Identity crisis within the role of the emergency nurse practitioner? : an exploration of autonomy and identity

• Main Author: Moyle, Sally
• Published: University of the West of England, Bristol 2018
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.752542

Aims: Whilst the Emergency Nurse Practitioner (ENP) role is now well established within urgent care settings in the UK, it has evolved in an ad hoc manner with a range of titles and scope of practice. This study explored the concepts and perceptions around issues of professional identity and autonomy within the role, and identified the factors that contribute (positively or negatively) to a sense of professional identity. The introduction of the national Advanced Clinical Practitioner (ACP) framework is explored in relation to supporting career development and identity. Methods: A qualitative approach was adopted to explore in depth attitudes and perceptions of professional identity amongst a group of ENPs from two different settings; a nurse-led unit and a multi professional Emergency Department. A case study methodology was chosen, and data was collected using focus groups and semi-structured interviews. The data was analysed using the Braun and Clarke (2013) thematic analysis method. Results: The study identified several key factors that influenced the ENPs’ sense of professional identity. These fit broadly into three categories: career structure; education; the role. Participants reported high levels of pride and self-confidence related to the delivery of high quality care and their clinical expertise, and gained job satisfaction from the autonomous nature of the role. Participants also reported feelings of uncertainty, and were less confident in other areas such as relationships with other nurses, the public perception of the role, education and career structure. Discussion: Participants in this study described moving away from their traditional nursing practice and expressed that they felt different to other nurses, although they were clear that they were not a doctor substitute. The work of Bhabha (1994) explores the concept of the ‘third space’, whereby two different cultural systems come into contact and those operating within this space combine elements of both to create something new. This thesis applies this concept to the findings of the study, and suggests that ENPs have adopted a hybrid role that is operating within a ‘third (or hybrid) space’, where new identity is formed. Conclusion: ENPs play an important role within the urgent care setting, and professional identity is an important facet of the role as it relates to autonomy and job satisfaction. This in turn impacts on organisational loyalty and retention. The development of a standardised national framework for the development of the ACP is a welcome development, but will require support from educationalists, employers and commissioners to ensure that all four pillars of advanced practice are developed to ensure the success of the role is fully maximised for both practitioner and employer.