The role and scope of the Clinical Nurse Consultant in Wentworth Area Health Service: a qualitative study

Researching the implementation of pioneering roles in nursing and midwifery

This paper presents research on the implementation of pioneering roles in nursing and midwifery in the United Kingdom—namely lecturer practitioners, consultant nurses and nurse registrars. It seeks to critique the empirical insights gained from studying new roles aimed at better integrating distinct aspects of nursing and midwifery, at solving long-standing ‘problems’ in nursing and midwifery, at extending traditional roles and at improving and advancing practice, education and research.

The paper draws upon knowledge derived from three empirical projects—an ethnographic study and survey of the role of lecturer practitioners, conducted in one setting in the UK (Lathlean, 1997), a study of the role of consultant nurses within healthcare Trusts (Lathlean and Masterson, 2004) and an action-based evaluation of an innovative work based pilot training programme for the development of nurse registrars as aspiring consultant nurses (Surridge and Lathlean, 2006). The paper sets these within the context of an extensive literature on lecturer practitioners and consultant nurses, and encompasses both a national and international perspective through the inclusion of UK, North American and Australian experiences.

The theoretical understandings gleaned from these studies include the apparent inevitability of certain challenges in new roles such as role ambiguity and role overload, the need for organisational commitment to establish and sustain such roles, the variability of roles and the uncertainty as to the achievements of these posts or, at the very least, the extent to which these achievements can be measured. Conclusions drawn include the value of longitudinal studies over short-term cross-sectional research, incorporating approaches that reflect the diversity of the roles; the complexity of ascertaining role impact; and the value of undertaking a qualitative meta-analysis or meta-ethnography of existing studies.

The role of a clinical nurse consultant in an Australian Health District: a quantitative survey

Background

This study replicates previous research undertaken in 2013 that explored the role of the Clinical Nurse Consultant in a metropolitan health district in Sydney, Australia.

Methods

A descriptive survey, using Likert scales, was used to collect data from Clinical Nurse Consultants.

Results

Clinical Nurse Consultants are well informed about the domains and functions of their role, as stipulated in the relevant award. They identified clinical service and consultancy as the area in which they predominantly practice.

Conclusion

Despite the clarity of the domains and functions as outlined in the relevant legislated award, the activities undertaken by these clinical nurses are institutionally, individually and contextually constructed.

Developing a culture to facilitate research capacity building for clinical nurse consultants in generalist paediatric practice

This paper reports a research capacity building exercise with a group of CNCs practicing in the speciality of paediatrics in New South Wales (NSW), Australia. It explores the first step in building a research culture, through identifying the research priorities of members of the NSW Child Health Networks Paediatric Clinical Nurse Consultant group, and this forms the major focus of this paper. A nominal group technique (NGT) was utilised with sixteen members to identify research topics for investigation which were considered a priority for improving children's health care. The group reviewed and prioritised 43 research topics in children's health which were identified in the literature. As a result of conducting this research prioritisation exercise, the group chose two research topics to investigate: reasons for children representing to the Emergency Department and a comparison of the use of high-flow and low-flow nasal prongs in children with bronchiolitis. The research team will continue to mentor the nurses throughout their research projects which resulted from the NGT. One bridge to leadership development in enhancing patient care is translating knowledge to practice and policy development. This study leads the way for a group of CNCs in paediatric nursing to combine their research capacity and influence clinical knowledge.

Advanced nursing roles: a systematic review

In this systematic literature review, we analyzed and synthesized the literature on one specialized advance practice nursing role in three countries for the purpose of describing and comparing these roles, as well as discussing whether an international consensus of the advance practice nursing definition is possible. A systematic search on CINAHL and PubMed Medline was conducted in 2011 to search the literature on the nurse consultant in the UK, the clinical nurse specialist in the USA, and the clinical nurse consultant in Australia. The studies (n = 42) were analyzed and combined using qualitative content analysis method. The roles of the nurse consultant, clinical nurse specialist, and clinical nurse consultant were similar. The variation in the roles appears to derive from organizational or individual choices, not the country in question. The study process comprised a synthesized representation of one specialized advance practice nursing role. More work is needed to further define the concept of the advance practice nursing, as well as its implementation on other cultures beyond this review. Based on this review, an international consensus regarding the definition of advance practice nursing and its subroles is possible.

Development of a tool to describe the role of the clinical nurse consultant in Australia

AIMS AND OBJECTIVES

To develop a tool for defining and measuring the role characteristics and responsibilities of an advanced practice nursing role in Australia.

BACKGROUND

Internationally, there is considerable confusion about the precise role responsibilities of advanced practice nursing positions. In Australia, the clinical nurse consultant is an advanced practice role with five nominated domains of practice. However, there are no tools for measuring the performance of clinical nurse consultants against the listed domains.

DESIGN AND METHODS

Participants were 56 clinical nurse consultants at a tertiary public hospital. The existing literature, an online survey, and position descriptions were used to generate the a priori themes for the initial template. Semi-structured interviews were conducted (in 2010) to test the template characteristics. The template underwent multiple iterations in its development.

RESULTS

A 50-item tool was devised, which consisted of five domains with a ten-point hierarchical scale within each domain. In preliminary testing, the revised template was found to provide greater clarity regarding roles and grades than the original position descriptions.

CONCLUSIONS

Further testing and refinement of the modified rating scale is needed, but it offers the possibility of a new tool that can be used by health service managers to determine the grade of a clinical nurse consultant position and for evaluating role performance.

RELEVANCE TO CLINICAL PRACTICE

This preliminary study suggests that the tool provides a useful means of measuring advanced nursing practice and responsibilities across different domains and levels of appointment. The tool may be able to be adapted for use with other advanced practice nursing roles both within Australia and internationally.

What is a nurse? Is there an international consensus?

BACKGROUND

Historical experience and health service modernization partly account for the variation seen in definitions of what a 'nurse' is from country to country. It is unclear if international disparities in nursing provision, apparent in health data for developed countries, demonstrate real differences in staffing patterns or simply reflect the wide variations in understanding and use of terms for different categories of nurse.

AIM

This paper is an opinion piece of international interest discussing the need for standardization in definitions of different categories of nurse internationally.

DISCUSSION

The International Council for Nurses (ICN), the World Health Organization and the Organisation for Economic Cooperation and Development (OECD) all have different ways of defining a nurse. The wide variation in terms is particularly apparent from OECD countries however, where nursing density data present wide disparities, not readily accounted for by gross national product. Skill mix and clinical role developments may account for these better.

CONCLUSION

Until proper consensus is reached on what a nurse is and does, any skill mix or clinical role developments will only have limited international relevance, especially in OECD countries. If nursing qualifications are to be valid even across the European Union, then recommended standards such as those of the ICN, must be specified in terms of what different categories of nurses actually can do, and their responsibilities and roles within that scope of practice. Standardization of definitions of categories of nurse internationally should reduce confusion and promote better understanding of patterns of nurse staffing and the effect these may have on patient outcomes.

The experience of being an advanced practice nurse in Australian acute care settings: A systematic review of qualitative evidence

BACKGROUND

There is a vast amount of international literature which, although agreeing on the need for advanced practice nurse roles, simultaneously debates and discusses the difficulties with nomenclature, definition and subsequent implementation of such roles. Due to this ambiguity it is difficult to equally compare evidence in this field across different countries. A context-specific systematic review on the qualitative evidence of the experience of being an advanced practice nurse in Australia has not been undertaken previously, however it is imperative for nursing managers and leaders to understand the complexities of advanced nursing roles in order to effectively utilise and retain these experienced and valuable nurses. With the creation of a national nursing regulating authority in 2010, it is timely to explore in-depth the experience of being an advanced practice nurse from a national perspective.

OBJECTIVE

To identify the experience of being an advanced practice nurse working in Australian acute care settings.

INCLUSION CRITERIA

Registered nurses working in advanced practice roles in acute care settings throughout Australia.The experience of being an advanced practice registered nurse working in an Australian acute care setting, as reported by the nurses themselves.Interpretive qualitative studies including designs such as phenomenology, grounded theory and ethnography.

SEARCH STRATEGY

A three step search strategy was used to identify published and unpublished studies. The search process was conducted from August to October 2011 and considered published and unpublished studies from 1990 to October 2011.

METHODOLOGICAL QUALITY

Studies were appraised for methodological quality by two independent reviewers using the Joanna Briggs Qualitative Assessment and Review Instrument.

DATA EXTRACTION

Data was extracted from the papers included in the review using the standardised Joanna Briggs Institute Qualitative Assessment and Review Instrument data extraction tool.

DATA SYNTHESIS

Research findings were pooled using the Joanna Briggs Institute Qualitative Data and Review Instrument.

RESULTS

Three published studies and one unpublished dissertation were included in the review. From these four studies, 216 findings were extracted, forming 18 categories which were then analysed to create six synthesised findings. Six meta-syntheses under the headings of expert knowledge, confidence, education, relationships, negative experiences and patient centred experience were formed from the findings.

CONCLUSIONS

The synthesised findings confirm that the experience of advanced practice nurses in Australian acute care settings is complex and greatly influenced personally and professionally by the organisation as well as the unpredictable nature of working with people.

IMPLICATIONS FOR PRACTICE

A deeper understanding of the essence of being an advanced practice nurse may be of benefit for recruitment and retention planning. Health care organisations must also be aware of the impact they have on the nurse's experience if they are to commit to retention of nurses and to patient safety.

IMPLICATIONS FOR RESEARCH

If the topic of advanced practice is to remain current in the Australian nursing profession then ongoing research must be conducted to identify if the title is being used more frequently within the nursing research. Nurses must be supported in publishing quality research if they are to improve articulation of their experiences.

Clinical nurse research consultant: a clinical and academic role to advance practice and the discipline of nursing

AIMS

This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role.

BACKGROUND

Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians.

DATA SOURCES

International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant.

DISCUSSION

The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus.

IMPLICATIONS FOR NURSING

Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support.

CONCLUSION

The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing.