The current role of the consultant nurse in critical care: consolidation or consternation?
BACKGROUND
The consultant nurse role emerged into the National Health Service in 1999, presented against a backdrop of practice and service modernisation. As with any innovative development, the role was originally subject to much scrutiny with regards to impact and outcome. However, six years after its initial introduction, continued focus and support on this role is less visible. This paper presents a follow-up review of the role and function of consultant nurses in critical care, using an original survey tool that underpinned Dawson and McEwen's work in 2003. From the results of the current study, key changes in role are identified and areas for further development are highlighted.


OBJECTIVE
To provide a contemporary profile of the consultant nurse in critical care. To identify changes in the consultant nurse role from 2003 to 2006.


METHODS
A national email survey of all known critical care nurse consultants in post in the United Kingdom was undertaken in October 2006. Using a validated survey tool originally used in 2003, a return rate of 73% (n = 47) was yielded.


RESULTS
Biographics of this survey reveal a static consultant nurse population with increasing length of tenure in post (mean = 60.2 months). There is no substantial increase in the size of the cohort since 2003. Postholders demonstrate advanced academic skills through higher degrees (94%) and carry a national and international profile through presentation and publication portfolios (92% national and 53% international presentation, 62% multi-authored publication, 47% single authored publication). The core role that consultant nurses in critical care engaged in is practice and service development (mean involvement score = 3.65), with expert practice holding least mean involvement scores (mean involvement score = 2.67). There is evidence of increasing use by these posts for strategic input at organisational/trust level.


CONCLUSIONS
This paper has identified ongoing strengths and limited developments of the consultant nurse in critical care role. Whilst it is clear that core role functions have not dramatically changed, there are demonstrable shifts towards more strategic engagement within Acute Care Trusts. This has brought about concerns regarding overall management of the role, and sustainability of postholders to balance this ever-increasing portfolio. It is also clear that there has been little new investment in this key leadership role, and this raises concerns as to the perceived contribution that experienced clinical nurses bring to a currently financially and operationally driven health service agenda.
Dawson
Deborah
D
St George's Hospital NHS Trust, GICU, 1st Floor St Jame's Wing, St George's Hospital, Blackshaw Road, London SW170QT, United Kingdom. deborah.dawson@stgeorges.nhs.uk
Coombs
Maureen
M
D000208:Acute Disease / Q000451:nursing; D000328:Adult; D001291:Attitude of Health Personnel; D003253:Consultants / Q000523:psychology; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D018166:Health Care Reform / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006801:Humans; D007587:Job Description; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians / Q000193:education / Q000458:organization & administration* / Q000523:psychology*; D024802:Nurse's Role / Q000523:psychology*; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009936:Organizational Innovation; D017009:Professional Autonomy; D011361:Professional Competence; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires; D006113:United Kingdom