In 1999, the Health Service Circular (HSC, 199) specified that irrespective of the field of practice, the nurse, midwife or health visitor consultant role must be centered around certain interrelated functions, including: expert practice, professional leadership and research and evaluation (Cox, 2000). It recommended a consultant post be based in practice at least 50 percent of its time and this should involve working directly with patients, clients or communities. The consultant is also expected to exercise a high degree of professional autonomy and make critical clinical decisions if precedents and protocols do not already exist. The competencies required of a nurse, midwife or health visitor consultant have been set by the United Kingdom Central Council (UKCC), but the criteria for appointment depend primarily on the employer's expectations of the consultant post.
In the United states, an advanced nurse practitioner (ANP), the equivalent of the British nurse consultant, is expected to have diagnostic and prescriptive skills (Cox, 2000). If this is to be required in Britain, then necessary educational standards will have to be set. In the United States and Canada, the standard is set at the masters degree level. In England, the qualifications and standards are not yet defined, and there are a number of labels given to advanced practice roles, such as nurse practitioner, clinical nurse specialist, clinical nurse consultant or nurse clinician. The roles in these pos
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