The ministerial taskforce on nursing: a struggle for control

Nursing Praxis in New Zealand, Nov, 2008 by Jill Wilkinson

Introduction

In August 1998, the Ministerial Taskforce on Nursing released a report detailing its response to obstacles the nursing profession faced in realising its full potential. The overriding concern of the Taskforce members was to recommend ways to enhance the capacity of nurses to improve access to health services. A key recommendation was the development of advanced clinical nursing roles that went beyond traditional and institutional boundaries. These advanced nursing practice roles would include prescribing rights, access to diagnostic and laboratory testing and direct specialist referral. The Taskforce identified substantial attitudinal, structural, legislative and health purchasing barriers to the development of advanced nursing roles. Their recommendations, however, did not arise from a unified nursing voice. Rather, a struggle within nursing arose over the power to control its future.

Drawing on a recent research project (Wilkinson, 2007), this article traces the constitution and work of the Taskforce. The withdrawal of the New Zealand Nurses Organisation (NZNO) from the Taskforce following the second draft of the report highlighted the divisions present within nursing. Eventually, a consensus position was reached, making space for the consequent construction of the most expert nurse, the nurse practitioner. The manner in which consensus was reached is examined in a second article, also in this issue of Nursing Praxis in New Zealand.

Research Approach

The research from which these two articles have been developed draws on a variety of texts chosen from published literature that illustrate particular discursive positions. Transcripts of interviews conducted with individuals who have been influential in the unfolding of the nurse practitioner role in New Zealand have also been used. Approval for the study was obtained from the Massey University Human Ethics Committee.

A discourse analytical approach, informed by the work of Michel Foucault, was used to examine the historical forces at play both inside and outside nursing during the late 1990s in New Zealand. Discourses, as explained by Foucault (1977), are bodies of knowledge construed to be 'truth' and connected to power by reason of this assumption, serving to fix norms and making it virtually impossible to think outside them.

A discourse of autonomy is evident throughout this article and the next and refers not only to clinical autonomy, but also educational practices situated at post-graduate level. Educational emphasis is placed on the individual's development of critical analysis and synthesis of practice, research and leadership, to construct an autonomous practitioner who is most expert in his or her particular scope of practice. The combination of research, advanced education, practice experience and ability (Adams et al., 1997; Paterson, 1987), marks a professionally self-determined and expanded scope of nursing.

In contrast, a discourse of unionism refers to a coherent system of discursive practices associated with the Trade Union movement. As such, nurses are represented not only as a workforce, but also as members of a democratic organisation with collective worker rights. Importantly, nurses are constituted under the normalising influence of the collective, to which the interests of the individual are subordinate. The 'rank and file' of union membership depicts conformity as a central value of unionism. Having their roots in revolutionary Marxism, unions are associated with battle metaphors of victory, defeat and militant strike action (Deeks, Parker, & Ryan, 1994).

Thus the route to professional self-determination differs as each discourse positions nurses and nursing in subjectivities that conflict: autonomy privileges the individual and his or her attainments and specific contributions to health-care needs; unionism privileges the collective strength of its membership and improved health services via a non-exploitative work environment that furthers professional development for all nurses.

Ministerial Taskforce on Nursing

Kathryn Adams (2003, p. 303) reported that towards the end of 1997, Jenny Carryer Executive Director of the College of Nurses, "approached the then Minister of Health, with a proposal that a high level strategy was needed to resolve the complex matrix of barriers impeding the full utilisation of nursing services". As a result, the Ministerial Taskforce on Nursing was commissioned in February 1998 by the Minister, in response to the "obstacles to the nursing profession realising its full potential" (Ministerial Taskforce on Nursing, 1998, p. 3). A report was due at the end of May, but an extension of one month was granted to allow for wider consultation ("Nursing taskforce granted a month's extension," 1998). It was followed by another extension until the end of July, 1998 (Oliver, 1998). The tight timeframe was agreed to because of the likelihood of the Minister of Health changing to the finance portfolio before the Taskforce recommendations had been considered.