Nursing roles and case studies

Nurse Consultants are qualified Nurses who have specialised in a chosen area of practice. It is not an overnight journey to become a Nurse Consultant and further academic study, research and extensive clinical experience is needed in order to progress to the role. Advanced Nursing practice can be classified into distinct areas, with the Royal College of Nursing outlining “four pillars”. Nurse Consultants in any clinical specialty need to be able to demonstrate competency and experience within these four pillars of clinical practice, which are the facilitation of learning, leadership, research and development.

 

What is the role of a Nurse Consultant?

A nurse consultant typically specialises in either patient care, management of nurses or administration. They often work within a certain medical specialty, such as paediatrics or oncology. In the nursing consultant role, you evaluate both overall health care delivery systems at hospitals and individual patient cases. You may be asked to assess a patient's care and treatment plan and make recommendations.

Health care facilities often depend on the expertise of a clinical nurse consultant when developing or evaluating standards of nursing practice. A nurse consultant definition at a hospital may include one who specialises in paediatric care to assess the care provided to the hospital's youngest patients. In that role you would monitor how nurses care for paediatric patients, both by observing and interviewing patients and analysing their medical records. You may identify areas where additional training is needed or make suggestions regarding changes or improvements the hospital can implement. You may also personally train or coach the facility's nursing staff.

 

What qualifications and experience do I need?

A nurse consultant is a highly trained, highly skilled advanced practice nurse who must have a post graduate health care degree in the appropriate field or subject

 

Pay and benefits

The banding for nurse consultants range from Band 8A – 8D (please refer to the latest Agenda for Change pay scales for salary details)

 

Registration

You would need to be a Registered Nurse and would need to hold an accreditation in your specialist field.

 

My Story: Huw Rowswell

I’m Huw Rowswell  and I am a Nurse Consultant specialising in Thrombosis and I have worked at University Hospitals Plymouth for 20 years.

 

How I got into this role

When I left school I spent some seven years working in banking but decided to spend a year travelling through Asia and Australia working in a variety of jobs from fruit picking, unloading fishing trawlers to working in bars and kitchens. On return decided to undertake my nurse training in London and qualified in 1997 working there in respiratory medicine and critical care. A jobs fare in Wembley was how I ended up moving to Devon and working in HDU here in Derriford.   After many years there I left to help set up the acute care team working mainly nights and weekends which I spent around 18 months working in. Feeling a change in career, and wanting to work in daylight hours, there was a post advertised as a venous thromboembolism (VTE) specialist nurse advertised following the publication of NICE guidance around risk assessment and prevention of this condition known to kill many hospitalised patients. I was fortunate to be appointed and it was a steep learning curve initially to understand what the role was and how to implement hospital wide change.

 

My role at UHP

The role initially involved a huge change to ensure all patients admitted to hospital underwent a risk assessment of their VTE risk and were prescribed appropriate chemical and/or mechanical prophylaxis to reduce the risk. There was a financial incentive later changed to a penalty to ensure we met compliance, this involved spending time on both medical and surgical admission wards to ensure this document was completed and to give feedback when this was not happening. At the same time collecting data on all cases of deep vein thrombosis and pulmonary embolism diagnosed within the hospital and to identify how many cases met the criteria to be termed hospital acquired thrombosis (HAT). These events require a root cause analysis to look whether appropriate VTE prevention was used and if not to investigate further. Back in 2010 there were 50 cases annually where this applied and as a hospital there were 2.25 HAT cases per 1000 admissions and by last year this had reduced to 4 cases and 1.4 cases per 1000 admissions.

Looking at VTE cases, by admitting speciality, allows investigation where more work may be needed to reduce incidence especially when this is compared to number of admissions seen by that speciality. In the past I have worked with neurosurgery for example to look at reassessment once bleed risk reduces which has led to a 50% drop in cases seen there.

I also follow up new VTE cases after 3-6 months anticoagulation following NICE guidance around the need for long term treatment involving the patient to compare risk of bleeding associated with long term anticoagulation compared to the risk of further blood clots where we to stop treatment.

I have recently been appointed as the Trust VTE lead and chair of the thrombosis committee which involves looking at any national guidance or new research around VTE and whether we are compliant or need to look at changes in practice. I produce reports for other committees to look at any issues around anticoagulation prescribing, administration or VTE outcome data and how we can improve patient outcomes.

 

The best bits and the challenges

I have been fortunate to have had the opportunity to attend and speak at conferences locally, nationally and internationally which is really useful for networking and looking at how other practitioners deal with similar problems and issues and what we can learn from each other.

I review all new VTE cases using radiology records and will on occasions pick up issues around prescribing and am able to change the prescribing to improve patient safety. Also in clinic I am fortunate to meet many interesting patients and learn much from them as much as I am able to advise on long term treatment.

 

Life outside of work

I am a keen runner regularly participating in marathons at both home and abroad including Chicago.

 

My top tips to being successful

Sometimes saying no can be as important as agreeing to everything.   Try to look at what is the most important and emailing management is hugely important, deal with what you can quickly and respond if there will be a delay its better than silence. Enjoy what you do as none of us are here forever.

 

My Story: Karen Snelgrove

I’m Karen Snelgrove and I am a Nurse Consultant specialising in Gynaecology and I have worked at University Hospitals Plymouth for 20 years.

 

How I got into this role

After having spent 5 years at Charing Cross Hospital I was desperate to move back home and found myself at the Nuffield Hospital. Although coming from a high dependency unit, I found the ward work equally as exciting due to the varied experience of all the specialities encountered. It gave valuable experience of managing a busy ward. I decided to specialise further and completed my midwifery training and worked on the labour ward as a midwife. However, I returned to working on a busy surgical ward and did not stay in that field.

I had three children in quick succession and worked for two split nights a week during that time. It was exhausting but enabled me to continue with my career. I left nursing altogether when my marriage ended and I became self-employed having bought a dry cleaning business and got involved in yacht valeting too!

I found I missed showing empathy to people when they were at their most vulnerable and generally “making a difference”.  Being self-employed was also very precarious financially and definitely not rewarding, so I applied to do the “return to practice programme” - that was 20 years ago. I worked in various places on the Plymouth NHSP (nurse bank) and then was successful at interview in the Gynaecology outpatients department and did further post graduate training to accredit in colposcopy and hysteroscopy.

 

My role at UHP

I am the Cervical Screening Programme Lead for the Hospital and clinical lead of the colposcopy service and am responsible for the quality and delivery of the service. I also perform colposcopy and hysteroscopy clinics autonomously and provide nurse leadership to the team. I am a National trainer and examiner, chair MDT and am the lead for cervical screening governance. I represent the Trust regionally / nationally and lead on developing and implementing new pathways. Primarily my work is clinical although it does have a strategic and corporate arm, also working with PHE.

 

The best bits and the challenges

The best bits are spending time in clinic with patients and staff, we have a great team; the challenges are when I do too much of that and then struggle with time restraints on other aspects of the role.

 

Life outside of work

I love my job but still look forward to Fridays! I run a small property business alongside my work but still have time to walk the dogs, see the grandchildren, paint and decorate etc

 

My top tips to being successful

Don’t underestimate what you can achieve, the busier you are the more you tend to accomplish. Stay driven– it’s what makes you move forward and who you become. Good luck in your journey, it’s fun!