title: Recognising the differences in the nurse consultant role across context: a study protocol.
abstract: BACKGROUND
  The advanced practice role of the Nurse Consultant is unique in its capacity to provide clinical leadership across a range of contexts. However, the Nurse Consultant role has been plagued with confusion due to lack of clarity over function and appropriateness for purpose within health organisations across contexts. Changing health service delivery models are driving the emergence of new nursing roles, further clouding the waters related to role positioning and purpose. There is an urgent need for evidence of impact and demonstration of how Nurse Consultants contribute to health care outcomes. This study aims to gain a clearer understanding of the Nurse Consultant role and its impact in metropolitan and rural New South Wales (NSW) Australia.
  
  
  METHODS
  The proposed study employs a sequential mixed method design, underpinned by Realistic Evaluation, to explore how Nurse Consultants contribute to organisational outcomes. The 'context - mechanism - outcome' approach of realistic evaluation provides a sound framework to examine the complex, diverse and multifaceted nature of the Nurse Consultant's role.
  
  
  METHODS
  Participants will be stakeholders, recruited across a large Local Health District in NSW, comprising rural and metropolitan services. A modified and previously validated survey will be used providing information related to role characteristics, patterns and differences across health context. Focus groups with Nurse Consultant's explore issues highlighted in the survey data. Focus groups with other clinicians, policy makers and managers will help to achieve understanding of how the role is viewed and enacted across a range of groups and contexts.
  
  
  CONCLUSIONS
  Lack of role clarity is highlighted extensively in international and Australian studies examining the role of the Nurse Consultant. Previous studies failed to adequately examine the role in the context of integrated and complex health services or to examine the role in detail. Such examination is critical in order to understand the significance of the role and to ascertain how Nurse Consultants can be most effective as members of the health care team. This is the first Australian study to include extensive stakeholder perspectives in order to understand the relational and integrated nature and impact of the role across metropolitan and rural context.
authors.affiliation: Hunter New England Local Health District, James Fletcher Campus, 72 Watt Street Newcastle, Newcastle, NSW 2300, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Giles
authors.affiliation: School of Health, University of New England, Armidale, NSW, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Parker
authors.affiliation: School of Business and Law, University of Newcastle, Callaghan, NSW 2308, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Mitchell
keywords: Advanced practice nurse; Nurse consultant; Nursing; Role clarity; Workforce