Forewarned is Forearmed: Preparing Nursing Students for Workplace Adversity

Friday, 25 July 2014

Julie Hanson, RN, BN, GradCertAdvPrac
School of Nursing and Midwifery, CQUinversity, Sunshine Coast, Australia


The poster presentation reports on an education-focused research project that is underway to explore contradictions in the way in which adversity is understood and responded to and the contribution the curriculum is (and is not) making in one university in Australia.  The project is divided into 3 stages: exploratory interviews with nursing students identifying critical events that have occurred in the workplace; the generation of learning materials that will assist educators, clinicians and students to explore these critical incidents in new ways, so that new insights may emerge, and then designing strategies to advance the prerequisite knowledge and skills that will prepare nursing students to think critically about their practice and remain resilient in the face of adversity. Whilst the academics designing curricula understand the mandate to provide the healthcare industry with ‘work-ready’ graduates to meet the increasingly complex care needs of clients (Wolff, Pesut, & Regan, 2010), they experience the common challenges of sequencing courses for delivery in nursing programs and of ever having the right level of prerequisite knowledge in the curriculum to develop students’ hands-on skills in addition to leadership and team work qualities.  The purpose of the research is to address the pressing concern of how nursing students can to be prepared for workplace hardships of staff shortages and the emotional exhaustion related to bullying because in the international literature, experiences such as these are reported as having a significant impact on nursing retention and workforce stability worldwide (Laschinger, Wong, & Grau, 2012). For over a decade dissatisfaction, oppression and violence have been prominent themes within the nursing literature affecting nurses and are attributed to a variety of reasons. Dissonance between ‘learned’ professional values and ‘experienced’ bureaucratic workplace values has been offered as one explanation (Kramer, 1970), along with marginalisation and lack of professional autonomy (Roberts, 1983), and increasing nurse-nurse workplace bullying (Croft & Cash, 2012), hostility (Hutchinson & Jackson, 2013) and incivility (Leiter, Price, & Laschinger 2010). One argument is that these phenomena are culturally derived because the cycle of interpersonal conflict that occurs within healthcare bureaucracies all over the world is accepted or at least not resisted in part because hegemonic forces convince nurses that working under these conditions is normal in health services (Austin, 2007). It is troubling that nursing students are entering a health care culture characterised by top-down leadership, cliques and increasing violence that is often unquestioned and are in danger of succumbing to the deleterious effects of these cultural norms and this research has been undertaken to search for solutions to a critical workforce issue.


Critical Social Theory underpins the exploration of adversity and the contribution of the curriculum to preparedness. Critical Incident Technique is used in individual guided interviews to elicit descriptions of meaningful events, progressing to individual interviews using original student narratives of adversity to uncover the educative potential of the stories from the student’s perspective, and concluding with validation of the findings in a final focus group interview. The value of critical analysis lies in its ability to interrogate critical moments, tensions and turning points in the discourses of the nursing students’ life-world. The narratives of the nursing students make their ordeals accessible and memorable to others revealing the subjective realities of the nursing world to learn from and prepare for.


Early findings from this project identify discursive practices that support the status quo of hostility, isolation and alienation as part of nursing culture and so it is proposed that, although the stories that nursing students tell are painful to hear, such critically meaningful events that individuals and groups experience can become a trigger for deep learning. A practice framework for the 21st Century nurse is offered that extends from the ‘doing’ and ‘being’ of nursing to incorporate high level critical thinking in ‘realising’ what happens in the real-world of nursing, to ‘critiquing’ the foundations of routinised practices. Thus, it is not the objective for educators to protect students from these experiences, but rather to foster skills in realising the existence of hostile cultural practices in nursing, and critically analysing them to arrive at new understandings of themselves and their discipline. Such an understanding would better equip students to become agents for change in their chosen profession.


It is interesting is that nursing students have been identified as particularly vulnerable targets of hostile practices (Jackson, Hutchinson, Everett, Mannix, Peters, & Weaver, 2011), but in the emergent literature internationally there is evidence that they are resisting and challenging the status quo (Curtis, Bowen, & Reid 2007; Pearcey & Draper, 2008; Jackson et al., 2011). Subverting cultural norms in this way is significant because students are potential agents of change, having yet to be socialised to accept the practices and internalise them.  This poster discusses early research findings, presenting one story of adversity as an example of the potential benefits of using narrative pedagogy for educators, clinicians and students to critique the culture of nursing. The educative potential of stories originating in the lived experiences of nursing students is to raise awareness of how nurses can unconsciously become a part of a hegemonic force and empower them with skills to notice, resist or negotiate culturally derived injustice and inequality.