Abstract: The development and role of the clinical nurse specialist in New Zealand is the focus of this dissertation. It is an area that has not clearly been documented previously and the author hoped that by articulating this role to nurses, educators, and administrators that the role of the clinical nurse specialist will be more clearly defined and perhaps recognised for the contribution it provides to health care in New Zealand. At present, it is difficult to justify the clinical nurse specialist position in New Zealand, when individuals have been left to define and develop their own positions. This has led to widely differing practice modes and role confusion, and therefore a varying degree of success in achieving improved nursing practice. Without title protection and some form of accreditation process to ensure standard of practice throughout the country it is not possible for post-holders to move from position to position throughout the country. The role and definition of the clinical nurse specialist must be clarified in order to reduce confusion. Restriction of the title to those who meet the defining characteristics will strengthen the role, improve collaboration with other members of the team as well as making it easier for the public to understand the role.

Abstract: This dissertation explores the assessment of nurses' clinical competence in the adult ICU setting. Specifically, methods for the assessment of competence are critiqued for their practical application to the novice nurse with less than six months experience in ICU. The assessment methods considered are continuous clinical assessment, self-assessment, peer review, objective structured clinical examination (OSCE), portfolio and computer assisted assessment. Several criteria are applied to the methods including the ability of each method to assess skills, knowledge and attitudes or values. Each method is critiqued for its implications in terms of cost and staffing resource, benefits and barriers to implementation. In addition, reliability and validity issues are considered for each method. The outcome of this exploration is the recommendation of a combination of methods; namely, portfolio and OSCE, for the assessment of competence in the ICU novice. The author concludes that this finding enhances current understanding within the ICU specialty of the multidimensional nature of competence assessment.

Abstract: This dissertation had two main aims. The first was to explore the literature from which nurse leaders of alcohol and other drug services might develop their leadership skills so as to enhance nursing practice within an interdisciplinary alcohol and other drug team. The second was to further utilise these skills to develop a 'toolkit' which would assist in the successful management of the team but would also aid with workforce development. In addition, this dissertation was linked to the Nursing Council of New Zealand Competencies for the Registered Nurse Scope of Practice (2005) and Competencies for Advanced Nursing Practice (2001). This dissertation provides direction for the nurse leader wishing to develop their toolkit. Implications for the advancement of nursing are suggested.

Abstract: Parent-infant skin-to-skin care has become an advocated aspect of care in neonatal intensive care units nationally within New Zealand and internationally. However the implementation of this care by nurses can be limited by a number of factors within the practice environment. This dissertation presents a critical analysis of literature alongside reflection on the author's own practice experience to explore factors that may be constraining the use of skin-to-skin care with the very low birth weight infant in the neonatal intensive care unit. These factors are examined through a lens of risk taking behaviour underpinned by the grounded theory work of Dobos (1992). The concept of risk is explored in order to develop an understanding of why, in the author's view, the practice of skin-to-skin care of very low birth weight infants may have declined in recent years. For neonatal nurses skin-to-skin care of the very low birth weight infant presents challenges related to the environment, physiological stability of the infant and changes over the past 10 years in the clinical management of very low birth weight infants. As progress is made toward the design, development and eventual move to a new unit in Dunedin recommendations pertaining to the change in physical space, the introduction of a structured model for nursing care and implications for nursing practice development in relation to skin-to-skin care are described.

Abstract: This pilot descriptive study examines and measures the characteristics of preceptors of new graduate registered nurses undertaking the Nurse Entry to Practice Programme in an acute hospital in New Zealand. Thirty-three new graduate registered nurses at the five month stage of the programme completed a questionnaire pertaining to the characteristics of their preceptors. The questionnaires were adapted from the Ferrans and Powers (1998) Quality of Life Questionnaire. The adapted questionnaires were designed to measure the importance, satisfaction and overall quality of the preceptor's characteristics as perceived by the new graduate registered nurse, using a Likert Scale. Literature both international and national was examined to gain an understanding of the importance of the characteristics in question, in relation to the new graduate registered nurse preceptee experience. Descriptive data revealed the importance of characteristics as perceived by the new graduate nurse preceptee, and how satisfied the new graduate nurse was with their particular preceptor's characteristics. The results identified that the majority of new graduates were satisfied with the characteristics of their preceptor but there was evidence of negative discrepancies between the mean importance and satisfaction scores. The range of data between the scores of the overall quality of the preceptor uncovered areas where the quality of preceptorship was unsatisfactory as perceived by the new graduate nurse. The discrepancies in the data were examined and recommendations made for additional research, regarding selection and evaluation of preceptors of the new graduate registered nurse within the hospital environment.

Abstract: Although it is accepted in rural nursing literature that the context shapes nursing practice there is limited opportunity to gain an understanding of how this occurs. This dissertation addresses this issue. Firstly, by employing a social geographical lens to define and examine the dynamic, evolving rural context and secondly, by considering the nursing concepts that arise from those contextual factors that relate directly to rural societal health needs. Defining 'rural' is essential when describing or debating rural nursing practice in context. However, there remains no universally accepted definition of 'rural'. Despite this and even though each location is individually specific, there are socio-cultural, occupational, ecological and health aspects that are common and bespeak rural society. These aspects have been developed into a Rural Framework Wheel as a visual reference to demonstrate the substantial influences which impact on nursing practice within the rural context. The framework encapsulates the distinctive dimensions that are hallmarks of rural nursing practice. Nurses can therefore use the framework to express concisely their individualised practice and competence by employing the two broad themes that have emerged from the literature; that of 'nursing per se' and 'partnership'. The Rural Framework Wheel is recommended as a paradigm to critique the practice of rural nurses from an educational, employment, research and political perspective. It is advocated that this framework be used by rural nurses to describe their practice and therefore to express the distinctiveness of the rural nursing identity.

Abstract: International nursing literature indicates nursing shortages are widely recognised; however efforts to remedy poor recruitment and retention of nurses have been largely unsuccessful. This paper presents the predominant factors influencing poor recruitment and retention of nurses, such as: the image of nursing as a career, pay and conditions of employment, educational opportunities, management and decision making, and low morale and then explores how Magnet hospitals address these factors. During the 1980s, several hospitals in the United States were identified as being able to attract nursing staff when others could not, they became known as 'Magnet' hospitals. The American Nurse Credentialing Centre developed the Magnet Recognition programme to accredit hospitals that meet comprehensive criteria to support and develop excellence in nursing services. Magnet hospitals not only attract and retain satisfied nursing staff, but also have improved patient outcomes compared to non-Magnet hospitals, such as decreased patient morbidity and mortality and increased patient satisfaction. The successes of the Magnet Recognition programme in recruitment and retention of nurses is discussed in relation to its transferability outside of the United States, particularly to New Zealand as a way of improving recruitment and retention of nurses here.

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.