Nursing Consultation: Honoring the Privilege

Teresa Anderson, MSN, RNC-OB, NE-BC


June 04, 2009

In the complex global healthcare arena of today, facilities can no longer afford to maintain internal experts in all of the area where development may occur. More and more organizations will use external consultants as a cost-effective way to leverage intellectual capital and experience. Nursing consultation is reaching a level comparable to other services and industries, which have capitalized on the advantages of the consulting relationship for years. An area of particular interest is Magnet Recognition Program® consulting. With literally hundreds of facilities on the journey to nursing excellence, there are many options for support. Before contracting with a consultant, it is important to carefully consider the needs of the organization and the services offered.

It is important to appreciate the difference between mentoring and consultation. A consultant should offer a variety of experiences in multiple facilities. This offers a base of comparison that exceeds the scope of practice in a single facility. Besides these varied experiences, in-depth current knowledge of the subject or process is required. Consultants should know the content well enough to make assessments and recommendations in "real time." Being able to structure interactions and to adjust agendas quickly maximizes the teaching moments that often occur during cultural or process assessments. The final authority on the requirements of the Magnet Recognition Program® is the staff at the American Nurses Credentialing Center (ANCC). Working with representatives of the ANCC to clarify and validate information is critical to the success of the journey.

Consultation also requires the ability to build relationships while maintaining objectivity. It is the consultant who must help the client to see the good, the bad, and the ugly. The best consultants don't provide all the right answers; they ask the right questions to guide clients and facilities to the answers that are right for them. It is common for consultants to receive requests to write Magnet submission documents for organizations. The Magnet story belongs to the organization and the nurses within it. This makes it very difficult for anyone external to the organization to write the documents. However, once the structures, processes, and outcomes of the organization are recorded, a consultant is very helpful in evaluating the documents for congruence with the intent of the sources of evidence and for literary clarity. A consultant review often serves to validate the impressions and conclusions already reached by staff members.

Consultation practice is a privilege. The consultant is invited as a guest and welcomed into the facility like "Sunday company." The facility trusts the consultant to offer service that is efficient, thorough, and cost-effective. Consultants are often given opportunities to meet with staff, review data, and access innovations. It is expected that the consultant will honor these opportunities by adhering to the highest code of ethical behavior and professional confidentiality. Interactions with frontline staff must portray confidence in the leadership team, managing up the positive aspects of the current state and enlisting support for changes which may be needed. The consultant should ascertain the goals and objectives of the nursing leadership team, and use meetings with executive leadership to help the Chief Nursing Officer to strategically position the division for success. An experienced consultant can facilitate a frontline readiness assessment by asking a few key questions. A direct care nurse who can readily identify what he or she is most proud of and who has a hard time finding items for their wish list, may be giving the consultant the first glimpse of a nursing excellence culture.

The best consultants feel comfortable and confident in the role and offer transparency of services. References from other clients and the opportunity to conduct an interview with the consultant prior to formal agreements should be standards of consulting practice. In addition to a legal contract, a detailed scope of work should be created which outlines the mutually agreed upon work to be completed and the estimated number of hours needed to complete the work. The consultant should not exceed this estimate without further communication with the client to validate their continued support for the work to proceed. The consultant should offer both a detailed accounting of the hours expended as well as a written report of the observations, findings, or work completed. Time to complete such a report should be included in the estimated scope of work. The client should always retain the option to cancel further work with the consultant if the services provided do not meet expectations. While a consultant cannot offer a guarantee related to the success of the journey to nursing excellence, they must provide the contracted services as agreed upon.

Consultation in nursing will continue to expand in the years to come. Magnet Recognition Program® Consulting will continue to be offered by a number of agencies and vendors. Preplanning and open communication can result in consultant-client relationships that exceed expectations and advance the culture of nursing excellence.

For information about ANCC consultants, please visit:

This content is provided by American Nurses Credentialing Center (ANCC) for publication on the website.

The American Nurses Credentialing Center's (ANCC) internationally renowned credentialing programs certify nurses in specialty practice areas, recognize healthcare organizations for nursing excellence through the Magnet Recognition® and Pathway to Excellence Programs, and accredit providers of continuing nursing education. In addition, ANCC offers an array of informational and educational services and products to support its core credentialing programs.

ANCC is passionate about helping nurses on their journey to nursing excellence. Visit ANCC's web site at

The American Nurses Credentialing Center (ANCC) is a subsidiary of the American Nurses Association (ANA).


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.