After analyzing the data from the reflective diaries and interviews, the following themes were identified:
1. What the student brings to the placement experience 2. Learning from others
3. Different ways of learning 4. Ward culture
5. Role of the university
This chapter explores each of these themes in more detail, and where a direct quote from one of the participants has been used to an illustrate a point, the student is identified by a letter and the origin of the quote is noted as being either from their diary (D), or their interview (I). The imbalance in representation of participants in the verbatim data resulted from the fact that some participants gave much more detailed accounts than others, finding it easier to relate their experiences in a narrative manner. All the themes identified in the research were, however, mentioned by many of the participants.
4.1. What the students bring to the placement experience
Most of the students talked about themselves as an important factor, in whether or not their placements were successful. The students who demonstrated the highest levels of self-awareness, and who were the most successful in
placement (obtained higher grades, reported feeling happier in their placements and reported receiving the most positive feedback), were particularly conscious of this fact. The students noted that being confident and assertive enhanced their ability to maximize their practice placement learning experiences.
...being assertive is actually quite important...you’ve got your role as a trainee nurse...rather than just someone who’s kind of observing or an extra pair of hands to do some other stuff...You have to see it as being in training for a job L I
I think I am going to be a more assertive on my last placement...and make sure that my mentor knows what I want to get from it TA I
The students also noted that a lack of assertiveness not only affected their learning opportunities, but that it could also compromise patient safety
I felt I should have spoken up about using the equipment he (patient) had been assessed for...this has made me realize how important
assertiveness is when working with other team members D D (The patient went on to fall)
The students acknowledged, however, that there is a fine line between being assertive and being seen as too pushy and they talked about negotiating with
their mentor concerning ensuring that the work gets done, before attending to their own learning needs.
All the students noted that in addition to be being assertive, a positive attitude, including the ability to proactively seek out learning opportunities in the practice placement setting, was also essential if they were to survive and thrive in their practice placements. In order to do this, however, good negotiation and interpersonal skills are required on the part of the student.
...there is no place that is perfect, but I think sometimes that it is just a case of changing your attitude, even in situations where maybe you are faced with people you feel you are not working well with...sometimes it is just a case of changing your attitude, rather than expecting someone else to change their attitude, or for a situation to be different...so I think be positive and take positive things out of the placement to build on T I
The students also observed that generally, they needed to accept the, sometimes, chaotic nature of practice and the resulting pressures on their mentors, and adapt their behaviour accordingly; they realized that they needed to learn how to steer a course through practice placements by adopting a very pragmatic approach. They also noted that there is often a tension for their mentors between delivering nursing care and teaching students and most of the students took it as a given that patient care will always come first.
Sometimes there is just so much pressure on people...that they don’t really have time to teach you, so you just get on, help out with the washes and that kind of thing and try and grab a bit of help if you can L I
There was, however, one very specific aspect of their practice placement
experiences that all the students talked about as being problematic and this was the fact that they are on a master’s level training programme. The students commented that many mentors, nurses and other students often viewed this very negatively in practice and so they described how they tried to handle this antipathy to their training. It is assumed by others that the students on this course will bring with them particular attitudes and aspirations, so these prejudices, particularly their mentors’ prejudices, had to be managed.
Sometimes this manifested itself in the belief that the students were perceived as being ‘too clever to care’, or ‘too posh to wash’, or they made the mentors feel that they did not have the skills or knowledge to mentor these students.
...Apparently year’s back when the course started, they used to get
students from this course who would go on the ward and not do anything. They would not wash patients...they would be like “Oh, we are here
because we are going to be managers” C I
She (mentor) was worried, because she said oh, I’m a diploma nurse, why are you giving me a master’s student, I can’t teach her anything and I remember thinking oh no she’s not going to like me very much! TA I
This antipathy towards these master’s level students sometimes spilled over into outright hostility. When they encountered these difficulties with their mentors, some of the students felt that the responsibility to resolve the issues lay primarily with them, but at the same time they were also aware of the power imbalance in their relationships, particularly with their mentors.
You have to make the most of it and if you’re not having a good time...it’s up to you to try to kind of work things out, or kind of suggest what things could be changed...I think it’s kind of the student’s role to make it work. But I understand how that might be difficult...it is a bit scary because they’re signing off your book D I
The students also observed that the student-mentor relationship is not, however, necessarily a one-way process and that mentors can benefit from being mentors. This is not just in the sense of providing an extra pair of hands when the ward is busy, although this is important, but students can also bring new knowledge, experience and skills to the placement.
I think they (mentors) felt they gained a lot from doing it...I said “oh why are we doing that?” it kind of enabled her to rethink why and we’d get a book and have a look, oh okay, that’s why we are doing it. Obviously we get loads from them, but they’re also gaining something from us...on this placement I felt it was a two way thing D I
The students were all very motivated to learn in practice and they expressed a strong need to feel that they ‘know what they are doing’, both as a student nurse, but particularly, once they are registered nurses.
I want to feel confident in thinking, in this scenario, I would do this... D I
This motivation to learn was also apparent in the student’s awareness of the need to prepare for each practice placement, but this is not always easy, as the placements often change at the last minute and sometimes the material being covered in the university did not align with the contiguous placement.
...Before every placement I write down what I think I might like to learn...so I go semi-prepared D I