A critical ethnography of the transition experiences of newly endorsed nurse practitioners in Australia

Research Doctorate - Doctor of Philosophy (PhD)Background: Whilst nurse practitioners have been an integral part of healthcare systems around the developed world for more than 50 years, they were first endorsed in Australia in 2000 following much resistance from powerful medical groups. The numbers of nurse practitioners in Australia have been slow to increase. The delayed uptake of nurse practitioners may be due to challenges of transition. Research Design and Methods: The aim of this study was to explore the transition experiences of registered nurse to nurse practitioner in Australia. A longitudinal design was used to provide insights into the participant’s perspectives as they transitioned during their first year of practice. Carspecken’s critical ethnography and focused ethnography comprised the study methodology. A purposeful sampling was used to ensure diversity in gender, age, clinical specialty and location of practice. Data collection involved face to face interviews with ten newly endorsed nurse practitioners who were interviewed 3-4 times during their first 12 months of practice. Data were analysed thematically. Key Findings: Analysis of the data from the 32 interviews revealed a range of personal, intraprofessional, interprofessional and organisational factors that impact transition. There were four main themes; <i>Great expectations</i> captures the personal aspirations participants held for their new roles and is presented as a paper prepared for publication titled ‘An exploration of the factors that influence nurse practitioner transition in Australia: A story of turmoil, tenacity and triumph’. <i>We eat our own/Tall poppies</i> depicts the participants’ intraprofessional relationships and their experiences of subversion and subterfuge. This theme is also captured in a publication titled ‘The enemy within: Power and Politics in the Transition to Nurse Practitioner’. <i>Building bridges: Collaboration and collegiality</i> shows that the nurse practitioners’ allies were medical colleagues. This theme is also reported in a publication titled: ‘Medical Acceptance of the Nurse Practitioner Role: A decade on’. Lastly, <i>Organisational labyrinths and hurdles</i> depict the confusing endorsement processes at the time of the study and is also presented as a publication titled: ‘A game of snakes and ladders: Negotiating the ‘ups and downs’ of endorsement as a Nurse Practitioner in Australia’. The publication ‘Nurse Practitioner Role Transition: A Concept Analysis’ clarifies the meaning of transition in the context of this study revealing antecedents, consequences and its attributes using model cases from this research. Conclusion: The findings of this study reveal an unsupportive nursing culture and lack of organisational support impacting newly endorsed nurse practitioners during transition. Rather than collegiality and support from their colleagues, nurses experienced bullying and power struggles that left them feeling isolated, powerless and alienated. Several of the participants resigned from their nurse practitioner positions, leaving their rural and remote communities without much needed healthcare services. Senior leaders and managers need to be aware of the potential challenges faced by NPs during their first year of practice. The findings of this study suggest that new nurse practitioners should be mentored and supported in scoping and embedding their role into the health care team. Education for nurse practitioners should include topics such as the transition experience, imposter syndrome, resilience, clinical leadership, conflict management and negotiating organisational change