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Aim. This paper is a report of a study to examine the social discourses of nursing within health care as these produce understandings about autonomy for Nurse Practitioners, where autonomy refers to the ability of Nurse Practitioners to practise as professionals in their own right. Background. Nurse Practitioners were recently introduced to the nursing career pathways in Australia. Despite a plethora of international information, the role implementation in rural and remote Australia is slow with a number of influences emerging to hinder progress. Method. Critical discourse analysis was used to examine the differences between policy and the reality of implementation. The notion of autonomy was used to explore texts in policy documents relating to Nurse Practitioner authorization and published between 1995 and 2006, and these were compared with the experiences of nurses working in Nurse Practitioner positions. Findings. Policy texts indicate support for advanced practice and the autonomy of Nurse Practitioners. The process for authorization; however, has constraints which support nurses' progress but also hinder it. Subsequent acceptance of Nurse Practitioners has also been problematic as colleagues struggle to understand the role within the current healthcare system. Conclusions. There is a significant gap between the rhetoric of policy and the implementation of Nurse Practitioner roles in rural and remote Australia. Whilst policy supports the notion of autonomy, the experiences of nurses indicate a mere shift in the traditionally-accepted boundaries of nurses' roles. Evidence from the United Kingdom and United States of America suggests that the findings in this study are relevant internationally as well as nationally. [ABSTRACT FROM AUTHOR]

In this very critical evaluation of the value and effectiveness of nursing audits, the author shares information about the state of nursing in Australia, gleaned from a recent study. Some myths about nursing practice are debunked. The stark reality is discussed and analysed and a direction for the future is suggested. Although the paper relates exclusively to Australia, its contents will undoubtedly ring true in many other countries. The dichotomy between nursing education and nursing service is considered at length. As are the resulting conflicts of nursing students, clinical instructors and nurse tutors. Teachers of nursing appear to decry the need for them to be clinically involved, as a result nursing education is less meaningful. A particularly strong plea is made for adequate inservice education programmes and a more flexible and thorough approach to change, free from undue commitment to the past. [ABSTRACT FROM AUTHOR]