The influence of outreach in the development of the nurse consultant role in critical care: Cause or effect?

Summary 

Background

Critical care nurse consultant roles have evolved against a background of service innovation that has resulted in the development of critical care outreach services. Despite compelling evidence that there was a serious problem with the management of critically ill patients in the ward environment, there is little evidence to support outreach as a concept or as a role for nurse consultants.

Aims

The aims for this part of the study were to:

Methods

A national postal survey of all 72 critical care nurse consultants in post in England by August 2003; response rate 72% (n=52). All data was entered on to a computer anonymously and analysed using SPSS version 11.5. A factor analysis revealed a sub-set of nurse consultants who had a significantly greater involvement in outreach activity.

Results

Critical care nurse consultants have a high involvement in the development of care for critically ill patients outside the traditional boundaries of critical care. A sub-set emerged that has a significantly greater involvement in outreach activity. This includes roles such as working with an individual or team to develop their practice (whole group mean involvement score M=4.45, outreach M=4.88, p<0.001); developing education outside the ICU/HDU (whole group M=4.13, outreach M=4.88, p<0.001) and receiving nurse led referrals from the wards (whole group M=3.92, outreach M=4.81, p<0.001).

Conclusions

Given the lack of evidence for outreach, organisations should consider the high level of involvement of the nurse consultant outside the traditional boundaries of the ICU/HDU.

Keywords: Nurse consultant, Critical care outreach, Role involvement, Survey