Copyright © eContent Management Pty Ltd. Contemporary Nurse (2014) 48(2): 130–132.



Editorial Nursing innovation and reform in health care

Debra Jackson, June Girvin* and Patricia M Davidson+ University of Technology, Sydney, NSW, Australia; *Oxford Brookes University, Oxford, UK; +Johns Hopkins University, Baltimore, MD, USA

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eading the way in discussion and debate of nursing innovation and health care reform, it is a great pleasure for us to present this special issue of Contemporary Nurse, devoted to nursing innovation and reform in health care. It is an exciting time to be a nurse. In many ways nursing is facing unprecedented challenges. Nurses all over the world are grappling with a range of complex issues; from conceptualising how care can best be delivered to as many people as possible, in a climate of an ageing workforce and shrinking resources, through to developing and delivering culturally-sensitive innovations in service provision, all within a context of nursing role development and workforce diversification. Nurses face an increasing complexity in ethical challenges, fuelled by technological innovation and increased fiscal constraints (Davidson, Daly, & Hill, 2013), and their education seems to be under almost constant review particularly in the UK (Royal College of Nursing, 2012; Health Education England, 2014, ongoing). Although these challenges may seem overwhelming at times, they also represent considerable opportunities for practice innovation and service reform. Indeed, there is growing interest in how to promote and enhance innovation among nurses (Tsai, Liou, Hsiao, & Cheng, 2013; Weng, Huang, Huang, & Wang, 2012). Internationally, nurses are at the front line of providing care, often in the context of highly sensitive, complex, and entrenched social disparities. Many of the individuals, families and communities served by nurses are vulnerable and chronically underserved, meaning that these nurses are engaged in giving care in a multiplicity of ­environments – some incredibly poorly resourced in relation to the level of community need and

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expectation. In Australia and despite recognition of the need for strategies that can improve the health status of Aboriginal Australians, real success is still elusive. There is acknowledgement that one crucial strategy to improve Indigenous engagement with health services is raising the number of Indigenous people in the nursing workforce. In this special issue, we include work by Neilson, Stuart, and Gorman (2014, pp. 190–196) who present the findings of a study that explored Aboriginal nurses experiences of the ‘whiteness of nursing.’ The insights provided in this paper are important in developing appropriate policy reform and interventions to enhance Indigenous participation in nursing. All the while that nurses are developing care interventions, they are doing so while also trying to meet the challenges of chronic and acute workforce shortages and workforce diversification. Many nurses work in a lone registered nurse setting; either as the only nurse in a multi-­ disciplinary team setting, or leading teams of unregulated health workers. It is so important that we reflect upon ways to best work in such contexts, and ensure that nurses in these situations still feel the collegial support and camaraderie of the wider nursing community. It is also crucially important that nurses act as advocates for the public, to ensure that unregulated health providers are appropriately educated and prepared for their roles. In this issue of Contemporary Nurse, Netherwood, Skittrall, and Obrey (2014, pp. 197–198) argue that if training and regulation are pre-requisites for ensuring the standards of care delivered by registered nurses, then this must also apply to nursing assistants. This is a crucial area for reform, and is an important debate that nurses internationally must engage in.

Nursing innovation and reform in health care Leadership is quite widely acknowledged as a key issue in health care provision and recent years have seen increasing international interest in, and burgeoning publications around nursing leadership (for example, leadership styles in ethical dilemmas – Zydziunaite and Suominen, 2014, pp. 150–167). However, there are still many gaps in the discourses around leadership in nursing. For example, Hutchinson and Jackson (2013) suggest that many of the current leadership models are derived from Western ways of thinking and being, and that there is a lack of acknowledgement of the role of culture in constructing some models of leadership. In this current issue, we are pleased to present a paper by El Amouri and O’Neill (2014, pp. 135–149) which surveyed nurses in the United Arab Emirates (UAE) to explore these nurses’ perceptions of the characteristics of effective leadership, and makes an important international contribution to the literature. Nurses have a crucial role to play in health care reform. There are many drivers/catalysts for health care reform. It is so important that we listen to and really hear the voices of our patients, their families and carers, and our colleagues because health care-related experiences and insights from front line clinical nurses can draw attention to crucial issues that may highlight a need for practice and system change. Unfortunately, as some recent reports have suggested (see for example: Francis, 2013), all too often these voices are either not heard or responded to effectively, until problems have become entrenched. Whistleblowing has an important role in upholding healthcare standards and nurses are frequently caught up in whistleblowing events. In this current issue of Contemporary Nurse, we present an integrative review of the data-based literature on whistleblowing in nursing. Findings reinforce the role of nursing in raising concerns about poor care or organisational wrongdoing, and highlight the need for research to inform reform in this area (Jackson et al., 2014, pp. 240–252). Other articles in this special issue highlight: The idea of support and its role in mitigating new graduate nurses’ experiences of bullying

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(Rush, Adamack, Gordon, & Janke, 2014, pp. 219–228); financial austerity measures and their effects on daily practice as perceived by Italian nurses (Palese, Vianello, Cassone, Polonia, & Bortoluzzi, 2014, pp. 168–180); and, information that can drive reform (for example: Jacob, McKenna, & D’Amore, 2014a, 2014b; pp. 199–211, pp. 212–218; Li, Yu, Liu, Shieh, & Yang, 2014, pp. 229–239). In preparing this special issue, we have aimed to reflect the international nature of these debates and discussions. Many of the issues are germane internationally and the forces of globalisation both help and hinder solutions. We are delighted to present papers from nurses in several countries – including Jamaica (Jones Hepburn-Brown, Anderson-Johnson, & Lindo, 2014, pp. 181–189), the USA (Falk & House, 2014, pp. 133–134), UK, Taiwan, Lithuania, Finland, Italy and the United Arab Emirates – in this special issue of Contemporary Nurse. We hope that these thought-provoking papers will enhance understandings of international perspectives on health reform and innovation, and are a catalyst for reflection, discussion and debate, that can foster increased recognition of the crucial role of nursing and nurses in health care reform and innovation. References

Davidson, P. M., Daly, J., & Hill, M. N. (2013). Editorial: Looking to the future with courage, commitment, competence and compassion. Journal of Clinical Nursing, 22, 2665–2667. El Amouri, S., & O’Neill, S. (2014). Leadership style and culturally competent care: Nurse leaders’ views of their practice in the multicultural care settings of the United Arab Emirates. Contemporary Nurse, 48(2), 135–149. Falk, N. L., & House, M. (2014). Don’t come late to the party: Step up and lead. Contemporary Nurse, 48(2), 133–134. Francis, R. (2013). The Mid Staffordshire NHS Foundation Trust Public Inquiry. London, England: The Stationary Office. www.midstaffspublicinquiry.com/report Health Education England. (2014, ongoing). The Shape of Caring Review: A Review of the Future Education and Training of the Nursing and the Care Assistant Workforces. Leeds.

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Debra Jackson, June Girvin and Patricia M Davidson

Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: Towards a more critical interpretation. Nursing Inquiry, 20(1), 11–22. Jackson, D., Hickman, L., Hutchinson, M., Andrew, S., Smith, J., Potgieter, I., Cleary, M., & Peters, K. (2014). Whistleblowing: An integrative literature review of data-based studies involving nurses. Contemporary Nurse, 48(2), 240–252. Jacob, E. R., McKenna, L., & D’Amore, A. (2014a). Similarities and differences in educational preparation of registered and enrolled nurses in Australia: An examination of curricula content. Contemporary Nurse, 48(2), 199–211. Jacob, E. R., McKenna, L., & D’Amore, A. (2014b). Senior nurse role expectations of graduate registered and enrolled nurses in Australia: Content analysis of open-ended survey questions. Contemporary Nurse, 48(2), 212–218. Jones, K., Hepburn-Brown, C., Anderson-Johnson, P., & Lindo, J. L. M. (2014). High patient satisfaction with nurse practitioner delivered services at two health centres in urban Jamaica. Contemporary Nurse, 48(2), 181–189. Li, Y.-S., Yu, W.-P., Liu, C.-F., Shieh, S.-H., & Yang, B.-H. (2014). An exploratory study of the relationship between learning styles and academic performance among students in different nursing programs. Contemporary Nurse, 48(2), 229–239. Neilson, A.-M., Stuart, L., & Gorman, D. (2014). Confronting the cultural challenge of the whiteness of nursing: Aboriginal registered nurses’ perspectives. Contemporary Nurse, 48(2), 190–196.

Netherwood, M., Skittrall, R., & Obrey, A. (2014). Regulation of nursing assistants: A critical international issue? Contemporary Nurse, 48(2), 197–198. Palese, A., Vianello, C., Cassone, A., Polonia, M., & Bortoluzzi, G. (2014). Financial austerity measures and their effects as perceived in daily practice by Italian nurses from 2010 to 2011: A longitudinal study. Contemporary Nurse, 48(2), 168–180. Royal College of Nursing. (2012). Quality with compassion: The future of nursing education. Report of the Willis Commission on Nursing Education. Retrieved from http://www.williscommission.org.uk/ recommendations Rush, Adamack, M., Gordon, J., & Janke, R. (2014). New graduate transition programs: Relationships with access to support and bullying. Contemporary Nurse, 48(2), 219–228. Tsai, H.-M., Liou, S.-R., Hsiao, Y.-C., & Cheng, C.-Y. (2013). The relationship of individual characteristics, perceived worksite support and perceived creativity to clinical nurses’ innovative outcome. Journal of Clinical Nursing, 22, 2648–2657. Weng, R.-H., Huang, C.-Y., Huang, J.-A., & Wang, M.-H. (2012). The cross-level impact of patient safety climate on nursing innovation: A crosssectional questionnaire survey. Journal of Clinical Nursing, 21, 2262–2274. Zydziunaite, V., & Suominen, T. (2014). Leadership styles of nurse managers in ethical dilemmas: Reasons and consequences. Contemporary Nurse, 48(2),150–167.

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Volume 48, Issue 2, October 2014

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Editorial: Nursing innovation and reform in health care.

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