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Constructing consensus: Developing an advanced nursing practice role

Jill Wilkinson, RN, PhD, MCNA(NZ), Senior Lecturer, School of Health & Social Services, Massey University, Wellington 

 Wilkinson, J. (2008). Constructing consensus: Developing an advanced nursing practice role. Nursing Praxis in New Zealand, 24(3), 17-26. 

Abstract
Following the release of the Ministerial Taskforce on Nursing in August 1998 and the withdrawal of the New Zealand Nurses Organisation from the Taskforce membership, a ‘decision-making’ workshop was held to further advance nursing practice roles in New Zealand. Momentum about advanced nursing roles had been gathering spurred on by political reform and the research about established nursing practitioner and clinical nurse specialist roles overseas. This study uses a discourse analytical approach to trace the ongoing struggle between nursing groups for power to control the future of advanced nursing practice. The convergence of political discourses with those that were dominant in nursing during this period produced considerable tension, but eventually led to a consensus position concerning the location of a nurse practitioner role within the regulatory framework of the Nursing Council of New Zealand.  

Key Words: Nurse practitioner, consensus, autonomy, unionism.  

Introduction
Following the release of the Ministerial Taskforce on Nursing in August 1998, the struggle within nursing over the power to control its future persisted. Two dominant and conf l ict ing discourses at play were autonomy and unionism and their convergence with the political discourses of this period continued to produce considerable tension. Eventually, a consensus position was reached and the advanced nursing practice role of nurse practitioner was placed within the regulatory framework of the Nursing Council of New Zealand (henceforth Nursing Council). This article follows on from the previous discussion in this issue about the Ministerial Taskforce on Nursing, drawing from the same recent research project (Wilkinson, 2007). The discussion begins by introducing the international and national influences on the work of the Taskforce team. The journey towards a consensus position about advanced nursing practice in New Zealand was set in motion by an academically-led ‘decision-making’ workshop that was fundamentally at odds with union democratic practices. Looking back at these events is a reminder of the real effects discourses produce and the importance of positioning nursing collaboratively in ways that will enhance its full potential. 
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