title: Challenges confronting clinicians in acute care.
abstract: OBJECTIVE
  To engage acute care clinicians in prioritizing professional issues of concern and to help them identify and design change projects. Background In order to meet and respond to challenges and to ensure safety, efficiency and positive patient and staff outcomes, it is imperative to understand the nature of difficulties faced by health professionals and for clinicians to be included in decision making and change.
  
  
  METHODS
  A three-phase mixed-method design utilizing descriptive and interpretive approaches. Data were collected via survey, focus groups and nominal group workshops.
  
  
  RESULTS
  Communication, skill mix and work environments were identified as issues of most concern. Participants were able to identify and prioritize a range of projects to help them better understand and alleviate workplace problems.
  
  
  CONCLUSIONS
  This study highlights key directions for practice change and confirms previous findings identifying urgent need for research that aims to overcome poor communication and skill shortages. It differs from other studies by providing a platform for participants to design projects leading to solutions and participate in change.
  
  
  CONCLUSIONS
  Support must be provided for managers in rostering, staffing, and resource procurement and allocation. The results of the present study highlights a need to refocus management styles on staff empowerment, participation and team building.
authors.affiliation: Research and Practice Development, Nursing & Midwifery Centre for Practice, Opportunity and Development, Hunter New England Area Health Service, NSW, Australia. vicki.parker@hnehealth
authors.forename: Vicki
authors.initials: V
authors.lastname: Parker
authors.forename: Michelle
authors.initials: M
authors.lastname: Giles
authors.forename: Isabel
authors.initials: I
authors.lastname: Higgins
mesh_terms: D000208:Acute Disease / Q000451:nursing*; D000328:Adult; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D003659:Decision Making, Organizational; D017144:Focus Groups; D006272:Health Facility Environment / Q000458:organization & administration; D006801:Humans; D007400:Interprofessional Relations; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D009517:New South Wales; D024802:Nurse's Role; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D009936:Organizational Innovation; D010561:Personnel Staffing and Scheduling; D011361:Professional Competence; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D016526:Workload / Q000523:psychology; D017132:Workplace / Q000458:organization & administration / Q000523:psychology