Negotiating symbolic space: strategies to increase NP status and value

Nurse practitioners (NPs) have an unprecedented opportunity to become key primary health care providers, yet barriers to independent practice still exist. The purpose of this research was to explore and describe the practice of NPs from their perspective. Open-ended, interactive interviews were conducted with 23 NPs. Data analysis using the grounded theory method revealed that NPs attempt to establish their roles from a marginalized position and are often subjected to psychological and structural discounting. To combat discounting, the NPs in this research worked to negotiate the symbolic space required for their acceptance as valued health care providers. They used techniques of cultivating, bargaining, confronting, and disengaging. All of these techniques promote NP role definition by generating and preserving role boundaries, thereby moving NPs toward the symbolic space necessary for them to become part of the national consciousness. This research contributes to clarification of the NP role and the building of a formal theory of advanced nursing practice.