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    What are the experiences of nurses working during the Covid-19 pandemic, and how were they supported? : a case study of two countries (Israel and New Zealand) : thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, School of Nursing
    (Massey University, 2023-12) Paletova, Martina
    The Covid-19 pandemic and all its associated stressors had a significant negative impact on the emotional and physical capacity of nurses. Now, as the pandemic ends, nurses are leaving the profession in droves, burnout being the suggested reason. This study examines the experiences of nurses in regard to the support they received during the Covid-19 pandemic. The theoretical framework chosen for this study was Critical Social Theory because it examines the power dynamics and structural factors that shaped nurses’ responses and their capacity to care. The methodology for this work was Critical Discourse Analysis, underpinned by a Foucauldian lens as it allows for a critique of how power relations and discourses shaped knowledge, practices, and subjectivities of nurses and their practice. A case study of nurses from two countries (Israel and New Zealand), was used to examine the discourses of the pandemic across public, organisational and operational levels of health care. Methods included interviews, a content analysis of texts, and archaeology/ genealogy of the pandemic. As my personal journey is integral to the study, I have also integrated an autoethnographic approach as its captures my firsthand experiences to provide rich, contextual data to support and inform the nursing perspective. The nurses working in health care in the pandemic years describe struggles with illogical rules, confusing information, lack of personal protection, and questions about principles and ethics, in contrast with the natural and professional commitment to care for the patient. In conclusion, rather than burnout due to Covid-19 pandemic, the concept of ‘moral injury’ due to systemic pressure more accurately reflects the ongoing crisis in the nursing profession. This issue cannot be solved through resilience training or special wellness programs, as advocated by some professionals. Instead, a need for a systematic change is argued.
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    Professional identity positioning of internationally qualified nurses during workplace interactions with colleagues in New Zealand healthcare settings : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Applied Linguistics at Massey University, Manawatū, New Zealand
    (Massey University, 2024) Taylor, Dana
    The global nursing shortage has been a catalyst for the international migration of nurses. Internationally qualified nurses (IQNs) are valued in New Zealand as capable and competent healthcare professionals. As limited research exists into the professional identity of IQNs in New Zealand, my aim for this study was to explore IQNs’ discursive identity positioning. Research determining ways to support IQNs’ career sustainability was missing in the extant literature, which this study sought to address. Taking a social constructionist perspective, I employed narrative inquiry to empower eight IQN participants to tell stories of challenging and positive workplace interactions with their colleagues. The participants had English as their first or additional language and had been nursing in New Zealand for at least three years. Narrative data from participants were collected during COVID-19 pandemic restrictions in New Zealand by means of semi-structured interviews (‘Story-Led Conversations’) and peer-facilitated conversations via Zoom (‘Zoom Pair Shares’). Participants’ storied experiences were analysed to reveal aspects of IQNs’ discursive positioning. This allowed me to identify: how IQNs positioned themselves and others as they told stories of participating in workplace interactions with colleagues in New Zealand healthcare settings; how they used discursive positioning in their stories to jointly construct aspects of their professional identity; and the implications of understanding, and responding to, participants’ stories for the IQNs themselves and the wider nursing community. I used thematic analysis to construct six themes related to IQNs’ workplace interactions. I also developed an analytical framework based on positioning theory—the multimodal positioning analysis (MPA) model—to analyse participants’ discursive positioning of self and others when telling their stories of workplace interactions. Research findings indicated that IQN participants’ workplace interactions with colleagues impacted upon their professional identity positioning. The nature of this impact included IQNs’ sense of professional self, agency, collegiality, and wellbeing, which are critical for IQNs’ feelings of belonging and career sustainability. Findings from this study may lead to greater understanding and support of IQNs as they build a successful long-term nursing career in New Zealand.
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    Negotiating the role of nurses in New Zealand general practice : a grounded theory study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Albany, Aotearoa New Zealand
    (Massey University, 2024-02-07) Hewitt, Sarah Louise
    Nurses in general practice improve health outcomes by working with patients with chronic conditions, coordinating care for high-needs patients, promoting population health and undertaking advanced practice roles, such as prescribing. However, the primary care environment is complex, and whether or not such non-traditional activities are undertaken by nurses in general practice in Aotearoa New Zealand varies from place to place. Insofar as ways of working within individual organisations may encourage or stifle innovation in clinical practice, understanding the processes involved in negotiating the nursing role may be key to the improvement of services. There is a significant evidence-base about the influence of context on nurses’ role development. However, little is known about the process by which nurses negotiate their roles in New Zealand general practice. This thesis reports on research undertaken to address this evidence gap by asking “How are the roles of nurses in New Zealand general practice negotiated?” A constructivist grounded theory design, informed by symbolic interactionism was used. Twenty-two participants from 17 New Zealand general practices contributed data, generated through semi-structured interviews conducted between December 2020 and January 2022. Through phases of concurrent data generation and analysis, using common grounded theory methods and constant comparison, the participants’ main concern and prime mover of behaviour were identified, leading to the construction of an explanatory theory around a core category. The resultant grounded theory of creating place provides a substantive explanation of how nurses’ roles in general practice are negotiated as individuals progress from roles defined by the care-philosophies of others to those that incorporate their own professional ethos. Conditional upon their access to role models, scheduled dialogue with mentors and decision-makers, and support for safe practice, nurses can progress through stages of occupying space, positioning to do differently, and leveraging opportunity, to realize individual concepts of need-responsive nursing practice. Such concepts are themselves developed during negotiation; nurses’ positive personal self-efficacy and strong organizational governance are enablers of effective negotiation. The theory of creating place offers new insights into the process of nurses role negotiation in general practice. Informed by the extant theory of job crafting and the job demands – resources model, findings support strategies to enable nurses to better negotiate their professional roles and advocate for patient health needs.
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    Self-employed registered nurses : the impact of liminality and gender on professional identities and spaces : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Manawatū, Aotearoa New Zealand
    (Massey University, 2022) Manning, Elizabeth
    This thesis explores the experiences of self-employed registered nurses in Aotearoa New Zealand working in the practice area of professional advice and policy. Liminality theory and gender theory, with a feminist post-structuralist lens, were used as theoretical approaches. The participants spanned the masculinist areas of business, self-employment and policy, while connected by a strong bond to the normatively feminine nursing profession. Considering these views using a gendered lens and the participants’ position as outsiders to both business and nursing proved a powerful way to interpret the data. The research was conducted using focused ethnography, enabling interviews and observation of the 13 participants’ home-based workspaces. Data chapters incorporate the phases of liminality, separation, transition and re-aggregation, all of which provided a strong foundation underpinning the participant journey. The participant group of mid- to late-career registered nurses had high levels of education, practice experience and skillsets, which could be used across nursing and the whole of health, yet due to their liminal and individualistic positioning the nurses remained invisible, both physically and professionally. Outcomes included insight into why the participants chose self-employment, the gendered assumptions they faced, the difficulties of learning new skills when separated from familiar resources and support systems and the tensions of working from home. The participants, while each at different stages, followed the phases of liminality in acculturating to self-employment, but remained in a permanent limonoid state for other aspects of their work life. My findings indicate that, anchored by historical discourses, nursing remains a devalued feminised occupation. Captured in gendered subjective positioning, the participants navigate complex and competing discourses in relation to work, home, profession and belonging.
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    Determining the value of Māori nurses in Aotearoa : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Business Studies (Management), School of Management, Massey University, Palmerston North, New Zealand
    (Massey University, 2020) Te Whata, Tracy Deborah
    This thesis examines the experiences of Māori Registered nurses within Aotearoa, New Zealand. This research offers an understanding of how Nursing discourse is embedded within legislation, regulatory bodies, and nursing practice and its direct impact on the health and well-being of Māori nurses. This discourse continues to marginalise and undervalue tikanga. As Māori nurse’s workplace expectations of cultural responsibilities are undertaken over and above standard nursing practices. Māori nurses often get allocated what was coined ‘difficult’ or complex Māori patient and their whānau. Māori nurses must ensure whānau are kept culturally safe while navigating and advocating for whānau in health care organisations where 1 in 2 Māori nurses face racism and discrimination. This thesis explored the experiences of Māori registered nurses using a kaupapa Māori, mixed-method approach. The survey was distributed during a two-week period during Covid-19. Five semi-structured interviews were completed, and responses were used to inform a survey of which there were 342 respondents. Once the data was cleaned, 333 valid responses were used to examine the perspective of Māori Registered nurses. Also identified were the experiences of Māori nurses and the impact on career advancement, use of tikanga in practice, cultural identity, professional development, and racism and discrimination within their work environment. This thesis’s findings validated the lack of leadership, opportunities, and responsive practices required to ensure Māori nurses are supported and valued not only within their profession but within their organisations honouring Te Tiriti o Waitangi requires creating real change for Māori nursing professionals to ensure they feel valued in their workplace, are fairly remunerated, and feel safe to identify and practice as Māori within their workplace.
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    New Zealand Defence Force nursing officers' navigation of professional accountabilities and role expectations : an exploration informed by Foucauldian concepts : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Wellington, New Zealand
    (Massey University, 2021) Sheard, Maree
    Nurses in armed forces are responsible to their defence employers for meeting the expectations of their roles but they also are accountable to nursing regulatory authorities for maintaining the standards expected of members of the nursing profession. Inherent dichotomies exist for those delivering healthcare in defence forces which are known to create challenges for nurses. This research examines the previously unexplored ways in which nurses serving in the New Zealand Army navigate their dual responsibilities. A qualitative approach was employed in the study using information provided by 11 experienced serving and immediate past members of the Royal New Zealand Nursing Corps. Foucauldian theoretical concepts underpinned a thematic analysis to reveal patterns in the techniques used by this group of military nurses to maintain professional standards whilst performing their roles. Complex interactions between a range of New Zealand Defence Force policies and nursing practice behaviours were found to impact upon the decisions that military nurses make and the degree of autonomy they possess. Institutional governmentalities drive a focus on combat ideologies and competition which for nurses, compels the suppression of interprofessional collaboration and affects the maintenance of nursing competence. Efforts by nurses to prioritise patient wellbeing and to comply with international humanitarian law are factors in the marginalisation of nurses. Ways in which nurses work to counteract the subordinating effects of an historic but enduring discourse of nurses not being needed has a consequence in that when nurses are needed, they may not be clinically prepared to deliver the care required. Paradoxically, the importance of nurses being operationally deployable positions those who work in clinical practice as holding higher status than more senior ranking nurses who work in management and leadership. This study found that nurses monitor practice environments to ensure that leadership in care delivery follows a congruent model and not the organisationally endorsed transformational leadership style. Consequently military nurses vociferously resist any perceived interference by general military personnel into professional nursing domains. Problematisation of nursing in the Army can delay nurses’ transition into the organisation but ultimately serves to motivate the construction of a strong military nurse identity.