Finally nurse practitioners in New South Wales, Australia, are legally recognized after more than a decade of struggle. In this article the authors provide an update on the nurse practitioner movement, including the continuing conflict with the medical profession as nursing strives to achieve full implementation and acceptance of the nurse practitioner role in New South Wales. Discussion includes nurse practitioner role legislation and authorization process. The issues and concerns expressed by the medical and nursing professions are outlined, and the authors make recommendations to strengthen and support the advanced professional role and status of nurse practitioners.

SPECIALIZATION IN NURSING is a phenomenon that occurs worldwide. In New South Wales, Australia, the positions of clinical nurse specialist (CNS) and clinical nurse consultant (CNC) were formally established only in the last decade. How these positions developed and the responses to the roles are considered in this article. In 1990/1991, we surveyed 568 specialist nurses (CNSs and CNCs) working in the Sydney metropolitan area to identify their perceptions of what they ought to be doing and what they were actually doing in the performance of their roles. The results revealed discrepancies in perceptions of the potential role and the actual role. Comments indicated the challenging nature of the roles and thematic analysis of the comments identified problem areas related to role performance, such as workload and role conflict. Further research should be undertaken to explore the origins of role expectations and current role satisfaction.

Recognition of clinical expertise seems to be a worldwide struggle for nurses. In New South Wales (NSW), Australia, nurse practitioners (NPs) are currently struggling for formal recognition of their position. The role of NP is seen as a means of fulfilling the desire of expert nurses for optimal autonomy and recognition in the health care system. This article examines advanced nursing practice within the context of the Australian health care system and the NP movement in NSW, including the pilot projects conducted. Discussion includes contentious issues such as nurse-prescribed medications, Medicare funding, and support for the NP role from within the nursing and medical professions.