Policy, politics and nursing: a case study of policy formation in New Zealand

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The aims of this thesis were to: describe the political development of nursing in New Zealand; promote an understanding of policy and politics and the nursing profession; provide policy learning for the international nursing community; and provide insight into the role of the government Chief Nursing Advisor, especially in relation to engaging with professional groups and central government. The thesis focuses upon a significant event in the history of New Zealand nursing politics and policy: the 1998 Ministerial Taskforce on Nursing. In 1998, after public outcry at the excesses of the health reforms, nursing professionals took advantage of the opportunity to put nursing on the government's agenda through a Ministerial Taskforce on Nursing. The Taskforce ended its work in a flurry of publicly expressed controversy. To develop the case study an Expert Reference Group was established to assist in the selection of subject matter and to provide sources of material and validity of interpretation. Sources of data included participant observations, reports and documents in the public domain, media and secondary sources from nursing, medical and policy, literature and diary entries from the researchers own records. The researcher held multiple roles as Chief Nurse Advisor Taskforce member, public servant and nursing leader. Analysis from all of these points of view aimed to identify the stage of nursing's political development as defined by Cohen et al (1996) and to explicate how nurses engaged in agenda setting as described by Kingdon (1995). Analysis was informed by locating the Taskforce in the policy and political contexts, especially policy entrepreneurship. Analysis revealed the mechanisms nursing organisations use to engage in agenda setting. Moving from agenda to action was non-linear and fluid. No one organisation or individual brought about the events of the case nor their outcomes. Analysis suggests a refinement of the Cohen model to include behaviours of responsible actors in nursing politics and policy. The role of the policy entrepreneur is developed especially in the Chief Nurse position. The thesis widens the understanding of how nursing engages not only in policy formation among nursing organisations but also with government. Implications for policy, practice, education and research not only for New Zealand but also for other countries are presented.
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