Feeling Vulnerable and Taking Control

The first four students indicated feelings of uncertainty and vulnerability within their socialisation experiences. The feeling of vulnerability and the ability to take control of their experiences appeared to be related to the quality of mentorship and practice placement leadership, components well recognised as influencing student learning in practice

(O’Driscoii et al., 2010). The sense of vulnerability for students also included their placement allocation as this was outside their control and they could find themselves being placed within a wide variety of care settings. This variation in placements allowed students to witness many different working practices, management and leadership styles:

Two of my mentors were ward managers...they both worked completely differently. One was very hands on... and she knew what was going on because she was there all the time. That made your piacement a bit easier... but then you’ve got some ward managers who...as soon as handover is done they’d be gone and then you’d not see them till maybe next handover. (EP1)

This student went on to explain attempts at trying to make sense of this variation and learn from it, including experiences where role expectations were unclear:

Tve had a placement before where I felt like an extra health care assistant on the shift. You go home and you just think I hate it... Sometimes you can say something and then sometimes you can’t, (iater adding) You just deai with it and i think it just makes you a better nurse anyway, learning to deal with problems, cos it’s not all going to be a smooth ride is it? Every day is not going to be a nice happy day on the ward, so you iearn from it, refiect on it. (EP1)

Uncertainty in student and RN role expectations was mentioned many times by these first four students and appeared to be important factors within the students’ vulnerability to learning from mentors what ‘good’ RN practice was. This finding concurred with previous research (Taylor et al., 2010) highlighting concerns around student learning from such confusion in RN role:

I mean they (RNs) do that (washes) sometimes, it’s not that they don’t do that, but it is more managing the care, on that ward anyway. Not on other wards, Tve seen them (RNs) go in and the first thing they do is they make ali the beds and then wash ail the patients...Every ward that i ’ve been on is very different, (iater adding) You see some very good practice and some poor practice and it’s easier to pick up the poor practice if you’ve not got a very good mentor. (EP2)

The sense of vulnerability was also expressed in terms of students learning from their mentors, where students expressed the need to build a positive relationship with their mentor because they were also their assessor. Such concerns resonate with a ‘hidden curriculum’ for students in accessing learning opportunities and enabling positive assessment (Allan et al., 2011).

Students’ expressed need to follow their mentor’s way of practising in order to be positively assessed by their mentor, appeared to be causing students some concern; particularly in relation to when their mentor may not be practising according to what the student had learned as ‘ideal’ standards. They identified that the mentors’ dual roles of teacher and assessor, increased their vulnerability as students;

You don’t want to get in their bad books because you’ve got to get your work signed off at the end. (EP4)

Holding dual roles has also been identified by mentors a challenging to them, finding it difficult to enact the role of teacher and assessor simultaneously (Bray and Nettleton, 2007; Wilkes, 2006).

Alongside vulnerability, these first four participants also identified some strategies to take control over their socialisation experiences. The students identified the behavioural unwritten rules of engagement with mentors in order to maximise learning opportunities, another reference to their hidden curriculum:

You have got to be kind of friendly, but not too pushy, ask questions and be interested really. If you are just floating around you just need to show a bit of interest and they (mentors) wiii help you. (EP2)

Alongside hidden rules were perceptions of luck, demonstrating students felt they were vulnerable to variability in placement and mentor quality, but that a combination of luck and using strategies for successful engagement could impact on their socialisation:

I have been lucky with my placements, Tve had really good mentors and really good support but I think that’s also how you are as a person and how you get involved on the ward, whether you are enthusiastic or just tend to stand back and watch. (EP4)

The recognition of an individualised approach to a student’s learning was also identified as a factor within their professional socialisation:

Tve had good placements where Tve really got involved and Tve been treated as an individual. (EP4)

This has interesting resonance with individualised patient care and compassionate practice, and with findings from research by Perry (2009), where ‘excellent’ role models were defined

as those who ‘connected’ to those they were working with, having genuine empathy for individual learners. Students compared the recognition of individuality within teams to being ‘part of a family’ and ‘feeling valued’, and that support within teams was important for all members, students and RNs:

I was in community and it was just like a big family. Nothing was too much troubie... that’s nice, you know even though you are qualified, and you’ve been doing the job for 5 years, you’ve stiii got your support... you are not isolated you’ve got supportive people there to help you. It’s not always just about having the support as a student; you need it all the way through, even when you have been nursing 20 or 30 years. (EP4)

One of the strategies students identified that could enable them to manage their concerns, was taking control over their future career direction and in particular seeking out jobs in supportive environments where they would be treated with kindness and respect; with links made between supportive employment and being able to engage in compassionate practice:

When i qualify i will probably have to get a job on a ward, which I will do, but hopefully I am going to try and go on the district, or perhaps A&E (Accident & Emergency) or HDU (High Dependency), somewhere where you get treated proper and you’ve got the support and the help, and you’re therefore able to give it back (to patients and staff). (EP4)

Students were also aware that they could take control of some of the factors that could compromise high quality nursing, although they could not provide clear strategies to explain how they might enable this to happen, and recognised this might impact on their relationship with colleagues:

/ think I could do that (spend time with patients) where ever I worked to be honest, you

don’t have to follow what everyone else is doing...If they are all funny towards me on the ward so be it. At least the patient will remember the nice nurse. (EP3)

Students expressed that maintaining professional ideals as a RN appeared to require an acceptance of personal consequence if their behaviour differed from those of the other staff. This resonated with previous research that had identified the importance of ‘moral courage’ if RNs were to maintain standards or care within the pressures of ‘belonging’ to the healthcare team in which they worked (Maben et al., 2006; Levett-Jones and Lathlean, 2008).