Abstract: This dissertation considers the implications of the relationship between nurses and the patient's family, when family members visit intensive care units (ICUs) following the acute admission of a relative there. In particular it explores the issues of power and control, nurses might have in this setting, the culture that supports that, and the implications this has for practice in the New Zealand context. A comprehensive literature review on the perspective of nurses in relation to relatives visiting adult intensive care units was conducted. The author concludes that nurses modify policies related to visiting access for family members to suit themselves, and the needs of their patient. Nurses use a variety of tactics to maintain a position of power and control by looking out for themselves first, their patient second, and relatives third. The need of the patient and their families is not well understood by nurses, and nurses feel they have inadequate skills to cope with the needs and stresses of visiting relatives. The author suggests that for nurses to provide family focused care in ICU they must develop a therapeutic relationship with all concerned. ICU nursing culture affects nurses ability to focus on caring for their patients and their families. Nurses in ICU appear to need to maintain power and control over their environment but further research is needed to identify the current situation in New Zealand ICUs.

Abstract: The process of describing her scope of practice led the author to become interested in just how she has advanced her practice and the journey that unfolded. The author was introduced to a number of models or frameworks and these frameworks have been critiqued within this dissertation.

Abstract: The nurse practitioner role is an important addition to nursing workforce development in New Zealand. At present there are relatively few nurse practitioners, however the number of nurses seeking Nursing Council endorsement continues to grow. These nurses are in a unique situation as pioneers having achieved the highest level of autonomous advanced nursing practice. This position will bring with it many challenges for those nurses who are among the first in the profession. Traditionally, nurses have always had formal and informal methods of support such as preceptors, role models and the hierarchy of nursing to help and guide them in their work. This network has generally been comprised of nurses more senior and qualified than the nurse needing support. Yet the nurse practitioner, considered to be the leading clinical nurse in New Zealand, may have very limited resources available for the clinical support needed to sustain their professional practice while keeping them refreshed, curious, creative and committed. The intent of this dissertation is to provide a framework of supportive mechanisms on which the emerging nurse practitioner can draw in their new professional domain throughout their career. The author explores the meaning of support, why there is a need for support for the nurse practitioner, the various methods of support noted in current literature and how these various methods can enhance the nurse practitioner's professional growth and development, maintain clinical safety, and foster job satisfaction.

Abstract: The introduction of the 2001 New Zealand Primary Health Care Strategy has seen increased emphasis on the development of the national primary health care nursing workforce. National and local nursing workforce development initiatives, in response to the strategy, have seen evolving models of primary health care nursing practice in New Zealand. Research was undertaken in 2007 to review the current position of the Wairarapa primary health care nursing workforce. Quantitative, descriptive data was generated through the application, at a local level, of the 2001 Ministry of Health Primary Health Care and Community Nursing Workforce survey tool. Many of the regional challenges highlighted by survey respondents in 2007 are similar to those identified in the national 2001 survey. These include predominantly low numbers of Maori, Pacific and male primary health care nurses and a fragmented, part-time and aging workforce with many respondents indicating they undertake more than one nursing role in their organisation. Respondents were similarly unsure or did not have clear clinical career pathways available to them, a mechanism by which nurses can advance their clinical practice. Some unique service provision and workforce development issues related to Wairarapa's rural context include: geographical barriers, population spread and the high health needs of its rural population. Some unique regional differences compared to the 2001 data are: lower numbers of nurses studying toward further qualifications and specific barriers to accessing education opportunities that can be linked to living in a rural region. More respondents indicated they could work collaboratively with other nurses and health professionals within their own and other organisations. While many respondents were able to provide insightful examples of specific nursing strategies in their practice targeted towards reducing inequalities for groups at risk, others could not. Enrolled nurses remain part of the Wairarapa primary health care nursing workforce. Ten percent of the respondents were actively practising enrolled nurses with an average of 24 years experience in primary health care nursing. Direction and delegation requirements by registered nurses for this group and national attrition trends with corresponding loss of workforce experience of enrolled nurses highlight an area in the Wairarapa primary health care nursing workforce that requires further consideration. Overall this study contributes to current knowledge by establishing a regional nursing workforce baseline from which to measure and enable focused future workforce development initiatives and research. Regional findings can be used to inform recommendations within the Wairarapa Primary Health Care Nursing Action Plan 2006-11 to enhance the delivery of well-developed primary health care nursing services with benefits for the Wairarapa community.

Abstract: The focus for this research was nursing culture satisfaction and intent to remain working within a secondary hospital in the New Zealand public healthcare system. A specific group of 117 registered and enrolled nurses were surveyed to identify what issues would encourage them to remain working within the organisation. Descriptive data derived from the Nursing Culture Satisfaction Questionnaire found higher levels of job satisfaction and intention to stay from the staff in operating theatre, compared to other surveyed areas. Factors reported as contributing to job satisfaction included supportive, friendly staff, teamwork, and organisation size. Important issues regarding recruitment and retention include pay parity, personal satisfaction, conditions of employment, the valuing of staff and poor nurse patient ratios. Findings suggest that hospital management should foster positive work environments and respect, to promote job satisfaction and discourage nurses leaving the organisation. While pay parity was a large issue at the time of the questionnaire, the inclusion of the district health board in the nurse Multi Employer Collective Agreement may have reduced this as a contributing factor.

Abstract: The development and role of the clinical nurse specialist in New Zealand is the focus of this dissertation. It is an area that has not clearly been documented previously and the author hoped that by articulating this role to nurses, educators, and administrators that the role of the clinical nurse specialist will be more clearly defined and perhaps recognised for the contribution it provides to health care in New Zealand. At present, it is difficult to justify the clinical nurse specialist position in New Zealand, when individuals have been left to define and develop their own positions. This has led to widely differing practice modes and role confusion, and therefore a varying degree of success in achieving improved nursing practice. Without title protection and some form of accreditation process to ensure standard of practice throughout the country it is not possible for post-holders to move from position to position throughout the country. The role and definition of the clinical nurse specialist must be clarified in order to reduce confusion. Restriction of the title to those who meet the defining characteristics will strengthen the role, improve collaboration with other members of the team as well as making it easier for the public to understand the role.

Abstract: The author tells a story to describe her advancing practice as a registered nurse practising in the rural context. Storytelling is a way to add to the growing knowledge of rural nursing practice in New Zealand. By sharing her rural nursing story through a storytelling framework, she suggests that other nurses may be in a position to utilise this framework and tell their own stories. She has adapted a formalised storytelling framework from McDrury and Alterio (2002). Concepts of the storytelling framework, including reflection, critical reflection and critiquing, can lead to new knowledge and understanding of nursing practice. Past experience is a component of this framework as are the concepts of surface and deep learning. In this way, nursing practice can be deconstructed then reconstructed for new knowledge to be obtained. The innermost thoughts and feelings of the nurse are an integral part of this whole process and need to be acknowledged. The author wanted to answer questions she asked of herself, namely, “how do I practise and how can I improve my practice for the benefit of my patients?” The rural context is expanded upon in her nursing story as this is where she practises as a registered nurse. Her various nursing roles, including advanced practice as a district nurse and rural nurse specialist, are described in depth as are the two areas where she has lived and worked as a rural nurse.