Date of Award

January 2015

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Elizabeth Tyree

Abstract

Frontier communities are the most sparsely populated and geographically remote areas in the United States. Residents of these communities often lack access to healthcare resources of any kind. Nurse Practitioners (NPs) are more likely than physicians to practice in these areas and provide a vital link in the frontier healthcare safety net.

This narrative inquiry into the practice experiences of frontier NPs informs the discipline of nursing regarding the significant contribution frontier NP practice makes to the delivery of frontier healthcare. This inquiry creates a repository of stories upon which nurse leaders, health care policy makers, and nurse educators interested in frontier healthcare can theorize and plan.

Themes specific to frontier NP practice emerged from participant stories. These themes were used to develop a conceptual framework for effective frontier NP practice. The framework consists of four types of frontier NP knowledge: contextual knowledge, frontier competency, the art of frontier practice, and political knowledge.

Several theoretical constructs emerged from the findings which support the following relational statements: (a) The more independent the practice, the more likely frontier NPs will be presented with patient situations in which they feel out-on-a-limb or scared, (b) the intimate bond frontier NPs experience with their patients may be partially rooted in geographic isolation, and (c) frontier NPs are both influenced by government policy and frontier NPs use political influence to change policy.

Results of this inquiry have implications for nursing education, workforce recruitment and retention, and the provision of emergency medical services in frontier areas.

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