title: Spheres of influence or autonomy? A discourse analysis of the introduction of Nurse Practitioners in rural and remote Australia.
abstract: OBJECTIVE
  This paper is a report of a study to examine the social discourses of nursing within health care as these produce understandings about autonomy for Nurse Practitioners, where autonomy refers to the ability of Nurse Practitioners to practise as professionals in their own right.
  
  
  BACKGROUND
  Nurse Practitioners were recently introduced to the nursing career pathways in Australia. Despite a plethora of international information, the role implementation in rural and remote Australia is slow with a number of influences emerging to hinder progress.
  
  
  METHODS
  Critical discourse analysis was used to examine the differences between policy and the reality of implementation. The notion of autonomy was used to explore texts in policy documents relating to Nurse Practitioner authorization and published between 1995 and 2006, and these were compared with the experiences of nurses working in Nurse Practitioner positions.
  
  
  RESULTS
  Policy texts indicate support for advanced practice and the autonomy of Nurse Practitioners. The process for authorization; however, has constraints which support nurses' progress but also hinder it. Subsequent acceptance of Nurse Practitioners has also been problematic as colleagues struggle to understand the role within the current healthcare system.
  
  
  CONCLUSIONS
  There is a significant gap between the rhetoric of policy and the implementation of Nurse Practitioner roles in rural and remote Australia. Whilst policy supports the notion of autonomy, the experiences of nurses indicate a mere shift in the traditionally-accepted boundaries of nurses' roles. Evidence from the United Kingdom and United States of America suggests that the findings in this study are relevant internationally as well as nationally.
authors.affiliation: Flinders University School of Nursing and Midwifery, Bendigo Central, Victoria, Australia. icms@bigpond.com
authors.forename: Clare
authors.initials: C
authors.lastname: Turner
authors.forename: Dirk
authors.initials: D
authors.lastname: Keyzer
authors.forename: Trudy
authors.initials: T
authors.lastname: Rudge
mesh_terms: D001315:Australia; D002983:Clinical Competence / Q000592:standards*; D006801:Humans; D016294:Models, Nursing; D020380:Needs Assessment; D009722:Nurse Practitioners; D024802:Nurse's Role; D019555:Physician-Nurse Relations; D011320:Primary Health Care / Q000458:organization & administration*; D017009:Professional Autonomy; D012423:Rural Health; D019035:Rural Health Services