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Nurses eating nurses: The caring profession which fails to nurture its own!

Leanne Davey
Undergraduate Student, Bachelor of Nursing, Wollongong University, VIC

Abstract

For many years student nurses were trained in a more disciplined approach with considerable time allocated to working in the hospital environment and specified times allowed for gaining theoretical knowledge throughout their formal training. Nurses therefore gained a tremendous amount of experience and competency in their practical skills. With the introduction of more specialized equipment and technology it was now desirable to improve the professional status of nurses and nursing education.
The introduction of university trained nurses has been met with much criticism. Student nurses are now being empowered and informed with theoretical knowledge from many health disciplines that allows them to use a holistic approach to patient care. The changes to nurse education were hoped to improve the professional status of nurses although this transition has not been without problems.
Experienced nurses who are already working in stressful conditions with continuous staff shortages and poor recognition of service see the student nurse sometimes as an extra hindrance to their already increasing workload. Student nurses are theoretically competent but lack the clinical expertise and experience to complement this knowledge which can also add to the professional pressure that experience nurses encounter. Most nurses would like to see themselves, as promoters of nursing but are frustrated and disillusioned with their profession. It would seem then that student nurses as a result of this dissatisfaction are often devoured by some nurses instead of being encouraged and nurtured in their enthusiasm for nursing.

Keywords

clinical experience, undergraduate, professional, nuture, nurse

Article Text

Introduction

We all go through many challenging years of being a student during primary and secondary education. Throughout these years, the student is guided and nurtured to achieve the best of their ability. It is a totally different situation however when you, as an adult, enter into undergraduate nursing education, for students are often 'thrown to the wolves' when in the clinical area. It is an experience that will make or break any enthusiasm that the student may have had for the nursing profession. The term 'professional' can be used very loosely when talking of nurses because there are some nurses who claim to be professional but neglect to behave in a professional manner that would enhance the status of the nursing profession.

It is somewhat ironic that whilst nurses are supposed to be part of the caring profession, some persistently treat students like they are invisible or grossly inferior. Students get so little practical experience that when they have a day or week that has been very unsatisfying it dampens their enthusiasm for the profession and may make them question their choice of career path. It seems like a no win situation sometimes with nursing students being blamed for the inadequacies of university education and their lack of clinical expertise. Perhaps a small part of the problem is that nurses may be reluctant to teach other nurses particularly students or are threatened by theoretical knowledge. All nurses would agree that theoretical knowledge is only a part of nursing and can only be enhanced by practical experience.

As a first year nursing student you liken the experience to being 'thrown to the wolves' and hope you survive the ordeal without being stripped of your pride and dignity on the first day. Those students who are lucky enough to survive into second or hopefully third year are still faced with the indignity and unprofessionalism of nursing staff as being treated like an invisible person. Graduates enter into a profession whose members often treat each other with hostility, creating an unfriendly environment which is unsuitable for productive learning. Why is it that many nurses persist with this type of treatment of their own peers? Many students will encounter this type of behaviour on practicum but thankfully it is a behaviour that is not common of all nurses.

Nursing education

The nursing profession has gone through many changes over the past 16years with nursing education changing from hospital to university degree in 1984 in N.S.W (Grealish and Carroll, 1998). This has been a very controversial change that is still creating unrest within nursing and medical professions. 'Out with the old and in with the new' way was not accepted favorably by the hospital trained nurses and doctors, with varying degrees of job dissatisfaction and conflict among nurses (Adamson, Kenny & Wilson-Barnett, 1995, pp.172-183; White & Begun, 1996, pp.79). It seems that historically nurses were satisfied with a more hands on approach to nurse education. It would then seem desirable that the current student nurse practicum should then be more productive if more support was given. It is a known fact that would be acceptable for most is that you cannot learn everything in a classroom and that experience is gained by doing procedures under supervision from other nurses. Unfortunately, hostility, disrespect and unfriendliness seem to be what many student nurses encounter when they are placed on the wards as part of their university clinical practicum. Nurses eating nurses seems to be what most student nurses experience at some time throughout their training.

According to Walsh & Ford (1994 cited in Oughtibridge 1998) nursing contains practices involving ritualistic behaviour that is resistant to change and appears to only accept changes when it is implemented by other nurses in the hierarchy without question or challenge. Traditionally nurses were passive recipients of someone else's knowledge and often performed tasks without question. Nursing education today requires the nurse to be an active participant in the learning process with constant reflection and critical analysis of one's practice (Driscoll, 1994, p.48).

I feel that current nurses throughout the transition period of nursing education were not properly informed of the new learning criteria for nurse education and what they could expect from these nurses or ways that they could enhance their learning experience. This has only exacerbated the relationship between student nurses and experienced nurses that has allowed both parties to be threatened and intimidated by each other.

Power

The framework used to describe this behaviour in the nurse / nurse relationship consists of power issues and the competency and ability of a mentor or preceptor to adequately undertake clinical teaching of a student or inexperienced peer. There seems to be a power struggle in the relationships between nurses that involves issues of power, knowledge and communication and how these issues can impede a student nurse from achieving a successful learning experience from fellow nursing colleagues.

Kanter's theory of power identifies those individuals that have access to power and opportunity structures within an organisation and describes them as being highly motivated and able to motivate and empower others by sharing skills, knowledge and power. Those individuals in the nursing profession are likely to be great mentors for students. Individuals that are experiencing frustration, burnout and job dissatisfaction are feeling powerless with their situation but do not seem to have access to power that may influence their situation (Kanter & Spence Laschinger, 1996, p.26). It seems that students are more likely to encounter a nurse who is experiencing job dissatisfaction and who will possibly cause the student nurse to suffer and experience an unproductive practicum experience.

Nurses who desire to achieve academic aspirations are often misunderstood as to why they want to further their theoretical knowledge. These nurses are often stereotyped and criticised by other nurses of trying to become too clever or like a doctor (Oughtibridge, 1998, pp.22-24). Foucault (1982 cited in Peterson 1994 p7) argues that wherever power relations exist and operate there will always be a degree of resistance from individuals or groups within an institution.

Power abuse

According to Duffy & Duffy (1998) power is defined as possession of control, authority or influence over others. Professional nurses have power but generally do not use this power in a positive manner that will benefit the nursing profession. Instead nurses tend to use their power negatively to hinder the growth and professionalism of nursing with nursing students (Duffy & Duffy, 1998, pp.89-92).

Students need to stand up and regain power and a degree of control over their education. The key to achieving this according to Duffy & Duffy (1998 p89-92) is to have people perceive that you have power because power perceived is power achieved. Unfortunately this is easier said than done. Students need to report the positive and negative experiences that they have encountered to educators and offer suggestions so that nursing education will always be enhanced and maybe more accepted by peers.

Clinical environment

Students on clinical practicum are often placed with dissatisfied nurses who continue to express their discontent and endeavour to discourage students from fulfilling their potential in the nursing profession. These nurses perceive nursing as a career path leading to nowhere. Their negative attitude can shatter or hinder the eagerness of a nursing student to extract vital knowledge and skills from these experienced nurses (Langston, 2001, p.2). Nurses have so much to give students but are often hindered by job dissatisfaction, staff shortages and increasing workloads which can hinder the teaching process. If this knowledge and experience is not passed on to student nurses then this vital information will be lost as experienced staff retire and leave the workforce (Buerhaus, 1998, p.35).

As a student nurse I have encountered dissatisfied nurses who persistently criticize my education but offer little or no suggestions on ways to improve the situation. Thankfully I have encountered more professional nurses who are keen to pass on their knowledge and expertise that has enhanced my clinical practicum.

Nursing is currently in a crisis situation with increasing staff shortages, lack of professional recognition and appropriate resources. Academic education has been blamed repeatedly for this dilemma, with students continually facing negative remarks regarding their education instead of being encouraged and nurtured by fellow nurses (Langston, 2001, p.2). Educators and nurses who are willing to share their professional experiences and knowledge are often seen as role models for students and can only offer a positive enhancement in the clinical experience (Elberson & Williams, 1996, pp.33-38; Fitzpatrick, 1998, p.107).

Mentoring

There is a concept known as 'barmentoring' which is a new addition to the mentor / protégé relationship (cited in DiVito-Thomas, 1998). This is an exciting concept that focuses on encouraging the novice nurse. This concept requires commitment from experienced nurses who are generally interested in providing the novice nurses with information, advice and emotional support that will promote growth and professional competence within the novice. According to Gailbraith, Brueggermeyer & Manweiler (1988), Rankin (1991) & Yoder (1990), the mentoring relationship is long term development process that evolves through five stages. The initial exploration stage is the establishment of the mentor / protégé relationship. Secondly the initiation stage consists of developing the purpose parameters, limitations and goals to be established. The early development of the third stage promotes self-evaluation and working independence by the protégé. The fourth stage is an expansion on the previous stage with encouragement by the mentor for the nurse to access other nurses and gain new experiences and information. When the protégé has successfully achieved increased competence and responsibility, closure is reached in level five where the protégé then progresses to achieve and attain a satisfying professional career (cited in DiVito – Thomas, 1998, pp.110-114). This gives hope of a positive approach to foster and nurture nursing students.

Novice nurses

Caine (1989) suggests the advantages of this relationship include sharing of knowledge, intellectual stimulation and motivation from the support that is given by the mentor. The disadvantages suggested by Caine (1989); Kirk & Reichert (1992) in this mentor / protégé relationship include negative role modeling of the mentors in which the protégé may duplicate unprofessional or unethical behaviour. An overdependence on the mentor may also inhibit the protégé / novice nurse from acting autonomously ( cited in DiVito-Thomas, 1998, pp.110-114). The term novice is not only limited to the student nurses. Experienced nurses who begin work in an unfamiliar ward or an area of nursing can be classified as a novice as they are out of their comfort zone of their own expertise (Benner, 1984, p.21). One is left wondering if these nurses are treated with the same contempt and disrespect that student nurses are exposed to.

Students also need to be accountable and seek to be involved and interested on their clinical practicum. Showing initiative can only enhance a student's chance of a more receptive learning experience with another nurse who is willing to share their knowledge with a student (Joyce, 2000, p.960). Nurses need to be aware of the value of their knowledge and endeavour to pass this knowledge onto new and inexperienced colleagues. (Joyce, 2000, p.960; Morrison et al, 2001, p.120). Experienced nurses have already developed confidence in their practice and their nursing care is focussed on the patient (Morrison et al, 2001, p.120). It seems that many students lack confidence and have inadequate clinical experience to prepare them for the hectic and stressful workloads and environment of the health system (Nay & Pearson, 2001, p.39). This situation can be improved if nurses would take some pride in their profession and actively pass on knowledge to inexperienced student nurses. Meissner (1999) suggests too many nurses commit a kind of genocide when dealing with young or inexperienced nurses. These inexperienced nurses are continually frustrated and disheartened by the treatment received by their peers. Students yearn to learn and are eager for mentors to pass on their knowledge. The experienced nurse may actually reap some benefit in aiding the student to achieve confidence and much needed skills. This practice may undoubtably decrease the pressures of their own workload as the student becomes more competent and confident and requires less supervision (Meissner, 1999, p.43).

The goal of clinical experience is to expose the nursing student to the reality of professional practice that cannot be learned from a textbook or simulated in a classroom. Gaberson & Oermann (1999 cited in Oermann & Lukomski, 2001, p.65) consider the provision of real life experiences essential to allow the student nurse to develop knowledge, skills and values that are essential elements of professional practice. Oermann & Standfest (1997 cited in Oermann & Lukomski, 2002, p.65) suggest that most students find clinical experience very stressful and the aim of educators and mentors should be to create an environment that is more productive and nurturing to promote learning. Fitzpatrick (2001) endeavours to learn from comments made by students in their appraisals of nurse education. As one student said, "care about me as a nurse, as someone who shares your profession, someone who someday may be caring for you or a loved one. As a student, I want you to impart enthusiasm for your chosen field, and a love of nursing that transcends the work of teaching" (cited in Fitzpatrick, 2001, p.5).

Communication

A vital component of nursing consists of communicating effectively with patients and their family. One would assume that this principle would also apply between colleagues. Nurses are professionals and therefore should communicate accordingly with fellow peers as one's attitude of another can jeopardize or influence others in regards to an effective working relationship and environment (Thurgood, 1995, pp.720-721; Earnest, 1989, p.42). Incompetent communication skills in the nurse / nurse relationship not only affect the working environment but can also have an affect on patient care and the relationship between other health professionals jeopardizing trust and credibility of staff (Pagano & Ragan, 1992, p.137).

Conclusion

The treatment of undergraduate students needs to be addressed if nursing is to evolve and continue to be seen as a rewarding profession throughout these crucial changes. The future of nursing education and the professional direction nurses take will depend on the attitudes of the students, mentors, preceptors, facilitators and educators that student nurses encounter on their practicum. Most student nurses are very enthusiastic when commencing their nursing career. Nurses should encourage and nurture this enthusiasm and pass on the much needed knowledge that is needed by these students. Student nurses have a lot to offer the nursing profession and may actually return a positive experience to the preceptor nurse. Only nurses can improve our professional status so it would seem more desirable if we were to all work together to enhance our profession. A reminder to all nurses to never forget that they too were once a student.

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