student perceptions of nursing from initiation to graduation
TRANSCRIPT
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!
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