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requiring intervention that very few individuals would even think about the wider DHB structure.

The CNLs’ duties and responsibilities include, but are not limited to, retaining information about patients’ progress throughout the patient health episodes, contributing the nursing perspective of patient care to the multidisciplinary team discussion, and guiding nursing staff in clinical standards. This DHB, in parts of its provider arm, operates a patient placement system. Some CNLs oversee the placement of patients after assessing her or his available bed status and responding to requests for both arranged and urgent admissions of patients. Consequently, this particular group may organise the admitting of patients requiring acute medical intervention and those requiring pre arranged or elective intervention. A ward may well include several patients who are not connected to the designated speciality of that ward. Therefore, some CNLs need to possess a clinical portfolio that not only includes the ward speciality profile and accompanying nursing standards, but also covers the patient who may be admitted to their area outside of this designation.

These types of duties or responsibilities of the role are typically defined within a position description on which performance is measured usually on an annual basis. Most, if not all CNLs are party to a collective senior nurse agreement which determines the employment conditions. This is complemented by a position description covering general role expectations. Such a document, from within the DHB where the research was undertaken, dated 2005 shows the nature and scope of the role. At the beginning of the document the purpose of the position includes: “the primary responsibility of the Nurse Leader is to lead, guide and manage the clinical nursing team in the promotion and delivery of safe and effective patient care and outcomes” (p.2). This purpose is linked to various accountabilities, one of which is the “provision of quality, comprehensive care and ward and unit team co-ordination” (p. 2). This accountability has 14 performance measures, which include the responsibility of managing workload, monitoring nurses, managing beds and co-ordinating meetings with the multidisciplinary team and the patients’ families. Another accountability includes ensuring effective staff management and development,

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