Practice nurses' perception of opportunities and barriers to the expansion of nursing roles within contemporary general practice

The New Zealand government’s plan for ‘better sooner, more convenient primary health care’ (Ryall, 2007) has a clear mandate for developing Integrated Family Health Centers (IFHC) which are patient-centered, lead by clinicians, cost-effective and have a focus on delivering health targets. What is not clear is how this will be achieved in practice, and how IFHC will address some of the disparities which exist in the current model of healthcare in New Zealand; a model which is based primarily on a medicalised model. With the escalating burden of chronic disease it is essential to clearly articulate, strategise and plan how the new model will be different to the current one, and to explore what will be the role of practice nurses in the new and changing environment. The co-location of a multi-disciplinary health team presents opportunities for new, expanded roles and improved collaboration with improved outcomes for patients, particularly for people with complex long-term health conditions (Baileff, 2000). This dissertation explores four practice nurses’ perceptions of opportunities and barriers to the expansion of nursing roles within contemporary general practice using a qualitative descriptive methodology; a methodology used when insight into particular situations, social settings and relationships is required. Purposive sampling was used to identify the participants for the study. This method is used when participants are chosen for their knowledge and experience of the phenomenon to be explored. Four practice nurses participated in the study. The nurses work in four different general practices within the same Primary Health Organisation. They all work and live in a rural area of New Zealand and all four identify as European / New Zealanders. The amount of time they have worked in general practice ranges from nine to twenty years. Three of the nurses have undertaken post-graduate study, two achieving a post-graduate certificate and one achieving a post-graduate diploma. The closest tertiary provider of post-graduate courses is a minimum of four hours travelling distance from the nurses’ homes. The four nurses were interviewed individually, each interview was tape-recorded and the tape recordings were transcribed by an independent person. The data were analysed using thematic analysis. Following coding of the interview narratives two main themes emerged: 1) further education is required before practice nursing roles can be expanded and 2) nurses who work in expanded roles experience enhanced professional self-esteem. Recommendations for further research and development include scoping enhanced and diversified learning methods for nurses who live and work in rural areas and; providing more ‘on-site’ clinical and academic support, mentoring and networking to practice nurses working in general practice in rural areas. Consideration should also be given to integrating practice nurse ‘short courses’ (e.g. vaccination and smear training) into post-graduate study as part of a Postgraduate Certificate in Primary Health Care Nursing. Blending ‘hands on’ courses with the theoretical underpinning of advanced study could attract more practice nurses into a post-graduate pathway of education, essential if practice nurses are to work in expanded, autonomous roles