ADVANCED NURSING PRACTICE

Advanced Nursing Practice

Advanced Nursing Practice

Introduction

In order to critically analyze the role of a consultant nurse the author feels it is important to look at the definition of a nurse consultant role, discuss and examine events leading to the existence and development of such roles (history) and finally the impact on quality of patient care of a consultant nurse. The author's current area of practice- a nine bedded adult intensive care unit, where no such role currently exists. However, the author will examine the potentialities of such a role, the possible benefits to patient care and barriers which may be encountered by a consultant nurse in this environment.

The paper will use research in order to identify key aspects the role would be likely to encompass, and then analyze and evaluate the advanced/consultant nurses role and conceptual framework will be applied. Discussion will also include possible legal and professional implications of the role and how it may be affected in the current climate of the NHS of ever changing and diversifying roles in order to meet patient demands.

Nurse consultant is an expert practitioner and professional leader able to assess information and mange change, someone who is capable of understanding and solving complex problems, able to shape the agenda for the future. (DOH, 2000)

Historical Background

Since 1972 The Briggs Report (cited by Bowler and Mallik, 1998) recognized an overlap between nursing and medical roles, and where these duties were performed by nurses they were termed 'extended roles.

In 1977 the DHSS (cited by Last, 1992) stated that the clinical nursing role may be extended by delegation from a doctor and in response to an emergency. Nurses had to gain certificates of competence in order to perform tasks referred to as extended roles, leaving minimal scope for nurses to take control of decisions necessary for patient care delivery (Bowler and Mallik, 1998). Thus nurses' expanded roles at this time appeared to be task orientated, and served the needs of doctors rather than necessarily those of patients.

In 1992 the publication of the Scope of Professional Practice (UKCC, 1992) appeared to redress the balance, removing the need for certification and placing patient need at the centre of development of nursing practice. It stated simply that; 'Practice must be sensitive, relevant and responsive to the needs of individual patients and clients and have the capacity to adjust, where and when appropriate to changing circumstances the range of responsibilities which fall to individual nurses should be related to their personal experience, education and skill' (UKCC, 1992). However, coming as did between the publication of the New Deal for Doctors (NHSME, 1991, cited by Hind et al, 1999) and The Calman Report (DoH, 1993), which respectively initiated reduction of junior doctors hours and shortening of specialist training, scope understandably created considerable tension within the nursing profession (Finlay,2000).

Many were concerned about the 'medicalisation' of nursing and the loss of its intrinsic value (Edwards, 1995). It was feared that in medical terms, the interpretation of 'good' may be to the ...