Practice development 'without walls' and the quandary of corporate practice.
OBJECTIVE
The context of this study is a group of clinical nurse specialists from across a Trust seeking accreditation as a practice development unit. The university was asked to facilitate the accreditation process via 11 2-hour learning sessions (including a one-hour focus group). During initial discussions between the university and practice development unit, the overarching research question for this study was set as: 'what are the main roles and responsibilities of clinical nurse specialists?'


BACKGROUND
Although there is no known study of a practice development unit based beyond a ward or speciality, the central tenet of the practice development unit literature is that units must demonstrate their worth if they are to survive and harness senior management support in doing so.


METHODS
Data gleaned from the transcribed audio tape-recordings of the learning sessions were studied at least three times to ensure transcription accuracy and produce detailed charts. Ethical approval was granted by the appropriate Local Research Ethics Committee and written informed consent obtained from clinical nurse specialists. The study lasted 30 months and ended in October 2004.


RESULTS
The four crucial statements that give meaning to specialist practice are: quality care giver; expert; information giver and initiator of change. Further analysis reveals the area of corporate and political practice as being missing from this and other lists of clinical nurse specialist attributes found in the literature. Clinical nurse specialists characterize their relationship with the Trust in terms of dichotomy--differing agendas and perceptions of value.


CONCLUSIONS
The specialist role requires professional development in the areas of corporate and political acumen and professional business management. While the findings of this study relate to one Trust and a group of 16 clinical nurse specialists, with careful application they may be transferable to other settings and groups of senior nurses.
Graham
Iain
I
Institute of Health and Community Studies, Bournemouth University, Bournemouth, UK. igraham@bournemouth.ac.uk
Fielding
Carol
C
Rooke
Debbie
D
Keen
Steven
S
D000068:Accreditation / Q000458:organization & administration; D001291:Attitude of Health Personnel; D004739:England; D017144:Focus Groups; D005544:Forecasting; D006301:Health Services Needs and Demand; D006757:Hospital Units / Q000458:organization & administration*; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007587:Job Description; D009720:Nurse Clinicians / Q000193:education / Q000458:organization & administration* / Q000523:psychology*; D024802:Nurse's Role / Q000523:psychology; D015402:Nursing Education Research; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D015399:Nursing Research / Q000458:organization & administration*; D015279:Organizational Culture; D010353:Patient Education as Topic / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011361:Professional Competence / Q000592:standards; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D013222:State Medicine / Q000458:organization & administration