Lack Of Role Clarity Research Articles

Occupational Stressors and Resources of Peer Workers in Social Psychiatry

Peer Support Workers (PW) were asked about stressors and resources and how stressful or relieving they perceived them to be. Questionnaire-based survey RESULTS: 175 PW were included in the data analysis and identified stressors and resources in their daily work. Psychological security and autonomy are the most frequently mentioned resources, while role clarity is the least frequently mentioned. Autonomy can also be more of a burden than a resource, especially in combination with a lack of role clarity. PW rarely feel stigmatized by their colleagues. However, when they do, they find it very stressful. Relevant stressors were uncertainty about decisions made, problems with the team culture, or perceived inadequate role fulfillment by the team. The lack of clarity about work processes and the roles of all participants is a significant stressor, despite the availability of relevant resources.

Intent to leave academia: perceptions and challenges of nurse faculty

BackgroundThe shortage of nursing faculty is a significant global issue affecting the nursing profession. Faculty turnover can negatively impact the institution by decreasing the number of qualified nursing faculty and disrupting the educational process. The cost of replacing departing faculty and recruiting and training new faculty may increase.PurposeTo describe perceptions of nursing faculty of intentions to leave academia and to identify challenges that contribute to nurse faculty turnover in academic setting.MethodA descriptive naturalistic, qualitative approach is used to explore nurses perceptions and intentions to leave academia.ResultsThe themes identified were unexpected journey, with two sub-themes, lack of role clarity and lack of preparation/orientation, and work environment, with four sub-themes: low Salary, workload, lack of support and favoritism.ConclusionThe urgency of addressing the factors that contribute to nurse faculty intending to leave academia cannot be overstated. The results of this study have direct implications for nursing schools’ administrators, where these findings can provide them with, valuable insights that they can be used to implement best practices and mitigate the problem of nursing faculty turnover.

System Reform: The Ever-Elusive Quest—An Australian Study of How System Middle Leaders’ Role Enactment Influences the Attainment of Policy Coherence

Within an educational context, the current aim of policy translation is to achieve policy coherence by strategically and structurally aligning components, enabling whole system reform. While acknowledging the importance of this coherence conceptualisation, the current literature perspective primarily emphasises message conveyance, and lacks a dimension that identifies policy coherence as the result of how individuals, including middle leaders, interpret and translate policy into actions, both individually and collectively. System middle leaders occupy a unique position within organisational structures, as they bridge the gap between executive system leaders and school- based leaders. To investigate how policy is interpreted and translated within their roles and the impact this has on attaining policy coherence, this study employed an interpretivist approach to exploratory case study methodology, grounded in a review of authoritative literature. The aim was twofold; first, to enhance understanding of policy coherence development at the system middle level by exploring the role enactment of system middle leaders within a large Australian government education system; and second, to examine the interconnectedness and impact of leaders’ role enactment on policy coherence for system reform. Findings suggest that achieving policy coherence is hindered by a lack of role clarity among system leaders, in relation to policy implementation, stemming from the inconsistent interpretation and translation of policy into system strategy documentation and a deficiency in formal policy interpretation and role induction practices. As a result, individual system leaders often turn to informal policy interpretations and interactions with peers to clarify roles, leading to role tensions, accountability ambiguity and partial policy implementation. As a result, this study concludes that the integration of role theory, policy implementation theory and organisational alignment theory offers an interpretivist insight into the development of policy coherence for system reform, illuminating a theoretical pathway and practical recommendations for systems to attain policy coherence.

Silo mentality in teams: emergence, repercussions and recommended options for change

PurposeThis article summarizes practitioner observations on three research questions. First, the factors that lead to the emergence and persistence of such teams. Second, the repercussions of siloed teams. And third, practical suggestions and recommendations that practitioners can employ to prevent silo formation or address existing silos. This article thus complements recent academic work that has previously explored the formation of silos.Design/methodology/approachThe authors used the input of current team leads from a focus group along with their consulting experience to explore these three research questions. The team lead input and consulting expertise are integrated with academic research on silos.FindingsThe emergence and persistence of silos was mostly attributed to company characteristics (size, growth and stakeholder management) as well as communication inefficiencies (lack of role clarity and ownership within teams), which in turn were impacted by situational variables (pandemic and turnover). The authors noted the effect of team composition effects, team competition and organizational changes (rapid growth and restructuring) as potential contributors to the formation and persistence of silos. The team lead experts and our consulting experiences were congruent with the literature focused on repercussions of silos, from poor information exchanges to inefficiencies, divisions and perceived isolation of teams from the organization. Solutions focused on project organization and documentation as well as the adoption of new decision-making tools and practices, and the creation of more exchange and learning opportunities. The authors added additional options to promote more visibility, appreciation, proactive monitoring within teams and organizational identification initiatives.Originality/valueThe current article adds a pragmatic perspective to silos and how organizations can address these when they become problematic and hinder performance and collaboration.

Perioperative Opioid Stewardship Program: Barriers and Promotors of Implementation and Sustainability

Perioperative opioid stewardship programs aim to harness the benefits of opioid analgesia for managing acute post-surgical pain whilst mitigating potential harm. Healthcare worker stakeholders are vital for the effective program introduction and continuation. However, their perceptions of program barriers and promotors are underexplored. We conducted twenty semi-structured interviews with healthcare workers across three health services that introduced a perioperative opioid stewardship program. The participants included specialist pain medicine physicians, anaesthetist managers, pain nurses, pharmacists and Junior Medical Officers. Interviews were transcribed and coded both inductively and deductively against the Consolidated Framework of Implementation Research. Key themes from the data were reviewed, refined and reported. Participants were generally aware of perioperative opioid stewardship principles but senior clinicians reported greater specific program knowledge. Adherence to the discharge opioid prescription guideline was promoted by hospital leadership endorsement and workflow integration. A universal barrier to program adherence was inadequate resourcing. Lack of role clarity was a barrier to patient discharge opioid education. Hospital-community prescriber communication was variable but generally limited to written discharge summaries rather than a comprehensive, personalised approach. Introducing an Electronic Medical Record was universally seen as an opportunity to promote better program integration and sustainment. This study deepens our current understanding of the drivers of observed perioperative opioid stewardship program outcomes from the perspective of healthcare worker stakeholders. The findings could be used to optimise existing programs or to guide the implementation of new programs to achieve effective clinical change.

Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries.

Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.

How Do Professional Associations Influence Health System Transformation? Lessons from Ontario, Canada

Introduction: Internationally, there are increasing collaborative efforts to transform health care systems in ways that align with the principles of integrated care. Within the Canadian context, the current province-wide reorganization of health care into Ontario Health Teams (OHTs) is an example of a large-scale system transformation, requiring collaboration between system stakeholders at macro-, meso- and micro-levels. Literature on the topic inter-organizational collaboration does not fulsomely consider the role of local professional associations in health system transformations. There is value in examining the role of professional associations in influencing health system transformations, as they have significant expertise and influence, particularly in the domain of health policy. 
 Methods: We used a qualitative descriptive approach to explore the research question: what strategies have local professional associations used to influence the development of Ontario Health Teams? We collected data from eight, 60-minute interviews with senior level leaders from eight professional associations. Interviews were transcribed and data were analyzed using content analysis to construct four descriptive themes. 
 Results: During times of health system transformation, professional associations balance the functions of: (1) supporting members, (2) negotiating with government, (3) collaborating with stakeholders, and (4) reflecting on their role. In this presentation, we focus primarily on themes #2 and #3, given the specific relevance of governance, leadership, and collaboration. In both themes, participants emphasized the importance of findings areas of alignment with the government and other stakeholders; and using shared aims as way to amplify their influence. Characteristics of a “good” collaborator included consistent demonstration of mutual respect, clear communication, and interest in building trusting relationships. Participants also described barriers to collaboration, such as power imbalances and lack of role clarity. These challenges were heightened within the context of the “low rules” OHT rollout, in which OHTs had a high degree of control in adapting their team structures to ideally meet the needs of their local care partners and patient population(s),
 Conclusion and Implications: Professional associations are highly connected groups, deeply engaged with their members (often frontline clinicians) and regularly engaged with other key stakeholders and decision-makers (e.g., government). PAs play a critical role in influencing health system transformations, by bringing forward practical solutions to government that reflect the needs of their members, often frontline clinicians. Sharing insights from this work with an international audience could support global dialogues with health system leaders, policymakers, and researchers about leveraging the strengths of professional associations to enhance large-scale health system transformations via strategic collaboration.
 Next Steps: This research was conducted to fulfill the requirements of the Health System Impact Fellowship (doctoral level, funded by the Canadian Institutes of Health Research). We have continued to engage selected professional associations in building a collaborative framework, grounded in their experiences of participating the development of Ontario Health Teams.

When routine becomes stressful: A qualitative study into resuscitation team members’ perception of stress and performance

ABSTRACT Interprofessional teamwork is of high importance during stressful situations such as CPR. Stress can potentially influence team performance. This study explores the perception of stress and its stressors during performance under pressure, to be able to further adjust or develop training. Healthcare professionals, who are part of the resuscitation team in a large Dutch university medical center, discussed their experiences in homogeneous focus groups. Nine focus groups and one individual interview were conducted and analyzed thematically, in order to deepen our understanding of their experiences. Thematic analysis resulted in two scenarios, routine and stress and an analysis of accompanying team processes. Routine refers to a setting perceived as straightforward. Stress develops in the presence of a combination of stressors such as a lack of clarity in roles and a lack of knowledge on fellow team members. Participants reported that stress affects the team, specifically through an altering of communication, a decrease in situational awareness, and formation of subgroups. This may lead to a further increase in stress, and potentially result in a vicious cycle. Team processes in a stressful situation like CPR can be disrupted by different stressors, and might affect the team and their performance. Improved knowledge about the stressors and their effects might be used to design a training environment representative for the performance setting healthcare professionals work in. Further research on the impact of representative training with team-level stressors and the development of a “team brain” might be worthwhile.

Application of “Agile” principles to business process management: enhancing organizational efficiency

Agile principles, originally developed for software development, have gained significant attention and popularity due to their ability to foster flexibility, adaptability, and continuous improvement. However, these principles are not limited to software development alone and can be successfully applied to various business domains, including business process management (BPM). This article explores the application of agile principles to BPM, highlighting the benefits and challenges that organizations may encounter during the implementation process. Agile BPM involves a shift from traditional process management methodologies to a more iterative and collaborative approach. It focuses on delivering value to customers by enabling organizations to respond quickly to changing market dynamics, customer demands, and internal requirements. The core principles of agile BPM include customer-centricity, iterative management, continuous feedback and improvement, cross-functional collaboration, and empowerment of teams. By adopting agile principles in BPM, organizations can enhance their ability to identify and prioritize process improvements, reduce time-to-market, and increase customer satisfaction. Agile methodologies, such as Scrum or Kanban, provide frameworks and tools to manage work in smaller, manageable increments, allowing for faster and more frequent delivery of process improvements. This iterative approach enables organizations to respond to changing business needs and obtain early feedback, ensuring that processes are aligned with current requirements. However, implementing agile BPM is not without its challenges. It requires a cultural shift within the organization, as individuals must adapt to a more flexible and iterative mindset. Resistance to change, lack of clarity in roles and responsibilities, and inadequate training and support can hinder successful implementation. Therefore, organizations need to invest in change management initiatives, provide training and support to employees, and create an environment that encourages experimentation and continuous learning. In conclusion, applying agile principles to BPM offers organizations a way to optimize their processes, increase agility, and deliver enhanced value to customers. Successful implementation requires careful planning, stakeholder involvement, and a commitment to fostering a culture of agility and continuous improvement.

Journey Toward Digital Transformation in the Age of COVID-19

A tertiary, non-profit academic medical center in California encountered the demands of a rapidly evolving set of COVID-19-related guidelines in 2020. Several outdated structures and processes were identified as operational inefficiencies compounded by siloed manual work, lack of role clarity, and increased operation costs. Thus, the department of nursing education began identifying opportunities for digital transformation to improve operational efficiency, streamline the scope of work, improve team collaboration, and reduce operating costs. Using Kotter’s eight-step process for leading change, implementing digital transformation decreased excessive costs. This was achieved by reducing nursing professional development practitioners’ time spent on task-related work by 63%, allowing them to practice at the highest level of their scope and training. Additionally, leadership support, innovation, conformity to experiment, visibility and accessibility of work, interdepartmental collaboration, and communication transparency were key factors for the success of digital transformation.

Barriers, facilitators, and opportunities for Doctor of Nursing Practice engagement in translational research

BackgroundLittle is known about how Doctor of Nursing Practice (DNP) graduates apply translational research competencies in the practice setting. PurposeThis qualitative descriptive study aimed to explore the barriers, facilitators, and opportunities for engaging in translational research among DNPs in practice. MethodsWe conducted semi-structured interviews with 11 DNPs working within an 8-hospital health system from November 2020 through July 2021. DiscussionWe identified four themes related to barriers (invisibility of the DNP degree and skillset; lack of role clarity and organizational structure for DNPs; lack of time for engagement in translational research; lack of support for engagement in translational research), one theme related to facilitators (encouragement from colleagues and supervisors), and two themes related to opportunities (DNP education promotes recognition of nurse role in translational research; DNPs are interested in role expansion to include translational research). ConclusionDNPs have the interest and training to engage in translational research but face structural barriers to doing so.

Exploring the role of the nurse unit manager in forensic mental health inpatient units: A qualitative study.

Forensic mental health (FMH) inpatient settings are complex working environments at times due to a number of factors including the presence of challenging behaviours that may include violence and aggression, restrictions related to legislation, extended length of stay and the impact of trauma. Nurse unit managers (NUMs) play an important role in managing the unit environment and clinical standards of care to achieve better outcomes for consumers and staff. However, the role of NUMs in an FMH setting is poorly understood. The overall aim of this study was to explore the role of NUMs working within an FMH setting in Victoria, Australia. To our knowledge, this is the first study that has examined the subject. Data were collected via focus groups from n = 32 participants which included NUMs, their managers, staff who work alongside the NUMs and the staff the NUMs manage. Data were analysed using thematic analysis and four themes were interpreted from the data, (i) lack of role clarity, (ii) the importance of clinical Leadership and forensic mental health knowledge, (iii) step up in responsibility and step down in pay and (iv) seeing the difference you make. The role of the NUM within a forensic mental health setting comes with a number of challenges, but also opportunities to enact change. An ongoing effort to better support those employed within the NUM role and make the role desirable for aspiring staff is critical to the sustainability of a skilled clinical workforce and quality of care in this complex setting.

Understanding the contribution of intellectual disabilities nurses: Paper 3 of 4 - evaluation.

The overall objective of this research was to identify intellectual disability nursing interventions and their impact on the health and healthcare of people with intellectual disability. This is part 3 of a 4-part series. In this paper we report the findings from quantitative questions from an online survey of intellectual disability nurses. The objective of this part of the study was to a evaluate intellectual disability nurses' confidence in their understanding of the interventions they undertook. Quantitative data was collected using an online survey questionnaire from a voluntary response and snowball sample of 230 participants from 7 countries. Thematic, descriptive statistical, and inferential statistical analyses were undertaken. The evaluation data suggest and demonstrate a lack of clarity among intellectual disability nurses of the interventions they can effectively undertake. There appears to be correlations between lack of role clarity and the types of employer organisations and countries. Further work need to be undertaken by nurse leaders ascertain and address this lack of clarity.

The role of local government in tackling a global pandemic: A lesson from Nepal

This paper critically analyses the scope of leadership in Nepal at the local government level when tackling the wider impacts of COVID-19, with a particular focus on health service delivery in line with World Health Organisation (WHO) frameworks. In-depth interviews with 66 representatives from local governments (LG) in the Madhesh and Sudurpaschim provinces were conducted, along with analysis of routine data from health management information systems. We found that Maternal Child Health (MCH) services at local health institutions were largely unimpacted, stocks of essential medicine were available, and the LGs exhibited determination and capability in getting to grips with the crisis, despite inadequate knowledge and resources. Nevertheless, there was sizeable shrinkage in the utilisation of services, which triggered public health concerns of a different nature, the LGs were inadequately prepared in regards to the capacity and availability of human resources, and there were explicit gaps in terms of coordination among all three tiers of government and a lack of role clarity that delayed the response to the pandemic at the local level. Our recommendations include continued investment in local MCH services, capacity building for local leaders with a focus on human resource management in emergency contexts, and the simplification of public procurement processes, particularly during crises, enabling LGs and other local actors to expediate procurement and improve response times.

Competing allegiance in an unclear role: Peer and non-peer understanding of peer support in Massachusetts, United States

Lack of role clarity is a central challenge to the growth and retention of the peer workforce as peer support specialists (PSS) increasingly work alongside non-peer providers in traditional mental healthcare settings. This study examined role clarity among peer and non-peer workers and identifies areas of consensus and disagreement in understanding the peer role. Qualitative interviews were conducted with PSS (N = 18), non-peer direct care staff (N = 15), and non-peer clinical staff (N = 6) employed at two behavioral health organizations in the Northeast. Thematic analysis was conducted. Most non-peer staff have generally positive attitudes towards the inclusion of PSS in behavioral healthcare organizations, and task overlap was not indicated as problematic. Non-peer staff report and demonstrate a wide range of understanding but little clarity about the peer role, and peer staff themselves describe diverging descriptions of their own role. A consensus emerged regarding peer roles related to individual and group support, facilitating community integration, and relationship building. Key areas of disagreement include peer inclusion on clinical teams and role in service engagement. Competing peer and organizational ethos were identified as a central challenge of workplace integration. In sum, while peer tasks, roles, and responsibilities are perceived as valuable and non-overlapping with non-peer tasks, they remain ill-defined. Existing role tension is not based on task overlap but rather emerges from competing peer and organizational ethos and allegiances. Education and cultural humility among non-peer staff are critical to reducing interprofessional tension. Simultaneously, peer teams must develop cohesive peer ethos and role identity to ensure internal role clarity.

Improving Collaboration Between Youth Peer Support Workers and Non-peer Colleagues in Child and Adolescent Mental Health Services

The involvement of youth peer workers (YPSWs) in child and adolescent mental health services (CAMHS) stimulates hope, destigmatization, and more culturally and developmentally appropriate support. Nevertheless, the collaboration between YPSWs and non-peer colleagues remains challenging, as it requires services to embed a new type of expert into practice. To stimulate the involvement of YPSWs in practice, this study reports on 27 semi-structured interviews with YPSWs and non-peer colleagues to provide insight into the barriers and facilitators in the collaboration process. The study took place in the Netherlands. A total of 10 interviews with YPSWs, and 17 interviews with non-peer colleagues in different healthcare occupations in CAMHS were conducted. Overall, the participants perceived relatively more barriers compared to facilitators in the collaboration process. Barriers to operate efficiently with YPSWs in multidisciplinary teams included: condescending attitudes and professional stigma towards YPSWs; concerns for YPSW boundaries; bureaucratic and clinical language usage by non-peer colleagues; conflicts due to different sets of expertise; and, lack of role clarity and guidelines for YPSWs. To improve the partnership between YPSWs and non-peer colleagues, participants described the importance of supervision and monitoring of YPSW activities. Moreover, participants also stressed the need for clear guidelines, and introduction and evaluation sessions to facilitate the collaboration process. While YPSWs seem to be an asset to CAMHS, there are a number of barriers to overcome. To overcome these barriers, organizational commitment, supervision (especially from peer colleagues), flexibility by non-peer colleagues, training non-peer staff to support YPSWs, and consistent evaluation of the implementation of YPSWs in services is recommended.

Implementation of a Severe Maternal Morbidity Quality Review Process at a Level IV Public Hospital [ID: 1377992

INTRODUCTION: Severe maternal morbidity (SMM) is tracked by national organizations offering opportunities to evaluate, monitor, and address in near real time. Using a multidisciplinary case review committee to analyze all cases of SMM at a level IV inner-city hospital, we hypothesized that case reviews will identify opportunities for improvement in obstetric practices. METHODS: A case review was triggered for any delivery with an SMM ICD-10 code, transfusion of greater than 4 units, readmission within 48 hours of discharge, a patient safety concern by staff, or a severe adverse neonatal outcome. This cohort study included all of the case reviews of cases between 2019 and 2022. Severe maternal morbidity outcomes, demographics, and obstetric practices were analyzed. RESULTS: Of 36,671 deliveries, 296 (0.8%) met criteria and were reviewed. Of these, 80 (27%) had two or more concurrent SMM events. Postpartum hemorrhage was the most common (37%), followed by intensive care unit admission (13%) and hysterectomy (12%). After review, practices done well included interdisciplinary communication and prompt decision-making. Opportunities for improvement included inadequate access to peripartum care due to socioeconomic barriers, communication, and lack of role clarity. CONCLUSION: Social barriers, inadequate communication, and lack of role clarity were identified as the most common areas of improvement in SMM cases. These findings led to the development of an escalation of care pathway for massive transfusion protocol and vital signs thresholds at which to contact anesthesia. The implementation of a standardized SMM surveillance system results in systematic improvements in obstetric practices.

Dynamics and processes influencing role integration of advanced practice nurses and nurse navigators in oncology teams.

Exploring the persisting presence of underlying processes, dynamics, experienced barriers and facilitators of Advanced Practice Nurses (APN) in oncology and Oncology Nurse Navigators (ONN) during their role integration in an interprofessional team over a research period of seven years. A qualitative study based on the principles of Grounded Theory, in which individual semi-structured interviews and focus groups were conducted with 51 ONN and APN from 11 university and local hospitals in Belgium between 2011-2018. Data were analyzed to develop a framework that consists of different themes. ONN and APN experienced a lonely journey during role integration. They were searching for partners, medical knowledge and acknowledgement from the interprofessional team. ONN and APN had a watchful attitude and tried to make themselves visible to ensure they were involved in the team and to preserve their role and responsibilities. An unclear role description to the interprofessional team, and a lack of coaching and guidance were influencing factors in the experience of ONN and APN. ONN and APN in oncology feel difficulties to integrate their role in existing interprofessional teams. A lack of role clarity, the interprofessional team environment and a desire for coaching and guidance are influencing factors to implement APN roles. Coaching and mentorship of novice ONN/APN and their interprofessional team and healthcare managers are needed to address these issues. These findings could form the basis for a mentorship program for ONN/APN and their interprofessional team to enhance role integration.

Australian and New Zealand Nurses: Social and Emotional Attributes and Work Engagement

The COVID-19 pandemic presented significant job engagement challenges for the nursing workforce with increased pressures and workplace changes. Nursing staff shortages have increased nurse anxiety, burnout, fear, low morale and intentions to leave the profession. Nursing care is inherently stressful and at times complex, with stress often due to work inconsistencies, a lack of role clarity, workloads and time pressures. This study explores nurses job engagement, by looking specifically at nurses social-emotional attributes – Occupational Commitment, Self-efficacy Beliefs, Collective Efficacy Beliefs, Resilience, Adaptability and Emotional Labour. This protocol describes a mixed methods convergent parallel study, incorporating a survey questionnaire. The survey comprised of quantitative and qualitative questions, with data collected simultaneously, analysed separately, and integrated in the final analysis step. The survey design used validated social-emotional items, sorting and ranking questions and short answer responses. Analysis will involve individual and comparative analysis of the two participants groups, they are: Australian nurses ( n = 86) and New Zealand Nurses ( n = 275). Data collection was conducted during two different time periods – Australian pilot (2020-21) and in New Zealand (2022–2023). Recruitment involved the use of professional and personal nursing networks, newsletters and social media communications. Ethics approval was obtained through participating universities in both countries. Results will be disseminated through peer-reviewed publications, conferences, blogs, newsletters and reports to nursing networks. The study will provide valuable insights into nurses’ social-emotional attributes and the role they play in job engagement.

Delegation of Work Within a Patient-Centered Medical Home.

The aim of this study was to analyze the perceptions of core team members implementing patient-centered medical home (PCMH) within the Veterans Health Administration regarding delegation of work. Significant overlap exists in the performance of work tasks among PCMH team members (primary care providers, RNs, clinical associates, clerks), and scant literature exists on appropriate delegation within PCMH teams. This study conducted used a quantitative and qualitative analysis of 4254 respondents to a 2018 survey. Primary care providers rely heavily on team members, and nurses report being relied upon at high levels. Lack of role clarity and a perceived need for a team leader were concerns voiced by participants. Findings indicated a need for clear guidance on roles and responsibilities within the team. Patient-centered medical home team members need information about the scope of practice of each professional group to allow providers to function at the top of their scope of practice and ensure effective delegation.