Student Expectations of Nursing Education
- Findings from the Focus Group Research
- Considering aspirations and expectations in nursing education
- Factors influencing desire to study
- Family and social background
- Experience of nursing
- Cultural representations of nursing.
- Factors influencing selection of course
- Proximity of a campus and low entrance scores
- Promotion of nursing as a career
- Pathways to entering nursing education
- Construction of nursing identities
- Professional
- Desires and deficiencies mapped onto nursing
- Students' views
- Awareness of transformation
Findings from the focus group research
This research was conducted by hosting ten focus group sessions on five separate university campuses in Victoria, New South Wales and Queensland. In all, 78 students of nursing education participated in the focus group sessions: 32 first-year, 35 second-year and 11 third-year. Of these students 22 had completed a Certificate IV in Health (Nursing) or the equivalent, also referred to as an Enrolled Nurse (EN) in NSW and Queensland, or a State Enrolled Nurse (SEN) in Victoria. The names used in this report are pseudonyms.
Considering aspirations and expectations in nursing education
What students aspire to do once they have gained a nursing qualification may be different to what they expected to be doing when they entered the program, and different again from that which was the initial impetus to train. While this research focuses on the aspirations student nurses have for their professional practice and how this combines with presumed lifestyle options, it also includes information about early influences that may have shaped these views. The focus group contributions will initially be analysed according to factors that were said to have influenced intentions to nurse, and why a particular course or institution was chosen. A series of common themes emerging from the study are then presented and those themes analysed according to certain group characteristics. The final portion in this section concerns issues raised about the courses and their teaching.
Factors influencing desire to study
Students in the focus groups chose to study nursing for a variety of reasons. Predominant among these were that family members had been nurses or had worked in allied health or caring occupations, or that the students had had the opportunity to observe nursing practice. This was often due to a period of hospitalisation of either themselves or a close family member.
Both the students from non-English speaking backgrounds who were in the study, explained that they felt that they were expected to go into nursing if they didn't gain qualifications in an administrative occupation.
The encouragement of older family members, particularly female members, strongly influenced a number of participants in the research. Female students also intimated that they considered nursing was the preferred choice from a limited array of traditionally female occupations.
A large proportion of participants, 31%, had worked as an EN or SEN prior to enrolling. This gave first-hand experience of providing patient care. In some cases, it was the frustration of being able to provide only a limited level of care that propelled students to undertake their course of study.
Elsie had worked in a retirement home before enrolling to become an RN via SEN training. The work in the retirement home was limited in scope and responsibility, predominantly supervising showering, making beds and checking blood sugar levels. Additionally, Elsie noted that the staff rarely used medical terminology when discussing patients and generally acted in a manner that she considered wasn't highly professional. Elsie saw enrolling to become an RN as a means of developing further skills and professional standards.
By comparison, Rae also worked with elderly people, but in a respite care facility. She began working there as a kitchen hand and was invited to progress to showering when her ease of interaction with the patients was noticed. For Rae, the satisfaction of her experience of working in a carer role with elderly people encouraged her to pursue a career in nursing.
The experience of working in health care positions provided a powerful incentive for some to pursue qualifications as an RN. Not only did qualifying as an RN hold the promise of greater status and responsibility but also higher pay and greater flexibility.
Cultural representations of nursing.
The popular television series ER and All Saints portray nursing as being a glamorous occupation where attractive hospital staff form stimulating relationships and perform heroic feats. The shows characterise hospitals as exciting, rewarding workplaces where an impressive degree of professional collegiality exists amongst medical staff. These representations were in stark contrast to the picture drawn by some of the staff teaching on nursing education courses, and by the experiences gained during clinical practice.
Some students cited a perceived stigma of nurses as 'dumb', which consequently contributed to a perception of nursing education as 'easy'. There was general agreement, however, that despite these perceptions, the course, like the profession itself, is difficult and demanding.
Factors influencing selection of course
Proximity of a campus and low entrance scores
The location of the campus in relation to students' homes and the possibility of gaining a place in the course were the two most common factors cited for studying at a particular university. On one rural university campus students were generally residents of the town, or had travelled from nearby rural areas to attend. Not surprisingly, a large proportion of these students planned to work locally once they had completed their qualifications. This is not to suggest, however, that a preference to study and work locally is solely a characteristic of rural students. Students in the study who attended a university campus on the western fringe of a capital city had also applied for places at their 'local' campus and aspired to work in that area.
The availability of places at a given university was also a key factor in determining campus and course. A number of students revealed that they had wanted to study other courses including medicine, psychology, veterinary science, speech pathology and physiotherapy, but had not gained high enough marks. For these people nursing had been accepted as a second preference. One student was studying nursing as a first degree before studying medicine, another as a component of sports medicine and another as part of a public health program. Some had been not offered places in a nursing program on the basis of their TER or UAI score, but instead had gained a place on direct entry.
Promotion of nursing as a career
There was little mention of school careers advisers or university open days influencing students to take up nursing as a career. Student's selection of nursing as an area in which to train was attributed mostly to the encouragement of family members or through personal observations of nurses at work.
There was some discussion around suitable ways of attracting appropriate students to nursing.
Louise found that in her Faculty a larger number of students than she had expected were doing nursing as a stepping stone to something else, or simply because it was the only course they could get into with a low TER. These, she believed, were not good reasons to be undertaking the course, because they were not dedicated to being nurses.
By contrast, Sandy, who had wanted to be a doctor but didn't gain a high enough TER, has found nursing to be a preferable alternative and now definitely wants to stay in nursing.
It appears to be an assumption that the requirements and practices of nursing are understood in the community, and perhaps because of this nursing is not promoted as a profession. However, a large number of nursing education students indicated that they had found nursing to be far more complex and varied than they had imagined. If nursing students had misapprehended the role of the nurse, then we might conclude that others have too.
Pathways to entering nursing education
The tertiary entrance or university admission scores (TER or UAI) for the nursing programs of the universities in this study varied from a high of 80 to a low of 60. However, many of the participants reported that they had gained admission through direct entrance schemes, and would not have been able enrol otherwise because their entrance scores were too low. Some of these students admitted to having gained TER scores in the 30s. However, the researchers made no attempt to determine the tertiary entrance scores of the participants in the study. In the study carried out by (Lawler, Ahern et al. 1997) it was found that, in 1997, 33.62% of applicants for nursing places had TER scores of less than 30, that 60.94% had TER scores of less than 50 and that 82.28% had TER scores of less than 60. This suggests that applicants for nursing programs are unlikely to be good students and possibly explains the preference of students for practical activities rather than theoretical approaches.
One university in the study offered a graduated entry to gaining a qualification as an RN. This pathway involved doing Science for Nurses, a 'Gateway' course to gaining entry to a program that would give a Division 2 nursing qualification (the equivalent of an SEN or EN. This Division 2 qualification then articulated to qualifying as an RN. One participant, Paula, reported having done the Gateway and Division 2 courses prior to her RN training.
Paula's primary and secondary education had been substantially disrupted as she and her family moved frequently. Her father was in the airforce and had been stationed in Malaysia, Thailand and at various bases in Australia, and the family was regularly relocated. Consequently, her educational preparation was fragmented and lacked vocational direction. She was pregnant at 18, had two children and was divorced by the time she was 20. Now in her early thirties, her income earning activities had consisted mostly of work as a waitress and a 'check-out chick'. Paula had wanted to nurse since childhood and gained a place in the Gateway program via a Job Education and Training (JET) adviser at CentreLink. A friend had suggested going to CentreLink after Paula had lamented not realising her ambition to qualify as a midwife.
Paula was one of four participants, in a focus group of seven, who had completed the Gateway and Division 2 programs. Three of the four Division 2 qualified nurses in this particular focus group had experienced educational interruptions or disadvantages. However, in NSW apparently the same option to articulate from Division 2 to an RN qualification did not exist. Participants in some focus groups conducted in NSW complained that no advanced standing or recognition of prior learning was given to Assistants In Nursing (AIN) or EN, despite their relevant experience.
Construction of nursing identities
The students contributing to the focus groups expressed views about the how they saw nursing and, in so doing, revealed that they identified nursing in a variety of distinct ways. However, while this information is often portrayed as fixed, identities are continually being revised and updated as new experiences and information is gained, this is also true of the nursing identity. The comments below reveal nursing identities as a construct of personal aspirations and as influenced by the experiences and activities offered through the course of their nursing education
When one focus group was asked their reasons for doing the course for, Terri responded,
To be a registered nurse and after [the experience of] my last placement, I'm planning to go into paediatrics.
This might seem to be the answer that most students doing a course to qualify as a nurse would give, but the comment has particular importance because it was not the answer that most gave. Many offered responses that suggested students had constructed nursing as something that would replace certain deficiencies in their lives, that they had undertaken the course because it was the best option available, or that they were beginning to glimpse a different image of nursing to that which they began the course with.
Desires and deficiencies mapped onto nursing
Denise described herself as a full-time mother who was doing the course because she 'didn't want to stay home for the rest of her life and wanted to help other people'. While this comment does identify nursing as a helping or caring profession, that information was preceded by a comment that essentially devalued the traditional female role of homemaker. Dana, a single mother who began nursing 35 years ago and was now retraining, had wondered "what am I going to do with the rest of my life?" and resolved that question by deciding to retrain.
Others highlighted the vocational aspects of nursing as an occupation. Willie explained his choice to study nursing using terms that emphasised its potential as a long-term vocation. He had worked as an assistant to a landscape gardener but found the work infrequent and irregular. Willie used words like 'interesting', 'career', and 'opportunity' when he described his intended nursing career, words that indicated the anticipated benefits to him rather than the benefits that might accrue to others. Jeff wanted to nurse as a change from his trade of upholstering, explaining that he was tired of working for himself.
Some conceptualised nursing as being composed of certain fixed qualities.
My satisfaction comes from doing a job well. I'm one of those people who believe in compassion, it's a basis for being a nurse. You need to be compassionate about your patients; you need to want to make a difference about human suffering. For me the satisfaction of nursing is the satisfaction of being able to make someone's life better (Terri).
However, Terri didn't think that the course she was studying offered support for this point of view at all. Trevor, from the same group, attempted to explain why this might be by stating that "compassion comes from within" and that while you can be taught to behave towards patients in a compassionate manner, compassion cannot be taught. "It's a core emotion that you've either got or you don't". This view indicated an assumption that nursing, as it is practiced, had a fixed identity. Therefore to be a nurse a student must have certain pre-requisite personal qualities to be successful.
The view of nursing as having a fixed identity was extended by some when discussing their courses of study. Willie, in his third year of nursing education, said he felt that "certain temperaments suited certain nursing positions" and that students needed to have these pointed out to them early in first year so that they could direct their studies towards their preferred specialisations. This view presumes that students have a comprehensive understanding of nursing as a profession and that students are aware of their work preferences at an early stage of their courses. Thus, we would conclude from this, that nursing education was unlikely to be more than a mechanism for training students to occupy predetermined workforce positions, and not expected to alter existing preconceptions or understandings of what nursing is. In some ways this view is not dissimilar from the position taken by those who argue that nurse training was better when it was based in hospitals. This position though, was not supported by all others in the group and others commented on how their interests had developed and changed after experiencing different nursing situations during clinical practice.
Students were aware of a tension between the identity of nursing as a task oriented activity (making beds, changing bedpans etc.) and the identity of nursing as a 'profession'. The latter is emphasised by their lecturers. However, even this professional identity was not consistently articulated by the teaching staff in nursing faculties. At one metropolitan university, students reported there being considerable differences between staff; some of whom talked of the 'nobility' and worth of nursing and some that sought to destroy the image of nursing as a glamorous activity. This picture was made additionally complex by the nursing staff the students encountered on clinical practice that dismissed all university teaching as irrelevant. Faculties that presented a cohesive image of nursing tended to empower students more effectively than those that developed conflicting identities of nursing.
Many first-year students were also contending with their own identities as students, and wondering whether they were capable of university study or not.
When looking for a suitable university at which to study nursing, Kim had specifically chosen the one that didn't require her to sit a written entrance exam. Having not been involved in any formal study for a period of 10 years caused her some anxiety about her ability to perform adequately as a student. Completing reports and other written assignments had been difficult at first but now as a third-year student she wasn't finding this a problem.
Nursing education in this example has an identity of being academic and demanding of the ability to study. This formulation is quite different to the views of nursing as a helping profession or one of practical skills.
When Tiffany began her nursing education she imagined that she would be working as a theatre nurse or perhaps as a mid wife. Now in third-year and after attending lectures and having had the experience of various of clinical practice placements her view of nursing has greatly expanded.
Now, everything's opened up! I could do cardio, thoracic, neo-natal, ... anything
Clinical practice experiences are often considered to be primarily a way of acquiring skills, they also served to provide a realistic view of what the work of nursing entailed. One student commented that "you realise how much there is to be done. How much behind the scenes activity goes on" (Jenny). With the benefits of observation, practice, theoretical explanation and critical engagement, many students constructed an expanded identity of nursing.
Dana and Terri both indicated a desire to 'fix the health care system' and imagined that this might best be done by embarking on political careers, in Terri's case by becoming Minister for Health. This view had formed while participating in the course and learning about the state of the health care system, and realising that what needed to be done could be done by someone with a knowledge of nursing.
You certainly aren't going to fix the problem if you have a shoe salesman as your Minister for Health (Terri).
These comments indicate an awareness of an emerging capacity and a developing sense of agency as a nurse. This appears to be an stage that must be achieved if a student is to embrace a professional identity and assume a place among peer nurses.
Any comments or queries should be sent to: highered@dest.gov.au
This page was
last updated on Tuesday, 04 December 2001
Department of Education, Science and Training
Copyright © Commonwealth of Australia
DEST Web Site Privacy Statement
Disclaimer