Exploring the relationship between nursing identity and advanced nursing practice: An ethnographic study

Background Advanced nursing practice continues to develop internationally. Previous studies suggest advanced practice may lack support within nursing, which may lead to underutilisation, retention and patient safety issues. However, the relationship between the wider nursing profession and advanced practice is poorly understood and the theory that professional identity creates cultural barriers to advanced practice has received little empirical attention. Aims and Objectives To consider the relationship between professional nursing identity and advanced practice by exploring intra-professional relationships between advanced nurse practitioners and nursing colleagues. Aims and Objectives To consider the relationship between professional nursing identity and advanced practice by exploring intra-professional relationships between advanced nurse practitioners and nursing colleagues. Design and Methods Ethnographic methodology was adopted. Fieldwork methods were participant observation and semi-structured interviews. Participants were advanced nurse practitioners (n=9) and nursing colleagues (n=5) across two primary care general practice organisations. Data were analysed thematically using framework analysis, underpinned a priori by professional identity theories. Reporting was guided by COREQ. Results Three themes were identified which indicated how intra-professional relationships were conducted: Conciliating Nursing, where advanced nurse practitioners took responsibility for developing positive relationships with other nurses; Vertical Discounting, where nursing colleagues were dismissive and undermined advanced nurse practitioners, who themselves behaved similarly towards other nurses; Lateral Othering, where advanced nurse practitioners undermined other advanced nurse practitioners. Vertical Discounting and Lateral Othering destabilised advanced practice. Conclusion Intra-professional relationships, and the broader nursing profession, shape advanced practice. We theorize this is underpinned by threats to professional identity, while weak professional identity among even established advanced practitioners exacerbates lack of support. Highlighting these issues allows space to develop alternative strategies to negotiate intra-professional relationships, informed by professional identity theories, which support rather than inhibit advanced practice. Relevance to Clinical Practice As advanced practice expands throughout primary and secondary care, and across allied health professions, the impact of professional identity and relationships on healthcare will likely increase and the importance of strong advanced practice identity will become increasingly relevant. Keywords • Advanced Nursing Practice • Advanced Nurse Practitioners • General practice • Intra-professional • Professional Identity • Positioning Theory • Primary Care • Social Identity Theory