Date of Award

2023

Degree Name

Doctor of Philosophy (College of Nursing)

Schools and Centres

Nursing and Midwifery

First Supervisor

Kathie Ardzejewska

Second Supervisor

Margaret McMillan

Abstract

The purpose of this study was to examine the Registered nurse standards for practice in relation to the policy intentions for the profession and implications for the recipients of care.

Case study methodology with Bourdieu’s field theory and theory of practice as a philosophical lens and interpretive description were used to provide a framework for data collection, analysis, and reporting. There were four units of analysis: document analysis; feedback from senior leaders; nurses working in higher education; and nurses working in clinical practice. Through both historical and contemporary document analysis, the intentions underpinning the development of the Standards policy were examined. From this analysis, a framework was developed and later applied to evaluate policy outcomes. Intensity sampling of senior leaders enabled identification of key informants, all of whom had social capital and were familiar with institutions, regulations, guidelines and had designations of authority and influence in the nursing field. Stratified purposive sampling was used for the nurses working in higher education and the clinical setting with their experiences providing a broad overview of the operationalisation/implementation of the Standards in education and practice.

Data collection and analysis occurred iteratively to allow for exploration of emergent themes. Interviews with senior leaders and workshops with nurses in higher education settings and the clinical context enabled examination of the policy intentions and outcomes in practice. Individual respondent’s capital, habitus, and their understanding of the field’s doxa (rules) influenced their contribution to the development and implementation of the Standards in education and for practice.

Two themes identified in terms of intentions and outcomes were professionalisation which remains an ongoing ambition for the discipline, and patient safety that is central to expectations of the public. The third theme implementation identified plans and strategies (or lack thereof) and revealed shortcomings around the uses of the Standards. Lack of visibility of the Standards has implications of limited understanding and operationalisation of the Standards in education and performance appraisal and management in workplaces. Some disconnect was found between intentions and outcomes. The extent to which individuals can conceptualise nursing practice in different contexts impacts the extent to which they can envisage the usefulness and/or relevance of the Standards.

This study has implications for informed policy development and translation of policy into implementation plans and strategies for practice. Bourdieu’s field theory and theory of practice provided a lens through which one can explain both the actions of institutions, groups, and individuals in the field of nursing that can inform development of plans to operationalise and translate policy for safe and therapeutic practice.

Further work is needed if the Standards are to have more meaning for nurses when they move beyond undergraduate studies and the formal transition into the workforce. Given that the Standards are intended to regulate behaviours within the nursing profession, more creative strategies are needed if the Standards are to become embodied within the habitus of nursing in a range of contexts of practice.

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