"When academics take over, who is going to work in practice?" - In a field of tension: APN role development in psychiatry.

Abstract

Background: Increasing demands in healthcare require the development of new structures and models in psychiatry, such as the implementation of the Advanced Practice Nurse (APN). The APN role development process is challenging and emotional, and interactional aspects appear to play a role. Research question: Which emotional and interactional aspects of involved or affected professionals appear to be relevant in the facilitation and hindrance of the APN role development and implementation process? Methods: 13 semi-structured, problem-centred qualitative interviews were analysed secondarily using thematic analysis. Results: APN role development in psychiatry operates in a field of tension, generated from overriding health policy and economic requirements and the development of the nursing profession. The three central themes of "Professional identity in a predicament", "Developing (having to develop) under pressure", and "APN as personification of change"were identified. They represent the emotional and interactional aspects which arise through the APN role development process in psychiatry. Conclusions: Little progress has been made in addressing the requirements for change and in professional role development. Investing in role clarification by involving key people and by considering emotional and interactional aspects, could support sustainable role implementation.