Knowing the nurse practitioner: dominant discourses shaping our horizons

Abstract

The purpose of this paper is to examine the various discourses, particularly the dominant instrumental and economic discourses that have brought the phenomena of the nurse practitioner (NP) into being. It is proposed that NPs have been constituted as an object of nature and therefore understood metaphorically as a tool or instrument within the health care system to be used efficiently and effectively. Heidegger's philosophical analysis of the question concerning technology is used to argue that our current ways of knowing the NP through these discourses, with their emphasis on calculative logic, have resulted from our modern view of the essence of technology. It is also argued that there is now a need to shape our horizons concerning the NP in new and different ways. There is a need to engage in dialogical forms of research in order to evoke the richness and depth of what it means to be an NP, that is, to reveal the other modes of expression by which we define ourselves, understand others and nursing.

Reflections on independence in nurse practitioner practice

“…Practice independence is central to the nurse practitioner’s (NP) professional role (Baer, 2003; Fagin, 2003). However, over time cultural, social, and political factors have come to dominate how the NP practices as a healthcare provider (Rashotte, 2005).…”

The mental health nurse practitioner in the emergency department: An Australian experience

“…Rashotte (2005) states that NPs have repeatedly been promoted as a cheap, although excellent, alternative to physicians. They have also been found to enhance the relationships with all members of the health‐care team.…”

“…Numerous reports conclude that NPs are successful and effective, no matter what measure is used or what question is addressed, be it access, availability, acceptance, satisfaction, cost or clinical outcome. Rashotte (2005) also identifies a framework for NP practice, which is centred on five domains – expert clinician, consultant, educator, researcher and leader. The NP is an advanced practice nurse who is technically and clinically competent and flexible in collaborating effectively across disciplines and specialties.…”

Progression of the mental health nurse practitioner role in Australia

“…The financial benefits of innovative nursing roles are generally not being measured (Pennery 2003). This claim is supported by Rashotte (2005). She states that cost‐effectiveness data help to mobilize into action those groups who carry influence in the healthcare system at state and local levels: ‘Legislators listen when nursing can speak to promote better utilization of services at a reduced cost with the same or better quality of care’ (Rashotte 2005, p. 56).…”

“…This claim is supported by Rashotte (2005). She states that cost‐effectiveness data help to mobilize into action those groups who carry influence in the healthcare system at state and local levels: ‘Legislators listen when nursing can speak to promote better utilization of services at a reduced cost with the same or better quality of care’ (Rashotte 2005, p. 56). Gardner & Gardner (2005) conclude that, in keeping with recommendations from other Australian NP trials, future research related to NP services should encompass a range of methodological approaches to investigate specific practice outcomes and include a cost‐effectiveness analysis.…”