Essay Writing Service http://StudyHub.vip/A-Key-Transition-For-Student-Nurses--Th 👈

1. Contemporary Issues
A key transition for student nurses: The first placement experience
Keywords:
Student retention
Clinical placements
Pre-registration
Transitions
Engagement with work
Introduction
Attrition from pre-registration nursing courses is a global concern
because of the economic implications, personal impact on the student
and the loss to the future nursing workforce. Promoting student re-
tention is therefore of interest to an international audience concerned
with the educational and clinical preparation of nurses to meet the
challenges of healthcare delivery in the 21st century. In the United
Kingdom (UK) the mandate to improve retention rates has been ac-
centuated by government policy drivers and the incentive of financial
rewards to Higher Education Institutions (HEIs) who succeed in re-
ducing their attrition rates (Department of Health, 2006). Reasons
for attrition have been widely discussed in the nursing literature and
acknowledged to be multifaceted (Cameron et al., 2011; Urwin et al.,
2010) and difficult to manage because they are complex and inter-
linked. The evidence base for effective interventions representing a ro-
bust, strategic approach to managing all the known contributory
factors is slow to emerge, despite the Department of Health's (2006)
guidance to HEIs on managing attrition in nursing and midwifery
courses.
The clinical placement experience is one of the factors that have
been identified as contributing to decisions to leave and recent litera-
ture shows increasing interest in this area (Eick et al., in press;
Hamshire et al., 2012; O'Donnell, 2011; Pryjmachuk, et al, 2009;
Royal College of Nursing, 2008). In our own institutions we have iden-
tified peaks in attrition in the first year, notably at the end of the first
clinical placement. The aim of this paper is to draw attention to the
first placement experience which we identify as a key transition that
greatly influences decisions to stay or ‘drop out’.
The First Year Transition
There is an extensive literature which relates transition into higher
education as a whole and the quality of the first year experience to risk
of withdrawal (Eun-Ok, 2011; Yorke and Longden, 2007, 2008;
Whittaker, 2008; Harvey et al., 2006; Parmar and Trotter, 2005;
Tinto, 1993). Recognition of the link to student retention has informed
a number of initiatives related to transition support during the first
year. Typical approaches integrate pre-entry preparation, timely pro-
vision of information at induction to avoid information overload,
focus on social and academic integration and development of peer
support networks. However, Harvey et al. (2006) concluded from
their review of the international literature that there is no single
“first year experience”, rather it should be viewed as “an important
part of the long process of cultural, social and academic assimilation
into the world of higher education” (p.139).
The Placement as a Transition
Many authors in the international nursing literature have examined
the transition from student to newly qualified nurse, often referring to
the “reality shock” coined in Kramer's (1974) seminal work. Although a
few authors have described transitions during pre-registration pro-
grammes (Bradby and Soothill, 1993; Baldwin et al., 1998; Holland,
1999; Brennan and McSherry, 2006), hardly any have focussed exclu-
sively on the transition through the first placement (Melling, 2011;
Andrew et al., 2009). In very simple terms a transition can be seen as
an event or series of closely related events (either anticipated or unex-
pected) that results in change from one state to another. Expectations as-
sociated with a transition may or may not be realistic; however the
experience is less stressful when the person knows what to expect
(Schumacher and Meleis, 1994). Meleis (1991) remarked that the per-
son in transition is required to assimilate new knowledge, alter behav-
iour and therefore adjust the concept of self in a social context. This
may be related to the dynamics involved in the process of developing a
professional identity as a nurse. Professional socialisation has been dis-
cussed extensively in the literature, and is described by Goldenberg
and Iwasiw (1993) as “a complex interactive process by which the con-
tent of the professional role (skills, knowledge, behaviour) is learned,
and the values, attitudes and goals integral to the profession and sense
of occupational identity which are characteristic of a member of that pro-
fession are internalised”(p. 4).
The “theory-practice gap” has long been discussed in the nursing
literature and criticisms levelled at university providers that stu-
dents are inadequately prepared to meet the reality of clinical place-
ments for the first time (Evans and Kelly, 2004; Wood, 2005). Price
(2009) argues that early socialization experiences such as exposure
to idealised views of nursing may cause dissonance in the initial
days of placement as previous assumptions and expectations must
be adjusted to accommodate what is encountered in practice. In ad-
dition, students are said to come to regard the university and clinical
placements as disparate “worlds” and struggle to assign meaning to
practices that are inconsistent with that taught in the classroom
(Grealish and Trevitt, 2005).
Millward (2005) refers to a useful description by Nicholson and
West (1988) of four stages in role transition: preparation (psychologi-
cal readiness); encounter (which may involve shock or surprise); ad-
justment and finally stabilisation. A number of authors have discussed
role adjustments and adaptations during professional socialisation of
Nurse Education Today 32 (2012) 779–781
0260-6917/$ – see front matter © 2012 Elsevier Ltd. All rights reserved.
doi:10.1016/j.nedt.2012.05.022
Contents lists available at SciVerse ScienceDirect
Nurse Education Today
journal homepage: www.elsevier.com/nedt

2. student nurses (Bradby and Soothill, 1993; Holland, 1999; Ousey,
2009). Some of the literature considers a conflict between dual roles
(university student and nurse) to be the source of much of the difficul-
ties experienced on placement as students are required to move be-
tween two worlds. Other commentators argue that these worlds
should not be incompatible and nurse educators should focus on creat-
ing communities of practice (Lave and Wenger, 1991) in both academic
and clinical settings at the beginning (Andrew et al., 2011). This would
encourage academic and professional integration and the sense of be-
longing and significance that have been identified as essential to the
success of the first year experience.
Various factors have been highlighted in the literature which we
view as important when considering how to provide support for during
the first placement experience: the quality of mentorship (Gray and
Smith, 2000); feeling valued (Last and Fulbrook, 2003); belonging and
support (Bowden, 2008; Levett-Jones and Lathlean, 2008). The conclu-
sions of Cameron et al. (2011) and from recent studies indicate that
research should now focus on understanding the conditions that en-
courage those who have considered leaving to stay (Bowden, 2008;
O'Donnell, 2009; Fowler and Norrie, 2009; Mallik et al., 2009). This is
consistent with the increased emphasis of Higher Education Academy
and the Quality Assurance Agency (the body responsible for assuring
standards in higher education in the UK) on developing strategies to
promote retention and student success through improving the overall
student experience rather than merely preventing attrition.
Placements and Retention
Although it is unfortunate that empirical studies directly investigat-
ing the relationships between the placement and retention are rare,
some recent studies have sought the views and experiences of student
nurses themselves (Hamshire, et al., 2012; Hinsliff-Smith et al., 2012;
Melling, 2011; O'Donnell, 2011; Keogh et al., 2009; Mallik et al., 2009;
Parmar and Trotter, 2005; Pearcey and Draper, 2008). This provides in-
valuable insight into what it is like to be a student on placement. For ex-
ample, McGarry et al. (2010) found that graduate entry nursing (GEN)
students on an accelerated pre-registration programme particularly
valued the shared input and support from their peers which enabled
them to process and incorporate their placement experiences into the
problem solving learning process.
The recommendations from the study by Mallik et al. (2009), in-
cluded suggestions from the student participants themselves. Listen-
ing to the student “voice” encourages us to recognise the needs of a
non-homogenous student population and to provide tailored support.
The mature students in the study reported by Hinsliff-Smith et al.
(2012) revealed a unique dimension to the dual role usually ascribed
in the literature to student nurses. Rather than reporting tension be-
tween being a university student and a nurse on placement, the par-
ticipants identified conflict between dual roles of student and parent
and coping with academic demands and childcare provision whilst on
placement. An unusual finding in Hinsliff-Smith's work is that the
participants identified themselves as individuals with life experiences
rarely acknowledged or incorporated into the learning experience on
placement and which caused additional role conflict (Hinsliff-Smith,
2011).
Student Engagement
The present trend in higher education towards promoting retention
through increasing student engagement corresponds to the emphasis in
occupational health psychology on the concept of “engagement with
work” (Maslach and Leiter, 1997; Schaufeli et al., 2002; Bakker et al.,
2008). Engagement with work is a useful theoretical framework to fur-
ther our understanding of factors that contribute to student retention
and to provide a basis for interventions related to improving the place-
ment experience. Work engagement is characterized by energy,
involvement and efficacy (Maslach and Leiter, 1997) and described as
“a positive, fulfilling, affective motivational state of work related well-
being that is characterised by vigour, dedication and absorption”
(Schaufeli et al., 2002 p.74). It has been associated with employee reten-
tion (De Lange et al., 2008), well-being and positive job performance
(Bakker, et al, 2008) and also applied to student populations (Schaufeli,
et al, 2002). It is particularly applicable to pre-registration students
because of the dual contexts of university and practice placements and
provides a framework for integrating academic and placement learning
support.
Harter et al. (2003) specify four elements required for engagement
at work:
1. clarity of expectations
2. feelings of contribution to the organization,
3. feeling a sense of belonging to something beyond oneself
4. feeling as though there are opportunities to discuss progress and
grow
We consider these useful principles to inform our strategic approach
to student retention as we seek to provide positive and supportive
placement learning experiences.
Conclusion
The significance of transitions in “the student journey” is acknowl-
edged in the general literature on student retention, in particular the
passage into higher education and the importance of providing aca-
demic and pastoral support at these points is well documented. This
paper has highlighted the first clinical placement as an additional
transition for student nurses that is both complex and dynamic and
a time when preparation and support is crucial. Innovations to expand
existing transition support could focus on pre-course preparation, clar-
ification of expectations and peer support before and during the first
placement. In 2006, Tinto stated “Most institutions have not yet been
able to translate what we know about student retention into forms of
action that have led to substantial gains in student persistence and
graduation”. Our challenge is to take forward our understanding of
the impact of this early experience on subsequent retention with a pro-
active, integrated approach to transition support that really does im-
prove course completion and success.
References
Andrew, N., McGuinness, C., Reid, G., Corcoran, T., 2009. Greater than the sum of its
parts: transition into the first year of undergraduate nursing. Nurse Education in
Practice 9, 13–21.
Andrew, N., Robb, Y., Ferguson, D., Brown, J., 2011. ‘Show us you know us: Using the
Senses Framework to support the professional development of undergraduate
nursing students. Nursing Education in Practice 11 (6), 356–359.
Bakker, A., Schaufeli, W., Leiter, M., Taris, T., 2008. Work engagement: an emerging
concept in occupational health psychology. Work and Stress 22, 187–200.
Baldwin, P., Dodd, M., Wrate, R., 1998. Nurses: training, work, health and welfare. A
longitudinal study 1994–1998. Working Minds, Edinburgh.
Bowden, J., 2008. Why do nursing students who consider leaving stay on their courses?
Nurse Researcher 15 (3), 45–58.
Bradby, M., Soothill, K., 1993. From common foundation programme to branch: Recognising
a status transition. Nurse Education Today 13, 362–368.
Brennan, G., McSherry, R., 2006. Exploring transition and professional socialisation from
healthcare assistant to student nurse. Nurse Education in Practice 7 (4), 206–214.
Cameron, J., Roxburgh, M., Taylor, J., Lauder, W., 2011. An integrative literature review
of student retention in programmes of nursing and midwifery education: why do
students stay? Journal of Clinical Nursing 20 (9–10), 1372–1382.
De Lange, A., de Witte, H., Notelaers, G., 2008. Should I stay or should I go? Examining
longitudinal relationships among job resources and work engagement for stayers
versus movers. Work and Stress 22, 201–223.
Department of Health, 2006. Managing Attrition Rates For Student Nurses and Midwives:
A Guide to Good Practice for Strategic Health Authorities and Higher Education
Institutions. Department of Health, UK.
Eick, S., Williamson, G., Heath, V., in press A systematic review of placement-related at-
trition in nurse education. International Journal of Nursing Studies http://dx.doi.
org/10.1016/j.ijnurstu.2011.12.004 (Available on line since Jan 23rd 2012).
Eun-Ok, 2011. Transitions theory: A trajectory of theoretical development in nursing.
Nursing Outlook 59, 278–285.
780 Contemporary Issues

3. Evans, W., Kelly, B., 2004. Pre-registration diploma student nurse stress and coping
measures. Nurse Education Today 24, 473–482.
Fowler, J., Norrie, P., 2009. Development of an attrition risk prediction tool. British Jour-
nal of Nursing 18 (19), 1194–1200.
Goldenberg, D., Iwasiw, C., 1993. Professional socialisation of nursing students as an out-
come of a senior clinical preceptorship experience. Nurse Education Today 13 (1), 3–5.
Gray, M., Smith, L., 2000. The professional socialization of diploma of higher education
in nursing students (Project 2000): a longitudinal qualitative study. Journal of
Advanced Nursing 29, 639–647.
Grealish, L., Trevitt, C., 2005. Developing a Professional Identity: Student nurses in the
workplace. Contemporary Nurse 19 (1–2), 137–150.
Hamshire, C., Willgoss, T., Wibberley, C., 2012. ‘The placement was probably the tip-
ping point’ – The narratives of recently discontinued students. Nurse Education
in Practice 12 (4), 183–186.
Harter, J., Schmidt, F., Corey, L., Keyes, C., 2003. Well-being in the workplace and its Rela-
tionship to business outcomes: a review of the Gallup studies. In: Keyes, C., Haidt, J.
(Eds.), Flourishing: the Positive Person and the Good Life. American Psychological
Association, Washington DC, pp. 205–224.
Harvey, L., Drew, S., Smith, M., 2006. The First Year Experience: A Literature Review for
the Higher Education Academy. Higher Education Academy, York.
Hinsliff-Smith, K., 2011. Am I just a student on a clinical placement or can I offer
more?” The voices of mature students on a DipHE/BSc nursing programme in the
UK. Paper presentation. NET 2011Conference. September 8–11. Cambridge, UK.
Hinsliff-Smith, K., Gates, P., Leducq, M., 2012. Persistence, how do they do it? A case
study of Access to Higher Education learners on a UK Diploma/BSc Nursing pro-
gramme. Nurse Education Today 32, 27–31.
Holland, K., 1999. A journey to becoming: The student nurse in transition. Journal of
Advanced Nursing 29 (1), 229–236.
Keogh, B., O'Brien, F., Neenan, K., 2009. The clinical experiences of mature mental
health nursing students in Ireland. Nurse Education in Practice 9, 271–276.
Kramer, M., 1974. Reality Shock: Why Nurses Leave Nursing. Mosby, St. Louis.
Last, L., Fulbrook, P., 2003. Why do student nurses leave? Suggestions from a Delphi
Study. Nurse Education Today 23, 449–458.
Lave, J., Wenger, E., 1991. Situated Learning: Legitimate Peripheral Participation. Uni-
versity of Cambridge Press, Cambridge.
Levett-Jones, T., Lathlean, J., 2008. Belongingness: A prerequisite for nursing students’
clinical learning. Nurse Education in Practice 8, 103–111.
Mallik, M., Avis, M., Leducq, M. (2009) Staying the course – an exploratory study of stu-
dent nurse persistence. Unpublished Report. University of Nottingham.
Maslach, C., Leiter, M.P., 1997. The Truth About Burnout. Jossey-Bass, San Francisco.
McGarry, J., Aubeeluck, A., James, V., Hinsliff-Smith, K., 2010. Maximising Graduate
Status in Pre-registration Nursing Programmes: Utilising Problem Based Learning.
Nurse Education in Practice 11 (6), 341–416.
Meleis, A., 1991. Theoretical nursing. Development and progress. J.B. Lippincott Company,
Philadelphia, PA.
Melling, S (2011) Transition: an exploration of student nurse experience in their first
practice placement. Unpublished doctoral thesis. The University of Nottingham, UK
Millward, L., 2005. Understanding Occupational and Organizational Psychology. Sage
Publications, London, p. 272.
Nicholson, N., West, M., 1988. Managerial Role Change. Cambridge University Press, London.
O'Donnell, H., 2009. The emotional impact of nursing student attrition rates. British
Journal of Nursing 18 (12), 745–754.
O'Donnell, H., 2011. Expectations and voluntary attrition in nursing students. Nurse
Education in Practice 11 (1), 54–63.
Ousey, K., 2009. Socialization of student nurses – the role of the mentor. Learning in
Health and Social Care 8, 175–184.
Parmar, D., Trotter, E., 2005. Keeping our students: identifying factors that influence
student withdrawal and strategies to enhance the experience and retention of
first year students. Learning and Teaching in the Social Sciences 1, 149–168.
Pearcey, P., Draper, P., 2008. Exploring clinical nursing experiences: Listening to stu-
dent nurses. Nurse Education Today 28, 595–601.
Price, S., 2009. Becoming a nurse: a meta-study of early professional socialization and
career choice in nursing. Journal of Advanced Nursing 65, 11–19.
Pryjmachuk, S., Easton, K., Littlewood, A., 2009. Nurse education: factors associated
with attrition. Journal of Advanced Nursing 65 (1), 149–160.
Royal College of Nursing, 2008. Nursing our future: An RCN study into the challenges
facing today's nursing students in the UK. Royal College of Nursing, London.
(November 2008).
Schaufeli, W., Martinez, I., Marqués-Pinto, A., Salanova, M., Bakker, A., 2002. Burnout
and engagement in university students: a cross national study. Journal of Cross
Cultural Psychology 33, 464–481.
Schumacher, K., Meleis, A., 1994. Transitions: A central concept in nursing. Image – the
Journal of Nursing Scholarship 26 (2), 119–127.
Tinto, V., 1993. Leaving College: Rethinking the Causes and Cures of Student Attrition,
2nd ed. University of Chicago Press, Chicago.
Tinto, V., 2006. Keynote address at Innovations in Student Success Conference. London,
Higher Education Academy Conference, 9th February. Cited in: Thomas, L., Jamieson-
Ball, C. (2011). Engaging students to improve student retention and success in higher
education in Wales. The Higher Education Academy (March 2011).
Urwin, S., Stanley, R., Jones, M., Gallagher, A., Wainwright, Perkins, A., 2010. Understanding
student nurse attrition: learning from the literature. Nurse Education Today 30 (2),
202–207.
Whittaker, R., 2008. Quality Enhancement Themes: The First Year Experience. Transition to
and during the first year. The Quality Assurance Agency for Higher Education, QAA,
Scotland.
Wood, S., 2005. The experiences of a group of pre-registration mental health nursing
students. Nurse Education Today 25, 189–196.
Yorke, M., Longden, B., 2007. The first-year experiences in higher education in the UK.
Report on Phase 1 of a project funded by the Higher Education Academy. Higher
Education Academy, UK.
Yorke, M., Longden, B., 2008. The first year experience of higher education in the UK.
Final Report. Higher Education Academy, UK (January 2008).
Marion Leducq
School of Nursing, Midwifery and Physiotherapy,
University of Nottingham, UK
Corresponding author at: Division of Nursing,
University of Nottingham School of Nursing, Midwifery and Physiotherapy,
B Floor South Block Link, Queen's Medical Centre, Nottingham NG7 2HA.
Tel.: +44 115 82 30925.
E-mail address: marion.leducq@nottingham.ac.uk.
Pauline Walsh
School of Nursing and Midwifery, Keele University, UK
Kathryn Hinsliff-Smith
School of Education; University of Nottingham, UK
Julie McGarry
School of Nursing, Midwifery and Physiotherapy,
University of Nottingham, UK
781
Contemporary Issues