A higher level of practice : community nurse practitioners at work
Community nurse practitioners from different parts of England were researched, who
worked in General Practice, minor treatment centres or with homeless people. The aim of
the research was to establish whether or not they were actually nursing, and if so, identify
whether they were able to achieve a 'higher level of practice' ,as articulated by the UKCC
Grounded theory, the qualitative research methodology developed by Glaser and Strauss,
was used as a framework for the research. Data was gathered using primary observation
with some participation (five hundred and eighty-one consultations being observed in the
process), and by interviewing the community nurse practitioners and their clinical
The data was analysed using Glaser and Strauss' constant comparative method. Three
theoretical frameworks emerged from the analysis.
'Negotiation for autonomy' is the core category at the heart of the overall theoretical
framework that emanated from the research data. Those community nurse practitioners
who were working at a 'higher level of practice' had the ability to negotiate for autonomy
with GPs and multidisciplinary staff. It was this ability that allowed them the opportunity
to practice with the autonomy required to be able to hold consultations with patients with
undifferentiated diagnoses, as first point of access, providing care through to discharge or
referral on to others.
From a category, 'combination model of care,' within the overall theoretical framework,
the researcher has developed a theoretical model of care, and a framework for the process
- 'HADPIPE'. This model of care (and HADPIPE) is unique, as there is no other model
of care, as opposed to a model of nursing, which has been developed, certainly in the UK,
from researching the practice of nurses.
The third theoretical framework sets down the characteristics of those practising at a
'higher level of practice. ,
This research highlights the nursing oriented approach to care taken by nurse practitio~ers,
counteracting the argument that they merely perform a technical role.