Commentary on McSherry, R., Mudd, D., Campbell, S. (2007) Evaluating the perceived role of the nurse consultant through the lived experience of healthcare professionals. Journal of Clinical Nursing 16, 2066–2080
Sue Duke, Cancer and Palliative Care Educaton, University of Southampton, Southampton, UK. E-mail: firstname.lastname@example.org
McSherry et al.’s (2007) study evaluates the nurse consultant role from healthcare professional stakeholders’ perspectives contributing to similar approaches taken by Manley (1997, 2000a,b, 2001) in its inclusion of role network perspectives and to recent evaluations of the nurse consultant role presenting perspectives constructed solely from nurse consultant participants (Hayes & Harrison 2004, Charters et al. 2005, Graham & Wallace 2005, Woodward et al. 2005, Booth et al. 2006). In addition, the study makes a particular contribution by adopting a collaborative approach to the research design. The researchers collaborated with three nurse consultants and their nominated managers to select participants, each nurse consultant and manager identifying with the researcher up to ten participant stakeholders able to give ‘detailed objective and relevant information surrounding all facets of the nurse consultant role’. The nurse consultants and managers were also consulted with respect to the interview guide and the research report. The use of a 360 degree process to guide the evaluation adds coherence to the collaborative intention, since this process ensures that feedback is designed to take account of and value varying views, rather than trying to ‘smooth these over’. In these ways the study embraces the principles of democratic evaluation (House 1993) and achieves its collaborative intent for ‘key parties to participate in the design, conduct and interpretation of the evaluation’ by both respecting persons and the dissemination of knowledge (Simons 2000).
A further positive feature of note relates to the research findings. In addition to supporting the importance of the individual, personal qualities of nurse consultants commented upon in other studies (Guest et al. 2004, Woodward et al. 2005) the authors point to a ‘potential organic evolutionary process to aid with the implementation and evaluation’ of nurse consultant roles. They suggest that, by involving stakeholders in the development of a nurse consultant post from conception and throughout implementation, ‘many of the practical and organisational issues could be addressed from the outset’. While this is not a new finding, in nurse consultant studies (for example, Manley 2000a, Guest et al. 2004), or in studies of new roles (for example, Lloyd Jones 2005, Vaughan et al. 2005), it does reinforce the point that there is no pre-existing space in an organisation for new roles. Some prior understanding of where a role will fit into an organisation will facilitate the negotiation between post holder and colleagues that characterises role development (Allen 2001) and will enable the evolutionary approach to role implementation suggested by McSherry et al. to be achieved. They describe, in detail, the issues of clarification around the role that need to be addressed by stakeholders and the support and communication infrastructure needed to enable nurse consultants to work the role. This discussion has the potential to enable nurse consultants to shape the space they occupy more readily in organisations rather than spending time in finding their space. In addition, it offers the possibility of untangling what is being evaluated in future studies – the impact of a new role or of nurse consultant qualities. On this note, I am not sure what meaning was intended by McSherry et al. by the phrase ‘mystic and magic locked within these new…roles’ but I agree that it is important to find ways to articulate knowledge about the nurse consultant role.
A comment about limitations
McSherry et al. state that ‘the small-scale nature of this study makes any generalisations and transferability of findings other than to those NCs who participated in the study, difficult to achieve’. In resorting to a general statement about limitations rather than a critical appraisal of their research process I feel the authors have sold themselves short by not recognising the positive achievement of the study as a collaborative endeavour. Some evaluation of how collaboration might have been enhanced, for example, by the nurse consultants being involved in publishing the study, would have added depth to the discussion and addressed this criticism. In addition, I think this general statement fails to recognise how their careful description of the data and its analysis builds confidence in the results and enables judgements to be made about its relevance; the findings resonate with my understanding of the body of knowledge of nurse consultant roles and to my experience of holding such a role. This confidence is built by illustrating how the findings were constructed from transcript to code to sub-category to category and this is further enhanced by the examples from the data given in the discussion of the results. For me, the key limitation of the study is the lack of discussion about the findings in relation to what is known; the authors being content to pass comment on where the findings correspond to previous work rather than actively employing the analysis in other papers to situate this study in a body of knowledge, nationally and internationally.
The literature review was undertaken to identify the key themes and trends of nurse consultant roles in order to inform the research interview guide. This is an appropriate approach since it recognises that innovations such as the nurse consultant role are never implemented homogenously. Rather they are influenced by choices made by the people who implement them and the particular context in which they are situated, these ‘changing its form and moderating its impact’ (Parlett & Hamilton 1977:12).
My commentary on the literature review is centred on the choice of literature selected and included. More detail about the decisions underpinning this selection would have deflected much of my criticism. Some detail about the process of identifying literature is provided – the database used and the limitation of literature to that with the words nurse consultant in the title. However, some of the literature included in the discussion falls outside these limits. For example, the paper by Carnwell and Daley (2003) is included but does not have nurse consultant in the title. It does have Advanced Nurse Practitioner (ANP) in the title and it may be that the McSherry et al. decided this was a role synonymous with nurse consultant, although this is not intended by Carnwell and Daley (2003) who state that ANP is a ‘potential…pathway to become a NC of the future’ (p630). Further, if it was the intention of McSherry et al. to include ANP in the literature review then the review is not inclusive of this body of knowledge; for example, excluding a review by Lloyd Jones (2005) and a study by Scarpa (2004). The review also excludes some papers that have nurse consultant in the title, for example Manley (1997) and Charters et al. (2005). The authors also include selective international studies evaluating clinical nurse consultants, including for example, Dawson and Benson (1997), Happell et al. (2002) and Hekkinki et al. (2005). However, they exclude other studies from Australia where the clinical nurse consultant role is more established, such as those published by Appel et al. (1996), Jannings and Maynard (1997), Dawson (2001) and Vaughan et al. (2005).
McSherry et al. claim that ‘the literature highlights the importance of evaluating the impact (of NC role) on a national and international level’. Two important issues arise: first, the importance of designing research so that it can be internationally assessed for local applicability and global contribution to knowledge about the NC role; second, to achieve this we need to be confident that the models of NC in different countries are comparable. The study goes some way to achieving the first point through the careful description of the research findings but no comment is offered by McSherry et al. (2007) concerning the comparability of NC roles internationally.