Journal of Nursing Education

The articles prior to January 2012 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here

Role-Orientation Change Among RNs in an Upper-Division Level Baccalaureate Program

Elaine Gilligan Whelan, RNC, MA, MSN

Abstract

ABSTRACT

Using the Corwin Role-Orientation Instrument as modified by Dr. M.E. Bevis, the author conducted a study within an upper division level Baccalaureate Nursing Program to determine the extent to which students were "professionalized" in the process of attaining a BS in Nursing. The study design involved a cross-sectional sample of entering and exiting students within the same university program. In addition to assessing the students for their role-orientations, personal and demographic data were collected in order to compare the respective student groups for profile similarities and differences. Analysis of the data collected suggested some similarities between the student groups in terms of such variables as age dispersion, sex, and basic nursing preparation. Differences detected between the groups included marital status, amount of clinical experience, educational goals, and career goals. Statistical analysis is presented to describe the distribution of scores attained by the two groups on the Corwin Role-Orientation Instrument. Responses to the 22-item questionnaire determine the extent to which the subject has a "bureaucraticorientation," a "service-orientation," and a "professional orientation." In this study, students who were about to graduate from the upper division level Baccalaureate Nursing Program hold a role-orientation which is less bureaucratic, more professional and more service oriented than their entering counterparts.

Abstract

ABSTRACT

Using the Corwin Role-Orientation Instrument as modified by Dr. M.E. Bevis, the author conducted a study within an upper division level Baccalaureate Nursing Program to determine the extent to which students were "professionalized" in the process of attaining a BS in Nursing. The study design involved a cross-sectional sample of entering and exiting students within the same university program. In addition to assessing the students for their role-orientations, personal and demographic data were collected in order to compare the respective student groups for profile similarities and differences. Analysis of the data collected suggested some similarities between the student groups in terms of such variables as age dispersion, sex, and basic nursing preparation. Differences detected between the groups included marital status, amount of clinical experience, educational goals, and career goals. Statistical analysis is presented to describe the distribution of scores attained by the two groups on the Corwin Role-Orientation Instrument. Responses to the 22-item questionnaire determine the extent to which the subject has a "bureaucraticorientation," a "service-orientation," and a "professional orientation." In this study, students who were about to graduate from the upper division level Baccalaureate Nursing Program hold a role-orientation which is less bureaucratic, more professional and more service oriented than their entering counterparts.

Introduction

For half a century or more, the nursing profession has experienced division in its ranks concerning such issues as defining the role of the nurse and where nursing education for "professional" practice should occur. Even defining the concept "professional" meets with a great deal of emotional upheaval. However, if one addresses the concept of professionalism in terms of its component parts, it can be seen that professionalism encompasses such behaviors as accountability, autonomy, a strong identification with standards of practice intended to ensure a meaningful, safe and productive service to society, and a commitment to continued acquisition and development of knowledge germane to the field. Further, with this conceptual definition in hand, one can then identify some measurable attributes that depict this concept of "professionalism."

In 1960, an instrument was developed to measure roleorientation of nurses in terms of three dimensions: "bureaucratic," "professional," and "service" (Corwin, 1962). This instrument was subsequently modified (Bevis, 1973). It is this instrument which the writer used to measure the direction and degree of change in role-orientation among RNs who are pursuing baccalaureate nursing education in an upper-division level program.

Theoretical Framework

Assumptions relevant to this undertaking include the following:

1. One's "role-orientation" as a nurse is a result of socialization which occurs initially as a consequence of participating in an academic program.

2. "Role-orientation" is not static but is dynamic and thus subject to change as a consequence of experience with the realities of nursing.

3. Change in "role-orientation" can occur as a result of planned cognitive, psycho-motor, and affective exposures.

4. Professionalism in practice is desirable and can serve as a prime force in actualizing high-level health care and illness care.

The two major theories which serve as the framework to explain the findings of this study include "role-theory" and "change-theory."

Briefly, role-theory provides an explanation for the who, what, where, when, why, and how of the parts one plays on the "stage of life." Examples of familiar roles we play include those generating from family relationships, friendships, and our occupations. The dimensions of these roles are complex and interdigitate upon one another, so that we often experience overlapping and overriding demands as we actively engage the experiences of life.

Since nursing is the occupation to which we are referring in this study, it is helpful to recognize that our definition of the role of the nurse emerges from initial nursing exposures which occur strategically in our basic nursing education programs (Jones & Jones, 1977). With this as a given, and in view of the research which has explained the effect of "bureaucratic" settings on the nurse's definition of her role (Kramer, 1969), this writer has sought to answer the question concerning the effect of planned, academic experiences stressing professionalism upon the RN who holds a "high-bureaucratic" and "low-professional" roleorientation.

In asking this question, one is drawn to the concept of "change." Change-theory is referred to quite often in contemporary nursing literature (de Tornyay, 1977; Gassett, 1976; Stevens, 1976). Perhaps the clearest definition of the "how" of change was presented by A. Reinkemeyer (1970), who categorized change as occurring by "drift," "traditional approaches," and "planned-change." Planned-change as a process consists of seven identifiable phases which can be paraphrased as:

1. Recognizing the need for change;

2. Seeking collaborative assistance from a "change-agent";

3. Specifying the needed change through a collaborative effort;

4. Exploring alternative routes and goals in order to make a decision as to which goal will best address the needed change;

5. Experimenting with the "new behavior";

6. Stabilizing the "new behavior";

7. Terminating the relationship between the "changeagent" and "client-system."

Relating these seven phases of "planned-change" to the RN who pursues a BS in nursing one arrives at the following description:

1. The RN decides to pursue a BS in nursing.

2. A program is selected. Faculty serve as "changeagents."

3. The RN confers with faculty concerning personal, professional and academic strengths and weaknesses. Specific areas needing change are diagnosed through an elaborate set of educational diagnostic tools (e.g., clinical and theoretical challenge exams).

4. A prescription for change is developed in the form of a specific student program guide determined jointly with faculty advisement.

5. Through a variety of cognitive, psycho-motor, and affective learning experiences, the "new behaviors" identified as desirable are "tried out."

6. Repetition and reinforcement serve to stabilize the "new behaviors" (in this case, attributes of professionalism).

7. Graduation from the program landmarks the "rite of passage" to "professional nursing practice" and termination of the relationship between the "changeagent" (faculty) and "client-system."

Thus, in a well-designed system, planned -change in roleorientation from "bureaucratic" to "professional" can occur among RNs pursuing a BS in nursing. This well-designed system is in the form of a curriculum conceptualframework which specifies the concepts to be addressed.

The student population selected for this study are attending a program in which "professionalism" is a specified thread of the conceptual -framework. This study is to some extent an assessment of the extent to which that program is successful in "professionalizing" the RN student.

Methodology

Study Sample and Design: The 74 students who participated in this study constitute a "convenience sample" in that they attend the same upper-division level baccalaureate program, located in the Northeast region of the United States. The two groups comprising the sample include 51 entering students and 23 exiting students, that is, those beginning the program and those about to graduate from the program. Sixty-eight percent of the graduating students participated in the study and 92% of the beginning students participated.

Study Instruments: In addition to the "Corwin Role-Orientation Questionnaire" modified by Bevis (1973), this writer included a data-collection instrument addressing such variables as age, sex, marital status, race, religion, basic nursing education, year graduated, years of nursing practice, current field of nursing, position, career goal, ultimate educational goal, and professional association membership.

Comparison of the Study Groups: Bearing in mind that the number of students who participated in this study included a total of 74, divided into two groups of 23 and 51, the following discussion will occur using percents to aid in detecting similarities and differences.

Although examination of the data reflects a younger population among the beginning students, it was noted that 74% of the beginning students and 70% of the exiting students are under 35 years of age suggesting a simijarity in age dispersion.

In terms of marital status, the majority of the entering students (65%) are single while the majority of the exiting students (57%) are married.

The racial backgrounds of the students include 94% of the entering students as white, six percent black and 78% of the exiting students as white, 22% as black.

The religious preference of the majority of entering students (73%) is Roman Catholic and among the exiting students 61% indicated that they are Roman Catholics. Thirtynine percent of the exiting students identified "Protestant" as their religious preference. The remainder of entering students identified themselves as either "Protestant" or "Jewish" or having no religious preference. Ninety-six percent of the entering student group and 91% of the exiting students are females.

The data concerning the basic nursing preparation revealed that 26% and 27% of the exiting and entering students respectively originally were graduates of "diploma" programs. Thus, 74% and 73% of the exiting and entering students were originally associate degree graduates.

Fifty-seven percent of the beginning students have graduated since 1978. The percent of students graduating before 1970 was similar in both groups, namely 18% of the entering students and 22% of the exiting students.

Membership in the American Nurses' Association is held by 24% of the entering students and 26% of the exiting students. A total of 65% of both groups hold some professional nursing association membership such as the state nurses' association or specialty nurses' associations. A possible explanation for limited membership among the students might be the financial burden which is a natural incursion of advancing one's education.

The entering students are not as experienced as a group as the exiting students. In fact, 16% of the entering students have not engaged in clinical nursing practice since graduating from their basic programs. Although the exiting students are more experienced as a group, 36% of the entering students have had four to ten or more years of nursing practice.

The percent of employed, experienced entering RN nursing students who identified the hospital as their base of practice is 80% by comparison to 74% of the exiting students. The percent of employed staff nurses among the entering students is 80% compared to 56% of the exiting students. Nursing leadership positions are held by 12% of the entering students and 43% of the exiting students.

Career goal aspirations include such nursing leadership roles as nurse educator, clinical specialist, primary healthcare practitioner, and nursing administrator. The percent of entering students who identified nursing education as a career goal was 16% compared to four percent among the exiting students. The exiting students had a nearly opposite profile for selecting clinical specialization (40%) over primary health-care practice (18%) by comparison to the entering students of whom 24% selected "clinical specialist" and 35% selected "primary health-care practitioner." Nursing administration is a career goal of 18% of the exiting students and eight percent of the entering students. Eighteen percent of both groups recorded career goal aspirations under "other," on the data collection instrument.

With regard to the final category, "Educational Goal," 41% of the entering students compared to 17% of the exiting students selected BSN as their ultimate educational goal. An MSN is the goal of 35% of the entering students and 57% percent of the exiting students. Sixteen percent of the entering students compared to 13% of the exiting students selected a PhD as their ultimate educational goal. Advanced Educational Goals outside the nursing profession were cited by eight percent of the entering RN students and 13% of the exiting RN students. Each of these findings suggests increased professionalism among these students.

Research Findings: The primary question of interest in this study is whether or not there is a change in roleorientation among RN students who attend an upper division level program. Statistical analysis of the findings are presented in Table 1. In order to understand the meaning of the data included in the Table, one needs to be aware of the design of the Corwin Role-Orientation instrument. Essentially, it is a 22-item questionnaire with three distinct divisions. The first division includes six items which assess the "bureaucratic-orientation" of the subject by having the person respond to a hypothetical nursing situation on a scale of strongly disagree to strongly agree. The second division includes eight items which assess the degree of "professional-orientation"; and the third division, also eight items, addresses the "service-orientation" of the nurse participant. The minimum score of six on the bureaucratic subscale indicates that a nurse has a very low "bureaucratic-orientation," while a maximum score of 30 projects an intense "bureaucratic-orientation."

The difference in the sample means on "bureaucraticorientation" between the entering and exiting RN students was determined with the t-test to be significant (p < .01). Entering students have a stronger bureaucratic-role-orientation than exiting students. Although the groups are composed of different students, the analysis of the student populations suggests more similarities than differences hi both groups on personal and professional data secured.

The "professional-orientation" subscale had a possible scoring range of 8 to 40. The closer one's score is to 40, the more intense the "professional-orientation" is. Again, there is a difference noted in the means which reflects a stronger professional orientation in the graduating RN students (p < .01).

The service subscale also contains eight items, a maximum score of 40, and a minimum score of 8. Both groups have a rather strong belief in service, but again a difference exists in favor of the exiting students whose service-orientation is even more intense (p < .01). None of the 74 students conceived of nursing as a religious calling, a connotation assessed in one of the items on this scale.

Students in this study reflected changes in role-orientations projected in the assumptions of this writer. In brief, exiting students originally graduates of AD and diploma programs who are now about to graduate from an upperdivision level baccalaureate nursing program, are less bureaucratic, more professional and more service oriented than their entering counterparts.

Before concluding the discussion concerning this study, the writer acknowledges that some of the entering students actually have a lower bureaucratic-role orientation, a higher professional-role orientation and a higher servicerole orientation than some of the graduating students. This study addressed the students as groups and thus did not seek to explain the performance of each and every student. However, a caveat is in order lest we assume that one's roleorientation is solely the result of an academic experience.

Table

TABLE 1STATISTICS DESCRIBING THE DISTRIBUTION OF SCORES IN THREE COMPONENTS OF ROLE-ORIENTATION OF ENTERING AND EXITING RN STUDENTS

TABLE 1

STATISTICS DESCRIBING THE DISTRIBUTION OF SCORES IN THREE COMPONENTS OF ROLE-ORIENTATION OF ENTERING AND EXITING RN STUDENTS

Acknowledging that this group is not from the same population of others studied in the past and that there are limitations to the generalizability of "convenience samples," the writer would still like to suggest comparisons with the students who participated in the study by Susan and Paul Jones (1977) (Table 2) and those of Kramer (1969) and Bevis (1973, p. 90) (Table 3).

In viewing Table 2, one can see that exiting students from this upper-division level program compare favorably with graduates of the five-year program in terms of "bureaucratic role-orientation"; with graduates of the fouryear program in terms of a strong professional-orientation; and graduates of the three-year program in terms of service-orientation. This leads the writer to suggest that a program which addresses "professionalism" conceptually and behaviorally, is likely to succeed in its mission to "professionalize" the RN student.

In comparing the graduating RN students with the baccalaureate graduates who participated in the studies by Bevis and Kramer (Table 3), it can be seen that these RN students have a lower bureaucratic role-orientation, a higher professional role-orientation and a comparable or greater service-orientation than those from these previous studies. These findings lend further support for the hypothesis for this study, that there will be a change toward increased professionalism among RNs attending an upperdivision level program, which specifies this intended change in the conceptual framework of its curriculum.

Conclusions

The limitations of this study include those inherent to a cross-sectional design, in which the groups compared on a variable are essentially different student groups. Further, since this is a "convenience sample," limited to one program, generalizability to other programs is limited. Still the accumulated data on the 74 students strongly suggest that this program designed to, among other things, "professionalize" the RN student does accomplish its objective.

Table

TABLE 2ROLE-ORIENTATION SCORES: COMPARISON OF STUDENTS IN THE JONES' STUDY AND THIS STUDY'S EXITING RN STUDENTS

TABLE 2

ROLE-ORIENTATION SCORES: COMPARISON OF STUDENTS IN THE JONES' STUDY AND THIS STUDY'S EXITING RN STUDENTS

Table

TABLE 3

TABLE 3

References

  • Bevis, M.E. (1973). Role conception and continuing learning activities of neophyte collegiate nurses. (Doctoral dissertation, University of Chicago, 1972). Comprehensive Dissertation Index, 33, 369.

Corwin, R.G., & Taves, M.J. (1962). Some concomitants of bureaucratic and professional conceptions of the nurse role. Nursing Research, 11(4), 223-226.

  • de Tornyay, R. (1977). Changing student relationship, roles and responsibilities. Nursing Outlook, 25(3), 188-193.
  • Gassett, H. (1976). Participative planned change. Supervisor Nurse, 7, 34-40.
  • Jones, S.L., & Jones, P.K. (1977). Nursing student definitions of the "real" nurse. Journal of Nursing Education, 16 (4), 17-20.
  • Kramer, M- (1969). The new graduate speaks again. American Journal of Nursing, 69 (9), 1903-1904.
  • Reinkemeyer, A.M. (1970). Nursing's need: commitment to an ideology of change. Nursing Forum, 9 (4), 343-350.
  • Stevens, B.J. (Ed.) (1976). Effecting change. In First-Line Patient Care Management (pp. 71-75). Wakefield, MA: Contemporary Publishing, Inc.

TABLE 1

STATISTICS DESCRIBING THE DISTRIBUTION OF SCORES IN THREE COMPONENTS OF ROLE-ORIENTATION OF ENTERING AND EXITING RN STUDENTS

TABLE 2

ROLE-ORIENTATION SCORES: COMPARISON OF STUDENTS IN THE JONES' STUDY AND THIS STUDY'S EXITING RN STUDENTS

TABLE 3

10.3928/0148-4834-19840401-06

Sign up to receive

Journal E-contents