De Rosis Carolina, Teixeira Maria, Jovic Ljiljana
Researcher University of Paris cité, INSERM ECEVE UMR1123, Paris, France.
Université Paris Cité, Inserm, ECEVE, F-75010 Paris, France.
Heliyon. 2023 Jul 22;9(8):e18590. doi: 10.1016/j.heliyon.2023.e18590. eCollection 2023 Aug.
Research on the deployment of advanced practice nurses (APNs) in healthcare settings highlights significant challenges for APNs transitioning to a broader, less well-defined nursing role in negotiating professional boundaries and a new work identity with other health workers. However, theories of boundary-work and professional identity have been rarely applied to APNs relationships with general nurses and colleagues in lower professional position such as nursing-assistants. APNs relationships with these colleagues remain poorly understood. This article aims to contribute to addressing this gap. It is based on qualitative research on a pilot-project prefiguring the introduction of APN (pre-APN) in the French Health system entitled the Prefiguration of Clinical Nurse Specialists (PrefICS). Data were collected through field observations and interviews with pre-APNs, general nurses, nursing-assistants, doctors and nursing hierarchy, to assess the implementation of PrefICS project in four hospitals, one health centre and one cancer control centre. The analysis shows that facing the risk of their role being limited to collaborations with doctors, pre-APNs engaged in different forms of boundary-work with general nurses and nursing-assistants, to negotiate new professional relationships with these colleagues. Some pre-APNs presented themselves as resource persons and led activities aimed at developing and sharing nursing knowledges and competencies with general nurses and nursing-assistants. Other pre-APNs shaped their work identity around a reformist role in terms of both the nursing profession and work environments. Pre-APNs boundary work with general nurses and nursing-assistants produced work spaces in which pre-APNs interwove their work identity with these colleagues by negotiating new professional ties and brokering knowledges between different professional worlds. Changes in levels of pre-APN self-categorization reflected different views of the nursing and nursing-assistant professions, from which pre-APNs started building new alliances for a shared reflective work on their practice and about caring.
关于在医疗机构中部署高级实践护士（APN）的研究凸显了APN在向更广泛、定义不太明确的护理角色转变过程中所面临的重大挑战，即在与其他医护人员协商专业界限和新的工作身份时面临的挑战。然而，边界工作和职业身份理论很少应用于APN与普通护士以及护理助理等较低专业职位同事的关系中。人们对APN与这些同事的关系仍然知之甚少。本文旨在填补这一空白。它基于一项定性研究，该研究围绕法国医疗系统中一个预示着引入APN（预APN）的试点项目展开，该项目名为临床护士专家预配置（PrefICS）。通过对预APN、普通护士、护理助理、医生以及护理层级人员进行实地观察和访谈来收集数据，以评估PrefICS项目在四家医院、一个健康中心和一个癌症控制中心的实施情况。分析表明，面对其角色可能仅限于与医生合作的风险，预APN与普通护士和护理助理进行了不同形式的边界工作，以协商与这些同事的新专业关系。一些预APN将自己定位为资源人员，并开展旨在与普通护士和护理助理发展和分享护理知识及能力的活动。其他预APN在护理专业和工作环境方面都围绕改革者角色塑造自己的工作身份。预APN与普通护士和护理助理的边界工作产生了工作空间，在其中预APN通过协商新的专业联系并在不同专业领域之间促成知识交流，将自己的工作身份与这些同事交织在一起。预APN自我分类水平的变化反映了对护理和护理助理职业的不同看法，预APN由此开始建立新的联盟，以便就他们的实践和护理进行共同的反思性工作。
