The New Zealand nurse practitioner polemic : a discourse analysis : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Wellington, New Zealand
The purpose of this research has been to trace the development of the nurse
practitioner role in New Zealand. Established in 2001, this advanced nursing
practice role was birthed amid controversy as historical forces at play both inside
and outside nursing struggled for power to control the future of the profession.
Using a discourse analytical approach informed by the work of Michel Foucault,
the study foregrounds the discourses that have constructed the nurse practitioner
role within the New Zealand social and political context. Discourses, as explained
by Foucault, are bodies of knowledge construed to be ‘truth’ and connected to
power by reason of this assumption, serving to fix norms and making it virtually
impossible to think outside them. Discourses of nursing and of medicine have
established systems of disciplinary practices that produce nurses and physicians
within defined role boundaries, not because of legislation, but because discourse
has constructed certain rules. The nurse practitioner role transcends those
boundaries and offers the possibility of a new and potentially more liberating
identity for nurses and nursing.
A plural approach of both textuality and discursivity was used to guide the
analysis of texts chosen from published literature and from nine interviews
conducted with individuals who have been influential in the unfolding of the nurse
practitioner role. Both professionally and industrially and in academic and
regulatory terms dating back to the Nurses Registration Act, 1901, the political
discourses and disciplinary practices serving to position nurses in the health care
sector and to represent nursing are examined. The play of these forces has created
an interstice from which the nurse practitioner role in New Zealand could emerge.
In combination with a new state regime of primary health care, the notion of an
autonomous nursing profession in both practice and regulation has challenged
medicine’s traditional right to surveillance of nursing practice. Through a kind of
regulated freedom, the availability of assessment, diagnostic and prescribing
practices within a nursing discourse signals a radical shift in how nursing can be
represented. The nurse practitioner polemic has revolutionised the nursing subject,
and may in turn lead to a qualitatively different health service.