Advanced nurse practitioners’ (emergency) perceptions of their role, positionality and professional identity.

Abstract

Nursing theorists have reviewed the contexts and continua into which advanced nursing practice roles in emergency care have evolved and developed, yet little empirical evidence has been gleaned directly from advanced nurse practitioners’ (ANP) perceptions. The nature and scope of this study is to explore ANPs’ (Emergency) perceptions of their role, positionality and professional identity from an Irish perspective. A qualitative narrative approach was used to gain insight into ten ANPs’ perceptions. The ANPs nursed in seven different emergency departments representing both urban and rural regions. Content analysis was applied to the narrative interviews to code and categorise the data and Bourdieu’s theoretical framework was applied to this analysis. This enabled the recognition and analysis of social and health contextual factors that related to professional advanced nursing practice in Ireland. Five key themes emerged: participants’ career pathways; personal and professional transitions; role dimensions and core concepts; position within the organisation; and emergent professional identity. Each theme contained a number of categories which included: starting points and management roles; structural changes; transitions and educational challenges; multidimensional nature of practice; ANPs’ communities of practice; and status and recognition. Discussion of these findings focused on: ‘Habitus - the transition from nurse to ANP’; ‘Field - reconstructing advanced practitioner positionality’; and ‘Capital - structure and agency that influence ANPs’ professional identity’. This study identified an in-depth understanding of ANPs’ experience of personal and professional transitional processes; heightened awareness of autonomy and accountability in decision making; waiting times, throughput numbers, X-ray and medication prescribing, and referral pathways as stressors; practice-based tensions regarding recognition at ADON level and communities of practice relations; and expressions of high job satisfaction in their provision of safe, timely, expert patient care. This provided a greater understanding of the ANPs’ (Emergency) role, position within the organisation and emergent professional identity. These are all unique important elements that were narrated in this study by the participants. The concepts of ANPs’ positionality and professional identity enable their role-fulfilment. The consequence of this is that ANPs’ roles reflect the attributes of advanced practice. This is seen to confirm and add to the current contemporary body of knowledge on the national and international stage. Recommendations for the domains of nursing, education, management and future research were drawn including: increasing awareness of ANPs’ (Emergency) role and scope of practice amongst healthcare personnel; forging links between nursing academics and ANP clinicians to create appropriate course curricula for ANPs’ continuing professional development; and the processes of reviewing future planning of nursing roles to include ANPs at strategic levels. Bourdieu’s model provided an important theoretical framework which exposed the interrelations and interconnectedness of ANPs’ habitus, field and capital. This played a major part in identifying and exploring ANPs’ unique perceptions, thus contributing to the body of knowledge for the domains of nursing, education, management and research. To conclude, this study has revealed that ANPs’ (Emergency) perceptions of their role, position within the organisation and emergent professional identity are multidimensional, complex and unique within the field of healthcare practice in Ireland.