The importance of compassion

During this early stage of data collection and analysis, participants identified that building relationships that demonstrated compassion for their patients was related to providing high quality care, and they expressed that engaging in high quality care was an important component of the RN role. One student expressed this in her awareness of her role to ‘be there’ for her patients, particularly in offering support to those who were the most vulnerable:

They may be an elderly lady, no children, and a husband at home and don’t want to ask (for help) so I tell them (to use their buzzer) that I don’t mind when they need something, because they’ll just sit there. (EP4)

Such values related to recognising and addressing the suffering of their patients, reflected the standards of practice within professional guidance, such as The Code (NMC, 2008). Students demonstrated sympathy for patients who found themselves in hospital and within care systems that were not very person-centred:

On a lot of wards you know what it’s iike, the wards are noisy, patients have been up since half five or six o’clock, and they are waiting like half a day before they have a wash, it’s not nice. (EP4)

As previously mentioned, students witnessed variability in role modelling and within some placements saw RNs who they believed did not live up to the professional ideals of listening to and attending to the needs and suffering of patients expected within compassionate practice;

it’s (nursing is) just so much about the people and sometimes you see a staff nurse when a patient asks for something saying ‘hang on. I’m doing my writing’ and they’d rather sit there and make sure their writing is done than see the patient... I just feel that you need to put your patients first because so what if the papen/vork is not done... You think when I ’m a staff nurse I’m going to make sure that i don’t turn out like that. (EP3)

Students expressed that witnessing what they saw as unacceptable care made them determined not to become like that. They also recognised that pressures existed to conform to joining in with ‘poor’ practice and that in doing so they could be working outside professional ideals. They saw that refusing to engage in poor practice might be ‘hard’ and that perhaps it was easier to join in, findings that resonated with Philpin’s (1999) study where nurses conformed in order ‘to belong’:

it is hard. Especiaiiy the moving and handiing, when they ask you ‘Are you OK with lifting them up the bed?’ and it’s hard to say no. (EP2)

The comment above that it is ‘hard to say no’ when being asked to undertake practice that could compromise safety, such as lifting instead of using slide sheets, is further illustration of the challenges students experienced within their professional socialisation, where practice did not appear to resemble the learned ideal.

Concerns were also identified in relation to the importance of delivering high quality care such as compassionate practice on students’ impressions of what a ‘good’ or ‘bad’ nurse was. Students expressed difficulty in understanding how a ‘bad’ nurse could continue in nursing when they were not meeting the professional ideals of practice:

I’ve seen different nurses and I could say now, after only a year and a half training. I’ve seen good nurses and bad nurses... you think how do they (bad nurses) get through the day and how do they carry on being a nurse? (EP1)

The understanding of professional values, as discussed within Chapter 3, through exposure to other practitioners is recognised as impacting upon student’s concepts of ‘good nursing’ (Benner, 2000). Students also saw the quality in the RNs or mentor’s care of students as important factors in their socialisation experiences, in a similar way to an expression of compassion for patients. Students demonstrated concerns about being mentored by someone who they believed no longer ‘cared’ about them:

I tried to be as nice as possible and when she (the mentor) was in a mood Td ask her if she was alright, but she’d not say anything. She was ready for retirement and I think she’d had enough. (EP3)

Students identified that some RNs did not appear to have ‘their heart in it’ (nursing) anymore:

I think a lot of them (RNs) when they get to a certain ievei just go in and do what they have to do. I don’t think their heart is in it. (EP4)

Students suggested this could be due to a prolonged time actively caring for others who were suffering, wearing nurses down emotionally. They also suggested it could be due to nurses entering senior positions that took them away from patient care and thereby meant they lost their caring ability.

Data from the first four student experiences illustrated exposure to variations in the quality of nursing and some approaches that did not ‘fit’ with the professional ideals students expected to witness. Very early analysis indicated a possible dissonance between professional ideals and witnessed reality.