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Advancing Nursing Practice In New Zealand:  A Place For Caring As A Moral Imperative  

 

Margaret J. Connor, RGON, PhD, FCNA(NZ)  Independent Nursing and Health Researcher and Consultant and  Associate Lecturer, Graduate School of Nursing and Midwifery,  Victoria University of Wellington 

Connor, M. J. (2003). Advancing nursing practice in  New Zealand: A place for caring as a moral imperative.  Nursing Praxis in New Zealand, 19(3), 13-21.     

Abstract   

Advanced nursing practice is now formally endorsed in New Zealand. However,  the framework of competencies that nurses applying for endorsement need to  demonstrate is functionally oriented. There is no recognition of the relational  competencies required to practice caring as a moral imperative. This gap denies  the significance of nursing as a moral practice. In this paper it is argued that a  more balanced framework would give equal attention to both functional and  relational competencies. A practice exemplar is used to demonstrate positive  outcomes from advanced relational competencies. Also evident in the practice  exemplar is the view that practising the relational competencies associated with  the nursing as a caring practice discourse ‘pushes the boundaries’ of the dominant  discourse of nursing as a functional service. This paper explores the history of  these two discourses and the assumptions that underpin them. When missing  from descriptions of advanced nursing practice, relational competencies are rendered  invisible and peripheral, rather than central and therapeutic. In our highly  technological health service the recognition of human to human connection is more  important than ever.   

Key Words: Competency, advanced practice, Nurse Practitioner™, moral imperative   

Introduction   

Formal acknowledgement of advanced  nursing practice is now a reality  internationally. In New Zealand the  Nursing Council of New Zealand  (NCNZ) is charged with the  endorsement process of advanced  practice. Nurse Practitioner™ (NP) is  the conferred title after successful  completion of endorsement. The  documents, which set out this  process, emphasise certain advanced  functional competencies designed to  be therapeutic in meeting particular  client needs relating to diagnosis and  treatment (NCNZ, 2001, 2002). In this  article I argue that equal attention be  given to the therapeutic significance  of relational skills associated with  caring as a moral imperative. To  advance functional competencies,  without the relational skills needed to  genuinely attend to the humanness  of people undermines the significance  of nursing as a moral practice  incorporating promotion of personfamily-  community well-being in all its  many guises (Johnstone, 1999). 

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