Evaluating nurse consultants’ work through key informant perceptions

Abstract

This multi-site evaluative study is the result of work commissioned by a number of National Health Service (NHS) Trusts to evaluate the impact of the nurse consultant role. It explored the views of both stakeholders and nurse consultants and was conducted by Northumbria, Teesside and Bournemouth Universities and a number of their affiliated NHS Trusts. The evaluation was based on the '360 degree feedback process' and used case study methodology, inviting stakeholders or key informants, including clinical and academic colleagues, students and managers, to provide information on their work with the nurse consultants. The findings are discussed around the themes of (1) role aspirations and lived reality, (2) challenging boundaries, (3) impact and outcomes and (4) leadership. The findings concur with previous studies demonstrating a series of common themes associated with leadership, clinical expertise, research and educational activity. Importantly, these findings articulate the ways in which nurse consultants are working to develop unique services to meet patient needs.Background

Advanced nursing roles: A systematic review

“…Certain personal characteristics, such as strength, creativity, dynamics, adaptability, and empathy, appear to be distinctive for these advanced‐level practitioners. These personal characteristics, combined with broad prior experience (Wood et al ., 1996; Manley, 1997; Dawson & McEwen, 2005; Woodward et al ., 2005; Wolf & Robinson‐Smith, 2007; Manley et al ., 2008), and an education “up to or beyond the master degree level” (Appel et al ., 1996; Wood et al ., 1996; Manley, 1997; Scott, 1999; Charters et al ., 2005; Dawson & McEwen, 2005; Woodward et al ., 2005; Jinks & Chalder, 2007; Redwood et al ., 2007; Wolf & Robinson‐Smith, 2007; Dawson & Coombs, 2008; Baldwin et al ., 2009), were identified as necessities for providing the skills and knowledge needed in the APN position (Manley, 1997). In comparison to their international colleagues, Australian CNC appear to have a lower level of education, and their career development is based more on their career history (Appel et al ., 1996; Vaughan et al ., 2005; O'Baugh et al ., 2007).…”

“…Thirty‐seven articles discussed advanced clinical practice as a domain of APN. As the essence of the APN role is expert nursing practice, there appears to be unanimity about advanced clinical practice being the main or central domain of the role (McFadden & Miller, 1994; Wood et al ., 1996; Scott, 1999; Dawson & Spence, 2001; Vaughan et al ., 2005; Jinks & Chalder, 2007; Redwood et al ., 2007) comprising 23–50% of the advanced practice nurse's total working time (McFadden & Miller, 1994; Charters et al ., 2005; Darmody, 2005; Jinks & Chalder, 2007). However, Dawson and Coombs (2008) found that NC expert clinical practice has moved from high involvement to the lowest involvement in just a few years.…”

“…Although management activities have been identified in many studies as part of the APN role (Walters, 1996; Scott, 1999; Dawson & Spence, 2001; Dawson & McEwen, 2005; Woodward et al ., 2005; Dawson & Coombs, 2008), there was less enthusiasm about it being important to the APN role (i.e. Woodward et al ., 2006; Jinks & Chalder, 2007); the emphasis rather remaining on leadership aspects (Manley, 2000; Woodward et al ., 2005; Abbott, 2007; Jinks & Chalder, 2007; Redwood et al ., 2007; Manley et al ., 2008; Baldwin et al ., 2009). Advanced practice nurses are well placed to provide leadership at both strategic and clinical levels (Manley et al ., 2008), which is a key mechanism for achieving and embedding transformation in practice (Manley, 2000).…”

“…In many cases, people do not know what advanced practice nurses do (McFadden & Miller, 1994; Wood et al ., 1996; Chevalier et al ., 2006). The vague definition of the APN role (McFadden & Miller, 1994; Chalder & Nolan, 2001; Abbott, 2007) does not help to untangle the role ambiguity (Appel et al ., 1996; Scott, 1999; Blackford & Street, 2001; Charters et al ., 2005; O'Baugh et al ., 2007; Redwood et al ., 2007; O'Connor & Chapman, 2008) surrounding this profession.…”

Facilitation skills: the catalyst for increased effectiveness in consultant practice and clinical systems leadership

“…Subsequent research on consultant practice developed in parallel with the project or subsequent to it; for example: the evaluation of consultant nurse/midwife roles ( Guest et al, 2001;Lathlean & Masterson, 2004;Redwood, 2007;McIntosh and Tolson, 2008); exploration of the role's complexity (Woodward et al, 2006;Jinks and Chalder, 2007;McIntosh and Tolson, 2008); leadership (Woodward et al, 2006;Lathlean, 2007;McIntosh and Tolson, 2008;Manley et al, 2008); and the role's impact on patients and/or across organisations (Ryan et al, 2006;Redwood, 2007;Avery and Butler, 2008). No other research focused on developing the facilitation skills of consultant practitioners or supporting aspiring consultants either prior to or since the study reported here.…”