Menu:
Background
The NHS Plan (DH 2000) outlined the UK government’s modernisation agenda for the NHS. Included within the plan was a commitment to invest in new clinical leadership roles in the form of nurse consultant posts. Nurse consultants were introduced into the NHS in England in 2000 and were intended to achieve better outcomes for patients by improving quality and services, influencing the practice of other health care professionals with whom they work, and providing an alternative career pathway for experienced practitioners to remain in clinical practice rather than move into management to progress their career (HSC 1999/217).
At the start of out study in 2009, little research had been undertaken examining these innovative roles that clearly demonstrated the contribution that nurse consultants make to improving patient outcomes or their impact on professional outcomes. Such knowledge was needed to help nurse consultants to improve the quality of the care they provide and to deliver more effective care, to demonstrate how and in what ways these roles 'add value' to care, for effective workforce planning, and to inform the educational preparation and support of nurses taking up these leadership roles.
An earlier study undertaken by members of the research team (Gerrish et al 2007) examined the contribution that nurses in advanced practice roles, including nurse consultants, made to empowering front-line staff to deliver evidence-based care. The study drew similar conclusions to an initial evaluation of nurse consultant roles (Guest et al 2004), namely that the impact of nurse consultants is multi-faceted and is inherently hard to capture. This is due to a number of factors including the diversity and complexity of the roles, the difficulty of attributing changes in outcomes to individuals who may work as a member of a multi-disciplinary team and the fact that many nurse consultants achieve change through influencing the practice of other staff (Coster et al 2006; Graham 2007).
As a product of their study, Gerrish et al (2007) identified a possible framework for identifying outcome measures to evaluate the impact of advanced practice roles (including nurse consultants), based on the work of Schulz et al (2002). This framework was explored in the current study. However, further development work was required to ensure that the patient perspective is fully captured within the framework. Research was also needed to evaluate the utility and applicability of the framework in practice and to explore its potential to assist nurse consultants evaluate their impact on outcomes which are important to patients, health care professionals and managers. As part of this process, there was a need to identify indicators (both quantitative and qualitative) which are sensitive to capturing patient and professional outcomes. There was also a need to identify the factors which may facilitate or hinder nurse consultants to demonstrate their impact on patient and professional outcomes.
Although it is recognised that nurse consultants experience considerable difficulty in demonstrating their effectiveness, there is little practical guidance available to assist them. Our project aimed to generate, pilot and validate guidance to assist nurse consultants evaluate their impact in terms of outcomes which are meaningful to a range of stakeholders, including patients.