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Through the Looking Glass

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Nurse Practitioner
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  Through the Looking Glass The Politics of Advancing Nursing and the Discourses on Nurse Practitioners in Australia Clare Lynette Eden Harvey RN, BA (Cur), MA, MRCNA A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy School of Nursing and Midwifery Faculty of Health Sciences Flinders University of South Australia January 2010   Declaration I certify that this thesis does not incorporate without acknowledgment any material  previously submitted for a degree or diploma in any university; and that to the best of my knowledge and belief it does not contain any material previously published or written by another person except where due reference is made in the text. I had a name change part way through this thesis. Because of this, mention of my  previous surname of Turner is sometimes made.  _____________________ _______________________ C. L. E. Harvey Date   Abstract  Nursing has a tradition of subservience and obedience. History provides an account of secular and religious orders of nursing shaping a view of virtuous and tireless dedication in carrying out the doctor’s orders. Nurse Practitioners were first introduced to the health care system in the 1960s as a solution to the medical shortage  being experienced in United States of America at that time. They assumed clinical tasks, traditionally regarded as doctor’s work. Since then the Nurse Practitioner movement has expanded globally. Australia introduced the Nurse Practitioner role in 1998, heralding a new era in the health system of that country. Its introduction has created diverging views which are influence role implementation. This study examines social and political discourses that are affecting the development of Nurse Practitioners in Australia, using text and language to identify discursive practices. It has set out to determine whether Nurse Practitioners have the autonomy that professional nursing leaders have described in  policy, or whether the introduction of the role has merely shifted nursing’s sphere of influence within a traditional health care system. Using Fairclough’s notion of power behind discourse, the language and discourses of  Nurse Practitioners were explored in relation to what was happening around role development and how Nurse Practitioners positioned themselves within the environment where they worked. The use of a Critical Discourse Analysis has allowed for the various social, historical and political perspectives of nursing to be examined. Fairclough’s three levels of social organisation have been used to identify the divergent discourses between the truths of implementation of the role at individual and organisational level and comparing it to that of the rhetoric of health policy. The discourses surrounding the creation of this advanced nursing role have been the focus of analysis. This analysis has revealed how role development is controlled by  powerful groups external to the nursing profession. The dominant discourses use the traditional health care divisions of labour to maintain control through a financially driven focus on health care which does not necessarily revolve around clinical need.  Further complicating the position of Nurse Practitioners is the internalisation of those dominant discourses by the nurses themselves. It reinforces Fairclough’s view that the dominant power lies behind the discourse, using the system itself to maintain a status quo, rather than overtly opposing it.  Nurse Practitioners, despite being held out by the nursing profession as clinical leaders, are not able to influence change in health care or in their own roles. The results have further shown that nursing managers do not have an influence over the direction that health care and nursing takes. Further research is necessary to examine the broader leadership role of nursing within health care nationally and internationally, in order to establish the real position of nursing within the decision making framework of health care service development.
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