A case study exploring the experience of graduate entry nursing students when learning in practice

Aim. To explore how Graduate Entry Nursing students present and position themselves in practice in response to anti-intellectualist stereotypes and assessment structures. Background. A complex background turbulence exists in nurse education which incorporates both pro- and anti-intellectualist positions. This represents a potentially challenging learning environment for students who are recruited onto pre-registration programmes designed to attract graduates into the nursing profession on the basis of the specific attributes they bring known as ‘graduateness’. Design. A longitudinal qualitative case study conducted over 2 years. Methods. Data were collected from eight Graduate Entry Nursing students at 6 monthly points between 2009–2011 via diaries, clinical assessment documentation and interviews. Forty interviews took place over 2 years. Additionally, three focus groups involving 12 practice assessors were conducted at the end of the study period. Data were analysed through a social constructivist lens and compared with a set of suppositions informed by existing empirical and theoretical debates. Findings. Demonstrated the interplay of performance strategies adopted by Graduate Entry Nursing students to challenge or pre-empt actual or perceived negative stereotypes held by established practitioners to gain acceptance, reduce threat and be judged as appropriately competent. Conclusion. Students interpreted and responded to, perceived stereotypes of nursing practice they encountered in ways which facilitated the most advantageous outcome for themselves as individuals. The data present the creative and self-affirming strategies which students adopted in response to the expectations generated by these stereotypes. They also depict how such strategies commonly involved suppression of the attributes associated with ‘graduateness’

A case study exploring presentation and positioning of self in graduate entry nursing students

Background At the inception of this research the academic level of pre-registration nurses education in England was receiving significant attention in the public and professional press. This was as a result of the decision to increase the minimum academic entry level from a Diploma in Higher Education to a Degree which created a contested climate amongst practitioners, educationalists and current students. A complex background turbulence was present surrounding nurse education, which incorporated both pro and anti-intellectualist positions with frequent contradictions made by those who are attempting to stand within both camps. Within this unsettled environment, the Division of Nursing at the University of Nottingham implemented a Graduate Entry Nursing (GEN) programme. This thesis took advantage of the unique opportunity to explore the experiences of the first cohort of students on this programme in practice. Aim To explore the way in which GEN students present and position themselves in practice in response to perceived stereotypes, media representations and the agenda of practice and education institutions. Method The study adopted a longitudinal case study design conducted over a 2 year period. It encompassed data arising from GEN students (n=8), mentors (n=12) and clinical assessment documentation which was generated through diaries, interviews and focus groups. A time-series analysis was conducted on the student data which identified how salient issues related to the research aim were expressed amongst participants over time. Data arising from other sources was utilised to offer alternative perspectives. These findings were compared to a series of analytical suppositions arising from the existing literature to offer insight into how the data confirmed, contradicted or expanded current knowledge (Yin 1994). Findings The findings demonstrated the interplay of performance strategies adopted by GEN students to challenge or pre-empt the impact of actual or perceived negative stereotypes held by mentors and other established practitioners. The students’ desire to appear to comply with the expectations of others arose from an awareness of their dependency on the established practitioner's perception of them as competent. This involved presenting a level of confidence which portrayed competence whilst not appearing arrogant or threatening to those assessing their practice. Numerous inconsistencies were present within the accounts of students and mentors which demonstrated the discrepancy between the publically endorsed position and the privately held adverse stance. Discussion It is proposed that the GEN students take the stance of the expert performer as a result of the life experience and resilience they have developed prior to commencing their nurse education. The mentor is conceptualised as the sceptical audience who is in the process of adapting to the implications of change arising from their response to a different type of nursing program and student entering the profession. The inconsistencies within the participants’ accounts are viewed as unmeant gestures (Goffman1959) and offer insight into the private view of self which challenges the stability of their performance. However, whilst this remains within the private domain and GEN students continue to portray sincerity within their performances, it is proposed that a predominately amicable relational encounter is facilitated despite the continued presence of stereotypes and perceived threat amongst mentors. Conclusion The transient performance mode adopted by students to navigate the mentor relationship and assessment structures within nurse education is clearly demonstrated in these findings. It remains unknown whether the acceptance of the temporary need to perform as will result in eventual conformity, or if the reflection and resilience documented throughout this study will provide the GEN students with the means of exercising their criticality publically within their future roles and achieve job satisfaction they privately desire. The wider implications of this thesis relate to understanding the rules of the game that students engage in in order to successfully navigate their nurse education in both practice and higher education institutions. This will require a convergence of agendas between education and practice as opposed to the current situation in which both institutions perpetrate their competing interests and the student is required to respond through adopting a variety of incongruent performances

A case study exploring presentation and positioning of self in graduate entry nursing students

Background At the inception of this research the academic level of pre-registration nurses education in England was receiving significant attention in the public and professional press. This was as a result of the decision to increase the minimum academic entry level from a Diploma in Higher Education to a Degree which created a contested climate amongst practitioners, educationalists and current students. A complex background turbulence was present surrounding nurse education, which incorporated both pro and anti-intellectualist positions with frequent contradictions made by those who are attempting to stand within both camps. Within this unsettled environment, the Division of Nursing at the University of Nottingham implemented a Graduate Entry Nursing (GEN) programme. This thesis took advantage of the unique opportunity to explore the experiences of the first cohort of students on this programme in practice. Aim To explore the way in which GEN students present and position themselves in practice in response to perceived stereotypes, media representations and the agenda of practice and education institutions. Method The study adopted a longitudinal case study design conducted over a 2 year period. It encompassed data arising from GEN students (n=8), mentors (n=12) and clinical assessment documentation which was generated through diaries, interviews and focus groups. A time-series analysis was conducted on the student data which identified how salient issues related to the research aim were expressed amongst participants over time. Data arising from other sources was utilised to offer alternative perspectives. These findings were compared to a series of analytical suppositions arising from the existing literature to offer insight into how the data confirmed, contradicted or expanded current knowledge (Yin 1994). Findings The findings demonstrated the interplay of performance strategies adopted by GEN students to challenge or pre-empt the impact of actual or perceived negative stereotypes held by mentors and other established practitioners. The students’ desire to appear to comply with the expectations of others arose from an awareness of their dependency on the established practitioner's perception of them as competent. This involved presenting a level of confidence which portrayed competence whilst not appearing arrogant or threatening to those assessing their practice. Numerous inconsistencies were present within the accounts of students and mentors which demonstrated the discrepancy between the publically endorsed position and the privately held adverse stance. Discussion It is proposed that the GEN students take the stance of the expert performer as a result of the life experience and resilience they have developed prior to commencing their nurse education. The mentor is conceptualised as the sceptical audience who is in the process of adapting to the implications of change arising from their response to a different type of nursing program and student entering the profession. The inconsistencies within the participants’ accounts are viewed as unmeant gestures (Goffman1959) and offer insight into the private view of self which challenges the stability of their performance. However, whilst this remains within the private domain and GEN students continue to portray sincerity within their performances, it is proposed that a predominately amicable relational encounter is facilitated despite the continued presence of stereotypes and perceived threat amongst mentors. Conclusion The transient performance mode adopted by students to navigate the mentor relationship and assessment structures within nurse education is clearly demonstrated in these findings. It remains unknown whether the acceptance of the temporary need to perform as will result in eventual conformity, or if the reflection and resilience documented throughout this study will provide the GEN students with the means of exercising their criticality publically within their future roles and achieve job satisfaction they privately desire. The wider implications of this thesis relate to understanding the rules of the game that students engage in in order to successfully navigate their nurse education in both practice and higher education institutions. This will require a convergence of agendas between education and practice as opposed to the current situation in which both institutions perpetrate their competing interests and the student is required to respond through adopting a variety of incongruent performances

Partnership working between UK and Oman to enhance mental health nursing education and practice

It is becoming increasing acknowledged that we live and work in a global economy where cultural, educational and health ideologies are suggested to collide. Working together to address global mental health is key to improving health and strengthening health care systems (APPG 2014, Prince et al. 2007). Inequalities in finance, employment, accommodation, nutrition, education, access to healthcare can be seen throughout the world (WHO 2015). Within this melee mental health issues are subjugated in an attempt to disassociate with its lingering stigma (WHO 2013). Regardless of the attempt to hide the ‘shame’ of mental ill health there are many throughout the world attempting to develop innovative and caring practices to enable people experiencing mental health problems to gain recovery and a good quality of life (WHO 2013). Over the past year we have been developing a mental health nursing education partnership between Cardiff University and Oman Specialised Nursing Institute. A shared belief of students as partners in learning has enabled the working relationships to promote standards and quality (QAA 2014). We have developed a shared understanding of mental health nursing based on the principles of recovery and person centre care and used a number of educational approaches to influence mental health nursing practice. No health without mental health (2011), Mental health measures (2010), Oman’s Health Vision 2050 (Ministry of Health 2014) and the World Health Organisations Mental Health Action Plan 2013-2020 (WHO 2013) provides a platform for collaborative working. In this presentation we will share our experiences of our partnership working and programme development (both undergraduate and post graduate) along with our blended teaching methods. In addition to the academic achievements of our students we have found partnership working has enabled a greater personal and cultural awareness for ourselves as lecturers and for our student

The rules of the game in graduate entry nursing: a longitudinal case study

Background Graduate Entry Nursing programmes are pre-registration nursing curricula designed for candidates who already have a health related degree. The programmes aim to attract highly motivated individuals who have a commitment to nursing and hold the cognitive abilities associated with studying in higher education including critical thinking styles and capability to study independently. These attributes are termed within the literature as “graduateness”. They are viewed by some as advantages to nursing. In contrast, however, there remains widespread scepticism amongst the public and some professionals towards those who are academically educated entering nursing. Objectives To explore how GEN students anticipate, experience, explain and respond to attitudes which imply resistance to those who are academically educated. Design Longitudinal case study informed by the conventions advocated by Yin (2014). Settings School of Health Sciences in a British University. Participants Eight GEN students participated over the two year duration of their programme. Twelve clinical assessors with a minimum of four months' experience of supporting GEN students in practice. Methods Students took part in individual interviews at six monthly periods which were informed by the content of diaries maintained throughout their clinical placements. Clinical assessors took part in focus group discussions. Practice documentation was accessed to identify the progression of clinical competency along with written feedback received by students from clinical assessors. Results Results demonstrate the ways in which GEN students position themselves performatively in order to pre-empt or challenge negative stereotypes relating to their competence, compassion and commitment. Conclusions Students employ a number of strategies to navigate the challenges of learning within an environment in which they are viewed with suspicion and distrust

Do graduate entry nursing student’s experience ‘Imposter Phenomenon’?: an issue for debate

The recruitment of Graduates into the nursing profession is seen as advantageous in the academic literature. Conversely educated nurses are often portrayed in the media as “too posh to wash”. We would argue these conflicting discourses have a negative effect on graduate entry nurse education. Graduate nursing students may be particularly susceptible to “Imposter Phenomenon” a concept that describes an "internal experience of intellectual phoniness" exhibited by individuals who appear successful to others, but internally feel incompetent. We would like to encourage debate through the presentation of a small set of pilot data that established that 74% of the participants had frequent to intense experiences of Imposter Phenomenon. Students experienced feelings of failure despite consistent high achievement. Our findings and the prevalent negative rhetoric surrounding highly educated student nurses raise concerns regarding the impact of the anti-intellectualism on the Graduate entry student’s perception of self. Others may argue that this could simply be a 'natural' or expected level of anxiety in a time of transition that has no lasting impact. We debate this issue in relation to the existing literature to encourage critical dialogue

Evaluation of the impact of leadership development on nurses and midwives underpinned by transformational learning theory: a corpus-informed analysis

Purpose The purpose of this paper is to evaluate the impact of leadership development programmes, underpinned by Transformational Learning Theory (TLT). Design/methodology/approach A corpus-informed analysis was conducted using survey data from 690 participants. Data were collected from participants’ responses to the question “please tell us about the impact of your overall experience”, which culminated in a combined corpus of 75,053 words. Findings Findings identified patterns of language clustered around the following frequently used word types, namely, confidence; influence; self-awareness; insight; and impact. Research limitations/implications This in-depth qualitative evaluation of participants’ feedback has provided insight into how TLT can be applied to develop future health-care leaders. The extent to which learning has had a transformational impact at the individual level, in relation to their perceived ability to influence, holds promise for the wider impact of this group in relation to policy, practice and the promotion of clinical excellence in the future. However, the latter can only be ascertained by undertaking further realist evaluation and longitudinal study to understand the mechanisms by which transformational learning occurs and is successfully translated to influence in practice. Originality/value Previous research has expounded traditional leadership theories to guide the practice of health-care leadership development. The paper goes some way to demonstrate the impact of using the principles of TLT within health-care leadership development programmes. The approach taken by The Florence Nightingale Foundation has the potential to generate confident leaders who may be instrumental in creating positive changes across various clinical environments

Development of Nightingale Frontline: a leadership support service for nurses and midwives during the COVID-19 crisis.

BackgroundAs COVID-19 hit the UK, it was apparent that frontline healthcare workers would be faced with challenges they had never encountered before. The longer-term leadership support needs of nurses and midwives were considered central to how they would psychologically emerge from the COVID-19 response. In response, a national leadership support service for nurse and midwife leadersat all levels, was rapidly established.MethodsA collaborative approach was used, drawing from an established community of healthcare leadership development consultants and senior healthcare leaders. Practical plans for how the service would run were formulated via online meetings, held between February and March 2020. An internal questionnaire was distributed to attendees, requesting demographic data and feedback to capture the perceived impact of the service on leadership.ResultsOverall, confidence in leadership ability/skills increased after attending the service; 68.8% of those who completed post-attendance questionnaires reported having learnt new leadership skills and a motivation to facilitate co-consulting sessions for their teams. The service was positively appraised and there were reports of a degree of influence on leadership, and improved confidence after attending.ConclusionLeadership and well-being support provided by an independent and external organisation can offer a unique and safe forum for reflection and for healthcare leaders to decompress. This requires a sustainable investment to mitigate the predicted impact of the pandemic