Northern Ireland Practice and Education Council

for Nursing and Midwifery

Professional Guidance
Supporting
Consultant Nurse & Consultant Midwife
Roles

Final Project Report

CONTENTS

PAGE

Acknowledgements 1

Section 1 2
Background

Section 2 4
Project Plan and Approach

Section 3 6
Project Outcomes

Section 4 11
Conclusion and Recommendations

References 13

Appendices
Appendix One 14
Appendix Two 15
ACKNOWLEDGEMENTS

The Chief Nursing Officer (CNO) commissioned the Northern Ireland Practice and
Education Council for Nursing and Midwifery (NIPEC) to lead the development of
Professional Guidance Supporting Consultant Nurse and Consultant Midwife Roles in
Health and Social Care (HSC) across Northern Ireland (NI).

It has been a pleasure to Chair this Steering Group with nursing, midwifery and education
colleagues, to develop this Professional Guidance which will provide clarity in regard to the
Government’s policy, for practitioners, employers, managers, education providers,
commissioners and workforce planners.

The Professional Guidance will facilitate the development of Consultant Nurses and
Consultant Midwives in the relevant area of clinical practice to enable them to meet the
challenging demands of the Minister’s reform agenda Health and Wellbeing 2026:
Delivering Together (Department of Health 2016).

I have valued the excellent contribution and support of the members of the Steering Group
who ensured that the Project achieved the objectives within the agreed timeframe and who
facilitated the engagement of all those to whom this Guidance applied. I am also indebted
to my Executive Director of Nursing and Midwifery colleagues and other organisational
Heads of the Nursing and Midwifery professions who helped shape the content of the
Guidance.

As Chair of the Steering Group I commend this Professional Guidance to you.

Brenda Creaney
Executive Director of Nursing & User Experience
Belfast HSC Trust

1
SECTION 1: BACKGROUND

Introduction

1.1 The policy for the establishment of Nurse, Midwife and Health Visitor Consultants1
was first introduced in NI in 2000 (DHSSPS 2004). The posts were created to help
provide better outcomes for patients/clients, strengthening clinical leadership and
providing new career opportunities with the hope of retaining expert practitioners in
clinical practice.

1.2 The policy guidance (DHSSPS, 2004) required that all Consultant Nurse and
Midwife posts:

“must be firmly based in nursing, midwifery or health visiting practice and involve
working directly2 with patients, clients or communities for at least fifty percent of
the time available (“communities” may be relevant in the case of a nurse working
in public health).”
(Annex A, Section B, para 6)

1.3 The policy guidance also identified four principal functions3 for Consultant roles
“irrespective of the field of practice, setting or service in which it (the role) is
based”:

• Expert Practice
• Education, Training and Development
• Professional Leadership and Consultancy
• Practice and Service Development, Research and Evaluation

Background

1.4 In 2013-2014 a project to develop an Advanced Nursing Framework (DHSSPS

2014) was led by NIPEC and chaired by Brenda Creaney, Executive Director of
Nursing, Belfast Health and Social Care Trust. One of the recommendations made
as part of this project was:

1
Although the policy refers to nurse, midwife and health visitor consultants the title to be used from 2016 is Consultant Nurse or
Consultant Midwife.
2
“working directly with” also includes practice which directly impacts upon the care of patients/clients or communities.
3
The four principal functions are referred to as the four core competencies in the Professional Guidance
2
 As a result of the development of the Advanced Nursing Practice Framework
including core competencies and learning outcomes a project should be
commenced to review the role of Nurse Consultants in NI.
(p.21 Final Project Report (NIPEC 2014)

1.5 On behalf of the Chief Nursing Officer, NIPEC agreed as part of its 2016-2017
business plan, to develop professional guidance to support Consultant Nurse and
Consultant Midwife roles in NI.

3
SECTION 2: PROJECT PLAN AND APPROACH

2.1 To ensure the success of the project NIPEC requested an Executive Director of
Nursing Brenda Creaney, Belfast HSC Trust to lead a Steering Group made up of
the key stakeholders and decision makers comprising Senior Nurses and Midwives
and where available Consultant Nurses/Midwives from the following organisations:
HSC Trusts, Public Health Agency, Clinical Education Centre, Department of Health
(DoH), Royal College of Nursing, Royal College of Midwifery, Trade Union Forum,
Queen’s University Belfast, Ulster University and NIPEC Council. See Appendix
One for the Membership of the Steering Group.

2.2 The project plan aim and objectives were as follows:

Project Aim

2.3 The Project Steering Group will develop professional guidance to support
Consultant Nurse and Midwife Roles across Health and Social Care in Northern
Ireland. This guidance will be designed to meet the needs of Consultant Nurses and
Midwives, commissioners and workforce planners.

Project Objectives

2.4 The objectives of the Project were to:

• explore the current roles and responsibilities of Consultant Nurse and Midwife
roles across Health and Social Care
• agree a definition for Consultant Nurse and Midwife roles developed in light of
the DoH policy circular and current literature
• align Consultant Nurse and Midwife roles to the Advanced Nursing Practice
Framework (revised) (DHSSPS 2016), in particular, to the core competencies,
educational requirements and ongoing continuous professional development
• develop a career framework to support Consultant Nurse and Consultant
Midwife roles
• explore the adoption of the Role Development Guide (NIPEC 2006) to guide
the approach to strategic workforce planning for the development and
succession planning for Consultant Nurse and Midwife roles.
4
Project Implementation

2.5 A robust project management approach was implemented supported by a project

plan. The Steering Group was responsible for overseeing the management of the
project and five meetings were held between May 2016 and May 2017. These
meetings also provided opportunities for members to provide feedback as
representatives of their organisations and the Executive Directors of Nursing/Senior
Nurse Leaders, where relevant. Progress against the objectives in the Project Plan
was also monitored and reviewed at Steering Group meetings.

2.6 A writing sub-group was established from the membership of the Steering Group
with the purpose of drafting the Professional Guidance (Appendix 1). This group
met between Steering Group meetings. The sub-group completed the development
of the components of the Guidance via face to face or virtual meetings. The virtual
meetings were facilitated using teleconference facilities and “go-to-meeting”
software. The latter enabled colleagues to view the document, in real time, whilst
situated in different locations. This approach was evaluated by all sub-group
members as very effective and efficient. The various stages of development of the
Guidance were reported to the Steering Group, discussed and either approved or
amendments were agreed.

2.7 The Steering Group wanted to ensure effective engagement and involvement of key
stakeholders in the development of the Professional Guidance. The Chair of the
Steering Group gave clear direction to members of the Group regarding their
individual responsibility to share the approved drafts of the document within their
organisations including with Executive Directors of Nursing and clinical teams. Each
member was responsible for gathering views, getting agreement and providing
feedback from their organisation to the Steering Group on the progressive
development of the Guidance. This was achieved and there was a high level of
engagement and seeking feedback in the organisations which employed
practitioners in all the relevant roles.

5
SECTION 3: PROJECT OUTCOMES

3.1 This section of the report provides information on the achievement of the project
objectives, together with any difficulties or challenges experienced. All project
objectives were achieved within the agreed timeframe.

Objective 1

Explore the current roles and responsibilities of Consultant Nurse and Midwife roles
across Health and Social Care.

Objective Achieved.

By October 2016, the Executive Directors of Nursing agreed the verification of the current
number of Consultant Nurse and Midwife posts in each of their HSC Trusts, see Table 1
overleaf:

6
Table 1: Consultant Nurse and Consultant Midwife Roles in HSC Trusts as at
October 2016

HSC Trust WTE Area of Practice AfC In Post/ Vacant

Band
1.0 Nursing: Respiratory 8C In Post
Nursing: Critical Care
1.0 In Post
(Resuscitation and Critical 8B
Care Outreach)
1.0 Nursing: Emergency Care 8B In Post
Belfast
Palliative Care (joint
1.0 appointment 8A In Post
BHSCT/QUB/Marie Curie)
1.0 Midwifery 8B In Post
1.0 Nursing: Cystic Fibrosis 8B Vacant *
Northern 1.0 Midwifery 8B In Post
1.0 Nursing: Dementia 8B In Post
South Eastern Nursing: Sexual Health
0.8 (joint appointment SEHSCT/ 8B In Post
QUB
In Post
Southern 1.0 Nursing: Older People 8B
In Post
Western 1.0 Nursing: Critical Care 8B
*Consultant Nurse: Cystic Fibrosis, this post was appointed in January 2017.

Objective 2

Agree a definition for Consultant Nurse and Midwife roles developed in light of the
DHSSPS (2004) policy circular and current literature.

Objective Achieved.

The Professional Guidance was developed in a style similar to that of the Advanced
Nursing Practice Framework so that the Guidance could be easily understood by all to
whom it would be relevant. Consultant Nurse and Midwife roles were defined in line with
the DHSSPS policy guidance:

“The Consultant Nurse and Consultant Midwife practises autonomously at an advanced

level in the delivery of high quality, safe and effective care. The Consultant role blends a
7
significant proportion of direct, higher level clinical care with education, research, service
development and evaluation activities. These practitioners work within multidisciplinary
teams across organisational and professional boundaries. They lead and influence service
and policy development at strategic level while continuing to provide a strong clinical
commitment and expert advice to clinical colleagues” p. 3.
(Department of Health 2017)

In addition, the use of the title Consultant Nurse or Consultant Midwife was debated and in
line with the policy guidance (DHSSPS 2004) the following was agreed:

The title Consultant Nurse or Consultant Midwife is only to be

used by those employed in the role which fulfils the four
principal functions in the DHSSPS policy guidance (2004)

Objective 3

Align Consultant Nurse and Midwife roles to the Advanced Nursing Practice
Framework (revised) (DHSSPS 2016), in particular, to the core competencies,
educational requirements and ongoing continuous professional development.

Objective Achieved.

A writing sub-group comprising members of the Steering Group was established to review
the competencies in the Advanced Nursing Practice Framework and develop relevant ones
for the Consultant roles which would include nursing and midwifery. The Writing Group
comprised: a Consultant Midwife, two Consultant Nurses, two HSC Trust nursing workforce
leads, education provider and NIPEC Project Lead.

Core competencies were developed under the principal functions (see Figure 1.) which
reflect Consultant Nurse and Midwife roles and can be used to support personal/career
development, appraisal, supervision and design of education programmes. A minimum of
Master’s Degree Level study is a requirement of the role, enhanced by a post-graduate
qualification in the area of practice. It was also agreed that continuous professional and

8
scholarly activity was essential this includes continuous study up to doctoral level, research
experience and publication.

Figure 1: Entry criteria and core competencies for Consultant Nurse and Consultant
Midwife Roles

Objective 4

Develop a career framework to support Consultant Nurse and Consultant Midwife

roles.

Objective Achieved.

The Professional Guidance developed for Consultant Nurse and Consultant Midwife roles is
one of a suite of resources which supports nurses and midwives in clinical roles. The
resources developed will be used to populate the clinical practice career pathway on the
nursing and midwifery careers website. The core components of the relevant roles are
presented in Appendix 2.

9
Objective 5

Explore the adoption of the Role Development Guide (NIPEC 2006) to guide the
approach to strategic workforce planning for the development and succession
planning for Consultant Nurse and Midwife roles.

Objective Achieved.

The Role Development Guide was commissioned research completed by Ulster University
in 2006. The Steering Group agreed that the Role Development Guide was a useful tool
and should be recommended for review by NIPEC.

10
SECTION 4: CONCLUSION AND RECOMMENDATIONS

Conclusion

4.1 The primary focus of the Project to develop Professional Guidance Supporting
Consultant Nurse and Consultant Midwife Roles was to achieve a regionally agreed
and standardised approach which would support the education, development and
workforce planning for Consultant Nurse and Midwife roles in HSC Bodies.

4.2 All project objectives were achieved and the Professional Guidance was developed
through effective engagement with and participation of nurses and midwives
including: Consultant Nurses and Midwives, Managers, Educators, Executive
Directors of Nursing.

Recommendations

The following recommendations are made to support the effective implementation of

the Professional Guidance Supporting Consultant Nurse and Consultant Midwife
Roles:

Recommendation 1

Following endorsement of the Guidance by the CNO, Executive Directors of Nursing

in HSC Bodies should promote the implementation of the Professional Guidance in
their organisation to ensure all Consultant Nurses and Midwives are supported to
meet the requirements of the guidance.

Recommendation 2

To facilitate the transformation agenda outlined in the Ministers vision, Health and
Wellbeing 2026: Delivering Together (2016), an implementation plan should be
developed with HSC Bodies to ensure effective workforce planning for and
commissioning of these roles. This should also include a plan for their evaluation.

11
Recommendation 3

As per the DHSSPS (2004) policy guidance the title of Consultant Nurse or
Consultant Midwife should only be used by those roles encompassing the four core
competencies.

Recommendation 4

As the Consultant Nurse and Consultant Midwife roles are continually evolving the
elements contained within the Professional Guidance will require 3 yearly reviews.

Recommendation 5

Executive Directors of Nursing of HSC Bodies should ensure effective support

mechanisms are in place within their organisation for Consultant Nurse and
Consultant Midwife roles including professional reporting arrangements and
infrastructure.

Recommendation 6

As a result of the development of the Professional Guidance for Consultant Nurse

and Consultant Midwife Roles, the Advanced Nursing Practice Framework should
be revised.

Recommendation 7

A formal regional network of Consultant Nurses and Midwives should be

established to provide peer support and influence the future development and
support for these roles.

12
REFERENCES

Department of Health Social Services and Public Safety (2004) Circular HSS (TC5) 1/2000
(GB Advance Letter (NM) 2/2000). Belfast: DHSSPS.

Department of Health, Social Services and Public Safety (2016) Advanced Nursing
Practice Framework: Supporting Advanced Nursing Practice in Health and Social Care
Trusts. Belfast: NIPEC

Department of Health (2016) Health and Wellbeing 2026: Delivering Together. Belfast:
DoH

Northern Ireland Practice and Education Council (2006) New Roles Guide. Belfast: NIPEC
http://www.nipec.hscni.net/download/professional_information/resource_section/role_devel
opment/roledevelopment_guide/newrolesguide.pdf

Northern Ireland Practice and Education Council (2014) Final Project Report: Advanced
Nursing Practice Framework: Supporting Advanced Nursing Practice in Health and Social
Care Trusts. Belfast: NIPEC

13
 Appendix One

Membership of Project Steering Group

Brenda Creaney Executive Director of Nursing BHSCT

(Chair)
Moira Mannion Co-Director Nursing BHSCT
Annemarie Marley Consultant Nurse: Respiratory
Allison Hume Assistant Director Nursing NHSCT
Shona Hamilton Consultant Midwife
Sharon McRoberts Assistant Director Nursing SEHSCT
Carmel Kelly Consultant Nurse: Sexual Health
Dawn Ferguson Nursing and Workforce SHSCT
Coordinator
Jane Greene Consultant Nurse: Older People
Annetta Quigley Lead Nurse: Workforce Planning WHSCT
& Development
Brian McFetridge Consultant Nurse: Critical Care
Siobhan McIntyre Regional Lead Nurse Consultant Public Health Agency/
Health and Social Care
Board
Garrett Martin Deputy Director Royal College of Nursing
Brenda Kelly Midwifery Manager Royal College of Midwives
Maura McKenna Joint Chair Regional KSF Forum Trade Union Forum
Marion Ritchie Trade Union Chair (SE HSC UNISON
Trust)
Maurice Devine MBE Assistant Head Clinical Education Centre
Verena Wallace Midwifery Officer DoH
Heather Finlay Nursing Officer DoH & Directors HR Forum
Dr Kevin Gormley Senior Lecturer ( Nursing) Queen’s University Belfast
Karen Murray Lecturer (Midwifery) (until
December 2016)
Prof. Owen Barr Head of School Ulster University
Mr Paul Davidson Lay Member NIPEC Council
Cathy McCusker Senior Professional Officer NIPEC
(Project Lead)

14
 Appendix Two
Table 2. Distinguishing characteristics between Specialist Practice Nurse, Advanced Practice Nurse and Consultant Nurse and Midwife Roles
Adapted from Advanced Nursing Practice Framework (DHSSPS, 2016)
Components of Specialist Practice Nurse Advanced Nurse Practitioner Consultant Nurse & Consultant Midwife
Practice
Clinical Practice & • work as member of a team, • work autonomously using a person- • exercise advanced levels of clinical judgment, knowledge and skill and possess a high
Scope of Role within a defined area of nursing centred approach within the degree of personal/professional autonomy to enable complex decision-making
practice; expanded scope of practice • use an innovative, person-centred approach to contribute to better outcomes and
• undertake comprehensive • undertake comprehensive health experience for patients/clients, families, carers or communities
assessments with differential assessment with differential diagnosis • provide strategic professional leadership to support improvements in professional
diagnoses and may diagnose; and will diagnose practice, standards of care and effective identification and management of risk
• prescribe care and treatment or • prescribe care and treatment or within the organisation’s clinical governance framework
appropriately refers and may appropriately refers and/or discharges • act as an educator for colleagues wishing to develop advanced knowledge and skills
discharge; and patients/clients and establish university links to provide academic and research support
• contribute to education, • provide complex care using expert • develop and influence professional practice locally and nationally through the
innovation and research. decision-making skills promotion and evaluation of evidence-based practice, research and service
• act as an educator, leader, innovator development
and contributor to research. • present and contribute to local/national professional conferences, special interest
groups/working parties, research and relevant publication
• lead and facilitate interprofessional working
Supervision • professional nursing supervision • supervision relevant to the area of • supervision relevant to the area of practice through local/national professional
Requirement practice* networks
• professional nursing supervision. • professional nursing/midwifery supervision.
Service Improvement • contribute to policy and service • responsible for policy development, • work with DoH and other relevant organisations to influence policy development
development implementation and service and service/quality improvement
• contribute to service development • lead on service/quality improvement initiatives at local, regional and national level
improvement initiatives • lead on service improvement • lead innovations across multidisciplinary teams.
initiatives
Education • live NMC registration • live NMC registration • live NMC registration
Requirement • BSc (Hons) in Nursing or other • has completed a Master’s programme • have completed a Master’s Degree as a minimum
Health Related Subject; in the relevant area of practice • have completed a post-graduate qualification within the relevant area of practice
• NMC recorded Specialist Practice • NMC recorded Non-Medical • may require a NMC recorded Non-Medical Prescribing qualification.
qualification; and Prescribing V300. • pursuing continuous professional and scholarly activity.
• may require a NMC recorded
Non-Medical Prescribing
qualification.
* The Advanced Nurse Practitioner should receive supervision from an expert within the relevant area of practice. In some instances this may be a practitioner from a discipline
other than nursing for example a GMC registered Consultant/Specialty Doctor grade or equivalent
15
 For further Information, please contact
NIPEC
25

Centre House
79 Chichester Street
BELFAST, BT1 4JE
Tel: 0300 300 0066
Fax: 028 9033 3298

This Final Project Report can be downloaded from the

NIPEC website www.nipec.hscni.net

June 2017