Self-empowerment
Being right was a focus of participant narratives about
their best practice experience. Some participant stories
wrapped around unraveling obscure patient diagnoses,
while others also embodied the importance of being right
as a function of the NP’s care. Being right reinforced confi-
dence in their competence, ability, and skills to do the job,
and as well as the impact they had on patient outcome—it
was also professionally rewarding. For example, one participant
said, “I hate being wrong with a passion, and I
will argue to the death if I am certain I am not wrong, because
I love to be right,” and for another, having “those
‘yes moments’” opened up the interpretive meaning of
self-empowerment. Although the dialogue was also interpreted
from the perspective that the participants were
judging themselves as a function of their NP care (Gilligan,
1993), Boudrias (2004) described similar attributes as psychological
empowerment where there is cyclical interplay
between the work environment and personality. Nevertheless,
the fusion of being right and fulfilling professional
duty was a powerful reward—it cannot be taken away.
One participant stated
So, three to four physicians this kid has seen and not one
of them could diagnose her accurately, and the first time
[ . . . ] she comes here and I diagnose her. We send her to
nephrology and she is fine now, with no residual which is
great with all the stuff she was on [ . . . ] but that was one of
my greatest [experiences].
Another participant described self-empowerment from a
different perspective:
Generally, it is when I feel like that “yes moment.” Someone
comes in that first time, and I see they had a problem for a
long time and maybe they saw somebody else, or didn’t, and
I am like, “I know what your problem is and I can fix it,” and
then they come back in couple of weeks and that is good. I
always strive to get the “yes moments” [because] it is not
fun for them to come back, and come back, and keep saying
“no I am not better” [ . . . ] I know I am missing something
here.
Understanding of narratives was further clarified when
viewed from Gilligan’s perspective that being right for the
patient is also being right for the participant.
Defending the NP role
Defending the NP role was interpreted from participant
narratives of challenges they faced in the daily work environment.
By defending their role, the study participants
shaped the meaning of autonomy because they believed
in themselves, and they envisioned themselves as professionals
and autonomous primary care providers. One participant
said, “I had to describe it [the NP role] to them, a
pediatrician, and his wife was a nurse, and he asked me
‘exactly what is this nurse practitioner thing?’ [ . . . ] I had
to explain it.” Another defended the role by confronting
conflict in the workplace, “I basically had to tell her one
day, ‘Look, you have two choices: One, you can go away
and let me practice, or two, you can fire me. It is up to
you,’ and she didn’t fire me.”
Some participants understood the daily struggle to maintain
professional identity as carving out the authentic self
within the context of the traditional model of physician
care. Interpretation through Gilligan’s (1993) lens took on
deeper meaning of being caught between the context of
wanting to become disentangled from a culture that ignores
the difference between physician and NP, and the