title: Leadership as part of the nurse consultant role: banging the drum for patient care.
abstract: OBJECTIVE
  This paper draws upon an evaluation of the first group of nurse consultants in Scotland. The evaluation aimed to identify the extent to which they fulfilled the remit of their posts which comprised four core functions. One of these functions was to provide professional leadership and this paper focuses on this element of the role and aims to explore it in relation to the attributes of transformational leadership.
  
  
  BACKGROUND
  Nurse consultants were introduced in the UK in 2000. Their purpose was to achieve better outcomes for patients and strengthen leadership. Nursing research identifies leadership as a key element of the role, with postholders adopting transformational leadership approaches. Research from the fields of sociology and psychology identifies difficulties in formulating a coherent theory of leadership, arguing for better understanding of leadership processes.
  
  
  METHODS
  Qualitative.
  
  
  METHODS
  This paper draws on 31 semi-structured interviews with four nurse consultants who were interviewed twice over six to nine months and 23 other 'stakeholders' who worked with them.
  
  
  RESULTS
  Varied leadership activity at ward, NHS Trust and strategic levels was identified. Postholders used approaches that resonated with the attributes of transformational leadership. Leadership processes included developing a vision for the service, acting as mediator and champion, and exerting control over complex change initiatives. Techniques of leadership included taking a 'softly softly' approach, pacing change initiatives and arguing assertively with those in senior positions. Interview findings also identified the level of preparation that was required to meet the remit of the posts, highlighting the importance of interpersonal skills and intellectual effort in achieving outcomes.
  
  
  CONCLUSIONS
  Nurse consultants require considerable technical expertise, cognitive and interpersonal skills, and the ability to take risks. The data suggest that the leadership attributes required are transformational in nature but that they also exceed those identified in much of the literature. These posts require appropriate support if they are to be sustainable. Relevance to clinical practice. This paper adds to our understanding of the complexity of the nurse consultant role and highlights the challenge of providing appropriate professional development for postholders.
authors.affiliation: School of Nursing, Midwifery & Community Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK. J.McIntosh@gcal.ac.uk
authors.forename: Jean
authors.initials: J
authors.lastname: McIntosh
authors.forename: Debbie
authors.initials: D
authors.lastname: Tolson
mesh_terms: D003253:Consultants; D004989:Ethics; D006801:Humans; D007857:Leadership; D009726:Nurses; D005791:Patient Care; D013222:State Medicine; D006113:United Kingdom