Exploring the relationship between nursing identity and advanced nursing practice: An ethnographic study

Abstract

Aims and objectives To consider the relationship between professional nursing identity and advanced practice by exploring intra‐professional relationships between advanced nurse practitioners (ANPs) and nursing colleagues. Background 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. Design Ethnographic methodology was used. Methods 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. Results 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. Conclusion 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. Relevance to clinical 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.

Coronavirus disease 2019 pandemic promotes the sense of professional identity among nurses

“…Professional identity, or how a nurse views himself or herself in their role as a nurse, affects every aspect of practice. It is the key to providing high-quality care ( Langendyk et al., 2015 , Andrews, Burr & Bushy, 2011 ), mediating job dissatisfaction and burnout ( Cao, Chen, Tian & Diao, 2016 ), and improving clinical performance ( Bjorkstrom, Athlin & Johansson, 2008 , Anderson, Birks & Adamson, 2020 ) and job retention ( Cowin, Johnson, Craven & Marsh, 2008 ). Previous studies have reported that the professional identity of nurses may be affected by an emergency event or special workplace settings ( Goddard, de Vries, McIntosh & Theodosius, 2019 , Heung et al., 2005 ).…”

Towards abandoning the master’s tools: The politics of a universal nursing identity

“…Thus, it has not only consented to the symbolic violence it is subjected to (Bourdieu, in Schinkel & Noordegraaf, 2011), but also participates in subjecting others and itself to this violence. The horizontal violence so broadly acknowledged in nursing can be understood as a consequence of the struggle for symbolic capital in an arbitrarily unjust system, and the obvious success of some nurses over others at attaining it, such as managers and advanced practice nurses (Anderson et al., 2020). As Drevdahl and Canales (2020) found, the legitimacy of a nursing identity is judged in terms of its proximity to medicalized acute nursing care.…”

“…Shared experiences and belongingness contribute to nursing identity development (Fitzgerald, 2020; Öhlén & Segesten, 1998; Willets & Clarke, 2014). Nursing identity is seen to be influenced by public discourse (Anderson et al., 2020; Hite & Godfrey, 2019; Parker, 2005) or more generally socially mediated (Anderson et al., 2020; Dombeck, 2003; Goopy, 2005; Parker, 2005; Pereira & Oliveira, 2019; Roberts, 2000). It is conversely understood to be passive, unconscious and inevitable (Dinmohammadi et al., 2013), and also proactive and strategic (Dubar, 2005, as cited in Pereira & Oliveira, 2019).…”

Pride, power and professional trust in each other are essential if we are to move forward in this year of the nurse

“…This will require our entire profession to come to understand that it is the people we serve who miss out when our knowledge is excluded from places where critical funding and policy decisions are made (Daly et al, 2020). When we focus on our victim status, undermine those who do step forward and waste our energies on horizontal and vertical violence (Anderson, Birks, & Adamson, 2019), the full breadth and potential of nursing remains tragically wasted.…”