THE LIVED EXPERIENCE OF NURSES WORKING WITH STUDENT NURSES IN THE ACUTE CARE CLINICAL ENVIRONMENT
Submitted to the Graduate Faculty of the Louisiana State University and Agricultural and Mechanical College In partial fulfillment of the requirements for the degree of Doctor of Philosophy In The School of Human Resource Education And Workforce Development
by Donna Coffey Hathorn B. S. N. Northwestern State University, 1977 M. S. N. Northwestern State University, 1986 December 2006
Copyright 2006 Donna Coffey Hathorn All Rights Reserved
ACKNOWLEDGEMENTS I wish to acknowledge the members of the graduate faculty committee, M. Burnett, PhD; E. Johnson, PhD; G. Johnson, PhD; K. Machtmes, PhD, and T. Page, PhD. I owe special thanks to the Chairperson of the committee, Dr. Krisanna Machtmes, who was always there for me as an advocate and advisor. I appreciate the support, guidance, encouragement, mentorship, wisdom, friendship, and timely humor that Dr. Machtmes provided for me. Dr. Machtmes had faith in my ability and like all great teachers and leaders inspired me to have faith in myself. This self awareness and personal enlightenment motivated me to work to my full potential to accomplish difficult tasks. Like a coach Dr. Machtmes urged me to reach down deep and apply the utmost rigor to produce a dissertation that I could be proud of. Most importantly, she treated me with genuine respect and collegiality. I will never forget her acts of kindness and empathy on several occasions when the going got rough. She and her family, Roland and Ryan, are very precious to me. I wish to thank my dear colleague, Kenneth Tillman for being a sounding board, study partner, carpooler, and friendly competitor throughout the past four years. As in any race, Ken was like a pace car that kept me from slowing down too much and getting behind. We spent hours together at the local coffee shop discussing, debating, studying, answering questions, and encouraging one another to continue on until our goal was reached. I appreciate his patience with me as I frequently interrupted him to say let me read this to you. We never realized what we were getting into that day when we both agreed to get our Doctor of Philosophy degree together. I also want to thank his wonderful family for the meals and study time in their home. Another colleague that I wish to thank is Dr. Jeanie Ricks Harper for her encouragement and help with qualitative research. Jeanies talent as a qualitative researcher was an inspiration toiii
me. I also wish to thank my teaching partner Dr. Lorinda Sealey who always altered my work schedule before I even asked so that I could have time to meet important deadlines regarding my program of studies. I appreciate the fact that she recognized that it was my turn to work on a Ph.D. and she offered understanding and encouragement. I am grateful to my husband Jeff for his willingness to make sacrifices to allow me to fulfill my academic dream. He tolerated me staying up late nights, being away at the coffee shop studying, and attending all those night classes. He has always been proud of me and supported me in my academic endeavors. To my sons Jeffrey, Jared, Jason, Joshua and to C.C. my new daughter in law, a special thanks for their understanding and patience. I hope that my achievement will be an inspiration for each of them to reach their full potential and calling in life. I acknowledge the members of Holden Baptist Church for all their prayers and encouragement as I pursued this great academic achievement. They understood how important this accomplishment was for me and cheered me on to the end. My faith in God helped me to be strong because I knew this was the right time and the right place. I give ultimate thanks to Jesus Christ my savior and my Lord!
TABLE OF CONTENTS
ACKNOWLEDGEMENTSiii LIST OF TABLES.....vii LIST OF FIGURES......viii . ABSTRACT.......ix CHAPTER 1 INTRODUCTION....1 Problem Statement.......2 Definition of Terms..3 Limitations....3 Significance of the Study..3 2 REVIEW OF THE LITERATURE......6 Clinical Environment as a Learning Environment.......6 Professional Socialization Attitudes......12 Nurses Motivation and Incentives to Work with Students...18 Role Theory and Professional Socialization..19 Collaboration between Nursing Education and Nursing Service..20 Legal Considerations in Nursing Education..25 METHODOLOGY.29 Qualitative Research..29 Phenomenology and Phenomenological Method...30 Phenomenological Processes.33 Epoche...33 Phenomenological Reduction....34 Imaginative Variation....35 Synthesis35 Data Collection Preparation...36 Conceptual Model..36 Researcher Role.37 Guiding Questions.40 Credibility..41 Sampling Strategy..............42 Informed Consent, Confidentiality, and Selection Process...44 Pilot Study.....45 Data Collection..46 Interview Process..46 Ethical Dilemmas..47 Organization, Analysis, and Synthesis of Data.49v
ORGANIZING, ANALYZING, AND SYNTHESIZING DATA ....52 Horizonalization.52 Meaning Units....52 Themes...79 Thematic Textural-Structural Descriptions....80 Kate.81 Jenny...86 Sarah...92 Tommy....98 Natina...104 Cindy.110 Composite Thematic Textural-Structural Descriptions...116 SUMMARY, OUTCOMES, AND IMPLICATIONS..127 Summary..127 Outcomes.130 Implications......136
LIST OF TABLES 1. Themes and descriptions of the lived experience of nurses working with student nurses.80
LIST OF FIGURES 1. 2. Conceptual Model of the Experiences of Nurses Working with Student Nurses.38 Conceptual model of Kates experience of working with student nurses in the acute care clinical environment..85 Conceptual model of Jennys experience of working with student nurses in the acute care clinical environment..92 Conceptual model of Sarahs experience of working with student nurses in the acute care clinical environment..98 Conceptual model of Tommys experience of working with student nurses in the acute care clinical environment104 Conceptual model of Natinas experience of working with student nurses in the acute care clinical environment110 Conceptual model of Cindys experience of working with student nurses in the acute care clinical environment116 Conceptual model of composite experiences of working with student nurses in the acute care clinical environment126
ABSTRACT The purpose of this phenomenological qualitative study was to describe the lived experience of nurses who work with baccalaureate student nurses in the acute care clinical environment. Because of the nursing shortage nursing education is challenged with equipping a safe qualified workforce while preventing or reducing student attrition. Students may choose to leave the profession or receive less than optimal learning experiences when exposed to negative socialization behaviors of nurses while in the clinical environment. Findings from this study can be used to foster collaboration between nursing education and nursing service in the development of positive clinical environments for nurses and nursing students. The methodology used for data collection was one-time, in-depth semi-structured informal audio taped interviews of staff nurses who worked with student nurses in an acute clinical setting. Saturation of the data was determined after six interviews. Data analysis was conducted according to the modified van Kaam method. The following themes emerged: beliefs about nursing education, role expectations, communication structure, motivational factors, deterrent factors, and professional socialization attitudes. Findings from this study revealed that nursing education and service should establish more effective communication between staff nurses by providing them with job descriptions and role expectations while working with students. Staff nurses also need to be informed of the students learning objectives, and competencies. Staff nurses need to be empowered to change the clinical environment and resolve conflicts that may arise as a result of having students in their work environment. Most importantly the staff nurses need to be educated about their legal liability and responsibilities when working with students. Students should also be informed of their legal responsibility for nursing practice before attending a clinical course.ix
Implications for research are to increase qualitative and quantitative studies on staff nurses who work with baccalaureate student nurses in all areas of clinical practice. Studies related to the nurses educational preparation and faculty perceptions of staff nurses working with students are needed. Future research is also needed on the effects that clinical practice models used in baccalaureate nursing education and collaborative educational reforms have on nurses, students, and faculty.
CHAPTER 1 INTRODUCTION The nursing shortage has presented nursing schools with the challenge of equipping a safe, qualified workforce of nurses to reduce the shortage; yet, retention of students is a major issue in meeting this challenge. Wells (2003) stated that inability to retain nursing students in nursing programs negatively impacts the supply of registered nurses to meet the demands of the nursing shortage. High rates of student attrition can be prevented by identifying critical points for intervention (Wells, 2003, p. 230). One critical point for intervention is in the area of clinical practice experiences. Negative attitudes of nurses toward nursing students in the clinical practice setting has the potential of obstructing student learning and therefore threaten student progression and retention within the nursing program (Chan, 2002). The clinical environment is a learning environment where students are soci