Nyutexaminerade sjuksköterskor yrkessocialisation - Erfarenheter av ett introduktionsprogram

Abstract

ABSTRACT

Through the ”VÅRD 77” amendment and the higher education reform from 1993, nursing education has been changed from vocational to academic. Theoretical aspects of nursing have been emphasised above clinical ones, and since 1993 clinical training has been reduced in such a way that the traditional professional and clinical skills of newly graduated nurses have changed. An increased theoretical focus and decreased clinical training have resulted in sharp criticism from health care institutions against the content of the nursing education programme, specifically regarding the fact that newly graduated nurses fail to meet demands and expectations on the professional skills and competence of a nurse. As a consequence of this criticism, employers offer newly graduated nurses introduction programmes after they have completed their nursing education. This study focuses on the newly graduated nurses´ experience of an introduction programme as they are about to enter the labour market. The aim is to analyse and describe the learning process of newly graduated nurses in professional situations and how they are socialised into the profession and seek meaning in their encounter with that environment. The theoretical framework is symbolic interactionism, used to understand how the newly graduated nurse interacts with other members of the staff as well as the environment in which interaction takes place. The research method is ethnographic, and the empirical material is based upon data from participant observations, interviews and field notes. The result shows that all eight workplaces use the master-apprentice system as a model for supervising newly graduated nurses during the introduction programme. In this model, the novices learn how to imitate and seek knowledge through the experienced nurses. The fact that workplaces are free to choose among supervision models may explain why the traditional model is used in the introduction programme. This model primarily offers the novices an opportunity to practice practical and technical tasks and learn how to act like the master. The result also shows that the novices have theoretical knowledge and know what action to take, but that they may have trouble assessing which part of their knowledge to use, which shows that they do not have the readiness to act or the competence required in the profession. The introduction programme must therefore give newly graduated nurses the opportunity to practice professional skills in different patient situations and allow them to perform tasks independently to a higher degree. Results also show that the staff questions and strongly doubts the professional skills of the novices, which means that they must constantly prove their professional ability in order to attain member status. Through various sanctions and master suppression techniques employed by the staff, the novice is formed into a nurse oriented towards medicine/science. The novices end up as outsiders if they deviate from the norms and expectations associated with the professional role. This explains why several of the novices in this study become outsiders. Novices must therefore adapt in order to avoid becoming outsiders. The result further shows that there is tension between the academic environment of the nursing college and the professional environment. Within nurse education the ideology of nursing and the development of critical thinking have been prominent, but within the profession the emphasis is on good vocational skills. This means that novices end up posited between two cultures, something which can be described as being in a marginal situation. One conclusion that can be drawn from the result of this study is that the introduction programme, as it is structured today, posits an obstacle in the professional development of the novices.