The characteristics, qualities and skills of practice developers

The characteristics, qualities and skills of practice developers

BRENDAN MCCORMACKBRENDAN MCCORMACK BSc, DPhil , PGCEA, RGN, RMN

Professor of Nursing Research/Director of Nursing Research and Practice Development, University

of Ulster, Jordanstown and Royal Hospitals Trust, Belfast, UK

ROBERT GARBETTROBERT GARBETT BN, MSc, RN

Research and Practice Development Fellow, Royal College of Nursing Institute, Radcliffe

Infirmary, Oxford, UK

Accepted for publication 10 August 2002

Summary

• There is a growing interest in practice development as a systematic process for

the development of quality patient care.

• Whilst there is a range of accounts of practice development in the literature,

little work has been undertaken to develop an understanding of the systems and

processes involved and there is even less on the roles involved in practice

development.

• This paper explores in particular the characteristics, qualities and skills of

practice developers, i.e. professionals who have formal responsibility for

developing practice in organizations.

• The paper represents part of a larger study exploring the conceptual basis of

the term �practice development�.

• Data for this part of the project were collected through literature analysis,

seven focus groups involving 60 practice developers and telephone interviews

with 25 practising nurses with experience of working with practice developers.

The data were analysed using cognitive mapping processes.

• Four role functions are presented in the paper, as well as qualities and skills

needed to operationalize the identified role functions.

• A clear picture of the skills and qualities required by practice developers

emerges from the data.

Keywords: change, concept analysis, facilitation, practice developers, practice

development.

Introduction and background

The range of functions and activities described in relation

to practice development is wide. This reflects the different

approaches taken to developing practice and different

organizational levels at which such activity takes place.

Correspondence to: Professor Brendan McCormack, Director of NursingResearch and Practice Development, Royal Hospitals Trust, First FloorEducation Centre, Royal Victoria Hospital, Grosvenor Road,Belfast, BT12 6BA, UK (tel.: +44 28 90346394; e-mail: [email protected]).

Journal of Clinical Nursing 2003; 12: 317–325

� 2003 Blackwell Publishing Ltd 317

Accounts of practice development and research and

development roles have been written from a number of

perspectives including roles in clinical practice (Thomas &

Ingham, 1995; Weir, 1995), organizational �insider�(Knight, 1994; Knight et al., 1997; McMahon, 1998)

and organizational �outsiders� (Johns & Kingston, 1990;

Ward et al., 1998; Jackson et al., 1999a, b; McCormack &

Wright, 1999; McCormack et al., 1999). To date there is

one published survey that attempts to map out the

activities of a group of people whose work explicitly

involves practice development (Mallett et al., 1997).

This paper, therefore, will explore the role of practice

developers as identified through a larger study exploring

the concept of �practice development� (Garbett &

McCormack, 2002). It will describe the characteristics of

practice developers and qualities and skills necessary to

operationalize the role, as well as identifying issues for

further research and development work.

Methodology

This main study from which this paper is derived (Garbett

& McCormack, 2002) adopted a �concept development�methodology, adapted from Morse’s (1995) approach to

concept analysis. According to Morse (1995), early

approaches to concept analysis in nursing were dominated

by methods founded in a logical positivist conception of

objective truth (Wilson, 1963). In contrast, Morse (1995)

argues for an approach that uses qualitative research

methods to analyse both primary and secondary sources of

data. Concept development involves three stages: identi-

fying attributes, verifying attributes and identifying man-

ifestations of the concept. The first stage of our study took

the form of a literature analysis. The second stage,

attribute verification, involved looking for the use of

concepts identified in the first stage and was a deductive

process. In the work described here a selective search of

the literature was employed, together with focus group

interviews with nursing staff involved in practice devel-

opment. The final stage, identifying manifestations of the

concept, involved refining the components of the concept

and describing how they are manifest in different groups

and settings. Telephone interviews and focus group

discussions were used as a means of exploring the meaning

and dimensions of key ideas arising from the study.

The literature analysis stage followed the four stages

described by Morse (1995):

• Literature review;

• Familiarization with the literature;

• Thematic analysis of the literature;

• Identification, description and comparison of emerging

categories.

The first two stages took the form of locating the

literature to be analysed. The intention here was to find as

much material as possible that directly related to the

concept of practice development. The Cumulative Index

for Nursing and Allied Health (CINAHL), Medline,

Royal College of Nursing’s library database and the

National Research Register were searched using the phrase

�practice development�. The term is not included in the

thesaurus of CINAHL and therefore the terms �practice�and �development� were combined. No limits were set on

date of publication. As well as these searches, references

were located if they were used to expand on the concept of

practice development. One hundred and seventy-seven

articles, books or book chapters were scrutinized in detail

for the purposes of this literature analysis (Table 1). On

detailed reading, 29 of these were not retained for further

study because of the limited quality of the information

they offered for study of the concept of practice devel-

Table 1 A summary of references found through searching the literature

Database

References

found (duplicated

references

in brackets)

References

duplicated

in Cinahl &

Medline

References

duplicated

in Cinahl,

Medline

& RCN

References

rejected from

lists generated

by databases

(duplicated

references

in brackets)

References

retained

(duplicated

references

in brackets)

References

incorporated

in addition

to searches

Total

number of

references

examined

Cinahl 173 79 94

Medline 46 26 16 (6) 30 (20)

RCN (journal articles) 137 8 98 (1) 39 (7)

RCN (books) 56 44 12

Totals (including duplicates) 412 (34) 238 (7) 175 (27)

Totals (excluding duplicates) 378 231 148 29 177

318 B. McCormack and R. Garbett

� 2003 Blackwell Publishing Ltd, Journal of Clinical Nursing, 12, 317–325

opment. A form of thematic analysis was used to approach

stages 3 and 4 of the literature analysis. This involved a

search for and identification of common threads that

extended throughout the body of the text. The results of

these readings were drawn together using cognitive maps

to formulate descriptive categories that in turn informed

the interview topics for the telephone and focus group

interviews. NUD*IST 4.0 (QSR International, Mel-

bourne, Australia) software was used to manage and

organize the notes made on the literature.

Two initial focus group discussions were used to pilot

questions, analytic procedures and equipment and an

interview guide was then developed which was used in

subsequent focus groups. Thereafter a purposive sampling

approach was used. People known to be active in practice

development �communities� across the UK were contacted

and asked to help with bringing together a group of six to

12 nurses active in practice development. The main

criterion for selection was degree of activity in the field;

however, some attention was also paid to geographical

spread. Seven focus groups were conducted, involving a

total of 60 participants active in practice development and

drawn from practice development posts, education, man-

agement or practice (or a combination of some or even all

of these). The focus groups were tape recorded with the

permission of the participants and with the understanding

that the contents would be made be anonymized, with no

individuals or organizations being identifiable in any

published material. Field notes were made straight after

the groups and integrated into the analysis. The tapes

were listened to as soon as practicable after the focus

groups for the purposes of making field notes and getting a

feel of the discussion as a whole, and then were listened to

again so that cognitive maps could be constructed.

The telephone interviews were conducted with prac-

tising nurses across the UK who had experience of

working with practice developers. Twenty-five practition-

ers were interviewed in their workplaces using an

interview schedule derived from previous stages of the

study. A full account of this component of the study can

be found in Garbett & McCormack (2001).

DATA ANALYSIS: COGNITIVE MAPPING

Cognitive mapping was used as a means of analysis in all

stages of the study. This has been defined as �a modelling

technique which intends to portray ideas, beliefs, values

and attitudes and their relationship to one another in a

form which is amenable to study and analysis� (Eden et al.,

1983, p. 30). It offered a practical way of taking a similar

approach to handling data gathered from different sources.

The procedures developed by Northcott (1996) were

adapted for this study. As Northcott suggests, the partic-

ular requirements of an individual study mean that the

researcher needs to be flexible in adapting the approach to

optimize the coding, categorizing, interpretation, and

transcription of the data into one activity. Each interview

was analysed individually to generate initial codes and

categories, before analysis of all interview records to refine

the emerging themes. The following steps were used:

• Maps were constructed as soon as practically possible

after the interview;

• The tape was listened to, without detailed note-taking,

to get a feel for the encounter as a whole and field notes

were taken based on the tape and on the original

conversation;

• Mapping of the interview, rewinding the tape to ensure

that ideas were accurately captured. The counter on the

tape recorder was used to indicate passages of particular

interest to be transcribed verbatim;

• The initial map was refined, formulating codes and

making connections clear. Unlike in Northcott’s (1996)

study, verbatim quotes were incorporated into the maps

themselves.

Whilst both the telephone interviews and focus group

discussions were used as a means of exploring the meaning

of the term �practice development�, participants in both

data collection activities raised issues concerning the roles

of practice developers. It is these combined data that are

reported here.

Functions and activities of practice developers

The literature identified a range of activities undertaken

by practitioners concerned with practice development

working in both internal and external roles. Two forms of

content analysis of the literature were performed. For the

first, accounts of roles were scrutinized and summarized to

generate lists of activities undertaken, the nature of

projects undertaken and the skills and qualities associated

with the role(s) being described. Accounts were included

if authors held or were describing practice development or

research and development roles. For the second, infer-

ences were drawn from descriptions of practice develop-

ment projects where a practitioner holding a practice

development or research and development role was

involved in writing the account. A list of 71 activities

was drawn up. Although there was overlap between these,

the terms and descriptions used were sufficiently distinct

to justify their initial listing as separate items (for example,

�teaching� and �giving lectures�). These terms were com-

pared and analysed to arrive at six descriptive categories:

Developing clinical nursing practice Practice developers 319


1 Promoting and facilitating change;

2 Translation and communication;

3 Responding to external influences;

4 Education;

5 Research into practice;

6 Audit and quality (including the development of

policies and guidelines).

Practice developers who took part in the focus group

interviews also described a wide range of activities.

However, mapping them onto the headings above sugges-

ted a more discrete scope of activity. For the most part

they talked about being concerned with promoting and

facilitating change and communicating about the work that

they were involved with. They talked relatively little about

work concerned with getting research into practice or

audit/quality activities. For this reason, only the first four

activities listed above are discussed in this paper. Quota-

tions from the data are identified by the relevant focus

group (FG) or interview (Int) number and line number.

PROMOTING AND FACILITATING CHANGE

Activities in this category were concerned with support-

ing, raising awareness and helping create a culture to

support change based on the perceptions and needs of staff

themselves [in two published accounts reference was also

made to the needs of service users (Weir, 1995; Jackson

et al., 1999a)]. This theme also emerged in two of the

focus group interviews.

The dominant model of change agency in the literature

is that which reflects normative-re-educative theory

(Bennis et al., 1985). Thus, Weir (1995) talks of a change

agent role with �a professional rather than a managerial

focus� that is concerned with the process of change as a

means to develop individuals’ skills and confidence as

much as with achieving an outcome for its own sake. Weir

positions the practice development nurse’s role as �work-

ing with and on behalf of directorate/clinical managers�.This is not a view shared by all practice developers. In the

focus group interviews, quite polarized views were present

concerning alignment with managerial structures. On the

one hand, there was a view that being involved with both

practice development and management represented a

conflict of interest and that the two functions should be

distinct, each providing a foil for the other. On the other

hand, participants considered that practice development

was integral to the �business� of health care and so was part

and parcel of the management and improvement of

services.

The majority of activities described by practice devel-

opers in the focus group interviews involved aspects of

promoting and facilitating change in practice. These could

be focused on individuals, teams or larger groupings

within the organization. Two groups described the

importance of working clinically. This could be used as

a means of modelling practice (particularly where senior

nurse posts incorporated practice development responsi-

bilities). It was also described as a means of building

credibility and as a �bargaining� strategy, trading hours in

practice in return for clinicians participating in an activity

contributing to practice development, such as searching

literature or completing data collection tools.

Working clinically could also focus on working with

individuals as a mentor or supporter, providing feedback

and guidance on performance. Those who received it

valued this aspect of practice development work; for

example one staff nurse said:

She worked with me when I looked after orthopaedic

patients when I felt a bit rusty. She was helpful and

wasn’t threatening and helped me working with a

student and we bashed our ideas out together (Int.

16/11).

Another aspect of working with individuals was termed

�counselling� in three of the groups and involved being

approached by clinicians about concerns that they had

about issues in their clinical practice. Participants in the

focus groups variously described this as being used as a

�sounding board� or as �troubleshooting�. This kind of

activity, and working alongside individuals providing

support and mentorship, seem to overlap with the clinical

leadership usually associated with ward leaders. However,

there was also a sense of its relevance to practice

development as a means of understanding clinicians’

perspectives on the issues that concerned them most.

Participants acknowledged this duplication, but argued

that it was something looked for by clinicians and

therefore as a valuable component of the practice devel-

opment role:

Practitioners use PD nurses as a �neutral ear�, as

sounding boards for problems they might have as a

source of advice and support that is not shaped by

line management. This is why practice development

roles could not be combined with managerial roles

(FG 8/419).

This aspect of the role was corroborated to some extent

in the telephone interviews; for example, a staff nurse in

an acute hospital setting reported that, �We go to her (the

practice development nurse) to discuss issues we are not

happy about� (Int. 19/045). However, as in a number of

cases, the practice development nurse was a former senior

clinician in the area and so apparently had existing rapport

with staff.



Identification of issues for practice development was

described as intimately tied up with resolution of those

issues. The emphasis of activities here was on using a

range of resources to help clinicians tackle issues for

themselves. Practice developers talked about their role as

gatekeepers to resources such as study days and courses,

expertise within and outside their organization, and

generating ideas for funding. This type of activity is one

that was raised frequently by clinicians, who talked about

being helped to make business cases, presentations and

bids for funding. Other clinicians talked about the role of

practice development staff in getting them involved with

service-wide initiatives such as working parties on aspects

of clinical care. Practice developers talked about a range of

facilitative approaches, including getting practitioners to

think creatively and more broadly and helping them put

their ideas into action. But they also saw their facilitative

roles as being required at a variety of organizational levels.

They frequently referred to their roles as being situated �inthe middle�, working with practitioners but also with

managers at middle and senior levels and increasingly with

representatives from other health care occupations and

user groups. One participant, who compared the role with

that of �keeping plates spinning� (FG9/267), perhaps

summed this up best. The image was of a person

maintaining the impetus of a particular project by dividing

their attention between a number of elements (the

spinning plates) and trying to attend to them all as and

when required. Other aspects of facilitative work des-

cribed by practice developers included acting as mediator

and negotiator where there was conflict and linking people

with similar ideas and interest and helping them to work

together.

TRANSLATION AND COMMUNICATION

People working in practice development roles both within

and outside organizations described a number of activities

that suggested that they were situated between top

management and the practice area. Some activities could

be characterized as �top-down�, such as interpreting and

disseminating policy documents and information from a

higher organizational level (Mallett et al., 1997). Others,

such as generating interest for project work at local level

amongst managers and opinion leaders in the broader

organization (Marsh & MacAlpine, 1995; Abi-Aad &

Raine, 1998; Jackson et al., 1999b), could be described as

�bottom-up�. These latter activities were seen as important

components in planning for successful change. Addition-

ally, working on various representative groups and

networking with other organizations were also described

(Thomas & Ingham, 1995; Mallett et al., 1997; Jeffries &

Timms, 1998).

This area of work was talked about in the focus group

interviews. As has been mentioned elsewhere, practice

development staff frequently saw themselves as �inbetween� managerial structures and clinical practice. Being

seen and being known was therefore important to their

work. Strategies employed ranged from �being seen to go

round and meet people� and �smiling at everybody� to more

formal activities such as representing nursing in meetings

with managers, members of other professions and service

users. Some practitioners interviewed by telephone talked

about the importance of this kind of work. One, for

example, contrasted a practice development nurse who

�could never be found� with one who always seemed to be

there when �you need her�.

RESPONDING TO EXTERNAL INFLUENCES

Ranges of external influences, to a greater or lesser extent,

have shaped the kind of work undertaken by health care

organizations. Respondents to Mallett’s survey (Mallett

et al., 1997) indicated that external directions, such as

policy documents, professional documents including the

Scope of Professional Practice (UKCC, 1992b) and shifts in

interprofessional boundaries such as those resulting from

the initative to reduce junior doctors’ working hours all

influenced how their roles developed.

In the UK, the influence of government policy has been

evident in the development of �named nursing� as part of

The Patient’s Charter (Department of Health, 1991),

supervisory arrangements (Department of Health, 1993),

and the development of dissemination networks (Depart-

ment of Health, 1993), to name but three. However, as

discussed above, the relationship between policy and the

development of practice need not be one of a reaction to

policy. The ideas and aspirations may be contained and

developed within the policy environment, and indeed the

policy environment can be used as a means for advancing

practitioners’ own agendas (Graham, 1996).

Practice developers acknowledged that policy docu-

ments could have a powerful effect on setting agendas for

development work. Most of the groups saw responding to

and working with policy agendas as part of their work, and

clinical governance seemed to feature particularly in their

working lives. However, involvement with work derived

from policy initiatives seemed to be something of a double-

edged sword. On the one hand, the fact that such initiatives

were perceived as being imposed could be problematic.

However, they were also seen as an opportunity to bring

different professionals together to address issues.



EDUCATION

Descriptions varied as to the extent to which educational

activities formed part of practice development. The term

�professional development� was frequently used to describe

postbasic education, which might or might not be

associated with systematic changes in practice, and was a

term frequently confused with practice development.

Mallett et al. (1997) suggest that the terms professional

and practice development are distinct but can easily be

taken as synonymous. They argue that professional

development refers to the skills of the individual practi-

tioner, while practice development is about creating the

conditions in which such skills and knowledge can be

applied. Confusion of the two terms is apparent in

accounts such as that by Hanily (1995). Under the title of

practice development Hanily describes the development

and implementation of a training strategy based on the

assumption that care will improve as a consequence of

providing new knowledge. This assumption has been

challenged as over-simplistic, neglecting as it does the

complexity of change (Kitson et al., 1996).

There seemed to be fewer references to educational

activities by practice development staff interviewed in the

focus groups than in the literature. By contrast, a majority

of clinicians interviewed by telephone defined practice

development roles in terms of providing access to personal

and professional development, both formally and inform-

ally. In one focus group where practice developers were

joint appointees between a university and a hospital, there

was a clear educational component to their work both in

terms of a commitment to particular courses and in

helping clinicians relate learning on taught courses to

practice. However, in most of the interviews educational

activities played little part in discussions.

By stark contrast, practitioners in telephone interviews

were more likely to say that practice development was

closely related to personal study and development rather

than to changes in a service as a whole (Garbett &

McCormack, 2001). For nearly half of the informants (12

out of 25), the term was synonymous with training and

attendance at courses. In a number of organizations the

term practice development was associated with groups

concerned with both co-ordinating and providing training,

as well as supporting change in the workplace. Where

practice development nurses were present in clinical areas,

at least part of their value was seen to be encouraging and

supporting practitioners to follow particular courses of

study. However, education was not necessarily seen as

separate from practice and orientated only to the needs of

the individual practitioner. Six informants described how

education and training were related to changes in practice.

In two organizations training and practice were linked

through plans developed from appraisal. In three instanc-

es, informants described a reciprocal relationship between

learning activities and the development of practice. For

example, one staff nurse working with older people said,

�(The) nurse adviser encourages nurses to constantly try

and improve the quality of care that we are giving, and also

to improve ourselves� (int. 14/002). One senior nurse

described personal development in terms of the necessary

skills required to deliver person-centred care, such as the

social skills needed to apply knowledge in a skilled and

individualized manner.

Qualities and skills

Relatively little attention is paid in the literature to the

qualities and skills required of people working in practice

development roles. Until recently the published informa-

tion was derived largely from two personal accounts

(Thomas & Ingham, 1995; Weir, 1995) and from conclu-

sions drawn by Kitson et al. (1996). Qualities described

include those of being pragmatic, a risk taker and able to

accept criticism. At a more ideological level, Weir (1995)

and Thomas & Ingham (1995) emphasize the importance

of a belief in the worth and value of people. In addition,

Weir describes the importance in gaining satisfaction from

seeing others succeed and Thomas & Ingham (1995)

consider the necessity of drive, commitment and patience.

Titchen (1998), based on in-depth research during a

long-term practice development project on an acute

medical ward, identified details, particularity, reciprocity,

mutuality, graceful care, saliency and temporality as key

elements of a facilitation relationship.

In our work, speaking to practice developers in a range

of different organizations and posts resulted in a rich

description of the kinds of qualities and skills considered

necessary to help develop practice. The qualities they

described bear close resemblance to those associated with

�transformational leadership� (Antrobus & Kitson, 1999).

They are concerned with helping colleagues develop ideas

and helping them articulate and think through ideas, but

also feeding in knowledge, information and skills where

necessary. There was consistent reference to under-

standing the experience of colleagues in practice as a

starting point for changing this. Another strong emphasis

was the tenacity and energy required to push ideas

forward. The qualities talked about in the focus groups

can be grouped under the following headings:

• Affective – Practice developers talked about the need

for energy, enthusiasm, optimism and having a positive



outlook, but also spoke with feeling about the need to be

�thick-skinned�, and to have a sense of humour, honesty

and patience. Making enthusiasm and emotional

engagement clear in their work appeared to be valued

by practitioners interviewed by telephone, who men-

tioned the difference that practice developers make

when they are energetic and enthusiastic. In contrast,

when they are seen as remote and governed by their

own or the organization’s agenda, their interventions

were seen as a nuisance.

• Having vision – Participants talked about the import-

ance of having a vision to underpin practice develop-

ment work. This sense of vision was uniformly

associated with bringing about improvement in patient

care.

• Being motivated – This seemed to be a very important

component of participants’ understanding of their work.

They talked with feeling about the energy, enthusiasm

and tenacity necessary to help change take place. One

described it in graphic terms: �You need this fire in your

bum that keeps driving you� (FG5/140). Maintaining

focus and impetus therefore takes place against a

backdrop of competing priorities that need to be

understood and worked with.

• Being empathic – The importance of understanding the

impact that practice development has on people’s lives

was particularly emphasized in three focus groups.

Participants talked about the importance of being aware

of the pressures on practitioners’ (professional and

personal) lives and the impact these might have on the

kinds of activities they could spare the time and energy

to be involved with.

• Experiential – The importance of being able to process

and learn from experience was prized by many partic-

ipants in the focus groups. Formal supervision rela-

tionships were seen as offering an opportunity to review

and refine skills, as well as maintaining a focus on the

job at hand. Participants spoke about the importance of

being aware of both their limitations and strengths.

Skills described in the literature range from clinical

practice-based knowledge (Weir, 1995; Kitson et al., 1996)

to those associated with bringing about change, such as

leadership (Knight, 1994; Jackson et al., 1999a), research

skills, change management skills, problem solving skills,

organizational analysis techniques, skilled interpersonal

behaviour, decision-making skills and facilitation skills

(Kitson et al., 1996). In addition knowledge of organiza-

tional culture is also described as important (Manley,

2000). Recognizing how unlikely it is that such a mix of

skills can be found in one individual alone, Kitson et al.

(1996) have advocated the need for centres of practice

development that draw such skills together. Marsh &

MacAlpine (1995) have described similar themes in

relation to the skills, knowledge and behaviour demon-

strated by nurse managers in Nursing Development Units

(Vaughan & Edwards, 1995).

Practice developers also talked about a range of skills

that they considered central to their work. These largely

mirrored the areas of activity identified by Kitson et al.

(1996), with the exception that they talked relatively little

about the need for research skills. Once again these can be

categorized under a range of headings:

• Cognitive – Participants talked about the need for

creativity, not only in problem solving, but also in

finding novel ways of communicating with others about

their work and, crucially, in finding resources. Simi-

larly, they talked about the need to recognize and seize

opportunities by thinking laterally and the central

importance of �being curious�.• Political – Practice developers frequently described

themselves as �being in the middle� and having access to

various levels of managerial activity while also working

with practitioners. While this could be a source of

tension, it was also seen as a unique feature of a practice

development role. Political awareness was seen as an

important attribute that underpinned successful pro-

motion of ideas and initiatives.

• Communicative – Effectiveness at a political level was

associated with ability to communicate well. This

involved being skilled at acquiring and processing

information, as well as being able to put arguments

across. Practice developers talked about the need to

�tune in� to what they were being told by practitioners.

In contrast, practitioners who did not feel that they

were listened to saw little value in the work of practice

development staff.

• Facilitative – There was a clear emphasis amongst

practice developers that their work consisted of helping

others to articulate, develop and act on their ideas.

• Clinical – The emphasis placed on the importance of

clinical skills varied between focus groups. Practice

development was seen by some as part of senior clinical

roles. Consequently clinical skill was seen as an integral

part of the work. In contrast, others who did not have a

clinical component to their role talked of the need to

�market� their facilitative skills but recognized the

importance placed on clinical credibility by practition-

ers. For some practitioners, clinical skills were seen as

of central importance. Telephone interviewees, who

talked about the practice developer’s skills as a

practitioner, gave the most enthusiastic accounts of

practice development and lack of clinical acumen was



seen as affecting the ability of practice developers to do

the job.

Discussion

The data gathered in the study pointed to a range of

attributes required of practice developers, including:

• Values and beliefs

commitment to improving patient care

enabling, not telling;

• Facilitative skills;

• Energy and tenacity;

• Flexibility, sensitivity and reflexivity;

• Knowledge;

• Creativity;

• Political awareness

�being in the middle’;

• Credibility.

These attributes should be considered by organizations

in the development of practice development roles. While

they are common to a number of roles, practice developers

might reasonably be expected to demonstrate particular

aptitude in some of them. For example, they need to

develop a complex social network within an organization,

learning the �language� that different stakeholders use in

order to negotiate with them. To this end, establishing

credibility with a range of colleagues appears to be crucial

to success. For practitioners, credibility seems to be

associated with ability to demonstrate clinical �know-how�.This does not require practice developers to be �subject

experts� in a particular speciality, but does require them to

have a deep understanding of the practice context in which

they work.

Practice developers also placed emphasis on achieving

credibility through their abilities to help practitioners

identify and resolve problems. However, the role can give

rise to ambiguity. The clinical leadership role of some

practice developers, for example, seems to overlap with

that traditionally associated with clinical leaders such as

ward managers. This was not a focus of the present

study, but references to practitioners using practice

developers as sounding boards and trouble-shooters

suggest that such ambiguity is worthy of further study.

The vital importance of clinical leadership in nursing is

enjoying renewed emphasis in the UK at present, with

the government’s recognition of the value of leadership

programmes (NHS Confederation, 2000). New roles such

as consultant nurse posts also demonstrate this commit-

ment (Manley, 2000). However, there remains a need for

systematic evaluation of how various approaches to

practice development function and in particular to

examine the impact of various models of practice

development posts.

Of particular interest is the lack of emphasis placed on

approaches to getting research into practice and audit/

quality activities. Whilst there is much emphasis in the

literature on getting research into practice (for example,

Vaughan & Edwards, 1995; Kitson et al., 1996, 1998;

Knight et al., 1997; Simpson et al., 1997; McMahon,

1998), by contrast, in our interviews, relatively little

emphasis was placed on this and it is worrying that only a

minority of practice developers reported that finding and

disseminating research was a part of their role. In

accounts of systematic practice development, quality

assurance tools such as QUALPACS have been used to

monitor improvements in care (for example, Johns &

Kingston, 1990; Ward & McCormack, 2000). However,

for those interviewed in this study audit and quality

activities did not appear to figure as part of practice

development roles. Based on our findings, we argue that

practice developers need to have knowledge and skill in

facilitating use of a variety of sources of evidence in

practice and evaluation of their effectiveness in developing

person-centred practices.

Interviewing practice developers demonstrated the

importance of organizational support for their work.

Unfortunately, for some this was apparent through its

absence rather than its presence. Lack of infrastructure

and strategic planning to support practice development

was seen to diminish the potential impact of such activity

and needs careful consideration when establishing future

practice development roles.

Conclusion

Descriptions of the activities involved in practice devel-

opment are complex and ambiguous. However, a clearer

picture seems to emerge from talking to those presently

involved with developing practice. The work they describe

is more discrete, being focused on promoting and

facilitating change in practice, with less emphasis on

educational and research activities than is found in the

literature. Nonetheless it is clear that there is considerable

local variation in practice development and its associated

roles and activities. Moreover, activities as described by

practice developers seem to overlap with other clinical

leadership roles, for example being used a sounding board

by clinical staff. A relatively clear picture of the skills and

qualities required by practice developers seems to emerge

from our data. However, it could be argued that the skills

and qualities identified are relatively undifferentiated from

those required by a senior clinician or manager.



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Documents

The characteristics, qualities and skills of practice developers