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

Abstract

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.