Measuring up the rhetoric and reality of Australian specialist and advanced practice palliative care nursing

This thesis describes and analyses the scope of practice and the practice capacity of the Australian specialist palliative care nursing community and investigates professionalisation strategies undertaken by this group. A national workforce survey was undertaken towards the end of 2002. A two-stage sampling method drew on a random stratified sample of 50% of Australian palliative care services. Experienced registered nurses who meet the criteria for inclusion were invited to complete the survey (n=224; response rate 67.47%). The survey yielded a large baseline dataset from which a detailed description of the scope of practice of the Australian palliative care nursing community was generated. This description was then benchmarked against international standards for advanced practice.

Critical analysis of the dataset provides a record of the unfolding professionalising strategies of the palliative care nursing community at the threshold of a new professional era for nursing in Australia. It is a dynamic era characterised by a rhetorical engagement with the concept of advanced practice nursing and the introduction of nurse practitioner roles. The findings of this inquiry reveal a community that claims to engage in advance practice nursing and has made significant progress in certain aspects of its professional project such as the acquisition of academic qualification, the provision of clinical education and in research related activities. At the same time it demonstrates only nominal progress in other areas when measured against the markers of professionalisation in the literature that give shape to the concept of advanced practice nursing such as in the areas of mentoring, clinical supervision and membership of a national professional association.

This thesis identifies the importance of a scholarly understanding of the rhetorical and discursive strategies utilised by members of professional communities of practice, as they seek to both advance and defend their shared professional development agenda. The findings point to a pressing need for critical rhetorical scholarship if the wider profession is to safely navigate the ever expanding zones of boundary overlap, inter-occupational rivalry and jurisdictional conflict that will increasingly dominate relations within and between the occupations across the healthcare sector in the future.