Role Transition and the Nurse Practitioner:
An Investigation into the Experience of
Professional Autonomy
Dr Andy Mercer
University Department of Mental Health
School of Health & Social Care
Bournemouth University
Project aims
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To explore nurse practitioners’ experiences of role
transition and professional autonomy, to gain a new
understanding of how nurse practitioners experience their
role, and new insight into the potential of the nurse
practitioner role in the ever changing arena of health care
delivery.
To addresses the concept of professional autonomy, the
boundaries of professional practice, and how this links to
the legal, ethical and epistemological foundations of
nursing practice in general, and more specifically to the
professional role of the nurse practitioner.
Initial considerations
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Personal history
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Philosophy & health care

Nursing ethics
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Patient/client autonomy
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UKCC-ENB-NMC
Focus & methodology
Consideration of research focus
Detailed discussion of methodology
Nurse practitioners
Professional autonomy
Role transition
Phenomenology (Husserl, Giorgi)
Hermeneutics (Heidegger, Van Manen)
Narratives, interpretation (Ricoeur)
Qualitative study, considering human
experience
 Link between nursing ethics, nursing
philosophy and method
 Phenomenology - hermeneutics

Paul Ricoeur (1913-2005)
“Who am I?”
 “How should I live?”
 People play an active role
in structuring their
perceptions, therefore the
meaning of perception
needs to be interpreted in
the context of the
individual's situation.

Ricoeur's ethics
Ricoeur believes that human
life has an ethical aim, and that
aim is self-esteem: “the
interpretation of ourselves
mediated by the ethical
evaluation of our actions”. Selfesteem is itself “an evaluation
process indirectly applied to
ourselves as selves”
(The Narrative Path, 1999)
Ricoeur's ethics
Ricoeur emphasises the
importance of the first
person perspective and
the notion of personal
responsibility, but notes
that we are “mutually
vulnerable”, and so the
fate (or self-esteem) of
each of us is tied up with
the fate of other
(Oneself as Another, 1992)
Rosemarie Rizzo Parse
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US nurse, studied
phenomenology at
Duquesne University
Best known for theory of
'human becoming'
Sees the key role of the
nurse as helping people
understand personal
(human) experience, and
achieve 'wholeness'
Linked nursing theory to
research method
Research process
Method, Data Collection

Derived from Ricoeur
Narrative interviews
Recordings transcribed to
create texts

Sampling
Purposeful sample: accredited NPs
Mix of UK & US registered, all with
experience of topic
Diversity of clinical experience
(Maximum variation sampling)

Data Analysis
Three phases:
Naïve interpretation
Structural (descriptive) analysis
Hermeneutic interpretation

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NPs were approached by
Email/ phone and invited to
participate
Information and consent
managed as per ethical
approval
Interviews typically lasted 45 –
60 minutes
Interviews were transcribed
verbatim
WinMax used as aid to analysis
Methodology - detail
Three stage process, based on Ricoeur,
borrowing from work carried out by Wiklund,
Lindholm & Lindström (2003), and by Lindseth
& Norberg (2004), among others
Naïve interpretation
 Descriptive structural analysis
 Hermeneutic Interpretation

Findings: naïve interpretation
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Initial impression was that participants discussed their
experience of autonomy with reference to:
Inspiration
Self promotion
Regulation
Frustration
Optimism
⦁ “Nurse practitioners are comfortable in their role, and believe
they are autonomous practitioners who offer a high standard of
care to their patients. They do however feel some frustration in
their day to day work within interprofessional teams because of
their unequal relationship with medical colleagues, and the way
in which care is organised and regulated, which together
interfere with their ability to maximise their effectiveness”
Findings: Descriptive structural analysis
First theme: Role Transition
 NP' experiences of role transition
 Barriers to role transition
 Other disciplines’ misunderstanding of the NP role
 Motivation to move into a NP role
Second theme: Exercising autonomy
 The exercise of autonomy in practice
 Developing self-confidence within the NP role
 Experiencing frustration
 Legal Restrictions on practice
Findings: Descriptive structural analysis
Third theme: NP’s professional relationships
 A unique perspective
 Professional boundaries
 Controlling influences
 Professional Relationships
Fourth theme: NP-patient relationships
 Nurse practitioners’ attitudes to patients
 Experiencing ‘role satisfaction’ through patient care
 Patients’ misunderstanding of the NP role
 Reluctance to see the NP
Findings: Descriptive structural analysis
Fifth theme: Nurse practitioners’ skills

Nurse practitioners’ use of nursing skills
Sixth theme: Reflections on the NP role

Future prospects for nurse practitioners
Interpretation and discussion
 1.
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Exercising autonomy
Feelings of pride, self-esteem
Evidence of doubt regarding potential for autonomy
Controlling influences, legal restrictions, and
prescribing
Organisational structures
Protocols, guidelines and clinical pathways
External factors limiting the potential for autonomous
practice
Feelings of inferiority, deference to others
Interpretation and discussion
 2.
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Nurse practitioner skills
Promoting the nurse practitioner role
Power and relationships
Holistic care, better care
Implementing care: knowledge and skills for practice
Reflections on the effectiveness of the nurse
practitioner role
Collaborative working - nurse practitioners’ relationship
with other disciplines
Responses to being mistaken for a doctor
Interpretation and discussion
 3.
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Role definition and role transition
Uncertainty about the future
Optimism
Implications for practice
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nurse practitioners have confidence in their ability to offer
care to patients that is holistic, evidence based and
effective
nurse practitioners need an assertive voice to promote
their role and their success in providing holistic care to
diverse patient groups.
ongoing uncertainty regarding statutory regulation of
nurse practitioners, and continuing variation in their
precise role definition have implications for maximising
the potential evident in existing nurse practitioner roles.
/cont
Implications for practice (cont.)
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the potential for nurse practitioners to work
autonomously is dependent on their relationships with
fellow professionals, particularly doctors
more effective planning within multi-disciplinary teams
prior to the introduction of a nurse practitioner might
help to enhance positive professional relationships.
nurse practitioners demonstrate evidence of ongoing
uncertainty, or at least ongoing dissonance with
regard to their position within the profession of
nursing.
Conclusions
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A more robust definition of the nurse practitioner role,
enshrined in statutory regulation, might pave the way for a
philosophical debate about the future of advanced
practice roles.
To achieve maximal autonomy in practice settings, nurse
practitioners may have to dissociate themselves further
from the wider nursing profession, or at least to establish
clarity in their role and regulation. This may provide the
best opportunity for nurse practitioners to realise the
external recognition that they appear to believe is vital to
their further professional development.