Abstract: This study examines the discursive formation of professional nursing in one country, as revealed by the history of nursing in New Zealand. Michel Foucault's approach to historical research signifies a different level of analysis from conventional approaches, focusing not on the history of ideas but on an understanding of the present, a history of the present. A genealogical method derived from Foucauldian poststructuralism reveals how different understandings of nursing have occurred and have governed nursing practices and scholarship in different historical contexts. The archaeological investigation in this study reveals two moments of epistemic transformation, that is, two intervals of mutation and discontinuity. The Nightingale era in the 1880s precipitated the first epistemic shift – premodernism to modernism. The transfer of nursing education from hospital based training to the tertiary education sector, followed by the introduction of the baccalaureate degree, precipitated the second epistemic shift in the 1990s, the advent of postmodernism. Encompassing these two epistemes, six historical contexts are identified, where significant disruptions to the nursing discourses overturned previously held assumptions about what constituted a nurse. Each historical context is identified by specific discursive constructs. The first is colonial caring, the second the Nightingale ethos and the third heroic, disciplined obedience. In the fourth context, nursing is framed by, and within, discourses of skilled, humanistic caring, in the fifth, scientific, task focused managerialism, and in the 1990s, the sixth context, by multiple realities in an age of uncertainty.

Abstract: This literature review critically examines contributing factors to the current nursing shortage in New Zealand, centering on recruitment and retention of registered nurses. There is a dramatic widening between the supply of registered nurses and the demand for their services. All regions in New Zealand are reporting difficulty in hiring experienced and specialty nurses, and recruiting time is lengthening. This report suggests that the shortage is closely linked to factors in the nursing care environment. As a result of multiple factors during the centralising, cost-containing, acuity-increasing decade of the 1990s, the care environment has driven practising nurses out of acute care settings and discouraged new students from entering the profession. The availability of numerous alternative career opportunities has heightened the effect. Continuing causes to the non-selection of nursing as a profession are the influences of wage compression and limited career progression over the lifetime of the nurse, and insufficient orientation and mentoring of new nurses. Recent changes in the health care system have gone unevaluated and without oversight by nursing regulatory agencies – a situation not in the best interests of patients or nurses. A number of both literature-supported and resourceful approaches, including recommendations towards addressing the nursing shortage are proposed in this review.

Abstract: This thesis concerns the Professional Development Programme at Lakeland Health. In New Zealand, such programmes were introduced as a mechanism to openly recognise the clinical expertise of nurses. Clinical Career Pathways were introduced to nursing in North America in the 1970's at a time of nursing shortage. Prior to their inception, nurses wishing to develop their careers had to move to administration, management or education. The programmes recognised and rewarded expertise in practice. A qualitative, descriptive approach (using focus groups) was used with Registered Nurses to gather their perceptions of what helps nurses enroll in the Professional Development Programme. The ideas and insights of nine Registered Nurses were clustered around three main categories: The People (fear; being struck; motivation; feedback; peer support; ways of learning); the Programme (relevance; flexibility; Bachelor's Degrees; implementation; supporting information; fairness); the Place (time; regular and accessible; support from nurse leaders; management). These perceptions are discussed in more detail in the context of nursing at Lakeland Health and of Clinical Career Pathways in New Zealand. The findings are helpful for the evaluation and future development of the Professional Development at Lakeland Health. The research contributes to our understanding of what helps nurses enroll in a Clinical Career Pathway, and emphasises the importance of the People, the Programme and the Place.