Abstract
Background: Health professional roles are being adapted in response to increased demand and declining medical workforces, both in England and internationally. This is exemplified by advanced nurse practitioners (ANP) in primary care. However, evidence suggests ANP practice may lack acceptability and understanding, leading to underutilisation. Professional identity (how colleagues are perceived by themselves and others) may influence how professionals work together to utilise such roles. Previous research has explored ANP professional identity during transition and in isolation from workplace cultures. Less is known about relationships between professional identity and established ANP practice within primary healthcare teams, or how ANP practice is affected by workplace cultures. Wider societal level influences have not been fully explored. This study aimed to explore the relationship between professional identity and ANP practice in a context where ANP practice was established.
Methods: The study consisted of a qualitative cross-sectional study which explored professional identity of ANPs on a sample of general practice websites. Then the relationship between professional identity and ANP practice was explored, in-depth, in an ethnographic study of two general practices in England.
Findings: ANPs lacked visibility on general practice websites. Both studies found ANPs were framed within a traditional nursing identity. This impacted on ANP practice and has implications for how professionals and the wider public understand ANP roles. Individual characteristics and interactional relationships were central to acceptance and utilisation of ANPs within the workplace, but were limited by broader societal level understanding of professional identities. ANPs negotiated their place within the workforce by utilising established understanding of professional identity. Intra-professional tensions were identified between ANPs and nursing.
Conclusions: Professional identity is a useful framework within which to develop contextual understanding of ANP practice. Primary healthcare team members utilised shared understanding of professional identity to shape ANP roles, which both supported and inhibited ANP utilisation.
