1. Being & Preparing to be a Consultant Nurse The RCN Consultant Nurse Project Kim Manley: Project Leader Rachael Rowe: Research Assistant

2. Consultant Nurse (Manley 2001) Consultant Nurse (Manley 2001) Expertise in:  The practice of nursing for a specific client group  Developing a learning culture  Practice-based research approaches and evaluation  Consultancy from clinical to organisational levels  Transformational leadership  Facilitation of individual, team and organisational learning, cultural change, practice and service development

3. RCN CONSULTANT NURSE PROJECT Action Research integrating Fourth Generation Evaluation (Guba & Lincoln 1989) Project TeamCo-researchers  Kim ManleyCohort 1: CN’s  Rachael RoweCohort 2: Aspiring  Angie TitchenCohort 3: CN’s

4. Cohorts: Total Participants  Cohort 1: 10 participant CN’s Mid- Trent/Nottingham  Cohort 2: 8 participant Aspiring CN’s England-wide  Cohort 3: 7 participant CN’s England-wide

5. PROJECT AIMS  To help CN’s and aspiring CN’s to become more effective in their work  To help CN’s to evaluate their work and demonstrate their impact  To help aspiring CN’s collect evidence of their readiness for CN posts

6. Purpose of action research   Develop practice, introduce a change, respond to a need or problem (Greenwood 1994; Elliott 1981; McNiff 1988; Whyte 1991; Lewin 1947)   Enable practitioners/participants to learn/develop/ become empowered (Grundy 1982; Greenwood 1994; Whitehead & Foster 1984; Kemmis & McTaggert 1988; Susmand & Evered 1978)   Contribute to or refine theory. ( Greenwood 1994; Elliott 1981; McNiff 1988; Whyte 1991; Lewin 1947)

7. Practitioner-researchers Participants of the cohorts are co-researchers, who through collaborative inquiry are focusing on their own actions and how they can become more effective in their work as well as how they demonstrate the impact of their role (consultant nurses) or their readiness for a consultant nurse post (aspiring consultant nurses).

8. Fourth Generation Evaluation (Guba & Lincoln 1989)   is integrated with action research enabling a focus on the concerns, claims and issues of stakeholders and the development of mutual understanding of these in relation to the evaluand – consultant nurse practice.

9. Claims, concerns, issues  Claims – a claim is any favourable assertion about the evaluand and its implementation  Concerns – a concern is any unfavourable assertion about the evaluand and its implementation  Issues – are questions which reflect what any ‘reasonable person’ might be asking about the evaluand and its implementation

10. SOME QUESTIONS & ISSUES   How are we going to make clear our role to the university?   What evidence currently exists to demonstrate effectiveness?   How can I become more strategic?   How do I facilitate the specialist nurses in their development to fit in with organisational aims?   What should I be doing to prevent this portfolio becoming a collection of paper?

11. Project processes/methods The processes of action research are the methods that practitioners use to enable them to research their own practice, they include:   Action Learning (McGill & Beatty 1997)   360 Degree Feedback (Alimo-Metcalfe 1996), reflecting stakeholder analysis   Process evaluation (Guba & Lincoln 1989);   Workplace Cultural Assessment (Manley 2001)   Critical Companionship (Titchen 2000) which includes critical observation of their own practice.  Development of a portfolio of evidence drawing on multiple sources

12. The project journey so far  Analysing concerns claims and issues  Analysing experiences presented Labelling trigger concepts & identifying evidence Labelling trigger concepts & identifying evidence Identifying goals that are SMART Identifying goals that are SMART Identifying strategies that are generalisable Identifying strategies that are generalisable Identifying evidence from practice Identifying evidence from practice Identifying theoretical concepts Identifying theoretical concepts  Linking processes to outcomes & evidence

13. Identifying trigger concepts  Role ambiguity  Obtaining support  Demonstrating effectiveness & impact  Lines of accountability  Project processes  Visibility & access  Political influencing  Dealing with challenging behaviour  Isolation  Role overload  Interagency working  Conflict with medical staff  Perceptions of others  Developing a common vision

14. The framework for capturing trigger concepts, strategies, outcomes & evidence

15. Aspiring Consultant Nurses - Trigger concepts & strategies Trigger concept  Influencing strategic agenda setting Outcome/Goal  Influence on the strategic agenda Strategies emerging  Meet formally with key stakeholders  Being opportunistic in doing work to enable others to recognise value  Being tenacious during committee meetings  Seeking advice from external agencies

16. Aspiring Consultant Nurses - Trigger concepts & strategies Trigger concept  Managing hidden agendas Outcome/Goal  Achieve transparency Strategies emerging  Submit written documents so as to receive a formal response  Challenging the presence of an audit trail  Thinking in advance the questions asked so as to achieve a meaningful answer

17. Consultant Nurses - Trigger concepts & strategies Trigger concept  Clarifying and achieving professional leadership Outcome/Goal  Clarity of what prof leadership means for me and others  Achieve professional leadership Strategies emerging  Opportunities for exchanging ideas formally  Clinical supervision  Exploring career pathways

18. Consultant Nurses - Trigger concepts & strategies Trigger concept  Managing being compromised Outcome/Goal  Others take responsibility for their actions  Others clearer about my role  Maintained clinical credibility Strategies emerging  Meeting proactively with key stakeholders  Honest and assertive in expressing feelings about the consequences of others actions  Challenging others about their responsibility and accountability

19. Aspiring consultant nurses framework and assessment tools

20. Discussion & Questions