Advanced nursing practice in New Zealand through the lens of postgraduate nursing students: a focused ethnography study

Background: Advanced nursing practice involves an expanded nursing scope, characterised by autonomy, expert knowledge, and complex decision-making to address diverse healthcare needs. Although roles such as nurse practitioner and clinical nurse specialist are established in New Zealand, there remains ambiguity in role definitions and a lack of exploration into the perspectives of registered nurses, particularly those pursuing postgraduate education. Aim: This study seeks to explore focused perspectives of postgraduate nursing students on advanced nursing practice in New Zealand. Design: A focused ethnography study. Setting: Interviews were conducted online via videoconferencing. Participants: The study involved fifteen registered nurses enrolled in postgraduate nursing programmes in New Zealand, who met the inclusion criteria, including providing direct patient care. Methods: Semi-structured interviews were guided by a literature review. Data were transcribed verbatim and analysed thematically using an inductive, data-driven approach. Reflective notes and independent coding by two researchers ensured rigour. Results: Two main themes emerged: (1) Defining advanced nursing practice, where participants associated advanced nursing practice with postgraduate education, autonomy, specialised care, advanced technology, and assessment skills. They emphasised the role of coaching and policy implementation. (2) Perspectives on advanced nursing practice roles in New Zealand, where participants voiced concerns about role ambiguity, limited career opportunities, and lack of clarity beyond nurse practitioner and clinical nurse specialist roles. They also noted insufficient emphasis on research within advanced nursing practice roles, despite the importance of evidence-based practice. Conclusions: Postgraduate nursing students in New Zealand perceive advanced nursing practice as a vital field that requires advanced education and specialized skills. However, role ambiguity and limited research engagement hinder its development. Addressing structural challenges, enhancing role clarity, and incorporating research-oriented pathways, such as the doctor of nursing practice, could strengthen the impact of advanced nursing practice on healthcare delivery and policy. Clinical trial number: Not applicable.