The Royal College of Nursing's decision to offer its general secretary post to US nursing leader and ex-Clinton aide Beverly Malone has fanned controversy about its 'undemocratic' selection process.

College activists are angry that strong internal candidates failed even to make it to the shortlist.

Ms Malone, the first black candidate to land the UK's most high-profile nursing job, is currently deputy assistant secretary of health in the US government's department of health and human services and is a former president of the American Nurses'Association.

But praise for Ms Malone's abilities was mixed this week with criticism of the means the RCN leadership has used to find a successor to outgoing general secretary Christine Hancock, who will give up the£100,000 top job in June.

RCN activist and recent candidate in the college's presidential election Ray Rowden called on the council to set up a review of its handling of the general secretary selection process.

'There is no doubt that Bev is a great appointment. She is a political big hitter. This sends out a signal that the college is moving up a gear politically.

'The problem is that the college spent a fortune on headhunters, who came up with only seven names above the line - and then the council didn't shortlist three of them, ' said Mr Rowden.

He said he had been contacted by many members angry at the exclusion of both deputy RCN general secretary Tom Bolger, and Jane Salvage, nursing director of EMAP Healthcare. Pippa Gough, head of the college's policy unit, also missed out on the final interview stage.

Unison head of nursing Karen Jennings extended a warm welcome to Ms Malone, but described the RCN's leadership selection process as 'less democratic than ours'. As HSJ went to press, the RCN was waiting to hear whether Ms Malone would accept the post. A last-minute upset was not ruled out.