Saving lives and changing dirty nappies : illuminating nursing in the neonatal nurse practitioner role : the New Zealand experience : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
In New Zealand Neonatal Nurse Practitioners (NNPs) have been practicing in an advanced nursing role since 1994. The nature of expert nursing makes it difficult for NNPs to articulate the nursing component of the NNP role. It is essential that the expert nursing component of the NNP role be documented to maintain the role within the culture of nursing. Aim: The aim of this thesis was to explore and describe how expert nursing is incorporated in the NNP role, in the New Zealand context. Method: An explorative design, using multiple data collection methods, was used. These methods included questionnaires, interviews, journal-keeping (journalling), and analysis of written data. All NNPs in current practice were sent questionnaires (n=18) and a purposive sample of 5 NNPs agreed to be interviewed and keep journals. Standing orders, job descriptions and other written data from each of the three neonatal services that employ NNPs was compared and analysed. Results: Fifteen NNPs (83.3%) responded to the questionnaires. Results showed that NNPs tend toward a nursing identity, but see themselves as sitting between nursing and medicine. Professional issues were important to the NNPs. There was some ambivalence toward the NNPs leadership role in the questionnaire results, but interview and journal data showed the NNPs performing a multifaceted leadership role. Neonatal Nurse Practitioners are committed to post-graduate education, with a tendency toward preferring that to be in a nursing school with access to medical resources. The qualitative data revealed six themes derived from practice. They were 'a consciousness of baby', 'orientation to family', 'uniqueness of NNP care', 'leadership', 'culture of nursing' and 'NNP experience of advanced practice'. Expert nursing was embedded in the clinical themes and implicated in the professional themes of NNP practice. Conclusions: Expert nursing is inherent in the practice of the NNP role in New Zealand. Neonatal Nurse Practitioners practice in a unique role in the care of sick babies, incorporating medical skills with nursing philosophy and expertise. Education needs to address some of the issues of nursing in this advanced practice role. There is a need for institutional support for the NNP role. The NNP group needs to develop as a support and educational network.