Nurse practitioner integration in primary health care: A case of strategic and collective negotiation shaping professional role and identity

Nurse Practitioner (NP) integration within primary health care (PHC) involves complex relational, organizational, political, and power dynamics. Despite extensive research on factors influencing NP integration, the processes through which it is negotiated in practice remain largely unexplored. Greater attention is therefore needed to understand how role integration is negotiated in practice. To address this gap, this paper applies Callon’s four-stage translation process to analyze NP role integration, drawing on a multisited ethnographic study. Findings show that strategic networking, professional dynamics, and power relations unfold within emerging spaces where the NP role is negotiated. NP role integration is constructed (problematization), aligned (interessement), tested and shaped in practice (enrolment), and stabilized (mobilization). Across these stages, we demonstrate how human and non-human actors negotiate competing interests and reach compromises that align discourses, roles, practices, and professional identities, thereby stabilizing the network. We further identify NP sub-roles and patterned responses (compliant, dissonant, and resistant) that illustrate how NPs actively navigate, reproduce, or contest integration dynamics. This analysis deepens understanding of how complex and strategic negotiation processes can strengthen, destabilize, or even threaten the NP role and professional identities. By reframing NP integration as a case of professional boundary negotiation and institutional (network) change, this study advances theoretical insights into professional role and identity construction within evolving healthcare networks and organizations, particularly in PHC contexts. • Reveals understudied negotiation processes in healthcare settings. • Uses Nurse Practitioner integration as exemplar of negotiation in healthcare reform. • Applies translation process to uncover strategic role negotiations and tactics. • Identifies transactional spaces shaping roles and professional dynamics. • Provides transferable insights into institutional change and professional identity.