BACKGROUND:Multiple aspects of nurses' rosters interact to affect the quality of patient care they can provide and their own health, safety and wellbeing.OBJECTIVES:(1) Develop and test a matrix incorporating multiple aspects of rosters and recovery sleep that are individually associated with three fatigue-related outcomes - fatigue-related clinical errors, excessive sleepiness and sleepy driving; and (2) evaluate whether the matrix also predicts nurses' ratings of the effects of rosters on aspects of life outside work.DESIGN:Develop and test the matrix using data from a national survey of nurses' fatigue and work patterns in six hospital-based practice areas with high fatigue risk.METHODS:Survey data included demographics, work patterns (previous 14 days), choice about shifts, and the extent to which work patterns cause problems with social life, home life, personal relationships, and other commitments (rated 1 = not at all to 5 = very much). Matrix variables were selected based on univariate associations with the fatigue-related outcomes, limits in the collective employment contract, and previous research. Each variable was categorised as lower (score 0), significant (score 1), or higher risk (score 2). Logistic multiple regression modelling tested the independent predictive power of matrix scores against models including all the (uncategorised) work pattern and recovery sleep variables with significant univariate associations with each outcome variable. Model fit was measured using Akaike and Bayesian Information Criterion statistics.RESULTS:Data were included from 2358 nurses who averaged at least 30 h/week in the previous fortnight in one of the target practice areas. Final matrix variables were: total hours worked; number of shift extensions >30 min, night shifts; breaks < 9 h; breaks ≥ 24 h; nights with sleep 11pm to 7am; days waking fully rested; and roster change. After controlling for gender, ethnicity, years of nursing experience, and the extent of shift choice, the matrix score was a significant independent predictor of each of the three fatigue-related outcomes, and for all four aspects of life outside work. For all outcome variables, the model including the matrix score was a better fit to the data than the equivalent model including all the (uncategorised) work pattern variables.CONCLUSIONS:A matrix that predicts the likelihood of nurses reporting fatigue-related safety outcomes can be used to compare the impact of rosters both at work and outside work. It can be used for roster design and management, and to guide nurses' choices about the shifts they work.

Background: There are numerous studies examining the experiences of migrant nurses. However, there is less literature related to the concomitant experience of host nurses. Objective: This is the first identified study of the cultural influences on perceptions, practices and cross-cultural communication interface between Registered Nurses (RNs) from diverse ethnicities across the Aotearoa-New Zealand (NZ) health sector. Design: A mixed-methods online questionnaire survey was designed to identify key influences on RNs in a rapidly culturally-diversifying healthcare environment. The critical incident technique provided further insight into cultural influences on communication and practice. Participants: 259 respondents completed the questionnaire sent to a random sample of RNs in the New Zealand Nurses Organisation (NZNO) database. Methods: The survey identified key factors present in the cross-cultural interface between host and migrant nurses. Principal components analysis uncovered the underlying structure of variables and thematic analysis of the qualitative data provided enhanced insight. Results: Three key areas accounted for 57.23% of variance: Factor 1: teamwork (40.2%); Factor 2: management (12.2%) and Factor 3: Organisational culture (4%). Sub-themes accompanied each factor to illustrate the impact on both groups of RNs. Conclusion: There was a clear desire for RNs, both host and migrant nurses, for support to enable them to foster good working relationships in collaborative teams. Empathetic, culturally-competent managers and organisational resources are required to facilitate this process. (C) 2019 Australian College of Nursing Ltd. Published by Elsevier Ltd.

The importance of health promotion and self-care to nurses provided the impetus for a project examining nursing students' knowledge about services, their access to facilities and their confidence in signposting sources of help to other students related to health promotion. A web-based survey exploring students' knowledge and confidence in self-accessing or signposting others to sources of help with a wide range of health promotion issues was widely advertised and distributed to nursing students at all 23 nursing schools (including separate entries from multi-campus programmes) providing undergraduate nursing education in New Zealand. Descriptive statistical analysis and comparisons between groups (age group, year of study and ethnicity) using 2-sample t-tests were carried out using statistical software within the Survey Monkey (Pro) platform. Nearly a thousand nursing students responded from across all years and from every nursing school. Respondents reported on service availability and health promoting aspects of each campus. Access to services and a healthy environment differed between schools. While there were differences attributable to age group, independently of age, confidence in giving health promotion advice increased as nurses progressed through the three years of undergraduate nursing education. Many aspects of nursing school campuses are less than ideal as health promoting institutions. Two key areas for improvement are the provision of affordable healthy food, and reinforcement of smoke-free messages. Additionally, issues such as gender diversity, financial management, shiftwork management and emotional preparedness all emerged as areas about which students needed more information. Given different age and ethnicity profiles in the different schools, a varied range of targeted health promotion education may be required. # *Te reo Māori translation* # Kei te mōhio ngā ākonga tapuhi me pēhea te whakapā atu ki ngā ratonga whakatairanga hauora, ki te tiaki hoki i tō rātou hauora? **Ngā ariā matua**\ Nā te hira o te whakatairanga me te taurima i a rātou anō mā te tapuhi, ka hua ake tēnei kaupapa tātari I te mōhiotanga o ngā ākonga tapuhi mō ngā ratonga, te wātea mai o ngā whare hauora ki a rātou, me tō rātou māia ki te tohutohu i ngā puna āwhina mō te whakatairanga hauora ki ētahi atu ākonga. I pānuitia whānuitia, i tohaina hoki ki ngā ākonga tapuhi i ngā kura tapuhi 23 (tae atu ki ētahi i whakauru mai i ngā kaupapa hōpuni maha) e hora ana i te akoranga tapuhi paetahi i Aotearoa, tētahi uiuinga ā-ipurangi e tūhuratia ai te mōhiotanga me te māia o ngā ākonga ki te tomo ā-kiri, ki te tohutohu rānei ki ētahi atu ākonga ngā puna āwhina mō te huhua o ngā take whakatairanga hauora.I kawea he tātaritanga tatauranga me ngā whakatairitenga i waenga i ētahi rōpū (reanga ā-tau, tau o te akoranga me te momo ā-iwi) mā te whakamahi i ngā 't-test' tātauira 2, me te whakamahi i ngā pūmanawa tatauranga i te pūhara Survey Monkey (Pro). Tata ki te kotahi mano ngā ākonga tapuhi i whakautu mai I ngā tau katoa mai i ia kura tapuhi. I whakahoki korero te hunga urupare mō te wātea mai o ngā ratonga me ngā āhuatanga whakatairanga hauora i ia hōpuni. He rerekē te wātea mai o ngā ratonga me te taiao hauora i waenga i ngā kura. Ahakoa i puta he rerekētanga nā te āhua o te reanga ā-tau, i piki anō te māia o te hoatu tohutohu whakatairanga hauora, ahakoa te pakeke, i roto i ngā tau e toru o te akoranga tapuhi paetahi. He maha tonu ngā āhuatanga o ngā hōpuni kura tapuhi kāore I te tino pai hei whare whakatairanga hauora. E rua ngā wāhi matua hei whakapainga ake, tuatahi ko te kaha hauora, ngāwari te utu, tuarua ko te whakapūmau i ngā pānui whakamutu i te kaipaipa. I tua atu i tērā, arā atu ngā wāhi pēnei i te kanorau momo ira, te whakahaere pūtea, te whakahaere mahi tīpako, me te takatū o te ngakau ki ngā uauatanga o te mahi, ēnei katoa, i noho hei wāhanga me nui ake ngā mōhiotanga mā te ākonga. Ina tirohia ngā kōtaha ā-tau, ā-momo iwi rerekē o ngā kura nei, me mātua hora pea te huhua o ngā momo akoranga whakatairanga hauora.

Background: Fatigue resulting from shift work and extended hours can compromise patient care and the safety and health of nurses, as well as increasing nursing turnover and health care costs. Objectives: This research aimed to identify aspects of nurses' work patterns associated with increased risk of reporting fatigue-related outcomes. Design: A national survey of work patterns and fatigue-related outcomes in 6 practice areas expected to have high fatigue risk (child health including neonatology, cardiac care/intensive care, emergency and trauma, in-patient mental health, medical, and surgical nursing). Methods: The 5-page online questionnaire included questions addressing: demographics, usual work patterns, work in the previous two weeks, choice about shifts, and four fatigue-related outcomes having a sleep problem for at least 6 months, sleepiness (Epworth Sleepiness Scale), recalling a fatigue-related error in clinical practice in the last 6 months, and feeling close to falling asleep at the wheel in the last 12 months. The target population was all registered and enrolled nurses employed to work in public hospitals at least 30 h/week in one of the 6 practice areas. Participation was voluntary and anonymous. Results: Respondents (n = 3133) were 89.8% women and 8% Maori (indigenous New Zealanders), median age 40 years, range 21-71 years (response rate 42.6%). Nurses were more likely than New Zealand adults in general to report chronic sleep problems (37.73% vs 25.09%, p < 0.0001) and excessive sleepiness (33.75% vs 14.9%, p < 0.0001). Fatigue-related error(s) in the last 6 months were recalled by 30.80% and 64.50% reported having felt sleepy at the wheel in the last 12 months. Logistic regression analyses indicated that fatigue-related outcomes were most consistently associated with shift timing and sleep. Risk increased with more night shifts and decreased with more nights with sleep between 11 p.m. and 7 a.m. and on which nurses had enough sleep to feel fully rested. Risk also increased with roster changes and more shift extensions greater than 30 min and decreased with more choice about shifts. Comparisons between intensive care/cardiac care and in-patient mental health nursing highlight that fatigue has different causes and consequences in different practice areas. Conclusions: Findings confirm the need for a more comprehensive and adaptable approach to managing fatigue. We advocate an approach that integrates safety management and scientific principles with nursing and management expertise. It should be data-driven, risk-focused, adaptable, and resilient in the face of changes in the services required, the resources available, and the overall goals of the healthcare system. (C) 2019 Elsevier Ltd. All rights reserved.

AimTo examine the factors contributing to nurses choosing to exit the nursing profession before retirement age. BackgroundPopulation growth, ageing and growing demand for health services mean increased demand for nurses. Better retention could help meet this demand, yet little work has been done in New Zealand to understand early attrition. MethodsAn online survey of registered and enrolled nurses and nurse practitioners who had left nursing was used. This study reports analysis of responses from 285 ex-nurses aged under 55. FindingsThe primary reasons nurses left the profession were as follows: workplace concerns; personal challenges; career factors; family reasons; lack of confidence; leaving for overseas; unwillingness to complete educational requirements; poor work-life balance; and inability to find suitable nursing work. Most nurses discussed their intentions to leave with a family member or manager and most reported gaining transferrable skills through nursing. ConclusionsNurses leave for many reasons. Implementing positive practice environments and individualized approaches to retaining staff may help reduce this attrition. Generational changes in the nature of work and careers mean that nurses may continue to leave the profession sooner than anticipated by policymakers. Implications for policyIf the nursing workforce is to be able to meet projected need, education, recruitment and retention policies must urgently address issues leading to early attrition. In particular, policies improving the wider environmental context of nursing practice and ensuring that working environments are safe and nurses are well supported must be developed and implemented. Equally, national nursing workforce planning must take into account that nursing is no longer viewed as a career for life.

AIMS To identify why some nurses cope well with continuing to work as they age and others struggle. BACKGROUND There is a need to understand better the challenges older nurses face and how they manage them. DESIGN Secondary analysis of existing data. METHODS Data collected in two separate studies were analysed. The first study (2012) was an online, anonymous survey that collected free text (qualitative) and categorical data (n = 3273, 57·6% response rate). The second (2014) was an explorative, descriptive study that collected data through focus groups and interviews (n = 46). Qualitative data from both studies were analysed using David Thomas' () general inductive approach. Research Ethics Committee approval was gained for the 2012 and 2014 studies. RESULTS Data were categorised in two themes: the challenges of ageing and nursing; and factors that enable nurses to continue to practice. Physical challenges, fatigue, guilt, ageism and demands to complete continuing education were considered challenges. Maintaining personal fitness, self care, flexible working and a strong belief in their ability to contribute to the profession were present in older nurses who continued to practice. CONCLUSION While older nurses face growing physical and cognitive challenges as they age, they demonstrate strong resilience in the face of these challenges. It is recommended nurses seek support from their workplaces early to address challenges. Organisations must address ageism in the workplace and provide practical interventions such as supporting changes to work hours, shifting nurses to less physical roles and providing career planning to support resilience in older workers.

The aim of this study was to explore the experiences of Māori nurses and student nurses in Aotearoa New Zealand who combine culturally specific customary obligations in all areas of whānau (family), hapū (kinship group) and iwi (wider kinship group) life (in particular, caregiving responsibilities) with working or studying. The study was underpinned by a collaborative Kaupapa Māori (Māori principles and values) approach. Paired or triad interviews were undertaken with 13 Māori nurses and two Māori student nurses (all women), aged between 22 and 57, and from all parts of Aotearoa New Zealand, between October and December 2015. Their stories give a picture of considerable community service and duty outside work. The impacts on emotional and physical health which caregiving responsibilities have on Māori nurses are under-reported to their management. Facilitating Māori voices and realities to be heard will raise awareness of the issues and help identify potential strategies, policies and employment practices that will validate and support Māori nurses in their workplaces and in the wider community.

AIMS:To examine the dual caregiving and nursing responsibilities of nurses in New Zealand with a view to identifying potential strategies, policies and employment practices that may help to retain nurses with caregiving responsibilities in the workplace.BACKGROUND:As the nursing workforce ages, child-bearing is delayed and older family members are living longer, family caregiving responsibilities are impacting more on the working life of nurses. This may complicate accurate workforce planning assumptions.METHOD:An explorative, descriptive design using interviews and focus groups with 28 registered nurses with family caregiving responsibilities.RESULTS:A depth of (largely hidden) experience was exposed revealing considerable guilt, physical, emotional and financial hardship. Regardless of whether the nurse chose to work or had to for financial reasons, family always came first.CONCLUSIONS:Demographic and societal changes related to caregiving may have profound implications for nursing. Workplace support is essential to ensure that nurses are able to continue to work.IMPLICATIONS FOR NURSING MANAGEMENT:Increased awareness, support, flexibility and specific planning are required to retain nurses with family caregiving responsibilities.

A recent NZNO study has shown patchy use by nurses of electronic devices and files. Nurses need more education and support if e-health is to be integrated successfully into nursing practice.

This paper reports a subset of data from a mixed methods project interviewing community nurses and nurse leaders/managers to explore the views, expectations, practice and attitudes of registered nurses working in the community concerning electronic health records and the use of mobile devices. Nurses displayed excellent understanding of privacy and consent concerning electronic patient records and health information technology (e-health). With targeted, individualised education, nurses use e-health and telehealth effectively. However, significant barriers were found regarding duplication of paper and electronic patient notes and multiple logins for different platforms and systems, resulting in forgotten and shared passwords. There was also evidence of some avoidance of essential systems; lack of infrastructure in some settings; inadequate systems for the use of digital cameras (e.g. tracking wound healing); and inability to access patient notes across settings to ensure integrated care. In conclusion, nurses are the largest group of health practitioners in New Zealand and are at the front line of patient care. Nurses need systems designed around their work methods and a good understanding of e-health in order to be able to use it effectively. Greater consultation with nurses is required to ensure the potential of e-health and its use is maximised.

AIM:To explore the experiences and needs of older nurses in relation to flexible working and the barriers and facilitators to implementation within workplaces.BACKGROUND:An ageing nursing workforce and anticipated nursing workforce shortages require effective approaches to workforce retention.METHOD:A mixed method approach (focus group and individual interviews) with nurses aged over 50 (n = 46) combined with analysis of district health board (DHB) flexible working policies.RESULTS:Participants had a good understanding of flexible working and recognised the importance of balancing their own needs with those of their organisation. Participants had legitimate reasons for making requests and became frustrated when turned down. They recommended job sharing, shorter shifts, no night shift and greater recognition of their work to improve retention. There was discrepancy between organisational policy (where this existed) and implementation.CONCLUSION:Organisations should review flexible working policies, ensuring these are understood and implemented at the unit level. Training of nurse managers is recommended.IMPLICATIONS FOR NURSING MANAGEMENT:Nurse managers must recognise the individual needs of nurses, be cognisant of workplace policies regarding flexible working, ensure these are implemented consistently and make the effort to recognise the work of older nurses.

It has been nearly quarter of a century since nursing educator Irihapeti Ramsden wrote the guidelines on cultural safety (Kawa Whakaruruhau), ratified in 1992 and subsequently much revised (most recently in 2011) by the Nursing Council. The Te Puna Hauora Kaupapa Nursing Service at Tauranga Hospital has been in existence for more than 18 years. Despite this, the experiences of Māori nurses described here, and the lack of adoption of truly bicultural nursing services in other parts of the country, indicate far more investment is needed in Māori nursing. What all those working in the health-care system need is the capacity to deliver whanaungatanga models of care, through cultural awareness education, and through the development of cultural competencies.

INTRODUCTION: Primary care nursing teams may now comprise registered nurses (usually termed practice nurses), nurse practitioners, physician assistants, enrolled nurses, and primary care practice assistants, clinical assistants, or nursing assistants. There is a need to understand how practitioners in the different roles work with patients in the changed environment. The aim of this study was to describe the different configurations of health professionals' skill-mix in three dissimilar primary care practices, their inter-and intra-professional collaboration and communication, and to explore the potential of expanded nursing scopes and roles to improve patient access.METHODS: Document review, observation and interviews with key stakeholders were used to explore how health practitioners in three practice settings work together, including their delegation, substitution, enhancement and innovation in roles and interdisciplinary interactions in providing patient care. A multi-phase integrative, qualitative and skill-mix framework analysis was used to compare findings related to nursing skill-mix across case studies.FINDINGS: Three models of primary care provision, utilising different nursing skill-mix and innovations were apparent. These illustrate considerable flexibility and responsiveness to local need and circumstances.CONCLUSION: Enabling nurses to work to the full extent of their scope, along with some adjustments to the models of care, greater multidisciplinary cooperation and coordination could mitigate future work-force shortages and improve patient access to care.