Role transition and the nurse practitioner: an investigation into the experience of professional autonomy.

Abstract

This research project explores nurse practitioners' experiences of role transition and professional autonomy, aiming to gain a new understanding of how nurse practitioners experience their role, and seeking new insight into the potential of the nurse practitioner role in the ever changing arena of health care delivery. The study addresses the concept of professional autonomy, and the boundaries of professional practice, and links this to the legal, ethical and epistemological foundations of nursing practice in general, and more specifically to the professional role of the nurse practitioner. Amongst specialist nursing roles, the position of the nurse practitioner is of particular interest, because nurse practitioners have evolved within an interprofessional philosophy of care, and therefore have complex issues relating to the scope of their professional practice, their individual and professional identity, and their professional autonomy. The research was conducted using a phenomenological hermeneutic approach inspired by Ricoeur (1976, 1981), and placed a significant emphasis on the meaning of the lived experience of the participant nurse practitioners within their professional role. Narrative interviews with fourteen nurse practitioners were transcribed to create a series of texts for subsequent analysis. Data analysis provided a progressive exploration of the meaning of the experience of professional autonomy for the participants in the study, and incorporated a descriptive analysis and an interpretive account of the phenomenon. From this hermeneutic analysis a new interpreted sense emerged, and a comprehensive understanding of the meaning of the phenomenon under review could be formulated. The findings reflect a generally positive view of practice on the part of nurse practitioners, but highlight a number of barriers to the development of their professional autonomy. Professional relationships are central to the experience of professional autonomy, and the future development of the nurse practitioner role. The findings reinforce the need for clearer definition of the nurse practitioner role, and suggest that further reflection on the nature of advanced practice, and the relationship between nurse practitioners and the wider profession of nursing might help in this regard.