Abstract: The author traces the development of the nurse practitioner role in New Zealand, which was finally introduced in 2001. It traces the key events, from early debates on the issue, the influence of the Centre for Rural Health, and a series of government investigations into nursing which noted the untapped potential of the nursing workforce and the lack of ongoing clinical career pathways. Barriers to rural nurses becoming endorsed as primary health care nurse practitioners are examined, and some of the solutions to this issue are explored. Relationships between nurse practitioners and the local general practitioners, and community resistance are areas that need management. Education is seen as a key response to many of these issues.

Abstract: This thesis examines the forces influencing the development of contemporary advanced nursing practice in New Zealand. It begins with an historical approach to explore the various meanings of advanced nursing practice from the late 1800s through the first years of the 21st century. Seven historical understandings of the meaning of 'advanced' nursing practice emerge. The author's analysis of the broad scope of New Zealand nursing history, including a case study of the development and implementation of the nurse practitioner, draws on theoretical perspectives from sociology, political science, and nursing. She develops a “framework of critical factors for nursing to take into account when considering how to ensure the profession is able to deliver on its great potential to improve the health of New Zealand communities”. Examining the work of a range of nursing leaders, past and present, and drawing on the work of political scientist, John Kingdon, the author describes the work of several nurses as “policy entrepreneurship.”

Abstract: The purpose of this essay is to examine why postgraduate education has become so important, to examine some of the issues around mandatory continuing education and the practical effect of this on a nursing career. Four strategies from the Ministry of Health, designed to facilitate changing nurse education, are discussed. The importance of Professional Development Recognition programmes is discussed along with the need for strong nursing leadership.

Abstract: Current New Zealand health policy encourages collaborative health promotion in all sectors of health service delivery. The integrated approach to the acute management of coronary heart disease in a coronary care unit, combining medical therapy and lifestyle change, supports clinical health promotion. The aim of this study was to use the grounded theory approach to discover the main concerns of nurses' promoting health in an acute coronary care setting and to explain the processes that nurses used to integrate health promotional activities into their practice. Seventeen registered nurses from three coronary care units within a large metropolitan city in New Zealand were interviewed. Data were constantly compared and analysed using Glaser's emergent approach to grounded theory.The main concern for nurses promoting health within coronary care was ritualistic practice. In this study, ritualistic practice concerns the medically-based protocols, routines, language and technology that drives nursing practice in coronary care. This concern was resolved via the socio-cultural process of attitudinal shifting that occurs over time involving three stages. The three conceptual categories, environmental pressures, practice reality and responsive action are the main components of the theory of attitudinal shifting. In environmental pressures, nurses experience a tension between specialist medically-dominated nursing practice and the generalist nursing role of promoting health. In practice reality, nurses become aware that the individual needs of patients are not being met. This causes role conflict until the nurse observes colleagues who role model possibilities for practice, working with patients to promote health. Responsive action sees the nurse engaging in self-development, also focusing on the nurse-patient relationship, thereby enabling active patient involvement in individual health-promoting decisions. The author suggests that the findings from this research have implications for nursing practice and education. With the increasing specialisation in nursing practice, these findings may be of interest to nurses working in delegated medical roles where the reality of everyday practice precludes nurses from undertaking their essential nursing role. Health care facilities also need to ensure that there are opportunities for the personal and professional development of nursing staff. The place of health promotion within nursing undergraduate curricula needs to be examined, as many nurses found that they were ill prepared for undertaking health promotional activities.

Abstract: The author reviews the report 'Fitness for Practice' by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) noting many areas of relevance for New Zealand educators in outlining possible strategies for nursing education. Discussion of some of the recommendations is put in the context of a strategic review of undergraduate nursing education recently commissioned by the Nursing Council of New Zealand. Issues such as recruitment and access to education; retention; clinical assessment and placements; clinical skill acquisition and partnership are valid concerns for educators here also. Internationally, the author suggests, the commonalties in issues of concern lend validity to the concept of the global village and the necessity for a global perspective in health care workforce planning, including educational preparation.

Abstract: This article discusses the disconnection between mental health nurses and policy, and the importance of reconnecting such relationships. It is suggested this will benefit consumers, provide influence in health care policies and, ultimately, contribute to strategies to improve the health of our nation. In this article, the author draws on her own experiences and applies these to a discussion of how mental health nurses can influence and strengthen their relationships with nursing policy.

Abstract: This article critiques the 'Strategic Review of Undergraduate Education' commissioned by the Nursing Council. The premise of the review is examined, along with the foundations of nursing practice and the role of nursing education.

Abstract: This paper discusses legal issues associated with the seclusion of acutely disturbed patients in psychiatric hospitals in Australia and New Zealand. There continues to be great variation in opinion and operational definition as to whether seclusion is a medical treatment, nursing intervention and management tool, or merely a form of situational restraint. Reflecting this lack of clarity, mental health acts and policies concerning the regulation and practice of seclusion lack consistency and focus across geographical boundaries and jurisdictions. Australian and New Zealand legislation and institutional policy is discussed in order to shed light on the contemporary issues highlighted by this controversial nursing practice. The authors note that mental health professionals must continue to review the practice of seclusion and to actively promote the use of acceptable alternatives. In addition nurses and other mental health professionals have a responsibility to understand current legislation and policy frameworks and to influence change where this is necessary to ensure the best practice possible in their clinical area.