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

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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.
nurses, nursing, general practice, primary care, primary health care, role, negotiation, grounded theory, job crafting