Recognising the Actual, Expected and Potential of the Nurse Consultant Role in Australia

Abstract

<p>This thesis by publication describes a study that explores the nature and contribution of the Nurse Consultant (NC) role in an Australian context. The research question asked: What is the actual, expected and potential of the Nurse Consultant role across health service delivery contexts?</p><p> The NC role is argued in the literature as central to reconceptualising models of care that are characterised by coordination, interprofessional practice and transitions across sectors and agencies. This makes the role well qualified to take on responsibilities that require activities beyond set scopes and boundaries to accommodate the change necessary in reformed models of care. Globally the NC role has been persistently plagued by confusion as to positioning and purpose. It is vital to seek role clarification if the role is to be seen as "fit for purpose" in current and future health care delivery models.</p><p> This research is underpinned by the theoretical perspective of Realism, utilising a Realistic Evaluation framework to inform design and methods. A mixed method phased sequential design was employed to explore NC activity, highlighting what works for whom and under what circumstances, including differences in role enactment between rural and metropolitan locations and across acute and community settings.</p><p> All NCs employed within a Local Health District (LHD) in New South Wales (NSW), Australia (n=194) were invited to complete an online survey designed to provide information about role characteristics, activity and engagement patterns and contexts of practice. Focus groups with NCs explored issues highlighted in the survey data. Focus groups with stakeholders, including clinicians, policy makers and managers assisted in developing understanding of how the role is viewed and enacted across a range of stakeholder groups and contexts.</p><p> The NC role is identified by many as a strategic clinical leadership role. The role has been shown through this research to be flexible, complex, highly engaged in service delivery on the one hand and struggling for recognition and clarity of purpose on the other. This study has illuminated several key constructs central to the success of the role that differentiate it from other advanced practice roles. These are: engagement across organisational and professional boundaries; connectivity and networking in the role; clinical leadership and influence across organisations and within interprofessional teams. These constructs are enabled through job characteristics such as job autonomy, job support, job satisfaction and role clarity.</p><p> This research challenges conventional views of static standardised role conceptions, and concludes that these conceptions compromise the role and its ability to have optimal impact in a dynamic and complex health care environment. This study's findings offer a unique and more contemporary understanding of how NC roles can be engaged and deployed. It provides new constructs through which to conceptualise the NC role in a way that better supports its development and operationalisation for optimal fit and performance.</p>