VOL: 98, ISSUE: 01, PAGE NO: 39
Alison Pottle, MSc, BSc, RGN, DipN, is a nurse consultant at Harefield Hospital, Middlesex
The introduction of nurse, midwife and health visitor consultants was part of the Department of Health’s national nursing strategy Making a Difference (1999). The aim was to keep experienced nurses in clinical practice and to provide a better defined clinical career structure.
The Royal Brompton and Harefield NHS Trust is the largest postgraduate specialist heart and lung centre in the UK. As such, it was one of the first trusts to establish nurse consultant posts. Two positions were approved at the beginning of 2000, one in critical care at the Royal Brompton Hospital and the other in cardiology at Harefield Hospital.
I had been working in the cardiology directorate at Harefield Hospital for 13 years, 12 of them as senior sister in the high dependency unit. Having completed an MSc in cardiology at the end of 1999, I was starting to explore possible future directions for my career, so the timing of the announcement of nurse consultants could not have been better. After a gruelling interview, I took up the post in June 2000.
It was quite difficult to adjust from being a ward sister to being a nurse consultant. It was probably made more difficult because the role was new. Some staff claimed to have not heard about the role and others had distinct ideas about what it should entail, some of which were different to my own.
I decided to spend the first six weeks assessing and planning exactly how I should set up this new post. I spent a week with each of the three cardiology consultants followed by two weeks with a variety of other staff within the directorate, including the general manager, bed manager and nurse manager. In the final week I attended a patient clinical assessment course, as this was an area in which I felt my skills were lacking.
This period of orientation proved to be invaluable. Many of my ideas were modified as a result of things I discovered during this time. I realised that I might have been in the hospital a long time but there was a lot that I didn’t know.
The following three to four months were spent planning exactly how I was going to put the ideas into practice. It was generally agreed that the most important element to concentrate on was the clinical work. Once this aspect of my work was established then the education, research, leadership and evaluation functions would fall into place.
At times I wondered if I would ever get to do all the things I was planning as everything seemed to take so long. In reality, six months is not a long time in which to set up a new post.
I have now been in post for about a year and my clinical commitments are well established. In addition to my role within the medical high dependency unit, I have taken over and reorganised the rapid access chest pain clinic. I run the follow-up clinics for all patients who have undergone coronary angioplasty and stent insertion and I have also set up a low density lipoprotein apheresis service. Formal audit of these services will take place after six months and I am now beginning to formulate plans for some research projects. I am also involved in lecturing within the unit as well as on local MSc courses. In addition, I have lectured to medical staff from within the trust and from local GP practices.
I am now in the process of planning further developments of my clinical roles and also new clinical roles. Additional nursing staff are needed to take these services forward. As a nurse consultant, my aim is not only to develop services but also to help to expand the roles of nurses into areas that they have not previously worked in. There is much enthusiasm for this among my colleagues.
The fact that I was already working at Harefield Hospital before I took up this post has, I believe, helped me to develop my new role. Medical and nursing staff are aware of my knowledge and expertise. It has also enabled me to spend more time on developing the role and has made it easier to identify needs within the cardiology department.
The role of nurse consultants must be evaluated locally and nationally. It is important to establish whether, in practice, nurse consultants are working in the way that the government intended. If not, modifications may be required to ensure that this new innovation takes the profession forward.
Within the trust, the role is being evaluated in various ways. Regular meetings with the directors of nursing and cardiology help ensure that the role is continuing to fulfil the needs of both the department and the organisation. More specifically, all the patients who attend the chest pain clinic will be contacted six months after their appointment and asked to complete a questionnaire. GPs who have referred patients will be asked for their views on access to the clinic and how satisfied they are with the service. Patients who are post-angioplasty will receive follow-up telephone calls after a year. Their comments on the quality of care they have received post discharge and the nurse-led aspect of the outpatient follow-up will be gathered.
Becoming a nurse consultant has encouraged me to examine the role of the nurse in cardiology and to think about where nursing is going. I also feel empowered to influence what happens in patient care. It is also helping my educational development - I thought the MSc course would be the end of my studying but now I’m not so sure.