Abstract: The introduction of nurse practitioner registration into New Zealand in 2001 was heralded as a move that would open up a wealth of opportunities for registered nurses to extend their practice into more independent roles and to provide a client-centred health service. It was also seen as a way to retain experienced registered nurses in the clinical practice area by providing a credible clinical career pathway. If nurse practitioner's are to meet these expectations, then, the author suggests, it is important to understand the processes that encourage or discourage nurses from advancing their practice. One of the early scopes of practice to be introduced was nurse practitioner with an endorsement in aged care scope of practice. Grounded theory was the method used to generate an explanation of how registered nurses working in aged care were preparing for the introduction of nurse practitioner roles. An analysis of early data highlighted codes around registered nurses in aged care extending and advancing their practice rather than preparing specifically for the nurse practitioner role. The research question for this study was: 'How are registered nurses in aged care advancing their nursing practice?' Semi-structured interviews were used to collect data from ten experienced registered nurses working in aged care clinical practice settings ranging from secondary hospital facilities, to community settings and residential care villages. Dimensional analysis of the data eventually generated three major conceptual categories: 'ownership of nursing', 'extending practice', and 'moving out of a comfort zone'. Of these, 'ownership of nursing' was identified as the core construct that linked the other categories together. The substantive theory that explains how registered nurses in aged care advance their clinical practice is 'developing autonomous ownership'. Nurses who develop autonomous ownership of nursing are more likely than other nurses to move out of a current comfort zone and advance their practice into more independent roles that suit their autonomous ownership of nursing. This study identified important contextual factors and conditions that support the development of an autonomous ownership of nursing and that subsequently facilitate advancing nursing practice. These include creating supportive environments, organisational commitment to advanced nursing practice roles, visible nursing leadership, congruence between organisational and nursing philosophies, interdisciplinary collaboration and participating in postgraduate education. The author suggests that the significance of this study is that it generated a theory about the processes that encourage or discourage nurses from preparing for, and progressing into, advanced nursing practice roles such as nurse practitioner.

Abstract: This thesis examines the forces influencing the development of contemporary advanced nursing practice in New Zealand. It begins with an historical approach to explore the various meanings of advanced nursing practice from the late 1800s through the first years of the 21st century. Seven historical understandings of the meaning of 'advanced' nursing practice emerge. The author's analysis of the broad scope of New Zealand nursing history, including a case study of the development and implementation of the nurse practitioner, draws on theoretical perspectives from sociology, political science, and nursing. She develops a “framework of critical factors for nursing to take into account when considering how to ensure the profession is able to deliver on its great potential to improve the health of New Zealand communities”. Examining the work of a range of nursing leaders, past and present, and drawing on the work of political scientist, John Kingdon, the author describes the work of several nurses as “policy entrepreneurship.”

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: 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: An analytical tool of Force Field Analysis was used to identify and describe forces influencing the development of innovative roles, including the nurse practitioner role, in primary health care nursing. At the commencement of the study an initial analysis of research, literature and policy identified forces driving or restraining the development of innovative roles. A mixed research method of surveys and focus group interviews with key stakeholders, namely nurses in innovative roles, general practitioners and nurse leaders, was then used to identify factors influencing development within the Northland District Health Board. Descriptive statistics and interpretative methods were used to analyse the data. A final analysis enabled a picture of forces influencing innovative role development to be presented. Driving forces reflected international trends and were strongly influenced by economics and a political imperative to reconfigure health care services towards a primary health focus. The Treaty of Waitangi was also a key influence. Driving forces had greatest impact on the development of new roles. Forces were identified as drives towards cost-effective evidence-based health care (effective services), equity for Maori, response to local needs and workforce reorganisation. The major forces restraining the development of innovative roles were reinforced by attitudes, customs and support systems. These forces were identified as poor professional identity and support, an outdated nursing image, inadequate education and training and slow transition from traditional practices and structures (tradition). These forces had a negative influence on support for innovative roles. Promotion of kaupapa Maori, involvement of the local community, local Maori and nursing in decision-making and promotion of a team culture have the potential to support further development of innovative roles. Political ideology and the Treaty of Waitangi will continue to be major influences directed through policy and the contracting and funding process.

Abstract: Uses a post-positivist mixed-methods convergent-parallel design to explore nurse practitioner diagnostic reasoning and compare it to that of registrars. Includes 30 nurse practitioners and 16 registrars in a case scenario. Outlines nurse practitioner practice in NZ and how the NZ title of nurse practitioner differs from that used internationally.

Abstract: Analyses retrospective prescription data for the years 2007-2015 to determine how access to isotretinoin altered before and after funded access was extended from dermatologists to include GPs and nurse practitioners who obtained a Special Authority. Assesses maternity outcomes for females dispensed the drug with regard to pregnancy terminations and isotretinoin-exposed live births. Examines outcomes based on type of prescriber and use or otherwise of the Best Practice Advocacy Centre (BPAC) electronic isotretinoin decision-support tool.

Abstract: Investigates how nurse practitioner and pharmacist prescriber roles are developing in NZ primary health care, and what is needed to better support the future development of these roles. Employs a qualitative research design involving semi-structured interviews of (1) policy, training, and advocacy stakeholders; (2) primary health-care nurse practitioners, pharmacist prescribers, and general practitioners; and (3) patients of advanced practitioners and carers of patients using such services.