Beverley Malone: The feisty American who is battling to improve the lot of her profession - and change the conservative world of nursing

The Monday Interview: General Secretary of the Royal College of Nursing

On any objective view, these ought to be good times for the world's biggest nursing union. Membership of the Royal College of Nursing is rising and the responsibilities thrust on nurses' shoulders are growing. The NHS is expanding, with thousands of extra jobs and challenging new opportunities.

The Government announced on Friday that nurses will take over the running of the NHS at night as junior doctors' hours are cut back. Proposals for a new pay structure agreed before Christmas could boost the brightest nurses to positions of real leadership in the NHS.

So why is there so little optimism and such a lack of expectation at the college's central London headquarters? Instead of surveying new horizons and opportunities, staff in the elegant offices on Cavendish Square are instead preoccupied with gossip, intrigue and rumblings of discontent.

Their focus is Beverley Malone, 54, the black American controversially hired as the college's first foreign general secretary 18 months ago to set a new course for the RCN as it battles for influence in an NHS that is struggling to modernise.

Since her arrival, Ms Malone, a former member of the Clinton administration who rose to be deputy assistant secretary of health, the highest position a nurse had held in the US, has rattled some of the staider members of the college with her American "can-do" management style. She is engaged in a major reorganisation of the college, which has caused upset, and completed the negotiations begun over three years ago on Agenda for Change, the pay proposals that are set to transform the salary structure for more than one million NHS workers. But she has been dogged by controversy, none of it the kind she might have chosen.

First was her salary and relocation package, together worth an estimated £200,000. That struck some as excessive in a profession where £20,000 a year is considered generous. But what really upset members of the RCN council was that they had refused a "golden goodbye" to the outgoing general secretary, Christine Hancock, only to be presented with the bill for a "golden hello" for her successor. Members were so angry that they forced Debbie Hancock, the chairwoman of the council, who had authorised the payment, to resign.

Ms Malone was bemused by the row because her pay had been agreed before she left the US. She was equally puzzled by the next controversy – over treatment she obtained for her mother on the NHS. "We followed all the rules," she says now, "I don't understand why it was considered inappropriate."

She was criticised for attending a Labour Party reception – breaching the RCN's code on political neutrality – and attracted headlines again when the next chairwoman of council, Pat Bottrill, was forced to resign after using the phrase "10 little niggers" during a council meeting attended by Ms Malone and three other black members of staff.

Ms Bottrill has since blamed "political correctness gone mad" for forcing her to quit. But Ms Malone played no part in her resignation (though she did not resist it) and speaks warmly of her. "I really respect Pat for making the decision she made. I am sure she never meant to say it."

Still ticking away is the case of Maria Cook, the regional director for the South-east and one of nine senior managers, who was suspended last summer on charges of bullying and harassment, fiddling relocation expenses and "behaving in an unprofessional manner" – a reference to a charity stunt at the college's annual congress last May when she dressed up as an elf (the pictures found their way into the Daily Mail and the Daily Express). Ms Cook denies the charges and is taking the college to an industrial tribunal.

Taken together, these incidents have focused an unwelcome spotlight on the RCN, which is not accustomed to providing fodder for the tabloid press. The council held a four-hour meeting with Ms Malone last September in which she was read the riot act. "Council gave her a tough time – but it does seem to have cleared the air," a source said.

What has Ms Malone made of this? She is a small woman – elegant, perfectly coiffured, noted for her warmth and feistiness, and with a reputation for her oratorical skills. But when we met in her unadorned office – four plain walls, a desk and small conference table – she sat on the edge of her chair and measured each phrase carefully, as if against some inner RCN censor. "Coming from the US, being an African-American woman, being the first non-UK general secretary of the RCN, I don't see how I could move out of controversy. It is helpful having been black for 54 years. I have noticed I am held up to scrutiny more than others. I think my colour and my non-UK status plays a part."

Being American is certainly a part of it. She is one of a family of seven, born in Kentucky in 1948 and raised by her grandmother in one of the most unequal societies in the world. She knows what it means to pull oneself up by one's bootstraps and used her talents to the full, working her way through a series of nursing posts and acquiring three degrees.

She is a huge admirer of the NHS, as only one who has seen the iniquities of the American system can be. But the entrepreneurial culture of the US is foreign to both the health service here and the conservative world of British nursing. "The NHS is huge and everyone is used to waiting for people at the centre to make the decisions. In the US, because there is no central system, nobody waits for any decision. You have to figure it out and advocate for your patient to get the care they need because the system is set up that way: to compete. You have to be a mini-warrior and scratch your way out of it."

It is the warrior in Ms Malone that seems to have alienated some of her colleagues. She is credited with securing good contacts with the Department of Health, No 10 and the Treasury but is criticised for being "high-handed", having a "secretive and egocentric" style and for failing to "embrace" her colleagues. "She spent her first year never going to a local branch meeting," one disgruntled observer said.

Her main achievement to date has been to bring forward, with colleagues in other NHS unions, the Agenda for Change pay proposals, agreed in November with the Department of Health. The aim is to replace the hugely complex system of pay and allowances with a simplified system that encourages flexibility by offering extra pay to those prepared to take on extra duties. Some staff could ultimately see rises of up to 30 per cent but others – estimated at one in 12 of all NHS staff – are set to lose

Although she was not directly involved in the negotiations, she is said to have "unlocked a few minds" at the Treasury and released extra money to fund the deal. Even so, by her own admission, the basic rise for nurses next year of 3.222 per cent is "disappointing" (hospital consultants recently rejected a deal worth 15 per cent). In year two, it gets better, with the same basic rise supplemented by 2.7 per cent for "assimilation" to the new pay scales and by a further 3.1 per cent the following year, giving a total increase of 15.8 per cent over three years.

"When you compare that to what we have been getting – no more than 3 per cent a year – it is quite amazing. But it is only a proposal; it is not a deal. It is only real when our members say it is," she said. The RCN is to ballot its 354,000 members early this year.

Better pay will help find – and just as importantly keep – the extra nurses the NHS needs. But they must also feel valued, she says. The image of nursing is a central issue for Ms Malone and the way to improve it, she argues, is to give nurses more autonomy.

"The whole idea of nurses is that they receive instructions. We have got to have nurses making the decisions, working in collaboration with colleagues. Frontline providers need to be more involved in decision-making."

It is probably what she hoped for herself: to be more involved in driving nursing on to the national agenda and less with keeping the RCN council off her back. She says she was "surprised" when she was offered the job – "they were incredibly bold to hire me" – and has given herself "three to five years" to deliver on it. That means she could be gone in another 18 months.

It has been a difficult and lonely task. A black woman who has made it to the top is celebrated in America but here in the UK we enjoy nothing so much as seeing a high-flyer brought to earth. I asked her what had been the worst aspect of the job and she paused for a long time. "Being away from my support network of family and friends and nursing colleagues. Building up relations with all those that is required for this organisation to flourish has been a big task," she said.

It would have been a big task for anyone. For a foreigner lacking the contacts a home-grown leader would have relied on, it is a mammoth task. After nearly 24 months at the RCN, 18 of them as general secretary, Ms Malone remains an outsider.

And where next? The World Health Organisation and the UN were on her target list when she got the RCN job. But the lure of friends and family in the US – she is divorced with grown-up children – is also strong. "My children have been murmuring about having babies and may tempt me to go back and behave like a respectable grandparent."

With a rueful laugh, she adds: "I bet you didn't notice but I'm not from here."