Being a real nurse : nurses' accounts of learning and working in practice

There has been much written regarding nurse education and the socialisation of student nurses in clinical areas in the past (Olesen & Whittaker 1968, Orton, 1981, Melia, 1987, 1997, Ogier, 1989, Castledine, 1995, Bradshaw 2001, Spouse, 2003). The originality of this thesis lies in the discussions and exploration of the concept of Problem Based Learning (PBL) as a teaching and learning strategy and the implementation of the Making a Difference (DoH, 1999a) recommendations in a nursing curriculum. It investigates whether or not these have indeed made a difference to the ability of the students to socialise into their clinical roles and effectively meet their ultimate aim of becoming a ‘real nurse’. The thesis is split into five chapters and employs qualitative research methods to present an ethnographic case study of the experiences of student nurses in clinical placement areas regarding the process of becoming effective student nurses who ultimately develop their knowledge and skills base to become ‘real nurses’. The sample consisted of fifteen (15) students, fifteen (15) student mentors, eight (8) ward managers, one (1) practice development coordinator and one (1) senior nurse responsible for clinical development. Interviewing and observation techniques were used to obtain the data. PBL as a teaching and learning strategy is investigated and discussed, in relation to the students’ ability to develop critical problem solving skills that can be incorporated into their student roles. The disadvantages of PBL are also debated and issues highlighted that may cast doubt that this strategy and the Making a Difference curriculum has actually changed attitudes in the clinical areas towards the capabilities of the student nurse role. Eight major themes arose from the data analysis; learning to be a student, fitting into the clinical team, being professional, being a real nurse, the role of the practice development co-ordinator, effective mentors, developing clinical skills and reflecting in practice. Integral to these were the concepts of professionalism, power, inequalities and culture that were identified as significant underlying issues for the students to recognize when performing and developing into their clinical roles. The data suggest that the new curriculum and PBL have offered some solutions to help overcome the perceived boundaries of professionalism, power, inequalities and culture but by no means provides all the answers. Overall the study has highlighted the importance of clinical skills development and effective delivery of them by students in learning to become a ‘real nurse’. Through their experiences the students have learnt how to overcome boundaries and to fit in with the culture of clinical areas thereby enabling them to learn the role of the student nurse. Furthermore, the newly developed roles of the practice development co-ordinator and established mentor roles are perceived to be invaluable sources of support for the students while in clinical placement area