Student Perceptions of Nursing from Initiation to Graduation

Student Perceptions of Nursing from Initiation to Graduation Madelyn 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 Perceptions • Nurses 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 1) Similar entering perceptions of the role of the nurse • Carer • Nurturer • Teacher • Advocate • Team member • Respectful • Competent 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

Student Perceptions of Nursing from Initiation to Graduation