Professor Rye: "I find it unbelievable"

But the choice of her successor, a former president of the American Nurses Association and senior health policy adviser in the Clinton administration, has already led one RCN committee chairman to resign in protest.

Professor David Rye, a nursing consultant, said that the choice to recruit from abroad for a general secretary reflected poorly on the state of the profession in the UK.

He told the BBC: "When it was announced I was very shocked and disappointed - mainly because we have got someone from the USA.

"My disappointment was that the Royal College of Nursing Council appeared not to be able to find anyone suitable for the UK.

"I find that quite unbelievable."

Uphill task

He added that the healthcare systems of the US and UK were so different that Ms Malone faced an uphill task adapting to her new environment, and that the RCN's traditionally politically neutral role was in jeopardy.

When it was announced I was very shocked and disappointed

Professor David

He said that an organisation of the calibre of the RCN should have a programme in place to decide the "succession" well in advance of the departure of one general secretary.

However, Ms Malone, talking to the BBC as she arrived to take up the post, appeared unfazed by the controversy surrounding her appointment.

She described the role as a "plum job", and said that she welcomed a healthy dialogue over the rights and wrongs of a US citizen.

She said: "The RCN is a very bold organisation and they wanted the background that I have.

"They wanted that blend of expertise to take the next step forward.

"I don't feel in any way torn down by the complaints or the discussion."