There is a significant gap between the rhetoric of policy and the implementation of Nurse Practitioner roles in rural and remote Australia. Whilst policy supports the notion of autonomy, the experiences of nurses indicate a mere shift in the traditionally-accepted boundaries of nurses' roles. Evidence from the United Kingdom and United States of America suggests that the findings in this study are relevant internationally as well as nationally.

This paper discusses the complex and interrelated roles of the rural nurse and doctor. These roles are viewed as being complementary to each other in any healthcare setting, but more so within the context of rural Australia. The current move towards the development of advanced nurse practitioner roles is often clouded by unnecessary medical fears that nurses are attempting to displace doctors. In contrast, this paper argues that the development of new rural nursing roles identifies rural nursing as a major specialist area within the wider profession of nursing and, at the same time, recognises the reality of practice for many rural nurses. Individual public figures may perceive the solution to the shortage of rural doctors to lie in their replacement with nurses. The nursing profession, however, will resist this approach. Nursing is not the first rung on the ladder to a career in medicine. Nurses are educated and acknowledged to focus their practice on the clients' responses to healthcare problems and not the practice of medicine. The primary role of the nurse is to provide care. The primacy of care should not be set aside by those nurses seeking to develop their practice, not should advanced practice be defined in terms of taking on tasks previously carried out by other healthcare professionals.

This paper exposes the influence that powerful discourses can have on a major change to professional practice.

This paper makes reference to some of the many issues and problems surrounding nursing research in the context of the rural and remote areas of Australia. The focus is on the use of case studies as an appropriate methodology for small-scale research projects and for students preparing for examinations at higher degree levels. Throughout this paper, the term rural will be used to denote rural and remote area nursing. This is for convenience and does not deny the special qualities of rural or remote area nursing.