An ethnographic study of the implementation and development of nurse consultant roles

The plan to implement the new role of nurse consultant across England was announced in 1998. A review of the literature highlighted there was a lack of knowledge about nurse consultants specifically and that previous implementation of new nursing roles had been problematic. This lack of knowledge underpinned the need for further exploration and led to the development of this study, the aim of which was to develop an understanding of the implementation and development of the nurse consultant role. A two stage focused ethnography was undertaken within one acute NHS hospital trust in England. The first stage involved documentary analysis and in-depth interviews with thirteen strategic stakeholders who were executive directors and senior directorate managers responsible for developing nurse consultant posts. The second stage involved: two in-depth interviews and five days of participant-observation with six nurse consultants, in-depth interviews with eleven clinical staff who worked with the nurse consultants, including medical consultants, clinical nurse specialists, ward sisters and matrons, and follow-up interviews with six of the first stage strategic stakeholders. The first stage findings identified that the factors which influenced the trust’s decision to develop nurse consultant posts were complex, with three strategic stakeholder decision making patterns emerging: realising, complying and resisting the opportunity. The interviews with strategic stakeholders also highlighted their expectations of the ‘ideal’ nurse consultant. The second stage identified a three phase ‘apprenticeship’ development process from which a model of nurse consultant preparation emerged. This model highlighted the extent to which individuals were prepared for their role. Findings which related to the ability of the nurse consultants to achieve their expectations for the role led to the development of a model of expectation realisation, which highlighted the extent to which they had achieved a sense of ‘being different’. Their ability to achieve their expectations was influenced by a range of organisational contextual and cultural factors. From the findings of the study as a whole a conceptual framework for nurse consultant transition was developed. The study findings reflected many issues reported in other studies of new nursing roles and nurse consultants. However, this study makes an important contribution to new knowledge through the development of a transitional framework which as a whole provides an understanding of the complexity of the inter-relationship of organisational and individual factors which affect new role implementation. In addition the individual models and typologies presented within the framework provide new insights into particular factors which affect successful role implementation which are useful for individuals and organisations and challenge some of the current evidence base. In particular the findings have practical implications for how decision makers analyse the readiness of the context and culture of the service for the implementation of new roles, and how they prepare their service to promote the ability of post-holders to achieve service expectations. Insight into how individuals can effectively develop the skills and knowledge required for the role provides evidence for nurses planning their careers, and importantly for organisations and education providers to provide the necessary development opportunities for individuals to attain the experience required. The findings provided new insight into nurse consultant expectations and the factors which affected their ability to realise their expectations which are helpful to individuals and organisations to plan for effective transition and successful role implementation.