Nurse practitioners and the problem of discounting

Nurse practitioners (NPs) are key primary care providers in health care reform. The purpose of this paper is to discuss discounting, a social problem for NPs discovered in this grounded theory study. Discounting refers to behaviours directed towards NPs that they perceived as degrading. Data collection included open-ended, in-depth interviews on the nature of NP practice with 23 NPs, and 10 key members representing the Florida State Board of Nursing, Florida Nurses Association, American Nurses Association, and National Council of State Boards of Nursing. Excerpts that illuminated discounting were obtained from field notes about organizational documents, state legislative committee hearings, and professional NP association meetings. Data analysis using the grounded theory method revealed that NPs in this study struggled to establish their roles from a position of marginality in a context of conflict and negativity. NPs were subjected to social psychological and social structural discounting. This research serves to raise the consciousness of NPs with the hope that such awareness will facilitate personal and group action to combat discounting in their daily work and at local, state and national levels.