A preliminary evaluation of the role of nurse, midwife and health visitor consultants

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A preliminary evaluation of the role of nurse,
midwife and health visitor consultants

• Funder Department of Health
• Kings College London
• David Guest , Sally Redfern
• Jenifer Wilson-Barnett, Riccardo Peccei, Patrice
  Rosenthal
• Birkbeck College - Philip Dewe
• Nurse Researchers
• Amanda Evans, Cath Young

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Aims of study

• compare activities across consultant types
• hospital, community, mental health, midwifery
• identify innovation in practice
• investigate
• job control and demands
• workload, role clarity, role conflict
• career and growth opportunities

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Role specification from DoH

• expert practice - 50
• professional leadership/consultancy
• education/training/staff development
• service development/research/evaluation
• introduced into all NHS contexts (England)
• acute hospital care
• community care
• mental health
• midwifery

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Breakdown by specialty ()

• acute specialty (area) 58
• acute specialty (condition) 11
• mental health 17
• midwifery 11
• community/primary care 4
• learning disability 3

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Previous research on CNS/ANPs

• high expectations
• work overload
• role confusion
• lack of management, admin, peer support
• sustainable or doomed to failure?

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Methods - 3 components Accounts of incidents and
experiences

• 32 consultants interviewed by telephone over time
• 4-5 per individual, total 138 interviews
• selected across region and type
• 4 MWs, 3 HVs
• 25 nurses 7 acute-area, 5 acute-disease, 5 MH, 4
  eld, 2 child, 2 LD
• questions on challenges, problems, support,
  hindrances, achievements, learning

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Role network analysis

• 10 case studies of consultants in their role
  context
• 1-2 day visits per case
• 2 MWs, 2 HVs 6 nurses 1 acute-area, 1
  acute-dis, 2 MH, 1 eld, 1 LD
• interviews with consultants and key members of
  role network
• informal observation
• document analysis

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Questionnaire survey

• all consultants in post January 2001 (158)
• H (83), C (35), MH (25), MW (10)
• questions on
• involvement in activities
• current-previous job comparison
• job control, complexity
• role clarity, conflict, workload
• rewards (career/prof growth)
• response 153 (95)

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Involvement in role functions in present and
previous jobs (n153)
responses rated on 5-point scale 1 not
involved to 5 I take the lead in the
activity all significant at plt.001
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Pattern of involvement across functions
score of 4 or above on 5-point scale
statistically significant difference across
consultant types at plt.05 level statistically
significant difference across consultant types at
plt.01 level
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Job characteristic and work experience scales

• job control
• job demands
• workload
• role clarity
• role conflict
• career opps
• growth opps

autonomy, discretion difficulty,
complexity overload, time pressure on duties,
responsibilities incompatible demands promotion,
advancement professional development
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Task characteristics high scorers
(147) (78) (34) (25) (10)
No significant differences across consultant type
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Role stressors high scorers
(147) (78) (34) (25) (10)
statistically significant across consultant
types at plt.05 level
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Job rewards high scorers
(147) (78) (34) (25) (10)
No significant differences across consultant type
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Lessons learned

• able to cope with job complexity
• professional rewards high
• work overload, role ambiguity need careful
  handling
• increase in workload over time needs confirmation
• danger of job becoming unmanageable, burnout
• pre-entry clarity and management support
  essential to ability to cope with pressures

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Lessons learned

• innovation is a feature of consultant role
• increase in
• leadership
• RD
• training
• expert practice

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The follow-up study

• DoH funded
• same team Samantha Coster
• additional aims
• impact on practice and outcomes
• investigate
• leadership
• job crafting
• work-non-work balance
• ends March 2004

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Access to reports

• http//www.kcl.ac.uk/nursing/nru/nru_res_rep.html
• http//www.kcl.ac.uk//depsta/pse/mancen/staff/davi
  d.guest.html