Development of a specialist nursing framework for New Zealand

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Specialist nursing services have been identified as an area of expected growth for the New Zealand health system. In the next decade more nurse specialists will be required particularly to provide services to manage long-term conditions, the burden of chronic disease and the provision of quality aged care. However, the current landscape and understanding of specialist nursing in New Zealand is well recognized as complex and fragmented, with professional groups looking for solutions. There are multiple pathways involving frameworks built on ever increasing lists of nursing competencies. As a nurse leader within New Zealand, my concern is that inconsistent specialist nursing workforce planning and pathways for nursing practice development will adversely affect needed service provision for the population. This dissertation reports the outcomes of my doctoral study, which suggests an alternate approach through the development of a single unified capability framework for specialist nursing practice in New Zealand. This study uses a qualitative descriptive and exploratory multi-method enquiry approach to review extant understandings and develop a consensus framework. A three-phased study with each phase informing the other was designed to answer the research question regarding the essential elements required for a single national framework for specialist nursing in New Zealand. The initial phase of the study considered the extant nurse specialist frameworks through literature review and document analysis, along with key stakeholder interviews to build elements for the next phase. The second phase used online survey software in an E- Delphi technique using the International Council of Nurses three criteria for orderly development of specialty practice. Following two rounds of the E-Delphi, the consensus outcome elements were integrated with a role development model to develop a draft framework. The third and final phase of the study validated the framework with a group of nurse specialists, culminating in the production of the New Zealand Nurse Specialist Framework (NZNSF). The dissertation widens the understanding of a more holistic approach to specialist nursing development, which holds great promise for the specialist nursing workforce in New Zealand and potentially internationally.
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