Student strategies for managing concerns about future role

The numerous student concerns about the role of the RN, maintenance of personal and professional values, and their personal future as a RN, were identifiable within the student interview data alongside expressions of intentions and strategies to resolve these concerns. Student resolutions to their concerns involved hoping things will become better, finding nursing career pathways that matched their personal ideals, or leaving the profession.

Numerous open and in vivo codes were identified during the coding of transcripts and were brought together into substantive codes. Each substantive code was analysed and two of these were brought together into the selective code ‘managing concerns about future role’ (figure 9). Both of the substantive codes within this selective code are discussed below.

Managing concerns about future role

r

1

1

Resting on a hope or quitting

Choosing a more fulfilling direction in nursing

Figure 9. Substantive codes within the selective code ‘Managing concerns about future role’

8.6.1 Resting on a hope or quitting

The exposure to loss of caring and disillusionment in some RNs was seen by students as something they ‘hoped’ they would be able to avoid in their own future practice, although strategies for managing this concern were not always evident:

I think it (losing compassion) depends on the environment that you are working in. I hope it will never happen to me. (P2)

I think sometimes it (pressures of RN practice) is used as an excuse (for not being compassionate), you know the barriers, the challenges, or maybe they (RNs) have just forgotten somewhere along the line. I can’t speak for them but I just hope I don’t become like that. (P8)

However, students were also exposed to ‘warnings’ during their socialisation indicating they too might be vulnerable to moving away from their ideals, that they too might not be able to resist changing when they face the realities of being a RN. Such experiences exposed students to the risks on their personal and professional values and this was something the students did not intend to allow, even if it meant ‘quitting’:

I hear mentors tell me that’s because you are only new, when you’re qualified and you’ve worked for years it will change, your mind will be reversed... over the years if I am not enjoying it (nursing) then I will look for something else. (P7)

They expressed determination that they would ‘not turn out like that’ and yet their solution was to leave that job or the profession if they did:

My attitude is if you don’t like nursing leave. Don’t stand there and moan... if I didn’t like it I’d leave, Td look for another job. (P8)

Students were able to see the potential risks to their personal and professional ideals and values. However, their main strategy for managing these pressures and risks was' to hope' they would not succumb to them and if they did, ‘to leave’ the profession. Using such a strategy may be another reason for the high risk of attrition among newly qualified nurses, seen in other studies (Maben et al., 2007; Mooney, 2007).

8.6.2 Choosing a more fulfilling direction in nursing

Students also identified that they could maximise their job and professional satisfaction by practicing to the standards they aspired to, through working within specific specialist or clinical areas. This expression of intention to find nursing work that better suited their values was a phenomenon identified within previous research (Parry, 2008). Many of the students identified specific placements where they had experienced compassionate practice as the sort of area they wanted to gain employment. Students identified that they would be able to become the RN they aspired to be if they worked in a specific area such as higher dependency, palliative care, or community nursing:

I have come across it (loss of values among RNs) more in hospital settings than I have in community settings. I think that is why I want to go back to the community because I am a people person and if I can’t do the job properly then I wouldn’t be happy. (P8)

However, students also identified that they would strive to maintain their compassion and uphold the standards of care they aspired to wherever they worked, and not become like the RNs who appeared to no longer care, although they were not able to say how this might be achieved:

Tm going to be a nurse and when I am I will make sure I don’t do it like that and I will do my best to put things in place where it can be better than that. (P10)

Selecting specific clinical specialities or areas for their own future careers also appeared to be dependent on the amount of staff support they saw within that area, as well as the staff to patient ratios. Students also wanted to feel intellectually challenged and have opportunities

to continue learning. Students wanted to avoid finding themselves in a job where there was not enough time or opportunity to develop or to provide individualised, high quality care:

An ordinary medical ward is not for me, you don’t have enough time, there are not enough staff, and so you can’t afford to give that quality care, you’re just patching over the cracks, and that is something that I can’t do... I loved Intensive care. It’s good care because you have the time to give the whole nursing package with everybody, or district nursing or day surgery. I really enjoyed It there... (RNs) have the time to communicate with them (patients) and have the time to speak with the family, instead of just whizzing around and spreading yourself too thin. (P5)

The decision to choose one job over another has been recognised as dependent upon the values within that work environment, with individuals selecting jobs that best match their own value aspirations (Judge and Bretz, 1992). The students appeared to be able to recognise the jobs that might best suit their desire to practise compassionate nursing. Students expressed a desire for a job where they would be happy and that meant providing care to the standards they aspired.

Students’ strategies for managing their concerns about the role, values and ideals as a future RN amounted to balancing between different intentions, to commit to uphold their own personal and the professional values and ideals within any future role and their intention to build their RN career within a practice area that matched their personal and the professional ideals. This finding resonated with that of Maben et al. (2007) who found that some of the ideals and values student nurses held dear during their professional education, such as individualised care, could be difficult to uphold when qualified and so these ideals were either abandoned, the nurses moved between different jobs, or they gave up nursing altogether. This also resonated with the ‘caring trajectory’ where student nurses started their socialisation feeling ‘fresh and enthusiastic’ and could end it feeling ‘cynical and disillusioned’ (Smith, 1992: 112).

Upholding the professional values of nursing requires courage and relies upon reinforcement from colleagues and managers (Maben et al., 2010). The students’ experiences and uncertainty about how to manage their concerns resonated with studies that identified RNs altruistic and caring behaviours deteriorated over time as they met with constraints to their

practice (Maben et al., 2007).