2. The role of the nurse consultant in palliative care: the story so far Sue Duke Nurse Consultant/Principal Lecturer Royal Berkshire and Battle Hospitals NHS Trust and Oxford Brookes University

3. Role: this is what I do This is how I do it This is the culture in which I do it Integrate different sorts of practice: clinical, education, research and leadership, across different layers of organisation: individual, team, board and national/international Enhance patient care through direct care, educating practitioners, changing contextual thinking about palliative care, disseminating knowledge Work on the brinkWatch like a hawkRising stars Where nurses are the cookie dough Where vampires, pirates and aliens roam Where new roles are under scrutiny

4. Role: this is what I do understanding the process of care across different layers of organisation and across practices involved in enhancing care Nurse consultancy = integration of processes between organisational layers and dimensions of practice

5. Clinical practiceEducationResearchService development IndividualProvide care to patients and their families with palliative care needs Educate individual practitioners about palliative care. education, research and leadership Support individual practitioners undertaking research. Undertake own research Understand and interpret policy for self and others TeamSupport CNS providing palliative care Support lecturers in palliative care and cancer care Co-ordinate research agenda Facilitate palliative care team development OrganisationInfluence nursing practice across the trust for people with palliative care needs Influence curriculum design in palliative care and cancer care Contribute to research within the Trust Clinical lead for the palliative care for the Trust National and International Disseminate knowledge about palliative care at individual, team and organisational levels

6. This is how I do it Working on the brink Watching like a hawk Nurturing rising stars

7. Working on the brink

8. Watching like a hawk

9. Rising star I can see that you are. I am glad, for Ive known the talents within you. Now its grown. You shine bright from certain perspectives. Not fully confident from all aspects.

10. My challenge: To watch, hold, nurture you; demonstrate those places unlit yet. All the while you judge me, un-nerve me. The places where you shine: intensely scrutinised. The danger rising star is that if we are not careful, you will burn out, not reach your potential.

11. This is the culture in which I do it Homeless concept Empty form Spatial vacuum Lifeless born

12. Where vampires, pirates and aliens roam Vampires suck my blood And wait for me to turn Like them competitive. I strive to stay alive, Resist the fanged club Instead, collaborate.

13. Pirates treat me as role contender, trespasser, accuse me of plunder. I am no skills thief, but see red jolly rogers warning hold no quarter.

14. Aliens baffle me Their culture quite unique. We find a meeting space In which to hold debate Tentatively touch it, Learn to communicate

15. Where new roles are under scrutiny

16. The sociologists Tell me that these three villains, Have other names instead Tell how professionals Keep strangers out, double Closure I read about. The dangers of these foes Include demarcation and peer separation designed to increase power between colleagues, but create enemies. Vampires, pirates, aliens Symbolic experience Remind me to value the nurse in consultancy Warns me not to oppress Others or indoctrinate.

17. Where nurses are the cookie dough

18. Changes Empty concept Lived concept Focus on differentiation Focus on fit Focus on establishing a role Focus on developing a team/service

19. Conclusion Actions, performances and culture (negotiating role) Truthful: something that both figures in the light of our understanding of what life is generally like and throws light on the road weve traveled and the path ahead (Carson 1998:233)