Department of Health Sciences, Faculty of Sciences, University of York, York, UK.
Social Policy Research Unit, University of York, York, UK.
J Clin Nurs. 2020 Apr;29(7-8):1195-1208. doi: 10.1111/jocn.15155. Epub 2020 Jan 27.
To consider the relationship between professional nursing identity and advanced practice by exploring intra-professional relationships between advanced nurse practitioners (ANPs) and nursing colleagues.
Advanced nursing practice continues to develop internationally. Previous studies suggest advanced practice may lack support within nursing, which may lead to underutilisation, retention and patient safety issues. However, the relationship between the wider nursing profession and advanced practice is poorly understood and the theory that professional identity creates cultural barriers to advanced practice has received little empirical attention.
Ethnographic methodology was used.
Fieldwork methods were participant observation and semi-structured interviews. Participants were ANPs (n = 9) and nursing colleagues (n = 5) across two primary care general practice organisations. Data were analysed thematically using framework analysis, underpinned a priori by professional identity theories. Reporting was guided by COREQ.
Three themes were identified which indicated how intra-professional relationships were conducted: Conciliating Nursing, where ANPs took responsibility for developing positive relationships with other nurses; Vertical Discounting, where nursing colleagues were dismissive and undermined ANPs, who themselves behaved similarly towards other nurses; and Lateral Othering, where ANPs undermined other ANPs. Vertical Discounting and Lateral Othering destabilised advanced practice.
Intra-professional relationships, and the broader nursing profession, shape advanced practice. We theorise this is underpinned by threats to professional identity, while weak professional identity amongst even established advanced practitioners exacerbates lack of support. Highlighting these issues allows space to develop alternative strategies to negotiate intra-professional relationships, informed by professional identity theories, which support rather than inhibit advanced practice.
As advanced practice expands throughout primary and secondary care, and across allied health professions, the impact of professional identity and relationships on health care will likely increase and the importance of strong advanced practice identity will become increasingly relevant.
通过探讨高级护师（ANP）与护理同事之间的内部专业关系，考虑专业护理身份与高级实践之间的关系。
高级护理实践在国际上不断发展。先前的研究表明，高级实践可能在护理中缺乏支持，这可能导致利用不足、保留和患者安全问题。然而，更广泛的护理专业与高级实践之间的关系理解甚少，并且专业身份理论创造了高级实践的文化障碍这一理论几乎没有得到实证关注。
采用民族志方法。
田野工作方法包括参与观察和半结构化访谈。参与者为来自两个初级保健全科医疗组织的 ANP（n=9）和护理同事（n=5）。使用框架分析对数据进行主题分析，框架分析以前提专业身份理论为基础。报告遵循 COREQ 指南。
确定了三个主题，这些主题表明了内部专业关系的进行方式：调解护理，其中 ANP 负责与其他护士建立积极的关系；垂直折扣，其中护理同事轻视和破坏 ANP，而 ANP 本身对其他护士也表现出类似的行为；和横向异化，其中 ANP 破坏其他 ANP。垂直折扣和横向异化破坏了高级实践。
内部专业关系以及更广泛的护理专业塑造了高级实践。我们的理论认为，这是由专业身份的威胁所支撑的，而即使是成熟的高级从业者的薄弱专业身份也会加剧缺乏支持。强调这些问题为发展基于专业身份理论的替代策略提供了空间，这些策略支持而非抑制高级实践，以协商内部专业关系。
随着高级实践在初级和二级保健以及联合卫生专业中扩展，专业身份和关系对医疗保健的影响可能会增加，强大的高级实践身份的重要性将变得越来越相关。
