Quality Advancement in Nursing Education - Avancées en formation infirmière Volume 4 | Issue 2 Article 4 October 2018 Becoming a Nurse: Student Experience of Transformation and Professional Identity - Devenir infirmière : l’expérience de transformation et l’identité professionnelle des étudiantes Pamela M. Nordstrom Ambrose University, pam.nordstrom@ambrose.edu Genevieve Currie Mount Royal University, gcurrie@mtroyal.ca Shirley Meyer Mount Royal University, smeyer@mtroyal.ca Credentials Display Pamela M. Nordstrom, PhD Genevieve Currie, MN, RN Shirley Meyer, MN, RN Follow this and additional works at: https://qane-afi.casn.ca/journal Part of the Other Nursing Commons Recommended Citation Nordstrom, Pamela M.; Currie, Genevieve; and Meyer, Shirley (2018) "Becoming a Nurse: Student Experience of Transformation and Professional Identity - Devenir infirmière : l’expérience de transformation et l’identité professionnelle des étudiantes," Quality Advancement in Nursing Education - Avancées en formation infirmière: Vol. 4: Iss. 2, Article 4. DOI: https://doi.org/10.17483/2368-6669.1154 This Article is brought to you for free and open access by Quality Advancement in Nursing Education - Avancées en formation infirmière. It has been accepted for inclusion in Quality Advancement in Nursing Education - Avancées en formation infirmière by an authorized editor of Quality Advancement in Nursing Education - Avancées en formation infirmière. Becoming a Nurse: Student Experience of Transformation and Professional Identity - Devenir infirmière : l’expérience de transformation et l’identité professionnelle des étudiantes Cover Page Footnote The authors wish to acknowledge the contributions of the following researchers: Maureen Mitchell, EdD Lynn Judd, MN Christine Brownell, MN, RN Les auteurs souhaitent souligner la contribution des chercheuses suivantes : Maureen Mitchell, D. Éd. Lynn Judd, MN Christine Brownell, MN, RN. This article is available in Quality Advancement in Nursing Education - Avancées en formation infirmière: https://qane-afi.casn.ca/ journal/vol4/iss2/4 Nordstrom et al.: Becoming a Nurse: Student Experience of Transformation Nursing programs are designed to respond to the evolving requirements for professional nursing in the 21st century. These education programs are known to be academically challenging and stressful (Reeve, Shumaker, Yearwood, Crowell, & Riley, 2013). Nursing students attending a western Canadian university have anecdotally indicated their undergraduate degree program was difficult, stressful, and had unique challenges that are intrinsic to a professional program. Their nursing instructors have asked: “Is the university experience for nursing students different than for students in other post-secondary programs?” An opportunity arose to explore this question when the same western Canadian university conducted a study exploring the student experience with participants from a cross-section of the university’s undergraduate programs. Because that original (primary) study included nursing students in all four years of the baccalaureate nursing degree, nursing instructors took the opportunity to explore the institutional data through a nursing education lens. The study reported in this paper is a secondary analysis of the primary study. The question explored in the secondary analysis asked what was distinctive about the post-secondary experience for nursing students compared to the general population of undergraduate students. The findings cluster around three themes: learning through experience, recognizing the link between theory and practice, and transition and transformation. The findings indicate that post-secondary education is challenging for nursing students and the transition process from a nursing student to becoming a nurse is important for transformation and professional identity. Recommendations from the secondary study reported in this paper arise from the student experience and provide strategies to shape and inform teaching and learning in undergraduate nursing programs. Background The literature search began with key terms to explore the post-secondary experience from a student perspective. The terms included “student experiences” matched with “post-secondary education” or “university education”. That literature directed further consideration of developmental growth in young adulthood and the high levels of stress among university students. Search terms of “development in young adults”, “young adulthood”, and “stress in university” were used. The same search terms were then used with the addition of “nursing education” and “student nurse”. The nursing literature pointed to personal and professional transition processes that occur during a nursing education program. There were no comparative studies found using the key search terms of “nursing student experience compared to general student experience”. The results of the literature review provided background to the topic of the experience of undergraduate education and located this research study within the existing literature on post-secondary education experiences and nursing education. University Student Experience The literature highlights the journey of personal growth and development in young adults as they navigate their university education. Chickering (1969), in his seminal research using developmental theory, reported personal, intellectual, and psychological changes that are anticipated during the ages of 17 and 22 years, the age of many post-secondary students. Perry (1999) explored developmental growth further with his scheme of intellectual and ethical development of undergraduate students. The scheme highlights a journey for students through dualism, multiplicity, and relativism to seeing the importance and utility of a commitment to values, person, and career. The theory demonstrates that students’ beliefs and how they manage and view transition are subject to change during their university experience. In addition, according to constructive-developmental theory, students depend on authority figures to Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2018 1 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 4, Iss. 2 [2018], Art. 4 determine what is right and wrong (Boes, Baxter Magolda, & Buckley, 2010). These authors state that students gradually transition towards developing self-authorship to internally generating their own beliefs. This journey is one of weaving back and forth rather than a linear trajectory, and a full sense of “self-authorship” is unlikely to be achieved by the end of the university experience. Students as young adults experience additional external influences impacting personal growth, such as faculty interactions, curricular content, and social and peer interactions (Ambrose, Bridges, Lovett, Dipietro, & Norman, 2010). Kuh (1995) developed these ideas originally in his college impact model looking at environmental and sociological conditions from the post-secondary education environment and their influence on students including peer interactions, leadership activities, academic pursuits, university values and obligations, and faculty contacts. Exposure to these conditions led to gains in self-competence, reflection and application of knowledge, and concern for the collective welfare of others (Kuh, 1995). Collectively, this literature indicates young adulthood is a time of significant personal growth and development with influence from external factors within the post-secondary environment. Stress in Post-Secondary Education Students indicate they experience stress during their university experience. A study of 10 Canadian post-secondary institutions surveyed undergraduate and graduate students (7240 responses) (American College Health Association, 2016). Of the respondents, 59.5% experienced more than average to tremendous stress. In a wellness survey conducted at the University of Alberta (2011), 72% of the 1600 students who responded were undergraduate students. The results indicated that across faculties, the majority of respondents felt overwhelmed within the last 12 months: Arts (93.9%), Physical Education and Recreation (93.1%), Nursing (89.2%), Education (89.2%), Science (88.5%), Agriculture, Life & Environmental Sciences (87.2%), Medicine and Dentistry (79.5%), and Engineering (79.4%). Further, 58.6% of undergraduate students in the wellness survey experienced more than average or tremendous stress. In a similar study of undergraduate students at Mount Royal University in Alberta, 56.3% of students experienced more than average or tremendous stress (American College Health Association, 2013). These studies suggest that during young adulthood, when there is profound personal growth and development, stress is a common experience. Nursing Student Undergraduate Experience An extensive review of the literature revealed a finite number of studies about the nursing student experience in undergraduate programs. The research focuses primarily on nursing student stress (Decker, & Shellenbarger, 2012; Gibbons, Dempster, & Moutray, 2009; Gibbons 2010; Magnussen, & Amundson, 2003; Reeve, et al., 2013). For example, Gibbons et al. (2009) and Gibbons (2010) studied the effects of sources of stress and the effects on nursing student wellbeing. They found three factors impacted student stress: learning and teaching, clinical placement, and course organization. A significant source of stress, which was interpreted to be an indicator of well-being and led to positive outcomes, was the clinical placement experience and quality of support. Self-efficacy, dispositional control, and support were important predictors of well-being. Reeve and colleagues (2013) suggested that stress is different between first and second year. Second-year students often experience an increase in stress due to a decrease in https://qane-afi.casn.ca/journal/vol4/iss2/4 DOI: 10.17483/2368-6669.1154 2 Nordstrom et al.: Becoming a Nurse: Student Experience of Transformation social support from family members, having more demands required of them in nursing classes and experiencing apprehension about their future nursing career. A qualitative study by Magnussen and Amundson (2003) described the experience of twelve nursing students in the second semester of a six-semester program. Four themes emerged in their study: (1) meeting conflicting demands, (2) feeling overworked, (3) feeling unprepared, and (4) seeking respect and support from one’s faculty. For example, students described experiences of stress in meeting conflicting demands as they attempted to balance their diverse personal roles with the role of a student. Students relayed feeling overworked with a heavy workload in nursing school. Students identified feeling unprepared for independent practice where professional expectations were perceived as being dynamic and evolving. Students shared positive and negative stories of their experiences in seeking respect and support from their faculty. The four themes describe a “period in the life of a developing professional that is filled with obstacles and stress” (p. 263). Becoming a Nurse Becoming a nurse is the transition from the role of a student to a professional and this process can be challenging and overwhelming. Drury, Francis, and Chapman (2008) looked at the experiences of students transitioning to become registered nurses and explored the experience of students leaving the familiar environment of the university to the unfamiliar world of a registered nurse (p. 788). Their study highlighted three phases of transition: “taking the first step”, “keeping going”, to “letting go and moving forward” (p. 785). Boychuk Duchscher (2009) found most new graduates transitioning to practice experienced feelings of anxiety, insecurity, inadequacy, and instability due to “transition shock” (p. 1103). New graduates often experience transition shock due to unfamiliarity with the professional role of a graduate nurse. This includes increased accountability and responsibility, unexpected performance expectations, and increasing episodes of patient instability and acuity within an unwelcome work environment. These expectations lead to feelings of incompetence, lack of safety in practice, and not coping with designated roles and responsibilities. Benner, Tanner, and Chesla (2009) discuss graduate anxiety when nurses transition to practice. These authors recommend undergraduate nursing programs use discretion when giving students the perception that they are fully fledged registered nurses upon graduation and ready for practice (p. 314). They suggest undergraduate educators emphasize the gradual transition of becoming a professional nurse through practice. The research question guiding this study is “How do nursing students describe their university experience as compared to the experiences described by university students in general?” This research study adds to the literature by describing a comparative experience in post-secondary education namely that of the student nurse in undergraduate education and the experience of the general university population. In addition, the authors provide recommendations for nurse educators that support successful student transition to becoming a nurse. Methods To compare the experiences of undergraduate nursing students with the experiences of other university students, a secondary analysis of existing qualitative data was chosen. This design was selected because the research questions in the secondary analysis focused on Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2018 3 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 4, Iss. 2 [2018], Art. 4 clarifying and interpreting the nursing students’ experiences rather than identifying and testing hypotheses about their experiences (Tammemagi, 2014). This study arose from an earlier primary study conducted annually for four years at a western Canadian university. The method used in the primary study was modeled after Light’s (2001) work referred to as the “Harvard Assessment Seminars.” In the primary study, random samples of university students were interviewed about their university experience; these samples included Bachelor of Nursing students. The study reported in this paper is a secondary analysis of the primary study’s data. Findings from the primary study have not been published but were available to the researchers. Specifically, the secondary analysis considers a subset of the primary study (i.e., nursing students) and explores and compares their experience within the context of the broader university community. Both the primary and secondary studies received research ethics approval for the analysis of four years of institutional “Assessment Seminar” data sets collected between 2010 and 2013. Participants In each of the four years of the primary study, a random pool of students was chosen who were then given the opportunity to self-select to participate in the study for that particular year (referred to as a “round”). Students participated in only one round (or year of the study). Students were informed about the study’s purpose, the nature of the interview and the taping and transcription of the interviews. Assurance was also provided regarding anonymity and confidentiality. All participants were advised that their engagement in the study was voluntary and they could withdraw at any point. All student participants signed an informed consent document prior to the study. Students in the primary study represented all academic areas of the university, however, the responses were not grouped by program of study. Rather, each data set (i.e., round of study) in the primary study focused on students in different years of their program. The first round of data focused primarily on students in the first year of their program, with a small number in the second year of their program (97 interviews). The second round considered students in the third year of the program (54 interviews). Students near completion of their fourth year of a program were the focus of the third round (96 interviews). The fourth round of data collection returned to students in their first year of a program, but posed different questions than in the first round of data collection (111 interviews). Following the analysis of the first two years of data, changes to institutional policies were introduced to support the student experience, which necessitated alterations to the interview questions in subsequent years. A total of 358 semi-structured interviews comprised the data for the primary study. Of these interviews, 64 respondents (18%) were registered in the Bachelor of Nursing Program. The nursing respondents represent approximately 7% of the nursing students registered at the university and nursing students represent 10% of the general university population. Table 1 summarizes the demographic data for both the primary and secondary studies. In the primary study, more than half the interviewees were female in each of the four round of data collection (59.8% to 68%). In the subset of Bachelor of Nursing respondents, there were more females than males in each of the four rounds of data collection (77% to 83%). The average age of the sub-set of nursing students was similar to the average age of those participating in the primary study. Student employment was measured in the second, third and https://qane-afi.casn.ca/journal/vol4/iss2/4 DOI: 10.17483/2368-6669.1154 4 Nordstrom et al.: Becoming a Nurse: Student Experience of Transformation fourth rounds of the primary study and was similar between the groups of nursing and the general university students. Table 1 Secondary data analysis of 4 sets of data highlighting nursing student participants Data Sets Round 1 Round 2 Round 3 Round 4 1st & 2nd 3rd 4th 1st Number of interviews in primary study 97 54 96 111 Number of nursing students in primary study (%) 17 (18) 12 (22) 17 (18) 18 (16) Gender: Primary study 59.8 61.1 68 68 % female Nursing students 77 83 82 83 Age: mean in years Primary study 20.8 23.8 26.1 18.7 Nursing students 21 22 24.6 19 Employment Primary study - 72% 73% 59% Nursing students - 75% 71% 61% Year in undergraduate program The number of nursing students that participated in the original study suggested a more in-depth assessment might ascertain if the experiences of the nursing students were similar or unique to the experiences of other university students in the study. The transcripts from interviews with nursing students comprised the data for the secondary study. All identifying data had been removed from the datasets prior to the secondary study. Data Collection and Management Secondary analysis of the qualitative data allowed for an in-depth exploration of a new question that was generated from the larger, parent study (Hinds, Vogel, & Clarke-Steffen, 1997). Because the study intended to compare the nursing student experience with the experiences of students in the primary study, a directed content analysis technique was used to code the data. Directed content analysis can be used to extend existing research by using preexisting coding categories, but does not necessarily exclude new category codes (Hsieh, & Shannon, 2005). The researchers drew from the themes reported in the primary study and allowed other themes to emerge that appeared unique to nursing students. The research team analyzing the data consisted of six registered nurses, five of whom were nurse educators. Data analysis was conducted simultaneously with data interpretation and narrative writing of the results (Creswell, 2014). Analysis for each of the four datasets was done separately. An analysis was conducted using an iterative process whereby each researcher read the transcripts and identified themes. These were brought to the larger group for further analysis and validation. Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2018 5 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 4, Iss. 2 [2018], Art. 4 There was one dataset, for each of the four years of data collection. For each dataset a table was constructed that listed the themes emerging from the analysis of the nursing student participants and the themes that were reported for the broader university group. Similarities and differences between nursing and general university students were identified. Analysis across the four nursing student datasets was also completed. Findings The overarching theme that emerged from the secondary data was “becoming a registered nurse (RN) through the experience of being a student.” The university experience was challenging and a time of transition but was essential for the transformation that is necessary to become a registered nurse. Three thematic clusters characterized the transformation: 1) learning through experience, 2) recognizing the link between theory and practice, and 3) transition and transformation. The overarching theme of becoming an RN through the experience of being a student was revealed in the students’ descriptions of their learning experiences as undergraduate students. As nursing students began their transformative journey, they may not have a clear perspective of the larger academic experience; however, they were impacted by the experiential learning opportunities. Midway in their journey, they developed a better sense of the academic experience and what to expect, that is, they started to understand why they were learning what they were learning. Near the end of their student experience, they reflected on their academic journey and sought opportunities for application of their learning. Underlying the student experience, and what appears to give meaning to the nursing student experience, is their belief that what is gained from being a student is transferable to their future career and indeed may be fundamental to becoming a registered nurse. During the interviews, students expressed strong emotions about their experiences and perspectives related to their program. Sometimes the interview questions directed the interviewees to a particular subject, but the nursing students circled back to discuss a transformative process from being a student to stepping into the identity of a registered nurse. This transformation required genuine changes on multiple levels. Their words often exposed a high level of uncertainty, stress, self-doubt, and blame during a period of transition. Learning through Experience In both the original study of the broader university group and the secondary study of the nursing program, students spoke to the power of the university experience. The following provides a comparison of the findings in the primary study with the secondary analysis findings. There were similar themes in the two study groups related to personalized and supportive learning environments, peer and family influence, valuing the focus on teaching and learning and experiential learning. Both groups were aware of the importance of connections with others: community connectedness and belonging. A difference existed between the original study and the secondary study in how the students referred to community. The broader university population identified community as the institution, the librarians, their instructors and study groups. In the secondary study, first-year nursing students were concerned about not knowing anyone and finding friends in their program. Third- and fourth-year nursing students expressed a strong affinity for their peers, often indicating friends were linked to their success in the program and would be important supports once they graduated. Also common to both the primary and https://qane-afi.casn.ca/journal/vol4/iss2/4 DOI: 10.17483/2368-6669.1154 6 Nordstrom et al.: Becoming a Nurse: Student Experience of Transformation secondary study groups was recognition that faculty members were significant mentors, motivators and role models. Nursing students spoke of positive faculty relationships motivating them to stay in the program. They anticipated ongoing professional contact with faculty beyond their program and into their careers. They [nursing professors] are the most passionate people when it comes to teaching what they are instructing; they are knowledgeable about what they are talking about. They can empathize with us. I think that would be the biggest thing, it is what has kept me in the program. (“Sam”, pseudonym assigned) An appreciation for group work was another common theme expressed by respondents in both studies. Those who valued relational experiences amongst peers and faculty were able to use group experiences to help them identify the significance and relevance of what they were learning. Third year students in both studies described experiential learning as powerful. In the original study, the respondents identified research opportunities with professors, hands on activities, and practical experiences as strong aspects of their experience. Nursing students in the secondary study valued the nursing practice experience and its impact on their understanding of nursing concepts. Nursing students stated it was during these times they “felt like nurses”. Both study groups indicated high levels of stress related to scholarly work, high standards, exams, and substantial volumes of reading. Nursing students reported learning could be all-consuming. I find that nursing has encompassed my whole life, and everything ends up being somehow nursing-related. It’s like you can’t turn it off. Which is a good thing. (“Morgan”, pseudonym assigned) Nursing students perceived they had an extraordinary amount of stress, which is consistent with findings in the literature about nursing students (Beck, Hackett, Srivastava, McKim, & Rockwell, 1997; Magnussen, & Amundson, 2003) and with the provincial findings that nursing students are in the top third of faculties reporting high stress (University of Alberta Wellness Services, 2011). The original study did not report student stress as a theme but referenced it as an occasional response. When stress was mentioned it was about transitioning to a new way of learning and studying (e.g., transitioning to post-secondary education, lack of student orientation, insufficient coping skills and the need for adjustment in life skills). Further, the original study did not link the few references to stress with the students’ programs of study, so comparisons of the amount of stress between the two studies and comparisons between types of programs of study were not possible. While it may not be clear within this study if the amount of stress is different between nursing students and those in the general university population, the focus of stress among student nurses was unique compared to the broader student population. First- and second-year nursing students were stressed by the volume of their academic work and third and fourth year students indicated concern about being ready for their transition into the profession. In their fourth year, nursing students began to speak about their capacity and capabilities and “worthiness” to fulfill their role in the profession. Their fear of making mistakes and the impact of those mistakes and their perceived lack of capacity were uncertainties they recognized as increasing stress. This response is consistent with the anxiety experienced by newly graduated nurses transitioning into their professional roles (Boychuk Duchscher, 2009). Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2018 7 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 4, Iss. 2 [2018], Art. 4 A unique aspect for nursing students that did not appear in the original study group was their reflection on the pressures of balancing their study-work-personal life. Examples included expectations from the program, their roles and responsibilities and the boundaries they needed to put in place to cope with the demands. They indicated to be successful in the program they needed to make changes in their priorities. Because of the course I am really a hermit almost, I am slave to the books...I really don’t talk to my family that much and I don’t get to socialize that much because nursing comes first... (“Taylor”, pseudonym assigned) Recognizing the link between theory and practice. Foundational to nursing is the reflexive spiral of the relationship between theory and practice, that is, praxis (Rolfe, 2006). Nursing students grappled with making sense of praxis. They struggled with linking classroom and practice environments. “In practice it doesn’t always happen like the books….if you didn’t have practicum you wouldn't be able to put that lecture piece and theory into practice.” (“Murphy”, pseudonym assigned). This thematic cluster was not found among the broader group of students; it was unique to nursing students. While there are three other professional programs at the university (business, education and social work), the number of respondents from these programs in the original study was small. So, the finding that this theme occurred only in the secondary study may be related to the sampling method of the original study that allowed for self-selection as a respondent and did not seek program representation in the study. Transition and Transformation. In both studies, students identified themes of developing self, transformation and growth, and anxiety regarding future plans and transition challenges. This thematic cluster was labelled “transition and transformation.” Students from both the broader university population and the nursing program were united in describing what it meant to be a full-time university student: a time of transition. When they entered university, many students were transitioning from high school to becoming full-time university students. Others had been out of post-secondary education for several years and were transitioning from regular employment to the student life. They indicated there were transitions in every year of their program. First- and second-year students identified the need for time management skills and strategies to cope with numerous competing pressures. Third-year students acknowledged gaining personal insights, noting they had a stronger sense of self. Fourth-year students had an awareness of ongoing self-transformation (i.e., growing confidence, becoming increasingly more reflective, and developing awareness of multiple perspectives). Students also spoke of changing personal insights and shifting interests. As early as the first year of the program, nursing students indicated that to be successful in their transition they needed to develop coping skills for survival in the program and for success in their future career. Nursing students shared the growing sense of self-development with the broader group of university students and also mentioned personal insight into being students and citizens. They also recognized the importance of developing a sense of community. Nursing students began seeing “everything” through the lens of a nurse. They recognized their transformation from student to nurse through their education and that this process occurred through valuable learning and growth opportunities. The focus of students’ transition changed over the four years of the nursing program. In the first year of the nursing program students described the transition from being overwhelmed with the change in their social lives and by fourth year they spoke about being overwhelmed with https://qane-afi.casn.ca/journal/vol4/iss2/4 DOI: 10.17483/2368-6669.1154 8 Nordstrom et al.: Becoming a Nurse: Student Experience of Transformation the idea of stepping into independent practice as a registered nurse (RN). One fourth-year student asked: “Am I ready for this?” (“Bobbie”, pseudonym assigned) meaning was she ready to be an independent practitioner of nursing. Another fourth-year nursing student questioned whether their transformation was complete and sufficient to become a registered nurse: “Is the transformation that I went through as a student sufficient for the complexities of being a competent RN?”(“Avery”, pseudonym assigned). Another example of their transition within undergraduate education was provided in their comments about stress. When a first-year student was asked to be more specific about what was causing stress in her life the response was that “it is all stressful”(“Donna”, pseudonym assigned). A third-year nursing student indicated her experience was “stressful but it is making sense” (“Michelle”, pseudonym assigned). A fourthyear student indicated that “it is stressful leaving this place and going out on my own” (“Darcy”, pseudonym assigned). Nursing students also spoke about changing notions of future career goals that occurred since they entered the program. Third-year nursing students began to describe changing ideas about the type of nursing practice they would like for their first work experience. They were beginning to value what they were learning and were taking on the identity of a nurse by applying or translating their developing knowledge into their personal as well as professional lives. I think now I’ve also thought about what I’m going to do to further my education... I think beforehand I maybe thought that ‘Oh well I’ll use nursing as a stepping stone to become a doctor’. No. I don’t want to become a doctor anymore. It’s not for me. I like the nursing scope. Now I see myself going on, in the future - not anytime very soon, but getting my masters and becoming an instructor. (Carter, pseudonym assigned) Fourth year nursing students used language illustrating how they were beginning to identify as nurses. They moved from navigating their role as a student through a required curriculum to thinking about being a nurse. I’ve grown and...grown into seeing…what I’m going to be and who that person I want to be is. I’ve seen a lot of nurses, um, who you know do this or treat someone this way, well I’ve taken the good things about this and moulded it here, and I’ve really moulded myself from my experiences into what nurse I want to be. I know who I don’t want to be and I know who I want to be. (“Avery”, pseudonym assigned) Discussion This is one of the first studies to analyze the experience of undergraduate nursing students compared to the general university population. Our findings indicate there are similarities and differences between the experiences of the two groups and that the transformative journey of the nursing student is characterized by stress and can be influenced by experiential learning. Educators may influence the student experience by creating nursing programs that support the transition to becoming a registered nurse. A key finding of this study is that transition from being a nursing student to becoming a nurse is about transformation in personal identity which is brought about through meaningful learning and practice experiences. That is, the student experience itself is fundamental to becoming a registered nurse. To foster this transformative journey faculty can support learning through experience, facilitating the recognition of the link between theory and practice and fostering transition and transformation. Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2018 9 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 4, Iss. 2 [2018], Art. 4 Students from both the broader university and the nursing program identified connections with peers and faculty as key factors in their learning experience. Peer support was significant in their experience of becoming a nurse. Nursing programs can support peer collaboration through encouraging student-led nursing societies and supporting opportunities for student peer collaboration and mentorship programs. For example, senior students could be given credit to provide formal and informal mentorship to junior students during orientation sessions and in practice settings (simulated and clinical). Students also commented that building relationships with faculty was instrumental in feeling supported. Faculty can be a unique and significant component of a student’s support system (Reeve et al., 2013). Further, faculty members who perceive and understand the emotional needs of their students add to the students’ positive perception of the educational environment, making it more conducive to learning (Rowbotham, 2010). In addition to learning activities in the classroom that promote interaction and engagement, faculty could create opportunities outside of the classroom where students and faculty can purposefully engage with one another. Examples would include engaging with students in research projects or community and volunteer service learning activities, and participating together in student and faculty social activities. Students could also engage as members of program committees where they would have an opportunity to interact with faculty in a different context. In this study, the focus on linking theory and practice was a theme for nursing students. They struggled with the practice of reflecting on the relationship between theory and practice but found experiential learning opportunities to be critical to learning this nursing skill. Thus, a result of this study indicates experiential learning opportunities should be retained in nursing programs because they are powerful tools in the transition of becoming a nurse. During experiential learning activities, students’ awareness of developing a new identity was most pronounced. This is congruent with literature which emphasizes teaching and learning strategies involving high and low fidelity simulation (Berragan, 2011; Cant, & Cooper, 2017). The changing perspectives and transitions experienced by students are better understood in the context of notable developmental changes that occur in young adulthood. For some of the respondents, their transformative changes could be interpreted as maturity and growth in their abilities as students and young adults. Young adults are developing new types of coping strategies to deal with life events and beginning to develop perspective-taking skills (Boes et al., 2010). Faculty need to recognize and understand not only professional development but also personal stages of development that students undergo as they progress and transition through their undergraduate program. Educators who are mindful of each student’s level of development can effectively understand the student’s unique learning needs and performance (Ambrose et al., 2010) and teach positive coping strategies (Reeve et al., 2013). Support programs contribute to developing self-efficacy because they help mitigate stress as students progress through the program. It is important to collaborate with students when building academic supports and resources into the nursing program (e.g., Academic Advisors, faculty mentors, peer support groups) (Freeman, & All, 2017). Nursing students reported stress as a significant part of their university experience, specifically as a result of program and faculty workload expectations. The primary study, however, did not specifically identify stress as a theme among the general population of university students, although some notations about stress were reported. Therefore, it is not possible to measure the amount of stress among nursing students compared to the broader https://qane-afi.casn.ca/journal/vol4/iss2/4 DOI: 10.17483/2368-6669.1154 10 Nordstrom et al.: Becoming a Nurse: Student Experience of Transformation student population in this study. It is possible, however, to note the nature of stress reported by nursing students. The difference for nursing students compared to undergraduate students who indicated the level of stress is the focus of their stress: volume of work, readiness for practice and their capacity, capability, and worthiness to fulfill the nursing role and the perceived pressures to balance their study-work-personal life. Communication is a significant factor in reducing student stress and enhancing the student experience. Given the student perception about the power of their experiences, it may be beneficial to offer increased opportunities to debrief experiences, particularly those from clinical practice settings. For example, faculty-led post-conference sessions and access to counseling services are resources that may support nursing students in creating meaning from their clinical experiences. Clear and transparent communication and identification of appropriate resources are important strategies to promote student access to support services (Decker, & Shellenbarger, 2012). Nursing faculty should recognize sources of student stress and use this knowledge to inform course development and revision (Gibbons et al., 2009). It is important to put strategies and resources in place to support students and assist with stress management, but also to reflect on the underlying causes of stress in nursing programs. Nursing faculty might ask themselves the following question: “Why do we require heavy course requirements in our programs?” Through powerful learning experiences, the student transitions into a nurse. Nursing student experiences brought about complex changes prompting them to develop new attitudes, perspectives, knowledge, skills and personal insights over time. These changes were not singular, nor did they occur at a particular point in time, and were essential in developing a new identity as a nurse. The transformation was not complete as fourth-year nursing students questioned whether their metamorphosis was sufficient to become a registered nurse. This uncertainty about one’s preparedness is consistent with Benner, Tanner, and Chesla (2009) who suggested it is a gradual transition that is achieved over time through practice as a registered nurse. Nursing students recognized the ongoing process of transformation when they asked questions such as: “How can I take what I learned here to help me throughout my career?” They recognized their transformation journey had not ended. There are several limitations of this study. First, the primary study and the survey questionnaire were not designed to explore the student nurses’ experience, but rather undergraduate students’ experience as a whole. Also, each year the survey instrument was redesigned to highlight various aspects of the undergraduate student experience. Therefore, the ability to compare data from year to year was not possible. Second, the university study was based on a randomly generated pool of students who were invited to participate in the study. The students then self-selected to participate. The participants may have had a variety of reasons (e.g., a need to share criticisms or accolades) to engage in the study which may have skewed their responses. For example, the nursing faculty was only a couple of years into the implementation of a new undergraduate program and participants may have desired to vent about issues experienced as the first students in a new program. Third, the number of participants may not be representative of the entire nursing student body (approximately 230 new nursing students were admitted each year of the study), so the transferability of the results may be limited. Fourth, the original study did not group students by program, so a comparison of nursing students to other professional programs was not possible. This study contributes to the literature by comparing the similarities and differences of the nursing students’ university experience with the overall general university student Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2018 11 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 4, Iss. 2 [2018], Art. 4 experience. A fuller understanding of the nursing student experience would benefit from further studies that measured stress levels between the two student groups, provided a global comparison of stress in nursing and other undergraduate programs, and explored the relationship between specific learning strategies, learning outcomes and stress. Conclusion The findings of this study suggest nursing students and other university students share many of the same experiences related to post-secondary education. However, there are two areas of distinct difference. Nursing students report the need to link the theory learned in classrooms with their experiences in the practice settings. Experiential learning activities were perceived to be significant supports in learning this nursing skill. The results of this study also suggest that the nursing student experience has different elements causing stress from the general student population, however, this study did not determine if their unique stressors make the nursing student experience more difficult than other student experiences. The theme of “becoming” was reflected in nursing students’ discussion of various transitions they engaged in over the four years of their education program. Analysis of the nursing datasets reflected a story of transition and transformation throughout all four years of the nursing program; specifically, it was a story of becoming an RN through the experience of being a student. The journey from student to RN was characterized by learning through experience; recognizing the link between theory and practice; and transition and transformation. Nursing educators can influence the transformation from nursing student to RN through the learning and practice experiences provided in each year of the nursing program. The journey from student to RN affects the ways they interpret their experiences, the way they negotiate meanings, make decisions, and construct their professional careers. https://qane-afi.casn.ca/journal/vol4/iss2/4 DOI: 10.17483/2368-6669.1154 12 Nordstrom et al.: Becoming a Nurse: Student Experience of Transformation References American College Health Association. (2013). American College Health Association- National College Health Assessment II: Mount Royal University Executive Summary Spring 2013. Hanover, MD: Author. American College Health Association. (2016). 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