A preliminary conceptual framework for an advanced practice/consultant nurse role is presented which links the role to its context and outcomes. The conceptual framework was developed in the process of analysing data from a 3-year action research study involving the operationalization of an advanced practice/consultant nurse role in a Nursing Development Unit. The skills and knowledge base of consultancy, underpinned by a strong nursing foundation, augmented by strong leadership and combined with the educator and researcher functions, are presented as the attributes of the advanced practitioner/consultant nurse. The facilitation of a transformational culture is highlighted as central to the skills and processes used within the role. Implications for the preparation and accreditation of the advanced practitioner/consultant nurse are highlighted.

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Organisational culture is presented as a complex concept underpinned by specific values, beliefs and assumptions that account for the way things are done. Strong organisational cultures and a number of other attributes are highlighted as having influence on performance. The role of leadership is recognised as key to facilitating cultural change, as is the use of approaches which clarify values and highlight contradictions between espoused culture and culture in practice. A three-year study in which a consultant nurse post in critical care was operationalised demonstrated the achievement of an organisational culture with positive impact on the unit in which it was based, on practitioners and their practice, and also on the trust. Transformational leadership combined with other facilitative processes, expertise in the practice of nursing, and other subroles of the consultant nurse are further highlighted as influential.

BackgroundContinuing professional development (CPD) in healthcare is fundamental for making sure frontline staff practice safely and effectively. This requires practitioners to update knowledge and skills regularly to match the changing complexity of healthcare needs. The drive towards using limited resources effectively for service improvements and the need for a flexible workforce necessitate a review of ad hoc approaches to CPD.ObjectiveTo develop strategies for achieving effective CPD in healthcare.DesignA case study design drawing on principles of realist synthesis was used during two phases of the study to identify and test what works and in what circumstances.SettingOne National Health Service Trust in South East England.ParticipantsCPD stakeholders including professional regulatory bodies (n = 8), commissioners of healthcare (n = 15), facilitators of clinical skills development (n = 34), NHS staff in clinical leadership positions (n = 38), NHS staff undertaking skills development post graduate programs (n = 31), service user advocates (n = 8) and an international expert reference group (ERG) (n = 10).MethodsData sources included a review of scholarly and grey literature, an online survey and a consensus workshop. Thematic and content analyses were used during data processing.ResultsThe findings present four interdependent transformation theories comprising transforming individual practice, skills for the changing healthcare contexts, knowledge translation and workplace cultures to optimize learning, development and healthcare performance.ConclusionsThe transformation theories contextualize CPD drivers and identify conditions conducive for effective CPD. Practitioner driven CPD in healthcare is effective within supportive organizations, facilitated workplace learning and effective workplace cultures. Organizations and teams with shared values and purpose enable active generation of knowledge from practice and the use of different types of knowledge for service improvements.

This new culture had a positive impact on the unit in which it was based, on practitioners and their practice, and also on the trust. A number of factors, including transformational leadership, other facilitative processes, expertise in the practice of nursing, and other subroles of the consultant nurse were shown to be influential. Part one, published last week, described the concept of organisational culture. This article discusses the consultant nurse outcomes.