cts

aration. Scores on the PSCNI ranged 58106 with an overall mean of 83. There was apositive correlation between age and level of professional self-concept. Single fac-

nurses identified themes as they assessed their educational preparation for their

confidence (Hughes et al., 1991). This gap between

expectations influences graduate nurses profes-

to diverse patient populations by expanding stu-dents knowledge, improving their clinical skills,and developing their professional values. However,academic institutions are under constant con-straints that limit their ability to influence

1471-5953/$ - see front matter c 2006 Elsevier Ltd. All rights reserved.doi:10.1016/j.nepr.2006.10.004

* Corresponding author.E-mail address: Kelly025@alltel.net

Nurse Education in Practice (2007) 7, 332337

NurseEducationin PracticeThe disparity in the educational experiences of stu-dent nurses and the expectations of graduatenurses by healthcare organizations contributes tothe overwhelming lack of new nurses self-

sional self-concept and their ability to be social-ized into the healthcare environment (Kelly,1998; Thomka, 2001). Nursing education is de-signed to prepare students to provide holistic careIntroduction educational influences and healthcare systemwork experiences.c 2006 Elsevier Ltd. All rights reserved.tor ANOVA showed no statistical differences between levels of professional self-con-cept, marital status (p = 0.43), and educational level (p = 0.09). New graduatea University of Kentucky, United Statesb University of North Carolina-Greensboro, United States

Accepted 1 October 2006

Summary The purposes of this study were to: (1) describe the level of professionalself-concept among new graduate nurses working in critical care and general med-ical surgical unit six months after completing a nursing program, (2) examine theprofessional self-concept in relation to age, marital status, and educational levelof new graduate nurses, and (3) examine graduate nurses perceptions of their nurs-ing educational preparation for their clinical area. One hundred thirty two (n = 132)new graduate nurses completed the professional self-concept nurses instrument(PSCNI) and answered two open ended questions focused on their educational prep-

KEYWORDSProfessional self-concept;New graduate nurses;Educational preparationThe professional self-congraduate nurses

Sarah Kelly MSN, RN a,*, Nancy Courept of new

PhD, RN b

www.elsevierhealth.com/journals/nepr

students professional development. New graduate tion has a positive impact on the professional

The professional self-concept of new graduate nurses 333nurses want to be successful and have a strongsense of professionalism. Exploring alternativeexperiences that enhance their chances of suc-ceeding in nursing should be a priority. The specificaims of this study were to: (1) describe the profes-sional self-concept of new graduate nurses workingin critical care units (CCU) and general medical sur-gical units six months after completing a nursingprogram, (2) examine professional self-concept inrelation to age, marital status, and educational le-vel of new graduate nurses, and (3) examine newgraduate nurses perceptions of their nursing edu-cational preparation for their clinical area.

In healthcare environments, the focus is on com-pleting tasks in the time allotted and functioningwithin the organization (Horsburgh, 1989). Experi-ences and situations within healthcare organiza-tions that do not meet graduate nursesexpectations may overwhelm them, adverselyaffecting their ability to develop a professionalidentity, and forcing them to reevaluate or com-promise their learned ethical values (Kelly, 1998;Thomka, 2001). These may ultimately lead to poorretention and a negative professional self-concept.

Self-concept provides the foundation for onesprofessional self-concept. An individuals self-con-cept is composed of a complex set of self-attitudes(Burns, 1979). Professional self-concept, the atti-tudes that develop from experiences that promotea professional identity, evolves from self-concept(Arthur, 1992). The professional self-concept ofgraduate nurses is influenced by the academic sys-tem, educational preparation and service, and pro-fessional development.

Academic system

In the United States (US) graduate nurses enter theprofession with a 2-year (associate), 3-year (diplo-ma), or 4-year (baccalaureate) degree. Theamount of clinical hours that students encounterduring their education varies according to theirnursing degree and the academic institution. Stu-dent nurses professional development and imageare influenced by the length of education (Phillipset al., 2002). The length of educational prepara-tion and the different degree attainments are influ-ential in developing a professional self-concept andidentity (Arthur and Thorne, 1998; Frahm andHyland, 1995). Arthur and Thorne (1998) found thatstudents view of professionalism and professionalself-concept was based on the type and level ofprogram; the students level of professional self-concept changed as they progressed through theeducational system. Further, the length of educa-self-concept and identity of practicing nurses(Frahm and Hyland, 1995). Theses studies supportthe notion that the length of education has a posi-tive influence on nurses professional developmentand self-concept.

Contrary to the above studies, several havedetermined that there was no relationship betweenthe length of education and professional self-con-cept. The tennessee self-concept scale (TSCS)was used to describe self-concept among seniornursing students attending different educationalprograms (Shepherd and Brooks, 1991). Self-concept did not differ by educational program;students at all educational levels had a satisfac-tory level of self-concept. Randle (2003) used theprofessional self-concept nurses instrument(PSCNI) and TSCS to examine the changes in nursingstudents self-esteem during a 3-year program.Students had a normal level of self-esteemthroughout the program. However, PSCNI scoresdid not differ as students completed each year ofstudy.

Academic systems have had a varying degree ofinfluence on the development of ones professionalself-concept. For the most part, there seems to bea positive relationship between the length of edu-cation and professional self-concept. The differentacademic influences can affect the gap that existsbetween the expectations of healthcare organiza-tions and the academic system.

Educational preparation and service

Various studies have highlighted the gap in thepreparation of nurses and the expectations ofthe healthcare organization (Evans, 2001; Godinezet al., 1999; Thomka, 2001; Whitehead, 2001).Nurses are prepared as generalists, with the knowl-edge to care for a wide variety of patients. Theireducation is focused on a holistic approach to pa-tient care (Horsburgh, 1989). To prepare new grad-uates, academic institutions have implementedcourses specifically related to increasing the levelof confidence and competency among students.Having a higher self-concept may enable the stu-dent to develop more easily into the role of a pro-fessional (Hughes et al., 1991).

Thomka (2001) reported situations from nurses,with varying degrees of education, which were de-scribed as not meeting their expectations and wereoverwhelming for them. The lack of consistencyamong preceptors and support encountered bythe graduate nurses resulted in their inclinationto leave the profession (Thomka, 2001). The strug-gle between graduate nurses self-expectations

and professional experiences can result in a revised

ment of a professional identity and self-concept(Evans, 2001; Godinez et al., 1999; Leathart,

The volunteer sample for this cross-sectional study

ing hospital (CH) in the southeastern US. All had

satisfaction, and communication. The PSCNI is a

letter, the PSCNI, and a demographic data sheet

334 S. Kelly, N. Courtsincluded new graduate nurses working in criticalcare or general medical surgical units at a large ur-ban medical center (MC) or large community teach-1994; Whitehead, 2001). Students believe that pro-fessionalism is influenced by three differentthemes (belonging, knowing, and affirmation).Belonging to a team, answering questions from pa-tients and family members, and being valued forwhat they were doing affected nursing studentsmeaning of professionalism (Secrest et al., 2003).In addition, students have suggested that nursingfaculty, clinical preceptors, peers in clinical envi-ronments, and family are influential in their profes-sional development (Heath et al., 2001; Kelly,1992).

Studies of the transition from student to profes-sional nurse have found that support and guidance,acceptance by experienced nurses, preparationand responsibility, and knowledge and confidencecan influence new graduate nurses. These influ-ences effected their socialization, professionaldevelopment, self-concept, and ultimately reten-tion (Evans, 2001; Godinez et al., 1999; Whitehead,2001). The different themes identified the con-cerns and realities of new graduates as they leftthe academic world and entered the professionalworld.

The length of educational preparation, the gapbetween academia and service, the expectationsof healthcare organizations, and the professionalexperiences of graduate nurses influence theirdevelopment of a professional identity and self-concept. A better understanding of graduatenurses experiences may enable both faculty andhealthcare organization staff to improve profes-sional self-concept and increase retention of grad-uate nurses.

Methods

Design and sampleself-concept. It has been shown that graduatenurses who were given a great deal of supportstayed in the profession (Kelly, 1998).

Professional development

The transition from student to professional nursehas yielded themes that are central to the develop-were given to each new graduate nurse. In addi-tion, two open ended questions assessed their edu-cational preparation for their clinical area: Howwell did your nursing program prepare you for yourwork experiences? Give examples. and, Whatsuggestions do you have for improving your educa-tional preparation for work experiences? Contentanalysis was used to examine the nurses views oftheir educational preparation. The new graduatenurses were asked to place the completed survey27-item Likert type scale with the options: (1) dis-agree, (2) tend to disagree, (3) tend to agree, and(4) agree. Negative items are reverse scored and allitems are summed for a cumulative score. Scorescan range 27108. Reliability coefficients were0.85 for the 16 professional practice questions,0.82 for the seven satisfaction questions, and0.59 for the four communication questions (Arthur,1995). Cronbachs alpha was 0.83 for this sample.Reliability coefficients for this study were 0.76for the 16 professional practice questions, 0.85for the seven satisfaction questions, and 0.45 forthe four communication questions. Studies havesupported the reliability and validity of the 27-itemPSCNI (Arthur et al., 1998; Arthur and Thorne,1998).

Procedure

Approval to conduct the study was granted by theinstitutional review board (IRB) at University ofNorth Carolina at Greensboro, Duke UniversityMedical Center, and Moses Cone Health System.Manila envelopes containing an informed consentcompleted their nursing program within the pastsix months, successfully completed the NationalCouncil Licensure Examination (NCLEX), and identi-fied themselves as registered nurses. Of the 170surveys distributed to new graduate nurses, 137surveys were completed and returned. Five nursesdid not meet the study criteria, having completeda nursing program longer than six months earlier.The final sample was 132, for a 78% overall re-sponse rate.

Measures

The instrument used for the study, the professionalself-concept nurses instrument (PSCNI), was devel-oped by Arthur (1992) to measure three dimensionsof professional self-concept: professional practice(subscales of leadership, flexibility, and skill),

and demographic data sheet in the original enve-lope, seal it, and place it in a larger envelope. Re-turn of the completed data sheet and instrumentindicated consent to participate. The completedsurveys and demographic data sheets were lockedin a box and shredded after the data were coded.

Results

The sample included 132 new graduate nurses. Themajority of nurses were between young with amean age of 26 years (SD = 7.03), single (n = 76,57%), prepared at the baccalaureate level (n = 71,54%), and worked in critical care units (n = 79,60%) (see Table 1). The nurses experiences duringtheir education included a mentored preceptedexperience, also known as a capstone course(n = 83, 62%), an internship/externship (n = 63,48%), and working as a nursing care assistant(n = 63, 48%).

Level of professional self-concept

New graduate nurses perceptions of their

3140 21 164150+ 8 6

The professional self-concept of new graduate nurses 335Marital statusSingle 76 57Married 47 36Divorced/widowed 9 7The range of scores on the PSCNI was 58106 witha mean score of 83 (SD = 8.80). The level of profes-sional self-concept was positively correlated withthe age of the new graduate nurses. However,the mean level of professional self-concept didnot differ by marital status (p = 0.43) or educa-tional level (p = 0.09). New graduate nurses work-ing at the MC did not differ on mean PSCNI scorescompared to those working at the CH.

Table 1 Characteristics of the sample by employ-ment setting, education, age, and marital status

n %

Unit typeCCU 79 60Med/Surg 53 40

EducationalBSN 71 54ADN 51 39Diploma 10 7

Age range2030 103 78educational preparation

The first open ended question was: How well didyour nursing program prepare you for your workexperiences? Six themes emerged, in this order,based on number of responses: (1) effective clini-cal experiences, (2) capstone course/preceptor-ship experiences, (3) effective coursework, (4)enhanced skills/critical thinking, (5) summerinternship/externship, and (6) negative aspects ofeducation or clinical experiences.

Most said they had good clinical experiences.Positive responses to these experiences rangedfrom we had a lot of clinical experiences tocomments about the variety of units, the numberof patients assigned, the ability to apply knowledgein clinical practice, and the fact that clinical wasincorporated early in the program. One nurse sta-ted, I feel my clinical experiences helped prepareme for the reality of professional nursing.

Several nurses said their precepted capstonecourse was the best preparation for their workenvironment. Some new graduates had their cap-stone course on the unit on which they presentlyworked. One said, A major/significant learningexperience would have to have been my lastsemester, when each student worked one-on-onewith a preceptor on two different rotations. Somethought that the opportunity to follow a nurse for12 hours 3 days a week was instrumental in theirtransition from student to professional.

Nurses also felt that nursing curriculum had pre-pared them well in content. One said, They edu-cated me to . . . operate efficiently as an ICUnurse. Many named specific courses (med-surg,pharmacology, and pathophysiology) and notedhow the courses provided them with a solid knowl-edge base. Several nurses said that being able tothink critically enhanced their development andprepared them for their professional roles. In addi-tion, they focused on their effective summerinternship/externship experiences. One said,The required participation in an internship pre-pared me for the work environment. Some(n = 24) made negative comments. They noted alack of preparation in critical thinking. Several saidthey felt more prepared to write papers than carefor patients.

When asked about ways to improve the educa-tional preparation for work experiences. Studentssuggested: increased clinical experiences, cap-stone course/preceptorship experiences, skills/critical thinking experiences, coursework/classes,and nursing faculty/clinical instructors. The need

for increased clinical experiences was a predomi-

The nurses also commented on the need formore nursing faculty. One said that having only

on the professional practice scale than second-year

336 S. Kelly, N. Courtsone nursing faculty with multiple nursing studentsdid not fulfill learning needs. The nurses also sug-gested a need for more nursing faculty who neverstop asking why and teach that it is okay not toknow everything and encourage questions. An-other commented we need more instructors thatlove their job and patients.

Discussion

In general, these new graduate nurses had a strongsense of professional practice, satisfaction, andcommunication. Their lowest score was in the areaof leadership. However, they were new not only totheir place of employment, but also to nursing, andthey were focusing on developing their skills. Theywere not expected to be in charge or lead oth-ers, so having a low score on the leadership sub-scale would be expected. With more experiencetheir scores might increase.

The new graduates scores on the PSCNI re-flected a higher professional self-concept than thatfound among registered nurses who had on averagebeen working for four years (Arthur et al., 1998).They scored higher on the satisfaction scale thannursing students studied by Arthur and Thorne(1998), and they also had higher scores on the com-munication scale than nurses enrolled in a bacca-laureate program (Arthur and Thorne, 1998). Notsurprisingly, the new graduate nurses scored highernate theme. The nurses expressed concern aboutthe lack of time on clinical units, wishing theyhad more. One suggested, more hands on experi-ence. Many suggested a variety of clinical oppor-tunities, more patient contact, and patients withdifferent levels of acuity.

Nurses also wanted the opportunity to partici-pate in a capstone course. They felt that their con-fidence would have increased, if they had theopportunity to participate in a capstone course orpreceptorship experience. Some said that havingmore opportunities to enhance their skills and crit-ical thinking would have better prepared them fortheir work environment. One suggested that,more help with problem solving, thinking thingsthrough logically with less focus on writing paperswould have improved their preparation. Further,they suggested that increasing coursework andclasses such as a focused assessment course orpediatric pharmacology would have been benefi-cial. Another suggested having more workshops,classes, and on-line courses.baccalaureate level nursing students (Arthur andThorne, 1998).

The professional self-concept of these new grad-uate nurses was not significantly affected by theirlevel of education. This is not surprising since amajority were prepared at the baccalaureate leveland had participated in a capstone course. Further,some were probably still in an orientation programreceiving support from mentors. Other studies sup-port these findings (Randle, 2003; Shepherd andBrooks, 1991). However, some studies comparingstudents and experienced nurses found significantdifferences in professional self-concept dependingon educational preparation (Arthur and Thorne,1998; Frahm and Hyland, 1995).

Most of these new nurses felt that their clinicalexperiences were the most important aspect oftheir education. They suggested that the amountof clinical, the ability to see a variety of differentclinical areas, and the ability to incorporate con-cepts into clinical had a positive influence on them.Many also said their capstone courses, preceptor-ship experiences, and summer internship/extern-ship programs helped them make the transitioninto the profession. The new graduates emphasizedthat core courses, along with classes such as phar-macology, had enhanced their ability to think crit-ically. Some nurses, however, indicated that theirpreparation could have been more realistic and intune with the expectations of the healthcare orga-nization in which they were employed.

These nurses suggestions for improvements ineducational preparation included providing stu-dents with more clinical experiences, greater vari-ety in clinical settings, and with patients withhigher acuity, particularly for those who want towork in critical care. The new graduates also iden-tified a need for more individualized attentionfrom nursing faculty and smaller clinical groups.They appreciated faculty who challenged andencouraged them always to ask why. New grad-uates wanted nursing faculty who enjoyed theirprofession and were able to create a positive atmo-sphere for learning. The effect that nursing facultyinteractions, clinical experiences, and course workhave on students shapes their professional develop-ment, thus influencing their professional image andself-concept.

The new graduates suggestions reflect their de-sire for a higher level of professional developmentwithin the academic setting. The ability to incorpo-rate academic and clinical experiences that fosterprofessional development into the curriculum ishindered by the constraints of the institution. Inlight of these constraints alternative experiences

should be explored. Experiences such as alteringcourse content to focus on professional develop-ment and/or providing students with the opportu-nity to be precepted by a registered nurse withfaculty directly overseeing the daily experiencesin the healthcare setting can influence studentsprofessional development. Promoting positive pro-fessional development can influence students andtheir desire to remain in nursing. Fostering profes-sional development and self-concept early in thelearning process is essential to students as theytransition into the profession.

Acknowledgement

Nursing for her editorial assistance.

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The professional self-concept of new graduate nursesIntroductionAcademic systemEducational preparation and serviceProfessional development

MethodsDesign and sampleMeasuresProcedure

ResultsLevel of professional self-conceptNew graduate nurses ' perceptions of their educational preparation

DiscussionAcknowledgementReferences