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PERSPECTIVE
Using the Nominal Group Technique to
determine a nursing framework for a forensic
mental health service: A discussion paper
Tessa Maguire,
1,2
Loretta Garvey,
3
Jo Ryan,
1,2
Michael Olasoji
4
and
Georgina Willets
5
1
Centre for Forensic Behavioural Science, Swinburne University of Technology,
2
The Victorian Institute of Forensic
Mental Health (Forensicare),
3
Department of Nursing & Allied Health, School of Health Sciences, Swinburne
University of Technology,
4
School of Health and Biomedical Sciences, RMIT University, and
5
School of Health,
Federation University Australia, Melbourne, Australia
ABSTRACT: The Nominal Group Technique is a method used to explore issues, generate ideas,
and reach consensus on a topic. The Nominal Group Technique includes individual and group
work and is designed to ensure participants have the same opportunity to engage and provide
their opinions. While the technique has been used for around six decades to assist groups, in
industry, and government organizations to examine issues and make decisions, this technique has
received limited attention in nursing research, particularly in mental health. This discussion paper
describes the use of a modified Nominal Group Technique for a study designed to determine a
nursing decision-making framework for a state-wide forensic mental health service. Modifications
were made to the traditional technique, to enable participants to make an informed and collective
decision about a suitable framework for the novice to expert nurses, across secure inpatient,
prison, and community forensic mental health settings. The Nominal Group Technique generated
rich data and offered a structured approach to the process. We argue that the Nominal Group
Technique offers an exciting and interactive method for nursing research and can increase
opportunity for minority group members to participate. This technique also offers a time efficient
way to engage busy clinical nurses to participate in research, with the advantage of members
knowing the decision on the day of the group. Consideration, however, needs to be given to the
duration and effect on participant concentration, and if not actively managed by facilitators, the
possible emergence of group dynamics affecting individuals’ decisions.
KEY WORDS: forensic mental health nursing, clinical reasoning, forensic psychiatric nursing,
mental health nursing, Nominal Group Technique.
Correspondence: Tessa Maguire, Centre for Forensic Behavioural Science, Level 1, 582 Heidelberg Road, Alphington Victoria Australia.
Email: tjmaguire@swin.edu.au
Declaration of interest: The authors report no conflict of interest.
Authorship statement: All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of
Medical Journal Editors, and all authors are in agreement with the manuscript.
Tessa Maguire, RN, BN, PGDip FBS, PGDip FMHN, MMentHlthSc, PhD.
Loretta Garvey, RN, BN (Hons), GCHPE, PhD.
Jo Ryan, RN, BEd, PGCert VRAM.
Michael Olasoji, RN, BN (Hons), PGDip MHN, PhD.
Georgina Willets, RN, RM, MEd, DEd.
Accepted May 03 2022.
©2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which
permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no
modifications or adaptations are made.
International Journal of Mental Health Nursing (2022) 31, 1030–1038 doi: 10.1111/inm.13023
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AIMS
Different research techniques can be employed to
explore opinions from a group of participants to ulti-
mately achieve consensus (e.g. the Delphi technique,
the consensus development conference and the Nomi-
nal Group Technique, see Søndergaard et al.2018).
The Delphi technique is one such method that has
been used more often in social sciences (Keeney
et al.2001), than perhaps nursing research. Delphi
studies are designed to engage participants in a staged
approach, with several Delphi rounds, where each
round builds on results from previous rounds, as par-
ticipants work towards achieving consensus (Maguire
et al.2022; McKenna 1994). One of the important
aspects of this process includes Delphi members mak-
ing their decisions independently from others in the
group (Jorm 2015), and for this reason, Delphi mem-
bers identities are not known among the group.
There are, however, other methods such as the Nomi-
nal Group Technique that can be used to inform nursing
education, as a method of extracting the collective
knowledge of a group (Foth et al.2016). The Nominal
Group Technique is a method that uses structure, to
conduct a small group face to-face discussion to integrate
viewpoints and opinions of a group of knowledgeable
participants, to gain consensus on a topic of interest
(Parthasarathy & Sharma 2014). The Nominal Group
Technique has been around for the last 16 years, used to
assist groups, the industry sector and government organi-
zations to analyse issues and make decisions (Cooper
et al.2020; Fink et al.1984; Van de Ven 1974). More
recently, it has been used in health care settings and gen-
eral nursing, however, has received less attention in
mental health nursing research (Cheevakasemsook
et al.2006; Cooper et al.2020; Harvey & Holmes 2012).
This discussion paper describes the use of a modi-
fied Nominal Group Technique, to enable a service to
select a suitable mental health nursing framework to
guide clinical practice. We provide an account of a
recent research project undertaken with a forensic
mental health service where the Nominal Group Tech-
nique was used to explore two nursing frameworks to
allow the nurses to select the most suitable framework
for their practice. We consider some of the advantages
and considerations when using this method in nursing
research. We hope that our learnings from this project
will provide valuable insight for other nurse researchers
who might be considering using this technique by
offering some practical suggestions.
BACKGROUND
Forensic mental health nursing is a subspecialty of
mental health nursing, where nurses will work in a
variety of forensic mental health and criminal justice
settings (Maguire & McKenna 2020). Forensic mental
health nurses work with consumers who have needs
related to offending behaviour, as well as a range of
mental health, physical, social, cultural, and risk related
needs (McKenna et al.2017). It is crucial that nurses
working in forensic settings can define their unique
knowledge and skills, recognize their role within the
multidisciplinary team, and identify their contribution
to assessment, treatment, and intervention (Martin
et al.2012). Having a framework to guide practice and
decision-making can assist in directing and defining the
nursing contribution to care.
In the state of Victoria, Australian Forensicare is
the state-wide service for forensic mental health care.
The service delivers a range of mental health pro-
grams across prison services, the community, and a
secure inpatient hospital for consumers, with different
needs at different stages of their recovery journey. In
recent years, the service has seen rapid expansion
resulting in the nursing workforce, increasing from
around 200 to over 500 in approximately 3 years (Vic-
torian Public Sector Commission 2020). Nurses work-
ing in this setting need the skills and knowledge
common to all mental health nurses, in addition to a
unique set of skills, knowledge, and attitudes to work
effectively with forensic mental health consumers.
These unique requirements are defined in the Foren-
sic Mental Health Nursing Standards of Practice,
often referred to as the ‘Standards of Practice’ (Mar-
tin et al.2012).
The nursing framework suggested in the Standards
of Practice and taught in graduate training at the ser-
vice is the Nursing Process (Younas 2017). The Nurs-
ing Process includes the following steps: assessment,
diagnosis, planning, implementation, and evaluation.
While the Nursing Process has been used since the
1980s as a guide for providing consumer care across a
range of settings (Jones 2020), there have been more
recent frameworks developed to guide nursing care,
such as the Clinical Reasoning Cycle (Levett-
Jones 2017). Furthermore, the Nursing Process while
providing a simple framework, has been criticized for
being too nursing focused, and not necessarily captur-
ing features of care provided in complex settings, such
as forensic mental health. Concern has also been
©2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
USING THE NOMINAL GROUP TECHNIQUE 1031
expressed that the Nursing Process does not necessarily
focus on patient-centred care (Maguire et al.2022).
In Australia, several universities have moved away
from teaching the Nursing Process in favour of the Clini-
cal Reasoning Cycle. The Clinical Reasoning Cycle has
eight phases: consider the consumer and the situation,
collect cues and information, identify issues and prob-
lems, establish goals, take action, evaluate outcomes, and
reflect on the process (Levett-Jones 2017). With an
impending review of the Standards of Practice by the
senior forensic mental health nursing group, and the
knowledge that many of the graduate nurses entering
the workforce were being taught the Clinical Reasoning
Cycle, the senior nursing group considered it timely to
explore the Nursing Process and the Clinical Reasoning
Cycle frameworks, to determine the most suitable frame-
work for nurses working across all settings in the service.
DESIGN
This paper describes how the research team modified
the traditional Nominal Group Technique to explore
the most suitable nursing framework for the nurses
across Forensicare, where the Clinical Reasoning Cycle
was selected by the participants in this study (see
Maguire et al.2022). We outline the modifications, the
process, and data collection. We also provide reflec-
tions about use of this technique along with considera-
tions that may enhance future use of this technique for
nursing research.
METHODS
The Nominal Group Technique
The Nominal Group Technique includes individual and
group work (Vander Laenen 2015), and is intended to
provide all participants with the same opportunity to
engage and participate during the group (Pokorny
et al.1988). A traditional Nominal Group Technique is
comprised of four mains steps (see table 1). While the
number of participants can vary, traditional groups
have around four to seven participants, but may have
up to ten (Fox 1989; Olsen 2019; Roth et al.1995).
Suitable participants include people who have the rele-
vant experience and knowledge in relation to the issues
being explored (Cooper et al.2020; Sanders 2008).
The Nominal Group Technique has been used for
defining, developing, and assessing nursing competen-
cies; curriculum development or renewal; and develop-
ing assessment tools (Fisler et al.2019). In
determining an appropriate nursing framework for the
service, we identified that the framework needed to be
applicable from the novice to expert nurse, and across
all settings (secure inpatient, prisons, and community).
The Nominal Group Technique was considered suit-
able to enable equal opportunity for a broad represen-
tation of participants to come to a final decision on
which nursing framework was most appropriate to their
working context. For these reasons, the key stakehold-
ers invited to undertake the Nominal Group Technique
were nurses from all settings, and with a range of clini-
cal, operational, and educational expertise.
Further considerations for the use of the Nominal
Group Technique over other data collection methods
included the need for an in-depth inquiry into the cur-
rent nursing issues across the service that may enhance
or hinder implementation of any selected framework.
As suggested by Olsen (2019), the Nominal Group
Technique can assist in highlighting issues and con-
cerns that may not have been previously identified.
The collaborative features of a Nominal Group Tech-
nique can enhance ownership of the issue under inves-
tigation, which may then increase the likelihood of
shifting clinical practice and policy (Harvey &
Holmes 2012; Vella et al.2000). In this study, it was
considered extremely important to involve the very
nurses that were going to be directly affected by the
framework, and who would be in positions to lead and
champion change.
Modification of the traditional Nominal Group
Technique
We modified the Nominal Group Technique in two ways.
The first modification was the inclusion of education on
the frameworks. Participants were sent a document that
TABLE 1 Components of a traditional Nominal Group
Step Components
1 Silent generation of ideas: Participants list individually and
without engaging in any form of discussion, their own
ideas on each of the questions contained in the NGT
guide
2 Round robin: Recording ideas, where there is a round robin
and each participant presents their ideas. This process is
repeated until all questions on the NGT guide have been
answered. All ideas are displayed or documented so all
participants can see them
3 Clarification: A structured discussion of the ideas from the
participants
4 Voting: Each participant privately votes, and the group’s views
are assessed
©2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
1032 T. MAGUIRE ET AL.
provided an introduction to the Nursing Process and the
Clinical Reasoning Cycle 1 week prior to the group dis-
cussion and were asked to familiarize themselves with the
content. On the day, the group began with a presentation
by a nurse academic with content expertise on both
frameworks and included opportunities to ask questions
and seek clarification. This modification was instigated to
ensure all participants understood the Nursing Process
and the Clinical Reasoning Cycle, so they were able to
make informed choices about application and suitability.
There was also an acknowledgement that most nurses
who have been practicing for more than 5 years were
more likely to have been trained in the Nursing Process,
and, therefore, it was considered important to provide
background to both options to avoid any potential bias.
The modification of including education was also consid-
ered important to ensure there was no perceived bias
from the researchers regarding a preferred framework
for use by the service.
The second modification was in the number of partic-
ipants included in the group. As mentioned previously,
Nominal Groups may have up to 10 participants. Rather
than running a series of Nominal Groups, over multiple
weeks, the preferred approach was to conduct the one
group, include all willing participants, and ensure repre-
sentation from across the service. To effectively run a
Nominal Group with larger numbers of participants, the
group commenced together with a total of 17 partici-
pants, as one large group for the education on nursing
frameworks. Following the presentation, the large group
was then split into two groups (one group of eight and
one group of nine), to run through silent generation of
ideas, sharing of ideas, and group discussion. Both
groups then re-joined and provided a summary of their
group discussion before members voted privately. The
total time of the Nominal Group Technique was 4 h
including scheduled breaks.
Participation on the day of the Nominal Group
Technique
Nurses who agreed to participate varied in skill level
with representation from lowest-to-highest nursing
grade, including senior clinicians, a graduate nurse,
nurses in operational and management positions, as
well as nurses relatively new to clinical nurse educa-
tion. This maximized diverse representation of nursing
practices and contexts from across the service ensuring
the results from the research aligned with the key
stakeholders’ goals for practice delivery. All participants
regardless of their contexts had a joint interest to
develop nursing skills and practices, and to identify an
appropriate supporting framework. As stated by Bailey
and Lumpkin (2021, p. 1) “stakeholder theory holds
that stakeholders with joint interests create new value
when they interact”. It was also considered important
to ascertain the drivers for engagement of the partici-
pants, this was seen to create a further opportunity to
establish the need for change and how and why this
might occur (Bailey & Lumpkin 2021).
The processes of Nominal Group Technique afforded
equal representation of participants to reach a consen-
sual final agreement on which framework was most
appropriate to their working context. Enabling equal
participation among members, along with the Nominal
Group Technique process assisted in reducing group
dynamics and influences of social power (Aspinal
et al.2006; Pokorny et al.1988; Vander Laenen 2015).
This technique was seen to be a particularly suitable
method in which the nurses could participate equally
whilst limiting the impact of group dynamics and the
influence of more senior participants may have on others
in the group. It was important that all participants be
provided the opportunity to equally voice their ideas,
especially when including graduate and junior nurses,
who may not always have the confidence to speak up in a
large group with senior nurses. The built in stages of the
Nominal Group Technique can assist to increase partici-
pation of the minority, by affording equal voting oppor-
tunities to generate data (Vander Laenen 2015).
Data collection
There were several modes used to collect data includ-
ing post-it notes from the generation of ideas, audio
recordings, and facilitator field notes. Within the two
groups, there were two facilitators; one facilitator took
field notes whilst the other presented the questions
and managed the group. The presenter facilitator posed
several questions (see Table 2), after each question,
each participant wrote their ideas on post it notes and
stuck these up on a whiteboard. We limited this pro-
cess to one idea for each post it however, participants
could generate as many ideas as they wanted, resulting
in many post-it notes from each participant for each
question. During this period, there was no conversation
rather silent generation of ideas. At the end of the
questions, once everyone was satisfied they had
exhausted the generation of ideas, the facilitators, and
group members themed the post it notes. The theming
of ideas was a collaborative and iterative process that
again enabled all to participate, for a more detailed
©2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
USING THE NOMINAL GROUP TECHNIQUE 1033
description of the data collection methods please see
Maguire et al.2022).
The method chosen allowed for group discussion,
clarification, and the sharing of experiences in using
the frameworks, past enablers, and dis-enablers of
using a nursing framework. These discussions were
audio recorded and field notes were documented by
one of the facilitators in each group. Finally, the larger
group reformed where the two groups came back
together and themes from each group were presented
and further discussion and generation and refining of
themes occurred. Again, this was audio taped and sup-
ported with documented field notes.
The audio recording continued until the session
ended, ensuring individual responses and group discus-
sion were captured. All participants written responses
to the silent generation of ideas were also collected
and transcribed, along with field notes. The collection
of multiple forms of data assisted in the interpretation
of the data and allowed for an in-depth analysis. The
recordings were then analysed using thematic analysis
to capture the richness of the dialogue that occurred
during both the group discussions of the theming of
the post it notes and then the further conversations
that occurred during the larger group discussion.
Opportunities afforded by the Nominal Group
Technique
The Nominal Group Technique was appealing as a
method to reach consensus on a suitable nursing
framework for novice to expert forensic mental health
nurses working across the varied service settings. The
flexibility and capacity to make necessary modifications
to the Nominal Group Technique was particularly
applicable to the research objectives, which has also
been noted by other researchers as advantageous
(Cooper et al.2020; Søndergaard et al.2018). In a ser-
vice that is spread across a large geographical area, and
where participation in this type of research takes clini-
cians away from direct consumer care, an important
consideration was the ability to limit the required time
to participate. The method allowed for a time-efficient
collection of data as noted by other studies using the
Nominal Group Technique (see Harvey &
Holmes 2012; Potter et al.2004), and allows the collec-
tion of a considerable amount of data in a short time-
frame (Harvey & Holmes 2012).
Another attractive feature of the Nominal Group
Technique is that once the voting is completed, the
results are known to the members of the group and
researchers as soon as the votes are counted (Cunning-
ham 2017). As noted by Cooper et al.(2020), knowing
the outcome can provide participants with a sense of
achievement, and in our study afforded the opportunity
to have subsequent fruitful discussion about potential
implementation of the selected framework.
The Nominal Group Technique also highlighted a
range of inherent challenges for nurses at the service
that perhaps would not have come to surface if another
method was employed. Having nurses from across the
service together in one room, allowed the exploration
TABLE 2 Questions for the Nominal Group
Questions for small groups Questions for the large group
After seeing the presentation write down your thoughts about the NP Do you think anything might need to be adjusted/added to the CRC
for it to be effective in forensic mental health nursing practice?
After seeing the presentation on the CRC, write down your thoughts
about the CRC
What strategies and processes do you think would need to be in
place for the adoption of the CRC across Forensicare?
Write down your and thoughts about use of the NP in a forensic mental
health setting
What would be the challenges to introducing the CRC into your
clinical area, if this was to be the preferred framework?
Write down your and thoughts about use of the CRC in a forensic
mental health setting.
What would assist implementation and embedding the CRC?
Can you identify what is currently working in relation to nursing
consumer care in the existing framework?
Can you identify the areas of concern in nursing patient care in the
existing framework?
Write down any advantages and disadvantages (if you identify any) for
forensic mental health nursing in continuing to use the NP across
Forensicare
Write down any advantages and disadvantages (if you identify any) for
forensic mental health nursing adopting the CRC across Forensicare.
Abbreviations: CRC, Clinical Reasoning Cycle; NP, Nursing Process.
©2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
1034 T. MAGUIRE ET AL.
of key challenges to everyday practice and dedicated
time to focus on and discuss nursing care. In practice,
these types of discussions may not occur frequently,
especially when some forensic mental health nurses
may experience professional isolation, for example,
nurses working in custodial and prison settings, where
they may be the only nurse working with a range of
other disciplines and criminal justice and correctional
staff (Martin et al. 2013).
Inherent challenges associated with the Nominal
Group Technique
It is important to highlight some of the challenges
encountered with the modification of the Nominal
Group Technique. Specifically, having a large group
made the discussion more complex to keep on track,
and there was potential for participants to dominate
conversation (Cooper et al.2020; Foth et al.2016). As
always in any group situation, there can be members
who will tend to be more vocal. While this was not an
identified issue in the smaller groups, there was notably
fewer participants contributing to the larger group dis-
cussion about implementation after voting was com-
plete. More junior nurses, or lower grade nurses may
have found the larger group to be somewhat con-
fronting, and perhaps less likely to contribute.
Another issue is that feedback given in the Nominal
Group Technique is not anonymous (Cooper et al.
2020; Ives et al.2013) and this may have the potential
to constrain discussion due to fear of peer group or
facilitator disapproval. While this was only an issue
after the group had voted on a preferred framework, to
avoid such issues occurring before voting, it would be
important for facilitators to intervene to ensure less
confident participants are involved, and that dominant
participants do not skew the conversation and influence
the voting (Ives et al.2013). It is worth noting however
that while a larger group may result in some people
participating less, the silent generation of ideas, which
are incorporated into the thematic analysis, ensures all
participants opinions and voices are heard. While this
was not identified as an issue in our experience, if not
checked, may be an issue if running am unmodified
Nominal Group with a larger number of participants.
Time taken to participate in a Nominal Group can
also be an impediment, and Cooper et al.(2020) sug-
gests that the extensive time required for the group
discussion may result in participants either losing inter-
est or struggling with concentration. While care was
taken to build in breaks, during the silent generation of
ideas phase, which required the nurses to write
responses to six questions and involved concentration
and reflection, both groups took an unplanned break.
Therefore, there is a need to consider the time taken
to complete the silent generation of ideas, to avoid par-
ticipants losing interest or having difficulty concentrat-
ing (Cooper et al.2020). As noted by
Cunningham (2017), only a limited number of issues
can be focused on during the Nominal Group.
Recommendations for future use of the Nominal
Group Technique
The Nominal Group Technique generates rich data,
not only from the discussions that occur in the group,
but also from the silent generation of ideas where par-
ticipants write down their responses to the questions.
Data collection includes the audio-recording, and the
collection of notes from participants. In our study,
while we were able to assign a unique identifier to par-
ticipants during the discussion sections, we were not
able to do this with the written responses. For this rea-
son, the written responses can only be attributed to the
group number (e.g. group one or group two) rather
than individual participants. While being able to link
written statements to participants was not seen as nec-
essary in our study, depending on the topic of interest,
the ability to identify participant’s comments of both
verbal and written nature may be necessary, or helpful.
Consideration could be given to the allocation of a par-
ticipant number for the purpose of the written infor-
mation collected during the group (which is then
assigned a different unique identifier to protect anon-
ymity for the purpose of reporting).
All participants were considered experts and as
White (2011) identified expert opinions can be quite
divergent. Therefore, it was important that the facilita-
tors were person-centred and able to understand and
navigate the dynamic processes of facilitation. This
dynamic process included an understanding of the
complexities of the Nominal Group Technique as a
dynamic entity and not a linear process. (Shaw
et al.2010). The facilitators were therefore chosen with
a diverse set of skills. All were experienced researchers;
one was a forensic mental health nurse researcher; one
was a mental health nurse researcher and two were
nurse academics with expertise in facilitation, but not
from a mental health or forensic mental health nursing
background, this also enable objective observation. The
facilitators were paired together with one mental health
nurse academic and one nurse academic, this ensured
©2022 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.
USING THE NOMINAL GROUP TECHNIQUE 1035
there was content expertise, an objective lens as well as
the ability to manage complex group facilitation.
Cooper et al.(2020) suggested that results from
Nominal Group need to be substantiated by others and
suggests this could be done by presenting the results
with additional participants or running a parallel study
to draw comparisons. Dividing the larger group into
two smaller groups, allowed the smaller groups to
explore the questions, but subsequently for findings
from each group to be compared. This was a time-
efficient method, as this was done on the day; however,
there is merit to having a different group of partici-
pants to undertake this task for additional rigour. It
may be helpful for others embarking on similar work to
consider how the findings may be verified by others.
In the preperation of reports or manuscripts where
the NGT has been used, the scientific write-up needs
to clearly articulate the steps taken in the NGT and
ensure participants and/or groups can be clearly distin-
guished from each other in both verbal and written
responses.
CONCLUSIONS
By using a Nominal Group Technique, nurses working
across a large forensic mental health service, with vary-
ing practice locations, were able to convey their views
and determine the most suitable nursing framework,
using the structured process afforded by this method.
Modifications made to the Nominal Group Technique
allowed for the provision of education, to ensure all
participants had a consistent fundamental understand-
ing of the frameworks. Splitting the participants into
smaller groups also encouraged focused exploration of
the issues, while allowing for comparison between
groups. The Nominal Group Technique is also a time-
efficient research method of exploring issues, with the
added advantage of the participants and researchers
knowing the result at the end of the group.
While there are several advantages, this technique
does require attention to facilitation of the group, to
limit negative group dynamics, and ensure equal partic-
ipation. The collection of written answers to questions
may also require a method of linking these answers to
individual verbal responses. Overall, the Nominal
Group Technique provided a suitable structure to
explore nursing practice and select a framework,
involving the very group of nurses that will be key to
implementation, and role modelling best practice in
the future. The modified Nominal Group Technique
was determined to have high utility, in determining a
consensus decision in the forensic mental health setting
for busy nurses. We recommend this technique as an
appropriate and robust methods of research for similar
settings and research questions.
RELEVANCE FOR CLINICAL PRACTICE
Increasing complexity of consumer care across all set-
tings in nursing creates workload challenges (Udod
et al.2021). While the clinical reality is that competing
demands can make participation in research challeng-
ing, the Nominal Group Technique may be a suitable
method for similar health care settings that service
large geographic areas, and where taking busy clini-
cians away from the clinical setting requires efficient
use of their time. Furthermore, while it does require
planning and support from the organization to conduct
such research, there are clear advantages in including
the nurses on the ground in decision making and gov-
ernance, to enhance ownership and buy in, and
improve health leadership through inclusive decision
making and change management.
FUNDING STATEMENT
The authors received no financial support for the
research, authorship, and/or publication of this article.
ACKNOWLEDGEMENT
Open access publishing facilitated by Swinburne Uni-
versity of Technology, as part of the Wiley - Swinburne
University of Technology agreement via the Council of
Australian University Librarians.
DATA AVAILABILITY STATEMENT
Data sharing not applicable to this article as no data-
sets were generated or analysed during the current
study.
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