health Empowerment theoretical framework. METHODS:Semi-structured interviews were conducted from March to October 2021, focussed on the lived experience of recovery post hip fracture. Thirteen participants were interviewed. Five people post hip fracture; four advanced practice nurses and four practice nurses. Data were analysed using thematic analysis. RESULTS:Fragments of hip fracture care was a major theme describing a disconnected pathway following discharge from hospital, and exposed the gap between recommendations for follow up and implementation. Gaps highlighted the need for a key contact clinician to support care coordination, use of individualised care plans, clinical pathways for practice nurses, and follow up post hip fracture. CONCLUSION:A disconnected recovery pathway was found from the lived experience of hip fracture. Findings highlight opportunities to develop integrated person-centred models of care that empower patients to self-manage their recovery. Implementation of an empowered coordinated pathway with a shared care approach integrates consistent care across the whole patient journey. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Identified gaps from a fractured recovery formed key components to support a connected care pathway post hip fracture. Linked by the overarching construct of Health Empowerment, policy and practice development embedding a connected pathway within nurse-led models of care should be considered. REPORTING METHOD:Consolidated Criteria for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION:No Patient or Public Involvement. IMPACT:This study explored what was important for recovery post-hip fracture. A fragmented recovery pathway was identified that highlighted key components for improvement. Research supports policy and practice development for nurse-led models of care with an empowered approach post hip fracture.

Introduction Over one billion adults attend emergency departments (EDs) internationally every year, including 6.6 million in Australia. Up to half of these patients have a peripheral intravenous catheter (PIVC) inserted. Although healthcare workers believe that placing a cannula is helpful (‘just in case’), PIVCs often remain idle. PIVC insertion is painful for patients, takes clinicians’ attention away from other care, has adverse outcomes and causes major economic and environmental burden. Our aim is to codesign an implementation toolkit to reduce unnecessary PIVC insertions and improve other national quality indicators using an implementation science framework.Methods and analysis A stepped-wedge cluster-controlled trial will be conducted in nine ED sites (clusters) across Australia. The interventions will be codesigned with and adapted to sites based on local context. The interventions are evidence-based multimodal intervention (MMI) and aligned to the 2021 Australian Commission for Safety and Quality in Health Care National PIVC Clinical Care Standard. The Consolidated Framework for Implementation Research and Learning Health System will be used to guide implementation. Interventions will be phased across three steps (three sites per step), and each site will collect control and postintervention data using mainly routinely collected clinical data. Each site will be allocated to receive the intervention at one of three study steps. Implementation strategies will tailor broad clinician and consumer engagement, policy changes, education, audit and feedback and clinical champions, along with environment and equipment changes, to each site. The primary objective is to reduce the proportion of adult patients who have a PIVC inserted by 10%. We will evaluate the clinical, implementation and cost-effectiveness of the intervention.Study findings will be used to conduct a health economic analysis, develop an implementation toolkit and inform a sustainable roadmap for national roll-out. This will meet the needs of a diverse range of EDs nationally and internationally.Ethics and dissemination The protocol was approved by the Monash Health Human Research Ethics Committee (HREC Reference Number: HREC/100808/MonH-2023-390692(v3)). The outcomes of this trial will be disseminated through peer-reviewed publications, conference presentations and communication with study partners and stakeholders including professional colleges and the Australian Commission for Safety and Quality in Health Care.Trial registration number Australian New Zealand Clinical Trials Registry registration number: ACTRN12623001248651. Date of registration: 1 December 2023. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386256&showOriginal=true&isReview=true

Background: Registered nurses (RNs) play an important role in providing primary healthcare (PHC) services. Longitudinal evidence on how the RN scope of practice in these settings has evolved over the years is currently missing and is critical in understanding how Australian government health policies have shaped the reality of nursing practice.Aim: To explore the scope of practice of RNs in Australian PHC workplace in both metropolitan and rural areas and among those with and without postgraduate qualifications during 2015–2019.Methods: Longitudinal survey data were retrospectively retrieved, collated and analysed using variate and bivariate analyses in SPSS Version 27.0. Composite items were used to combine survey items into seven key areas of nursing practice.Results: Majority of the 3882 participants were female (n = 3782, n = 97.4%), worked in general practice (n = 2916, 75.1%) and in metropolitan areas (n = 2145, 55.3%) and had completed a short course (n = 2470, 63.6%). A total of 904 participants (23.3%) completed at least one postgraduate degree. There was no significant and substantial difference in the frequency, and preference for frequency, of seven PHC practice areas by participants in different workplace localities, with or without a formal postgraduate degree as well as throughout the 5‐year survey period.Conclusion: The findings on the scope of practice by the RN participants might be explained by the interplay of interprofessional, organisational and institutional factors (more than individual factors).Implications for Nursing Management: Multilayer strategies targeting interprofessional, organisational, institutional and individual factors should be in place to enable RNs to work to their full capacity and advanced level of education. RNs also need to be included in major policy‐ and decision‐making that affects them to ensure their job satisfaction, retention in practice and contribution to patient health outcomes in PHC are sustained.

BackgroundEmergency Department (ED) care is provided for a diverse range of patients, clinical acuity and conditions. This diversity often calls for different vital signs monitoring requirements. Requirements often change depending on the circumstances that patients experience during episodes of ED care.AimTo describe expert consensus on vital signs monitoring during ED care in the Australasian setting to inform the content of a joint Australasian College for Emergency Medicine (ACEM) and College of Emergency Nursing Australasia (CENA) position statement on vital signs monitoring in the ED.MethodA 4-hour online nominal group technique workshop with follow up surveys.ResultsTwelve expert ED nurses and doctors from adult, paediatric and mixed metropolitan and regional ED and research facilities spanning four Australian states participated in the workshop and follow up surveys. Consensus building generated 14 statements about vital signs monitoring in ED. Good consensus was reached on whether vital signs should be assessed for 15 of 19 circumstances that patients may experience.ConclusionThis study informed the creation of a joint position statement on vital signs monitoring in the Australasian ED setting, endorsed by CENA and ACEM. Empirical evidence is needed for optimal, safe and achievable policy on this fundamental practice.