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

Abstract

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