Finessing incivility: The professional socialisation experiences of student nurses' first clinical placement, a grounded theory

Abstract

Background: Clinical practice is where student nurses are socialised into a professional role and acquire the distinct behaviour, attitudes and values of the nursing profession. Getting it right at the outset can maximise the development of a professional identity and the transmission of robust value systems. Objectives: To explore the impact of the first clinical placement on the professional socialisation of adult undergraduate student nurses in the United Kingdom. Design: Data of a longitudinal qualitative nature were collected and analysed using grounded theory. Settings: First year student nurses in hospital ward placements comprising a rural District General Hospital and a large inner city Hospital kept daily unstructured diaries for six weeks. Participants: A total of 26 undergraduate adult student nurses were purposefully sampled between 2008 and 2010 before undertaking their initial clinical placement. Methods: Data collection and analysis used grounded theory and the key question asked of the diarists 'tell me what it is like to be a first year nurse on a first placement' was theoretically adjusted during constant comparison and as the theory emerged. Ethical approval and consent was obtained. Results: The theory of finessing incivility comprises a conceptual framework depicting how student nurses deal with professional incivility during their initial clinical placement and sustain a student identity. Being disillusioned with their role as worker rather than learner yields a sense of 'status dislocation'. Despite needing professional benevolence, they remain altruistic and seek recompense from significant others to negotiate for learning opportunities and relocate their student status. Conclusions: Despite the stressful transition into clinical practice rather than 'fit in', the student nurses want to belong as learners. His or her own resilience to learn nursing and be a professional student maintains their resolve, their altruism and strengthens their existing values to be benevolent towards an indifferent profession. This behaviour ultimately mirrors the social nature of the practice community.

“My mentor didn't speak to me for the first four weeks”: Perceived Unfairness experienced by nursing students in clinical practice settings

“…Thomas and Burk () found multiple “Injustice Incidents” in their study of junior student nurses who described behaviours such as being ignored, disbelieved and humiliated by qualified staff. Thomas, Jinks, and Jack () described the stressful transition experienced by first‐year student nurses entering their first clinical placement and having to deal with professional incivility from other members of staff. Student nurses often feel devalued and disempowered during clinical placements, which have a negative effect on their learning and increase the chances of them leaving their nursing programme (Bradbury‐Jones, Sambrook, & Irvine, ).…”

Lying to ourselves: rationality, critical reflexivity, and the moral order as ‘structured agency’

“…To address the reality of patient care, various defences were erected to avoid emotional and psychological involvement with patients. More recent literature describes the often very difficult student experience (Maben et al ., ; Chachula et al ., ; Goodare, ; Thomas et al ., ). Maben et al .…”

“…The mismatch between a caring discourse (the espoused theory) and actuality (theory in action) in nursing has been noted for quite some time (Castledine, 1994;Jewkes et al, 1998;Wright, 2006), often in the context of care for older people (Chan & Chan, 2009;Goodman, 2011;Hillman et al, 2013) and in the socialization of student nurses for compassionate practice (Curtis et al, 2012;Del Prato, 2013;Curtis, 2014;Thomas et al, 2015). Compassion fatigue (Kitwood, 1997;Coatzee & Klopper, 2010;Kelly et al, 2015), malignant social psychology (Kitwood, 1997), burnout (Kanai-Pak et al, 2008;Gustavsson et al, 2010;O'Mahoney, 2011), bullying (Hutchinson et al, 2006;Hoel et al, 2007;Jackson et al, 2011;Hutchinson & Jackson, 2013, and anxiety/ threat (Kouchaki & Desai, 2014) all may characterize some clinical settings and lead to unethical behaviour, preventing nurses from exercising compassionate agency.…”

“…To address the reality of patient care, various defences were erected to avoid emotional and psychological involvement with patients. More recent literature describes the often very difficult student experience (Maben et al, 2006;Chachula et al, 2015;Goodare, 2015;Thomas et al, 2015). Maben et al (2007) revealed that within 2 years in practice, newly qualified nurses could be categorized as sustained idealists, compromised idealists or crushed idealists.…”

Preparedness of Graduate Paramedics for Practice: A Comparison of Australian and United Kingdom Education Pathways

“…However, the evidence supporting clinical practicums is mixed. Across professions, professional socialisation has been identified as a means by which students can acquire the necessary behaviours, values and skills of the profession in which they are entering (20)(21)(22). However, professional socialisation in the clinical practicum context is not undertaken consistently.…”