Aim To establish whether or not community nurse practitioners were able to achieve a ‘higher level of practice’, as articulated by the United Kingdom Central Council.

Method Grounded theory was used as a framework for the research. Data were gathered using primary observation with some participation, and by interviewing community nurse practitioners and clinical managers.

Findings ‘Negotiation for autonomy’ is the core category at the centre of the overall theoretical framework that emerged from the research data. Those working at a higher level of practice had the ability to negotiate for autonomy with GPs and other doctors. This ability gave them the opportunity to practise with the autonomy required to hold consultations, as first point of access, with patients with undifferentiated diagnoses, providing care through to discharge or referral to others.

Conclusion The research highlights that unless community nurse practitioners can negotiate their role with GPs and hospital doctors, they are unable to achieve a ‘higher level of practice’.