Abstract: In 2003 the Health Practitioners Competence Assurance Act was introduced and established separate regulatory authorities for nursing and midwifery. This study is designed to explore the experiences of dually registered practitioners affected by this divide, as now there are two separate and possible paths, and two corresponding sets of competencies to fulfil. The design for this qualitative descriptive study utilised the written and oral narratives of three practitioners affected by this professional regulation and demonstrated its impact on their career development. Individual storytelling, as narrative, provided a theoretical lens aiding insight into their experience and pattern of decision making. In addition, symbolic consideration of the study data was provided by collective storytelling via the perennial myth of the hero journey. Shifting professional ground following the Health Practitioners Competence Act 2003 generated a focus for the inquiry into practitioners' modes of adjustment. For the practitioners in the study, transition between the occupational roles of nursing and midwifery comprised the possible career trajectories. A status passage, as the process of change from one social status to another, is described and includes the transitional experience of anticipation, expectation, contrast, and change. The author suggests that the findings from this research provide illumination of the nuances of professional decision making as a lived experience, and highlight how these practitioners dealt with shifting meaning, values, awareness, choices, and relationships. Aspects of group agency and identity, change management, and professional role transition were revealed. Life pattern, revealed through narrative, was an important research construct for exposing the ways in which the participants negotiated change, and displayed the function of their thinking and reasoning through dilemmas. Perception of individual and group identity revealed attitudes of esteem to the dominant discourse, and exposed dynamic tension between work patterns and life stage. Renegotiating arrangements of personal and professional commitment resulted from this dynamic interplay, and the relationship to stress and burnout was explored.

Abstract: This study uses a critical approach to analyse influences connected to opportunities for nurses to have their unique contribution to the health system recognised, and identifies a plan of action. The stories as told by four Northland nurses, identified the underlying principle of self-knowledge which, when connected to core values emerged as personal power with the language of possibility. Other factors which enabled opportunity recognition were labelled as: knowing the self, integrating core values from personal and professional qualities, connecting these to an intuitive plan, trusting it because it is value-based, using that plan to form goals and achieve direction. Integrating core values into goal setting enabled people to make choices that would enhance as well as protect their personal development. This study has implications for nurses as they seek out places where they can work well and for health planners to design systems where this can happen.

Abstract: The low numbers of nurses attracted to work in mental health is a concern particularly with the increased demand for mental health services. Strategies are required to increase recruitment to this less popular area of nursing to ensure that a high quality of care is provided for people suffering from mental illness. The World Health Organisation is aware that this area of health has been neglected and that it is time to promote mental health. This study aimed to examine the influences involved in nurses choosing to work in this area. A descriptive survey using a questionnaire was given to seven groups of new graduates enrolled in the New Graduate Mental Health Nursing programme through five educational institutes. At the time of writing there were no published studies around this topic in New Zealand. This study will attempt to inform nurses, the Nursing Council of New Zealand, tertiary institutions and the government of New Zealand that there is evidence of a need to develop and change practices to address the predicted workforce decline.

Abstract: Huarahi whakatu describes a pathway for recognising the expertise of nurses working in kaupapa Maori mental health services and recommends a professional development programme that can lead to advancement along the pathway. An emphasis on dual competencies – cultural and clinical – underlies the rationale for regarding kaupapa Maori mental health nursing as a sub-specialty. Eight levels of cultural competencies and twelve levels of clinical competencies are used to differentiate career stages and it is recommended that movement from one level to another should be matched by increased remuneration. The report also contains a recommended professional development programme to support the operationalisation of the career pathway.

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: 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.