student perceptions of nursing from initiation to graduation

Student Perceptions of Nursing from Initiation

to GraduationMadelyn Danner MS RN CCRN CEN

CNE

Renee Franquiz MS RN

Theresa Libershal BSN MA RN FCN

NLN Outcomes for ADN Grads

Professional behavior

Communication

Assessment

Caring

Teaching & learning

Collaboration

Managing care

Literature Review

Sparse publications on this topic

Much published work is from other countries

Most of it is old

Entering Level PerceptionsNurses are caring (O’Brien, Mooney, & Glacken, 2007)

Nurses are caring, nurturing, teachers. “Professional” lower on the identity list, but higher than “manager of care” (Cook, Gilmer, & Bess (2003)

Identity Change During the Program

Students value providing competent care with dignity; collaboration with other HCPs & professional development ranked low (Leduc & Kotzer, 2009).

Tasks and routines remained the primary structure focus of the work of nurses. There was little evidence of holistic, patient-centered care (Pearcy, 2007).

Identity Change During the Program

By last term, the image of the work of nursing had not changed, but students were describing a feeling of “belonging”, but not being yet a nurse (Kiger, 1993).

Buckenham reported similar findings in her 1988 study.

Keywords

ENTRY•Physical care

•Psychological

care

•Preventative

care

•Rehabilitative

care

EXIT•Hardwork

•Commitment

•Knowledge

Keywords

ENTRY•Caring

•Using

science/knowledge

•Attain, Maintain Health

EXIT•Caring, Science,

knowledge is easy

•Everything I do affects

a person positive or

negative

Keywords

ENTRY• Clinical and caring

relationships

• Knowledge

• Skill

EXIT• Wear all kinds of hats

•It’s not about

performing skills

•It’s about how you

interact

Keywords

ENTRY• Caring for the sick

•Treat

•Heal

EXIT• Responsibility

•Communication

•Safety

Keywords

ENTRY• Caring for the

sick

• Counselor

•Physical, mental,

emotional health

EXIT• Profession

• Not Easy

• Compassion

Keywords

ENTRY• Care about others

• Knowledge

•Whole picture

•Adjust beliefs

EXIT• Prioritize

•Flexible

•Non-Judgmental

Findings that Concur with the Literature

Carer

Nurturer

Teacher

Advocate

Team member

Respectful

Competent

1) Similar entering perceptions of the role of the nurse

2) A growing sense of identity as “nurse”

Findings that Differ from the Literature

Our graduating students reported

Awareness of responsibility

Identity as a professional

Growing awareness of the nurse as care manager and health care team member

Conclusions

Students are entering nursing for the same reasons we did

Our program is graduating students who profess our core values and who meet the core competencies for ADN graduates outlined by NLN

Entering idealism gave way to the reality of the responsibility

Image Development

“The greater the disparity between student nurses’ pre-conceptions and the reality, the greater the potential for dissatisfaction.” (Stoller, 1978)

Reasonable disparity can be non-problematic if support is provided (Kiger,1993)

Kiger’s Process of Image Development (1992)

Reality Shock

Key points from Marlene Kramer’s Reality Shock: Why Nurses Leave Nursing (1974)still apply today:

• There is a lack of precision and certainty in clinical practice.

• School experiences are more concrete than real life.

• “anticipatory socialization” is key for the transitioning student.

Next Steps“The limited scope of knowledge about

professional role transition in undergraduate nursing theory may be contributing to students’ unfamiliarity with and lack of preparedness for what awaits them after graduation.” (Duchscher, 2008)

How does this impact student perceptions?

What strategies could we implement to address this persistent disparity?

Supporting Transition to Practice

• Use simulation to provide realistic care scenarios, including distractors

• Collaboration of senior with lower level students reinforces to senior students that they do have nursing knowledge

• Bring students back in at 6 months for a follow up de-briefing

• Increase extern opportunities

• Develop alumni-student mentorship program

• On-line mentoring, such as through school Facebook site

• Nursing “Hot Line” on Bb where students could post questions or get support

• Prepare students to ask about support for them as new grads when they interview

Thank You!

If you would like a copy of this power point, we would be glad to e-mail it to you

mdanner@harford.edu

rfranquiz@harford.edu

tlibersh@harford.edu