An evaluation of the role of the clinical nursemidwife specialist

1
An evaluation of the role of the clinical
nurse/midwife specialist

• The National Council
• IADNAM Centenary Conference
• 8th October 2004

2
National Council for the Professional
Development of Nursing Midwifery

• Statutory responsibility to monitor the ongoing
  development of nursing midwifery specialities,
  taking into account changes in practice service
  need

3
Terms of reference

• To examine the literature
• To establish the parameters of the scope of the
  role
• To examine how the specialist supports the staff
  nurse/midwife
• To determine the geographical spread

4
Methodology

• Mixed
• Focus groups
• Literature review
• Questionnaire
• Use of the National
• Council database

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The focus group (cont.)

• Targeted specialists, directors, staff nurses
  midwives, middle managers patients
• OHM (2002) patients have a right to play a more
  active role in defining and assessing quality of
  care.

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The Literature Review

• The Working Party on General Nursing (1980)
  evolution of the roots of specialism
• Policy documents Quality Fairness (2001), Hanly
  (2003), Towards Workforce Planning (2002),
  Empowerment (2003)
• Irish academic literature minimum, concerned
  with clinical educational roles Ruddy (1985),
  Cunningham (1993), Boland (1995), Redmond (1997),
  Shanahan (1997) and Meagan (1998)

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Literature Review

• No other nursing role has been so thoroughly
  evaluated
• Reiter (1943) Nurse clinician
• Role acceptance, conflict, clarity integration
  -1970s 80s
• Value for money, performance outcome 1990s
• Developmental continuum
• Where is Ireland on this continuum?

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Questionnaire

• Bamford Gibson (2000)
• Pilot adjusted accordingly
• Response rate 61 n808
• Demographic data
• Educational preparation
• Barriers/inhibitors to role development
• Five core concepts

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Findings

• Focus groups analysed using content analysis
• Questionnaire SPSS
• Huge volume of data realised

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Geographical spread

• ERHA sick children - 61
• All other health boards 4
• Average per health board per population 2,584
• MHB 3,366 lowest
• NWHB 1,994 highest
• Workforce planning Vs. Service need

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Educational qualifications

• 77 certificate level
• 54 undergraduate diploma
• 15 primary degree
• 23 post graduate/higher
• diploma
• 5 masters degree
• 28 of respondents educated to required level

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Five core concepts

• Operating within the five core concepts
• Differing emphasis depending on the care setting
  and role
• Clinical aspect most important all respondents
• Education needs a little more emphasis
• Research Audit education required
• Consultancy advocacy accepted well

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Success of the role

• they opened up a service need (director)
• as healthcare is becoming more specialised, it
  is fitting within this model (director)
• patients are better educated going home
• (manager)
• there are so many consultants, they are now
  referring patients onto the cns, thats a huge
  success because it recognises their function
  (staff)

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Barriers to the role

• Lack of understanding of the role 60
• Lack of resources 57
• Lack of academic qualifications 19
• Dublin focus

• Lack of CPD opportunities 39
• Lack of relevant p/g diplomas
• Lack of cns/cms network 12 (Stevens 1996)

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The patients perspective

• she translated for me what the consultant was
  talking about, there was so much to digest she
  helped me focus
• I always felt she was there, I could ring her at
  anytime
• my lifeline is the cns
• the nurses are fantastic, they should get paid
  more than the government

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The patients perspective

• she facilitates all of my healthcare
• What the cns did was to really humanise my
  experience, it was like meeting a close friend
  who was also objective had a lot of
  information, so better than a close friend

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Summary

• Extremely successful
• Robust foundations in place
• Some aspects of the role need developing
• Potential for the role to develop further
• Development has been flexible and innovative

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Conclusion

• Irish specialist nurses/midwives exist on a
  developmental continuum
• Brief snapshot
• Recommendations on three levels
• Local, regional national
• Available www.ncnm.ie