The Acute-Care Nurse Practitioner


The Acute-Care Nurse Practitioner

From the moment it was first proposed, the role of the nurse practitioner has been steeped in controversy. In the fields of both nursing and medicine, the idea that a nurse practitioner can, to some degree, serve as a replacement for the physician has sparked heated debates. Perhaps for that reason, despite the progress of the nurse practitioner movement, NPs have been reluctant to speak about themselves and their work, and their own vision of their role has thus remained largely invisible. Current research is dominated by instrumental and economic modes of discourse and tends to focus on the clinical activities associated with the role. Although information about demographics, educational preparation, position titles, reporting relationships, and costs of care contribute to our understanding, what was missing was an exploration of the lived experience of the nurse practitioner, as a means to deepen that understanding as well as our appreciation for their role.

The Acute-Care Nurse Practitioner is based on in-depth interviews with twenty-six nurse practitioners working in acute-care settings within tertiary-care institutions all across Canada. Employing a hermeneutic approach, Rashotte explores the perspectives from which NPs view their reality as they undergo a transformational journey of becoming—a journey that is directed both outward, into the world, and inward, into the self. We learn how, in their struggle to engage in a meaningful practice that fulfills their goals as nurses, their purpose was hindered or achieved. In large part, the story unfolds in the voices of the NPs themselves, but their words are complemented by descriptive passages and excerpts of poetry that construct an animated and powerful commentary on their journey. Poised between two worlds, NPs make a significant contribution to the work of their colleagues and to the care of patients and families. The Acute-Care Nurse Practitioner offers an experiential alternative to conventional discourse surrounding this health care provider’s role.

Table of Contents

Table of Contents
Cover 1
Contents 8
List of Figures 10
Acknowledgements 12
Introduction 14
The Research Journey 15
Background of the Study 17
Connecting Voices 22
Introducing the Nurse Practitioners 25
Nurse Practitioners’ Transformational Journey 28
Chapter 1. Being Called To Be More 34
Being More Connected 38
Being More in Control 39
Being More Visible 42
Being More Challenged 45
Being Able to Make More of a Difference 48
Answering the Call: Initiating the Journey 50
Chapter 2. Being Adrift 56
Being Disconnected 62
Being Uncertain 73
Being Lost 95
Staying Afloat 105
Chapter 3. Being a Nurse Practitioner 120
Being Competent 123
Being Confident 134
Being Comfortable 151
Being Committed 166
Being Connected 186
Being Content 205
Chapter 4. Being Pulled to Be More 224
Being a Wearer of Two Hats 241
Chapter 5. Being More 250
Being an Advanced Practitioner 256
Chapter 6. Breaking Silence and Giving Voice 270
References 280
Publication Acknowledgements 292