title: Critical care without walls: The role of the nurse consultant in critical care.
abstract: BACKGROUND
  The nurse consultant role was first described in 1999 and has undergone little evaluation since. Critical care nurse consultant roles have developed against a background of service innovation following a review of adult critical care and have resulted in a variety of job roles and titles. There is some evidence to suggest that these posts are developing differentially and with varied role content.
  
  
  OBJECTIVE
  To provide a profile of the nurse consultant in critical care. To identify critical care roles in practice.
  
  
  METHODS
  A national postal survey of all 72 critical care nurse consultants in post in England by August 2003; response rate 72% (n = 52).
  
  
  RESULTS
  The majority (54%) of critical care nurse consultants were aged between 40 and 50 years with a mean of 18.4 years post registration experience. The majority held a higher degree (71%) and at least one additional professional qualification (96%); many (44%) continue to study. Most critical care nurse consultants (69%) reported that a nurse does not manage them operationally. Nurse consultants were taking the lead in developing care outside the traditional boundaries of the Intensive Care Unit (ICU) (mean involvement score, M = 4.25) and with outreach rounds on the wards (M = 3.78). Despite having an overall high involvement (M = 3.37) with the practice and service development function, they had a lower involvement with research activities (M = 2.87). They also had a low involvement with strategic organisations such as the Department of Health (M = 1.63), Strategic Health Authorities (M = 1.54) and Primary Care Trust's (M = 1.49).
  
  
  CONCLUSIONS
  The critical care nurse consultants who responded to this survey were clinically experienced and educated to an advanced level. They were leading the care of critically ill patients outside the traditional boundaries of the ICU, but have significantly less involvement within the ICU. Nurse consultants' restricted involvement with strategic organisations may limit the development of the role.
authors.affiliation: St. George's Hospital NHS Trust, General Critical Care, St. Jame's Wing, Blackshaw Road, London SW17 0QT, UK. deborah.dawson@stgeorges.nhs.uk
authors.forename: Deborah
authors.initials: D
authors.lastname: Dawson
authors.forename: Andy
authors.initials: A
authors.lastname: McEwen
mesh_terms: D000328:Adult; D003159:Community-Institutional Relations; D003253:Consultants; D003422:Critical Care / Q000458:organization & administration*; D004509:Education, Nursing, Continuing; D004511:Education, Nursing, Graduate; D004739:England; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007587:Job Description; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009718:Nurse Administrators / Q000193:education / Q000458:organization & administration; D009720:Nurse Clinicians / Q000193:education / Q000458:organization & administration*; D024802:Nurse's Role; D015399:Nursing Research / Q000193:education / Q000458:organization & administration; D009741:Nursing Staff, Hospital / Q000193:education; D011795:Surveys and Questionnaires