Leadership, management and partnerships are pivotal for the creation and maintenance of positive learning environments. Diagnostic measurement tools can provide specific information about weaknesses across these areas. This knowledge can guide future initiatives.

This article discusses the process of building a learning culture. It began with establishing acceptance and connection with the nurse unit manager and the ward team. In the early phases of developing rapport, bullying became apparent. Because bullying undermines sharing and trust, the hallmarks of learning environments, the early intervention work assisted staff to recognize and counteract bullying behaviors. When predominantly positive relationships were restored, interactions that facilitated open communication, including asking questions and providing feedback-behaviors commensurate with learning in the workplace-were developed during regular in-service sessions. Staff participated in role-play and role modeling desired behaviors. Once staff became knowledgeable about positive learning interactions, reward and recognition strategies began to reinforce attitudes and behaviors that align with learning. Through rewards, all nurses had the opportunity to be recognized for their contribution. Nurses who excelled were invited to become champions to continue engaging the key stakeholders to further build the learning environment.

Middle management should work closely with facilitators to assist embedding practice interventions.

Nursing has a history of poor workplace contexts in which the focus has been on performing and completing tasks, rather than engaging fully with patients. Further, nursing practice is increasingly driven by bureaucratic demands and service requirements, which can result in neglect of the workplace needs of staff. This article describes how a nurse unit manager changed a poor working environment in one surgical unit by using transformational leadership techniques to address procedural employment practices and poor team relationships. With support from nurse educators in the nursing practice development unit, clinical staff engaged in a series of activities that improved their work relationships, as well as professional and clinical development.

Perspectives of cancer survivors, caregivers, and social workers as key stakeholders on the clinical management of financial toxicity (FT) are critical to identify opportunities for better FT management. Semi-structured interviews (cancer survivors, caregivers) and a focus group (social workers) were undertaken using purposive sampling at a quaternary public hospital in Australia. People with any cancer diagnosis attending the hospital were eligible. Data were analysed using inductive-deductive content analysis techniques. Twenty-two stakeholders (n = 10 cancer survivors of mixed-cancer types, n = 5 caregivers, and n = 7 social workers) participated. Key findings included: (i) genuine concern for FT of cancer survivors and caregivers shown through practical support by health care and social workers; (ii) need for clarity of role and services; (iii) importance of timely information flow; and (iv) proactive navigation as a priority. While cancer survivors and caregivers received financial assistance and support from the hospital, the lack of synchronised, shared understanding of roles and services in relation to finance between cancer survivors, caregivers, and health professionals undermined the effectiveness and consistency of these services. A proactive approach to anticipate cancer survivors’ and caregivers’ needs is recommended. Future research may develop and evaluate initiatives to manage cancer survivors and families FT experiences and outcomes.

The article 'Developing a framework for nursing handover in the emergency department: an individualised and systematic approach' is a commendable endeavour by the team in a busy emergency department in Melbourne, Australia. It is a very timely paper for staff in emergency departments in Australia given the mandate specified in the National Safety and Quality Health Service Standards states 'Health service organisations implement effective clinical handover systems' (ACSQHC 2011). These requirements are based on the compelling evidence that good communication, namely the transfer of the appropriate breadth and depth of information pertaining to patient care issues to the relevant staff, is instrumental in reducing misadventure that results in poor patient outcomes. When advocating 'effective handover', the Australian Commission on Safety and Quality in Health Care recognises that handover occurs in many different situations for many different reasons. It is therefore appropriate that teams explore the best processes for their circumstances.Handovers in emergency departments are particularly challenging, and the authors clearly acknowledge some of these difficulties. Circumstances that are common to emergency departments and generally not as common to other in-patient areas include increased unpredictability and disruptions, nurses requiring to multitask and staff attending to patients with diverse and disparate needs. Given the unique nature of emergency departments, it is commendable that the team, Klim et al. (2013), are adopting a consultative approach to systematically explore what a useful tool would look like. If new initiatives and accompanying processes are to be successfully embedded into practice, then it is essential there are mechanisms for staff to discuss and provide suggestions about the intended activity (Henderson et al. in press). The broad consultation process and opportunity for feedback is a strategic approach to maximise staff engagement. However, these systematically organised and orchestrated processes may not be considering nurses capability in the many facets required in effective handover, in particular, the highly emotively charged situations that regularly confront emergency department staff.Nurses' emotional capability to openly discuss socially 'unacceptable' diagnoses and backgrounds have been given little consideration in the logical and ordered approach to nursing handover that is being developed by the team. The situation is that nurses can feel capable attending to the physiological abnormalities or deviations that can result following volatile situations such as drug overdoses or domestic violence, yet they may not feel confident to introduce and discuss these issues with the patient in the handover process. The authors identify 'recognition and inclusion of patients and carers' are recommended in the handover process (Klim et al. 2013). However, openly raising these issues with patients and carers can result in awkward social and emotional situations. Many nurses in emergency...

It is important that investment is made to commitment and resources to all four stages before embarking on change processes.

Optimum individual and team functioning can be progressed through organizational learning. Organizational learning is facilitated through positive team interactions. However, the process of shifting and shaping team behavior is not simple. This article offers strategies to help teams modify their interactions to better engage with and learn from each other. The effectiveness of these strategies in continuing staff development is evidenced in the development of highly functioning teams.