Summary

This review has discussed the cultural, political and historical influences that are viewed as relevant to the current context of nurse education and how it is regarded externally by the public and internally by established healthcare professionals. What has emerged is an engrained culture of anti-intellectualism that is maintained by discourse within the media and potentially transferred to the day-to-day rhetoric on the ‘shop floor’. This is contradicted by a pro-intellectualist stance that tentatively challenges long-standing criticisms in a way which attempts to maintain public favour and in doing so presents further contradictions. These complex and competing debates are viewed as restricting the progress of nursing and demonstrate that there are recurring themes and abiding images in circulation. A discourse that constructs the nurse as female heroine healer, doctor’s loyal assistant, and girl of ‘average intelligence’, now co-exists with a new discourse that positions the nurse as, over educated for the work of tending to the sick. This new discourse portrays a nurse who is ‘too clever to care’ (Templeton, 2004) and ‘too posh to wash’ (Hall, 2004), and who has unilaterally rewritten her contract with society and withdrawn from ‘core nursing’ (Healy, 2005). This debate continues to be conducted in the pages of the nursing and medical professional press and in the national press. It is present alongside the stance that modern healthcare requires nurses who are educated, adaptable and able to practice advanced skills.

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In some contexts nursing is perceived as the common sense application of a set of basic skills, rather than a challenging role that involves working within complex environments, demonstrating ethical integrety and carrying out intricate care in a compassionate manner (Longley et al 2007; Watson 2011). It is argued that the educational progression of the profession is continually hindered by an education system which is required to justify attempts to foster enhanced knowledge and critical thought, due to a misconceived polarisation of intellect from compassion. Drawing on these arguments it appears that in order for nursing to address these constraints, the development of higher order thinking skills among practitioners is not only desirable but also essential (Watson 2006).

Within this climate, new educational programmes are being developed internationally that are designed to attract graduates into the nursing profession. The arguments discussed in this review indicate how nurse education could present a potentially resistant environment for nursing students with a background in higher education to learn. It is possible that they may encounter hostile and negative attitudes from within the profession. The way in which current GEN students interpret this reception and reaction presents an opportunity to explore its impact on presentation of self and their perception of their positioning within nursing as a profession.

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Chapter 2: Literature Review

Perception of Self: Identity, Role, Performance and Professional

Socialisation

2.1 Introduction

The evidence base relating to GEN students and graduates is markedly underdeveloped despite the growing popularity of GEN programmes and the positive rhetoric that surrounds the potential contribution graduates could make to nursing as a profession (Neil 2011). There remains a lack of qualitative data that explores _{GEN students’ experiences of} becoming a nurse, the factors which influence their perception of the profession and how they position themselves within this (Neill 2012; Hackett and McLafferty 2006). As a result, programmes of study are not necessarily designed to meet the unique requirements of this student group because they rely upon educational and sociological research relating to students who have a different personal and professional background (Hackett and McLafferty 2006). It is possible to speculate therefore, that assumptions are required to be made by educationalists and that these are are likely to reflect media portrayals of traditional nursing programmes, the experiences of graduates entering another profession (such as medicine) or mature students entering nursing through more traditional and arguably accepted routes. It is proposed that GEN students are exposed to a range of prevailing discourses in education, practice and the media regarding the negative association between higher intellect and the ability or willingness to show care and compassion. This is alongside a pro-inteelectualist stance which maintains that nurses now require cognitive abilities which are fostered through university education. There is potential for students, educationalists and practitioners to rely on stereotypes or false perceptions influenced by these competing discourses to moderate their interactions. These could have _{the potential to influence the students’ sense of personal and} professional self and how the nursing profession receives them.

These issues will be explored within this thesis through the analysis of the experience of the first cohort of GEN students to complete a programme within a geographical locatilty that had not been exposed to this type of student before. It is therefore important to consider theoretical and empirical debates surrounding the construction of professional

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identity as potential lenses through which to view the GEN students_{’ accounts of their} experience of nurse education. The following section discusses seminal theoretical debates regarding the way in which identity is formed and presented within social interaction. It draws on theorists and research evidence that specifically attempts to explore the concept of professional identity and socialisation in nursing. The literature informing this discussion was generated from the original writings of seminal theorists and by searching the journal databases OVID, Medline, Synergy and CINAHL between 1985 and 2012. The search terms included: professional identity; professional socialisation; role and attributes combined with nursing. The key commentators and researchers in this area were identified and all related work in alternative locations was sourced. Finally, the reference list of articles judged as relevant were scrutinised and potentially informative citations were located.