An analysis of forces influencing innovative roles in primary health care nursing

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The reorientation of health care systems towards a primary health care focus provides opportunities for the development of new or expanded nursing services. While considerable literature exists on nurse practitioner (NP) and new innovative roles in general, little has been written about influences on the development of innovative roles in primary health care nursing. An analytical tool of Force Field Analysis was used to identify and describe forces influencing the development of innovative roles, including the NP role, in primary health care nursing. At the commencement of the study an initial analysis of research, literature and policy identified forces driving or restraining the development of innovative roles. A mixed research method of surveys and focus group interviews with key stakeholders, namely nurses in innovative roles, General Practitioners and nurse leaders, was then used to identify factors influencing development within the Northland District Health Board (NDHB) of New Zealand. Descriptive statistics and interpretative methods were used to analyse the data. A final analysis enabled a picture of forces influencing innovative role development to be presented. Driving forces reflected international trends and were strongly influenced by economics and a political imperative to reconfigure health care services towards a primary health focus. The Treaty of Waitangi was also a key influence. Driving forces had greatest impact on the development of new roles. Forces were identified as drives towards cost- effective evidence-based health care (effective services), equity for Maori, response to local needs and workforce reorganisation. The major forces restraining the development of innovative roles were reinforced by attitudes, customs and support systems. These forces were identified as poor professional identity and support, an outdated nursing image, inadequate education and training and slow transition from traditional practices and structures (tradition). These forces had a negative influence on support for innovative roles. Promotion of Kaupapa Maori, involvement of the local community, local Maori and nursing in decision-making and promotion of a team culture have the potential to support further development of innovative roles. Political ideology and the Treaty of Waitangi will continue to be major influences directed through policy and the contracting and funding process. Nurses must develop their political astuteness and be ready to influence decision-making within their organisations, within primary health organisations and within the NDHB. This requires the development of leadership at all levels. A strong regional nurse leader network, development of individual nurses leadership competencies, development of education opportunities and support from strong leadership at a national level, has the potential to reduce restraining forces and positively influence the future introduction and support of innovative roles. This work provides a research basis from which nurse leaders, the NDHB and others can develop strategies for planned change to contribute to future development of innovative roles including the NP role, in primary health care nursing.
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