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
Reference: 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.
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.
Competency, advanced practice, Nurse Practitioner™, moral imperative
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).