Abstract: This thesis concerns an investigation of the tripartite arrangements between the government, the nursing and the medical sectors in New Zealand over the period 1984 to 2001 with a particular focus on primary health care. The start point is the commencement of the health reforms instituted by the Fourth New Zealand Labour Government of 1984. The thesis falls within a framework of critical inquiry, specifically, the methodology of depth hermeneutics (Thompson, 1990), a development of critical theory. The effects of political and economic policies and the methodologies of neo-liberal market reform are examined together with the concept of collaboration as an ideological symbolic form, typical of enterprise culture. The limitations of economic models such as public choice theory, agency theory and managerialism are examined from the point of view of government strategies and their effects on the relationships between the nursing and medical professions. The influence of American health care policies and their partial introduction into primary health care in New Zealand is traversed in some detail, together with the experiences of health reform in several other countries. Post election 1999, the thesis considers the effect of change of political direction consequent upon the election of a Labour Coalition government and concludes that the removal of the neo-liberal ethic by Labour may terminate entrepreneurial opportunities in the nursing profession. The thesis considers the effects of a change to Third Way political direction on national health care policy and on the medical and nursing professions. The data is derived from various texts and transcripts of interviews with 12 health professionals and health commentators. The histories and current relationships between the nursing and medical professions are examined in relation to their claims to be scientific discourses and it is argued that the issue of lack of recognition as a scientific discourse is at the root of nursing's perceived inferiority to medicine. This is further expanded in a discussion at the end of the thesis where the structure of the two professions is compared and critiqued. A conclusion is drawn that a potential for action exists to remedy the deficient structure of nursing. The thesis argues that this is the major issue which maintains nursing in the primary sector in a perceived position of inferiority to medicine. The thesis also concludes that the role of government in this triangular relationship is one of manipulation to bring about necessary fundamental change in the delivery of health services at the lowest possible cost without materially strengthening the autonomy of the nursing or the medical professions.

Abstract: This thesis explores the shortage of general hospital nurses in post World War II New Zealand between 1945 and 1955. Historical inquiry is used to identify the causes of the shortage and the response to the shortage by the Health Department, hospital boards and nurse leaders. Christchurch Hospital, administered by the North Canterbury Hospital Board, is used to illustrate the situation at one large, public, general hospital. Primary sources provided the majority of material which informed this thesis. Two themes emerge regarding the causes of the shortage of nurses: those that were readily acknowledged by nurse leaders and other health professionals at the time, and those which were less widely discussed, but which contributed to the nature of nursing work appearing less attractive to potential recruits. In response to the shortage the Health Department, hospital boards and the New Zealand Registered Nurses Association mounted several recruitment campaigns throughout the decade. As the shortage showed no sign of abatement the focus turned from recruitment to retention of nurses. While salaries, conditions and training were improved, nurse leaders also gave attention to establishing what nurses' work was and what it was not. Nurse leaders and others promoted nursing as a profession that could provide young women with a satisfying lifelong career. Due to these efforts, by 1955, this episode in the cycle of demand and supply of nurses had begun to improve.

Abstract: The chapter explores the process of nursing practice and how it contributes to health, derived from research undertaken in New Zealand. It presents the nature of nursing research as if practice – the researcher as if practitioner – establishing a foundation for the development of nursing knowledge that would make a distinct contribution to health and health care. It includes the philosophy and practicalities of nursing through the use of a case study of nursing a family with complex health circumstances.

Abstract: This article elaborates the meaning of partnership in practice for nurses practising in different and complementary way to nurses in specialist roles and medical practitioners. It positions partnership as the relational core of nursing practice. Partnership is presented as an evolving dialogue between nurse and patient, which is characterised by open, caring, mutually responsive and non-directive approaches. This partnership occurs within a health system that is dominated by technologically-driven, prescriptive, and outcome-oriented approaches. It is the second of a series of articles written as a partnership between nurse scholars from Iceland, NZ and USA.

Abstract: This article reports the results of a research study undertaken to examine how nurses manage their professional and personal selves while working in small rural communities. The participants were a small group of rural nurses on the West Coast. The rationale for the study was the long-term sustainability and viability of the service to this remote area. The research showed that the rural nurse specialists' role is a complex and challenging one, performed within the communities in which nurses live.