The enemy within: Power and politics in the transition to nurse practitioner

MacLellan, Lorna; Levett‐Jones, Tracy; Higgins, Isabel

doi:10.1016/j.npls.2016.01.003

Cited by 23 publications

(45 citation statements)

References 41 publications

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“…While these previous studies focus on novice and ANPs in transition, findings reported in this study demonstrate that such behaviours are experienced in environments where ANPs, both as individuals and as a concept, are long embedded within study sites. While overt aggression described by MacLellan et al, was not evident in this study, subtle undermining of ANPs was demonstrated by some nurses. They ignored ANP contributions, made negative comments, questioned competence and expressed dislike of carrying out work to support ANPs.…”

Section: Discussioncontrasting

confidence: 72%

“…There is a small but growing body of evidence to suggest that the profession of nursing, and individuals within it, may be complicit in undermining and inhibiting advanced nursing practice. For example, studies of ANPs’ experiences of role transition have identified deliberate techniques to undermine individuals and roles by other nurses who withhold information, dismiss, demean and behave in a passive‐aggressive way towards ANPs (Brown & Draye, ; MacLellan et al, ; Martin & Hutchinson, ). MacLellan et al () also identified that novice ANPs felt deliberately unsupported by other ANPs.…”

Section: Discussionmentioning

confidence: 99%

“…For example, studies of ANPs’ experiences of role transition have identified deliberate techniques to undermine individuals and roles by other nurses who withhold information, dismiss, demean and behave in a passive‐aggressive way towards ANPs (Brown & Draye, ; MacLellan et al, ; Martin & Hutchinson, ). MacLellan et al () also identified that novice ANPs felt deliberately unsupported by other ANPs. While these previous studies focus on novice and ANPs in transition, findings reported in this study demonstrate that such behaviours are experienced in environments where ANPs, both as individuals and as a concept, are long embedded within study sites.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, nurses working in nontraditional roles may be mistrusted and hindered by nursing colleagues, as well as sometimes subjected to open hostility (Powell & Davies, ). MacLellan, Levett‐Jones, and Higgins () found newly qualified ANPs in Australia reported resistance by other nurses. This manifested in negative conduct ranging from dismissive and secretive behaviour to “turf wars,” with implications for patient safety, as well as ANP retention (MacLellan et al, , p. 5).…”

Section: Introductionmentioning

confidence: 99%

“…MacLellan, Levett‐Jones, and Higgins () found newly qualified ANPs in Australia reported resistance by other nurses. This manifested in negative conduct ranging from dismissive and secretive behaviour to “turf wars,” with implications for patient safety, as well as ANP retention (MacLellan et al, , p. 5). Furthermore, studies suggest ANPs differentiate themselves from other nurses by identifying themselves as elite and consider themselves to be held in higher regard than the broader nursing profession (Piil, Kolbaek, Ottmann, & Rasmussen, ).…”

Section: Introductionmentioning

confidence: 99%

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Exploring the relationship between nursing identity and advanced nursing practice: An ethnographic study

Anderson

Birks

Adamson

2020

Journal of Clinical Nursing

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Aims and objectives To consider the relationship between professional nursing identity and advanced practice by exploring intra‐professional relationships between advanced nurse practitioners (ANPs) and nursing colleagues. Background Advanced nursing practice continues to develop internationally. Previous studies suggest advanced practice may lack support within nursing, which may lead to underutilisation, retention and patient safety issues. However, the relationship between the wider nursing profession and advanced practice is poorly understood and the theory that professional identity creates cultural barriers to advanced practice has received little empirical attention. Design Ethnographic methodology was used. Methods Fieldwork methods were participant observation and semi‐structured interviews. Participants were ANPs (n = 9) and nursing colleagues (n = 5) across two primary care general practice organisations. Data were analysed thematically using framework analysis, underpinned a priori by professional identity theories. Reporting was guided by COREQ. Results Three themes were identified which indicated how intra‐professional relationships were conducted: Conciliating Nursing, where ANPs took responsibility for developing positive relationships with other nurses; Vertical Discounting, where nursing colleagues were dismissive and undermined ANPs, who themselves behaved similarly towards other nurses; and Lateral Othering, where ANPs undermined other ANPs. Vertical Discounting and Lateral Othering destabilised advanced practice. Conclusion Intra‐professional relationships, and the broader nursing profession, shape advanced practice. We theorise this is underpinned by threats to professional identity, while weak professional identity amongst even established advanced practitioners exacerbates lack of support. Highlighting these issues allows space to develop alternative strategies to negotiate intra‐professional relationships, informed by professional identity theories, which support rather than inhibit advanced practice. Relevance to clinical practice As advanced practice expands throughout primary and secondary care, and across allied health professions, the impact of professional identity and relationships on health care will likely increase and the importance of strong advanced practice identity will become increasingly relevant.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Exploring the relationship between nursing identity and advanced nursing practice: An ethnographic study

Anderson

Birks

Adamson

2020

Journal of Clinical Nursing

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An exploration of the factors that influence nurse practitioner transition in Australia

MacLellan

Higgins

Levett‐Jones

2017

Journal of the American Association of Nurse Practitioners

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Background and purpose Nurse practitioner (NP) legislation was introduced in Australia in 1998 with the first NPs endorsed 2 years later. Although the number of NPs has slowly increased, they still face significant challenges adjusting to their new role. The aim of this study was to explore the factors that influence the experience of new NPs. Methods Ten newly appointed NPs were interviewed three to four times over a 12‐month period. Using a summative content analysis, data were reduced to four key factors that influence the experience of role transition: personal, intraprofessional, interprofessional, and organizational. Conclusions The findings illustrate that for many participants, transition was a time of turmoil and a great deal of tenacity was required to navigate the journey. However, despite the challenges, some participants were triumphant and able to forge a successful role for themselves. Implications for practice This study highlights the need for the nursing profession to support new NPs. It also demonstrates that the provision of structured orientation programs is needed to facilitate effective transition to these complex and challenging roles. Clarity of expectations and a gradual increase in responsibilities are likely to optimize adjustment to the NP role.

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Transforming Healthcare: The Australian Nurse Practitioner Role

Helms

Boase

2023

Advanced Practice in Nursing

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The enemy within: Power and politics in the transition to nurse practitioner

Cited by 23 publications

References 41 publications

Exploring the relationship between nursing identity and advanced nursing practice: An ethnographic study

Exploring the relationship between nursing identity and advanced nursing practice: An ethnographic study

An exploration of the factors that influence nurse practitioner transition in Australia

Transforming Healthcare: The Australian Nurse Practitioner Role

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