RCN Children’s Leadership & Management Forum

Nurse Consultants in Children’s Services

Purpose

This position statement outlines the need for NHS organisations to ensure Nurse Consultant posts are established within all settings in which children, young people and their families receive healthcare.

Background

Tony Blair announced the proposals for the introduction of Nurse Consultant postsin his speech to the Nurse’98 awards. The intention was to “keep experienced Nurses at the bedside”. The role formulated within the national nursing strategy “Making a Difference launched by the prime Minister in July 1999. This led to the DOH paper on “Establishing posts and making appointments”(HSC/199/217).

There are 3 policy objectives of the Nurse Consultant role. These are: -

  • To provide better outcomes for patients by improving the service & quality of care.
  • To strengthen leadership.
  • To retain experienced nurses, midwives & health visitors in practice

There have been many documents that reflect the need to strengthen leadership within Children’s services (Audit Commission 1993, RCN 2001). This has been stressed recently in the modern matron role in Children’s Services (Oughtibridge 2003). Nurse Consultant posts aim to achieve some of these by putting nurses at the forefront of improving and contributing to patient care.

Roles of the Nurse Consultant

These are clearly described as four roles (HSC/199/217). These are: -

  • Expert practice
  • Professional leadership & Consultancy
  • Education, Training & Development
  • Practice & Service Development

Each of these may be interpreted differently within each post. However, the expert practice must make up 50% of the time.

How Nurse Consultant Roles can apply within Children’s Services

Application of the role can vary within the different contexts within which the role is set. This may be towards practice development, developing new services, or facilitation of care through a team of professionals.

But the core skills remain the same and encompass those expert care skills of working with the child and family so that “hands-on” patient care influences the domains of leadership, consultancy & developments in practice.

However, this also includes operating beyond boxes & across boundaries. In the context of Children’s Services this is frequently across agencies namely Education and Social Services.

Therefore, the Nurse Consultant needs to be an expert in facilitation in the achievement of cultural change with both the organisation and the teams of professionals he/she is working with (Reid & Dewing 2003).

Present Situation

The arrangements for the approval of new Nurse Consultants posts will be with the agreement by the local Strategic Health Authority. The central scrutiny & approval has ceased from April 2003 (PL CNO (2003) 5).

The role of the Nurse Consultant is expanding within the field of Children & Young People’s practice but there still remains a dearth within both acute and community settings.

Generally, there are approximately 400 Nurse Consultants in post.

However, within the field of Children and Young People there are:

  • Approximately 37 Nurse Consultants known to be in post.
  • This collates to 9.25% of the Nurse Consultant workforce.
  • 3.75% are posts within Child & Adolescent Mental Health Services
  • 1.75% within the context of Child Protection.
  • 3.75% of Nurse Consultant posts spread over practice areas such as Paediatric Assessment /Accident & Emergency, Intensive Care, Community settings and other specialist settings such as haematology or Cleft Lip and Palate Services, or working with nurses who work with children in different settings.

There are few posts for the general acute specialisms (e.g. general children’s wards/departments) to develop, lead and enhance practice within these settings.

Nurse Consultants can lead practice in a variety of ways, by working within a specialist field, or by facilitating care in the wider context, this is in parallel to the fact that Nurse Consultants can act as advisors to the NHS at Strategic, Regional & National level.

This would benefit the field of practice of children and young people by providing a direct link between strategic-level decision making, hands-on expert patient care and leadership. This aspect of the Nurse Consultant role needs to will expand, enabling the child and families experiences to be taken into account when decisions on care are being made (Adam 2002). In addition, children’s nurses operating at both the “bedside” and at strategic level will clearly strengthen children’s nursing leadership at a strategic level thereby influencing the future direction of Children’s and Young Peoples Services.

The RCN urgently calls upon all trusts to establish Nurse Consultant posts across Children’s and Young People’s services as a key mechanism to achieve implementation of the Children’s national Service Framework and equivalent policy initiatives in Scotland and Northern Ireland.

References

Adam. S (2002) The role of a nurse consultant in expanded critical care. Nursing Times; 98:1, 34-36

Audit Commission (1993) Children first: study of hospital services London HMSO

Department of Health (1999) Nurse, Midwife and Health Visitor Consultants: Establishing Posts and Making Appointments (Health Service Circular 1999/217). London: The Stationary Office

Department of Health (2003) CNO Letter re Consultant Nurse Posts (PL CNO (2003) 5) London

Oughtibridge. D (2003) The Modern matron Nursing Management Vol.10, No 2, pp 26-28

Reid .B. & Dewing. J. (2003) A model for clinical practice within the consultant nurse role Nursing Times; 99:9

Royal College of Nursing (2001) Children‘s Services: acute health care provision. London, Royal College of Nursing