Narratives of transition: Opening Dialogues into the

Complexity of Nursing Education

Joanna Szabo Hart Mount Royal University

Outline

• Overview of the SOTL study • Background to NURS 4111: Leadership, Trends

& Issues • Stories of transition • Implications for practice

Research Question:

How do fourth year nursing students at Mount Royal University (MRU) in NURS 4111 (Leadership, Trends & Issues) make meaning of their transition to practice?

Literature Review

• Nursing literature on transition focused on clients (Chick & Meleis, 1986; Kralik, Visentin & van Loon, 2006; Meleis & Trangenstein, 1994; Schumacher & Meleis, 1994)

• Transition for RNs within their first 6 months is most significant (Boychuk Duchscher, 2009; 2008; 2001; Ellerton & Gregor, 2003; Gerrish, 2000; Olson, et al., 2001)

• Employers and institutions of higher learning concerned with “readiness for practice” (Murphy & Calaway, 2008; Oermann, 2004; Romyn, et al., 2009; Santucci, 2004; Sherman, 2010; Wolff, et al., 2010)

Claim

The findings of this SoTL study support the claim that becoming-nursing students share narratives that bring to light their perceived gap between theory and practice.

COMPETENCE & PRAXIS

Overview of Course Assessments

Leadership, Trends & Issues Blended delivery: • Community of Practice Working Groups

http://www.ewenger.com/theory/ • Interview a Nurse Leader • Individual Field Notes and Summary • Final Group Project: Abstract, project proposal and

action plan possible action item

Descriptive exploratory: analysis synthesis

– 22 field notes (Initial “what does leadership mean to you” writing, ongoing field notes, field notes summary)

– 7 out of 11 face-face semi-structured interviews (discussions ranged from 25 min- 1 ½ hours)

Interview questions Objective: To describe the meaning of the experience of transition for

fourth year nursing students Guiding questions: • How would you describe yourself? What is most important to you?

As you take the next steps toward your nursing career, what have you learned about yourself and what is most important to you at this time? What does transition mean to you?

• Describe an example of a situation in which you noticed tension between your status as a student and as someone transitioning to professional practice. Use any example that comes to mind. What is it about what happened in this situation that is most meaningful to you? What did you learn about yourself and your practice, through this situation?

Interview questions con’t…

Objective: To describe the way relationships unfold when nursing students are experiencing transition in particular contexts

Guiding questions: • Who has influenced your transitions in your

nursing practice to date? Explain. • What is it about what they said or did that

influenced your nursing practice? • How did the context of your nursing practice

influence your relationship in this particular situation?

Interview questions con’t…

Objective: To describe the changing views of possibilities that surface for nursing students when they are experiencing transition

Guiding questions: • Tell me about your experience writing field notes for this

course. Do you see yourself using some form of reflecting on your practice after you graduate? If so, what form would work best for you?

• What is your greatest concern or fear about your transition to your role as an RN? What is your greatest hope about your transition to your role as an RN?

• Where do you see yourself in your future nursing practice?

Participants

All 35 students were offered the opportunity to participate in this SOTL project the last day of the course (no exclusion criteria), end of session

Findings

• struggling with uncertainty • longing to belong in the midst of feeling alien • developing personal vision of nursing identity

Struggling with uncertainty

Zofia: “I say it doesn’t matter, I want to do my work

well. (…) but the nurses in practice really influence me, and I don’t know what will happen or what happened to some of these nurses, will I be like them, I don’t know.”

Longing to belong in the midst of feeling alien

“I know I am different from them but I still feel it. I learn and I study really hard but I still feel I am not as knowledgeable as my peers. I am lucky when I have an instructor who understands.”

Developing personal vision of nursing identity

• “standing for what you believe in” • “I can affect/influence” [other people with]

“my knowledge, experience and other abilities”

• “I’ve learned the type of nurse I don’t want to be”

• “chatty nurse”

Some thoughts…

• Praxis manifests in the spaces where we promote reflection that has space to flourish and it emerges when we try to engage in meaningful dialogue

• Currently clinical practice has variability in who teaches – require investment of ongoing dialogue in theory course…and clinical communication between instructors/professors…the students are telling us this

• Expect creativity but hard to take risks and where are the models

Where do we go from here?

• Ask students what is most meaningful • Raw reflection (discussions about how to get

there) • Engaging students where they are • Building community • Building trust: Is this possible? • Paying attention to the everydayness; taken

for granted assumptions

What I learned…

• We need to introduce leadership in a more obvious way from year one on the program and I want to be involved in cultivating that processes throughout the curriculum

• This course needs to incorporate both online and face-face dialogue to develop course concepts and engage students where they are, but we need to be rigorous about how we make choices about delivery

• SOTL studies in nursing education are important. Students have a lot to say about “what is actually happening” in the health care system and in their programs of education. Institutions and faculties need to recognize the importance of sharing these stories in terms of the future of the academic discipline and practice profession of nursing.

What has actually happened in the classroom?

• Increased face-face classroom time • Building community and building trust as a priority…but it’s tricky • Life is happening (break ups, deaths in family) and this influences

coping and ability to engage in learning…this is when support is needed most, when we fall off the radar

• Feedback for writing ongoing • Ongoing feedback is a lot of work (needs to be acknowledged as

such and considered in planning assignments and working out details between professors)

• Academic Response Journals (Richard Erlendson) …google.docs (Rod Corbett)

• What is Nursing and nursing identity made explicit • Building up to complexity

References Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical

transformation. Standford, CA: Jossey-Bass. Chick, N. & Meleis, A.I. (1986). Transitions: A Nursing concern. In P.L. Chinn (Ed.). Nursing Research

Methodology: Issues and Implementation (pp. 237-257). Rockville, MD: Aspen. Curzon-Hobson, A. (2002). A pedagogy of trust in higher learning. Teaching in higher education, 7(3),

265-276. Deary, I.J., Watson, R. & Hogston, R. (2003). A longitudinal cohort study of burnout and attrition in

nursing students. Journal of Advanced Nursing, 43(1), 71-81. Duchscher, J.E.B. (2001). Out in the real world: Newly graduated nurses in acute care speak out. Journal

of Nursing Administration, 31(9), 426-439. Duchscher, J.E.B. (2009). Transition shock: The initial stage of role adaptation for newly graduated

Registered Nurses. Journal of Advanced Nursing, 65(5), 1103-1113. doi: 10.111/j.1365-2648.2008.04898.x

Duchscher, J.E.B. (2008). A process of becoming: The stages of new nursing graduate professional role transition. The Journal of Continuing Education in Nursing, 39(10), 441-450.

Ellerton, M.L. & Gregor, F. (2003). A study of transition: The new nurse graduate at 3 months. The Journal of Continuing Education in Nursing, 34(3), 103-107.

Gerrish, K. (2000). Still fumbling along? A comparative study of the newly qualified nurse’s perception of the transition from student to qualities nurse. Journal of Advanced Nursing, 32(2), 473-480.

References con’t… Goldberg, N. (2005/1986). Writing down the bones: Freeing the writer within. Boston, MASS:

Shambhala. Kralik, D., Visentin, K. & van Loon, A. (2006). Transition: A literature review. Journal of Advanced

Nursing, 55(3), 320-329. Meleis, A.I. & Trangenstein, P.A. (1994). Facilitating transitions: Redefinition of the Nursing

mission. Nursing Outlook, 42, 255-259. Murphy, G.A. & Calaway, A.B. (2008). Professional development for professionals: Beyond

sufficiency learning. Australian Journal of Adult Learning, 48(3), 424-444. Oermann, M.H. (2004). Reflections on undergraduate nursing education: A look to the future.

International Journal of Nursing Education Scholarship, 1(1). doi: 10.2202/1548-923X.1011 Olson, R. K., Nelson, M., Stuart, C., Young, L., Kleinsasser, A., Schroedermeier, R., & Newstrom, P.

(2001). Nursing Student Residency Program: A Model for a Seamless Transition from Nursing Student to RN. The Journal of Nursing Administration, 31(1), 40-48.

Pinar, W.F. & Irwin, R.L. (Eds.). (2005). Curriculum in a new key: The collected works of Ted T. Aoki. Mahwah, NJ: Lawrence Erlbaum Assoc.

References con’t… Romyn, D.M., Linton, N., Giblin, C., Hendrickson, B., Limacher, L.H., Murray, C., Nordstrom,

P., Thauberger, G., Vosburgh, D., Vye-Rogers, L., Weidner, A., Zimmel, C.M. (2009). Successful transition of the new graduate nurse. International Journal of Nursing Education Scholarship, 6(1). doi: 10.2202/1548-923X.1802

Santucci, J. (2004). Facilitating the transition into Nursing practice: Concepts and strategies for mentoring new graduates. Journal of Nurses in Staff Development, 20(6), 274-284.

Schumacher, K.L. & Meleis, A. I. (1994). Transitions: A central concept in Nursing. Journal of Nursing Scholarship, 26(2), 119 - 127. doi: 10.1111/j.1547-5069.1994.tb00929.x

Sherman, R.O. (2010). New graduate transition into practice during turbulent economic times. Journal of Nursing Education, 49(7), 367-368. doi: 10.3928/01484834-20100621-01

Smith, D.G. (2003). Curriculum and teaching face globalization. In W.F. Pinar (Ed.), International handbook of curriculum research (pp. 35-51). Mahwah, NJ: Lawrence Erlbaum.

Taylor, E. (2008). Transformative learning theory. New Directions for Adult and continuing Education, 119, 5-15. doi: 10.1002/ace.301

Wolff, A.C., Regan, S., Pesut, B. & Black, J. (2010). Ready for what? An exploration of the meaning of new graduate nurses’ readiness for practice. International Journal of Nursing Education Scholarship, 7(1). doi: 10.2202/1548923X.1827

Thank you…

Special thanks to Richard Gale, Doug Hamilton

(Royal Roads), Jim Zimmer and the SOTL 2010 scholars cohort for all their support and encouragement!