Advanced nursing practice and the nurse practitioner : New Zealand nursing's professional project in the late 20th century : a thesis presented in fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Palmerston North, New Zealand

Abstract

Beginning with the question, "what are the forces and voices influencing the meaning of the concept, and the development of advanced nursing practice in New Zealand in the 1990s”, this thesis uses an historical sociological approach to explore what New Zealand nursing is becoming and what it is ceasing to be. Through the examination of New Zealand nursing history from 1860 through the first years of the 21st century, seven historical understandings of the meaning of 'advanced' nursing practice emerged: nurses with higher education; nurses with more than one type of registration; community nurses; nurse educators and administrators; specialty nursing; a career hierarchy based on further education, experience and clinical focus; and the contemporary Nurse Practitioner. The thesis argues that each of the earlier historical connotations of advanced nursing practice is reflected in the Nurse Practitioner. The analysis of this broad scope of New Zealand nursing history, including a case study of the interpretation and implementation of contemporary advanced nursing practice, reveals essential themes of profession and professionalisation; politics and political sophistication. Drawing on theoretical perspectives from sociology, political science, and nursing, these concepts are further analysed, and developed into a representational framework. This conceptualisation depicts critical factors for nursing to achieve its preferred position in the context of time. Therefore, this study is also an exploration of New Zealand nursing's professional project A professional project is the process through which an occupational group gains control over the education and entry to practice of practitioners; secures legitimacy through the state and the public; achieves self-regulation over its practice; and secures, maintains and extends a market, or jurisdiction for itself. This thesis illustrates that while the course of action of a professional project is not always clear or deliberate for all the members of the profession, it nevertheless has a coherence that may be seen ex post facto. It is argued that what became the drive for the development of New Zealand's Nurse Practitioner and the expansion of nursing's jurisdiction at the turn of the 21st century, began long before the 1990s. The importance of history to understanding the past, the relevance of history to the shape of the present, and the significance of history's influence on the future are affirmed.