Abstract: The nurse practitioner role is an important addition to nursing workforce development in New Zealand. At present there are relatively few nurse practitioners, however the number of nurses seeking Nursing Council endorsement continues to grow. These nurses are in a unique situation as pioneers having achieved the highest level of autonomous advanced nursing practice. This position will bring with it many challenges for those nurses who are among the first in the profession. Traditionally, nurses have always had formal and informal methods of support such as preceptors, role models and the hierarchy of nursing to help and guide them in their work. This network has generally been comprised of nurses more senior and qualified than the nurse needing support. Yet the nurse practitioner, considered to be the leading clinical nurse in New Zealand, may have very limited resources available for the clinical support needed to sustain their professional practice while keeping them refreshed, curious, creative and committed. The intent of this dissertation is to provide a framework of supportive mechanisms on which the emerging nurse practitioner can draw in their new professional domain throughout their career. The author explores the meaning of support, why there is a need for support for the nurse practitioner, the various methods of support noted in current literature and how these various methods can enhance the nurse practitioner's professional growth and development, maintain clinical safety, and foster job satisfaction.

Abstract: The particular, contemporary meanings ascribed to “advanced nursing practice” in New Zealand have been debated and delineated in the 1990s, culminating in the launch of the nurse practitioner role at a conference sponsored by the Ministry of Health and the Nursing Council of New Zealand in August, 2001. Drawing on archival materials, documents, other texts and voices, this article explores the evolution of connotations and meanings of the word “advanced” as applied to nursing in New Zealand. The focus is on clinical practice, research, teaching, consulting, higher education, and advancement of the profession. Historical aspects of advancement in New Zealand nursing are examined, including registration, unsupervised practice, technical specialisation, and career development.

Abstract: The purpose of this research has been to trace the development of the nurse practitioner role in New Zealand. 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. The author suggests that 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 author concludes that the nurse practitioner polemic has revolutionised the nursing subject, and may in turn lead to a qualitatively different health service.

Abstract: The researchers present a survey of a sample population of 32 advanced practice nurses (APN) in the US about their experiences of acquiring and implementing prescriptive authority. The issues relevant to nurse practitioners in New Zealand are discussed, around acquiring knowledge and education, relationships with other professionals, establishing the role, and retaining the nursing role. The intent and scope of APN prescribing in the US is also discussed.

Abstract: This article draws on empirical evidence to illustrate the core role of nurse practitioners in Australia and New Zealand. A study jointly commissioned by both countries' Regulatory Boards developed information of the newly created nurse practitioner role, to develop shared competency and educational standards. This interpretive study used multiple data sources, including published and grey literature, policy documents, nurse practitioner programme curricula and interviews with 15 nurse practitioners from the two countries. The core role of the nurse practitioner was identified as having three components: dynamic practice, professional efficacy and clinical leadership. Nurse practitioner practice is dynamic and involves the application of high level clinical knowledge and skills in a wide range of contexts. The nurse practitioner demonstrates professional efficacy, enhanced by an extended range of autonomy that includes legislated privileges. The nurse practitioner is a clinical leader with a readiness and an obligation to advocate for their client base and their profession at the systems level of health care.

Abstract: This article reports the implementation of a collaborative project undertaken to monitor and improve the effectiveness of the prescribing practicum papers delivered within two Master's degree programmes in advanced nursing practice. The recent introduction of Nurse Practitioner registration in New Zealand has resulted in the development of a number of Master's degree programmes in which students can complete a Nursing Council of New Zealand approved programme for prescribing. For the study, a developmental action research approach was used. Data were collected through interviews with practicum students, their medical supervisors and academic staff. Formative findings were progressively used to refine delivery of the practicum papers and a thematic analysis of summative findings identified areas for further improvement. The findings suggest that the processes being implemented are developing well. The researchers recommend that further education is required to clearly differentiate medical and advanced nursing roles. They recommend that greater attention needs to be paid to the preparation of medical supervisors and, most significantly, revision of funding is required to more equitably support the ongoing development of nurses for advanced practice roles.

Abstract: This dissertation reports on a scholarly journey to better understand the processes of clinical decision-making by nurses. It begins by identifying the various terms used to describe a clinical decision, its components and the contexts within which clinical decisions are made. Two philosophies of decision-making are summarised. Some insight into the history of the phenomenological and the rationalist theories of decision-making is offered. The author notes that it became evident that both of these theories are applicable to all nurses and their clinical decision making competencies. Four studies that were undertaken to analyse the decision-making methods of nurse practitioners are critiqued. Of the studies two are British, one is American and one is Australian. The author has summarised the combined findings that identified that the nurses were using a blend of decision-making processes that involved rational decision making as well as the use of intuition. The studies identified that sound clinical decision-making is determined by appropriate educational and clinical preparation and supported by a formal mentoring process and the use of critical reflective practice. In conclusion, the author reflects on her knowledge of decision making prior to embarking on the dissertation and states her intent to facilitate and support advanced decision-making by her colleagues. She goes on to say that uppermost is the need for an institutional and managerial environment that encourages advanced and independent decision-making by nurses.

Abstract: This paper reports an initiative which is an example of partnership between education and health organisations resulting in the implementation of a jointly funded advanced nursing practice role. The model is for community based Nurse Practitioner-managed health care for primary health and disease management. The key partners in this project are the Eastern Institute of Technology, Hawke's Bay District Health Board, and a Primary Health Organisation (Tu Meke – First Choice). This article summarises the objectives, implementation, evaluation and benefits of the programme.