The purpose of professional socialization is to develop a personally and professionally acceptable role (Cohen, 1981). This process involves acquiring knowledge and skills as well as the norms and values of the professional culture ( Jacox, 1973). Two major theoretical frameworks that have been used to explain the process of professional socialization are the functionalist approach and the interactionist approach.
The functionalist approach to professional socialization reflects the functionalist approach to role acquisition and socialization in general (Linton, 1936; Parsons, 1951). Briefly, this perspective views role expectations as grounded in shared values and norms that are internalized through a process of socialization. Individual motivation to conform to these expectations is produced by a favorable self-image that results from positive feedback from others and the assumed complementary nature of roles with correspondingly dove-tailed expectations (Stryker & Statham, 1985). Generally speaking, a functionalist perspective accords less significance to individually based determinants of social behavior and to the importance of ongoing social interaction in the creation and modification of role behaviors. That is, roles are viewed as institutionalized expectations that exist prior to interaction rather than negotiated and developed through ongoing social interaction (Stryker & Statham, 1985).
A functionalist approach to professional socialization was first described by Merton, Reader, and Kendall (1957) in their study of medical students. This approach assumes that there is a "consensual" value system among practitioners, students, and faculty, each fulfilling interrelated functions for continuance of the system. The professional school is viewed as a suborganization of the parent profession. Faculty members, professionals in the work environment, and peers are seen as the socializing agents of students (Simpson, 1979). Faculty and students are assumed to have common objectives and to act collectively toward the acquisition of the skills, norms, and values attached to the role of the professional (Simpson, 1979). In the functionalist approach to socialization, students are regarded as relatively "passive" recipients of the education and socialization experiences offered by the professional school (Merton, Reader, & Kendall, 1957), with less emphasis placed on students' perspectives and responses in role acquisition.
The interactionist approach to professional socialization is based on symbolic interactionism. The interactionist perspective assumes that a person acquires meaning through interaction with others and the environment as well as through a reflective process (Mead, 1934). Consequently, a person will act toward others and the environment according to the meaning they have for the person. An interactionist approach views role behavior as a process rather than conformity to preexisting social norms (Turner, 1962). As in the functionalist perspective, others' expectations are seen as important components in determining role behavior; however, an interactionist perspective views role behavior as the outcome of a process of social interaction in which individuals are active and creative rather than merely responsive to the cultural internalized norms. That is, role behaviors result from "role-making" in which initial expectations from earlier definitions of the situation may be modified through subsequent social interaction that involves taking the role of others ("role-taking"), modifying expectations and then creating new role behaviors ("rolemaking") (Turner, 1962). Roles are therefore continually being revised during the course of interaction. Using a dramaturgical metaphor, "the scripts are not detailed directives to be played as given but are constructed in the course of the play itself and are constrained only in outline form by the culture and social organization within which the play takes place" (Stryker & Statham, 1985, p. 312).
Professional socialization using an interactionist perspective was first described by Becker, Geer, Hughes, and Strauss (1961) in a study of medical students, and later by Olesen and Whittaker (1968) in a study of nursing students. This perspective contends that student behaviors emerge from transactions between the self and the exigencies of the situation, hence, the context of the professional educational experience is viewed as a particularly important determinant of behavior. In contrast to the functionalist view, the interactionist approach to professional socialization considers the professional school as an organized social unit independent of the parent profession (Simpson, 1979) and does not assume a consensual value system among the professional school, practitioners, and students. For example, norms of the professional school may not be reflected in the social contexts where professional roles are enacted (Freidson, 1970). Moreover, students and faculty may differ in their interests and role expectations. Socialization from a symbolic interactionist perspective is an ongoing process characterized by "situational adjustment" rather than the transmission of norms, values, and behaviors that can be transferred across all situations (Stryker & Statham, 1985). Students are seen as active participants in their professional socialization (Olesen & Whittaker, 1968; Simpson, 1979). In this perspective, emphasis is placed on the students' "reactions" to their educational experiences (Simpson, 1979) and their management of these situations (Becker, Geer, Hughes, & Strauss, 1961).
Alternative frameworks of professional socialization combining the functionalist and interactionist approaches have been proposed by Bûcher and Stelling (1977) and Simpson (1979). These researchers argue that there are various dimensions to the professional socialization process and that one approach cannot adequately capture or explain how socialization occurs. While there have been several more recent studies exploring various aspects of the socialization process in nursing (e.g., Cohen, 1981; Mackenzie, 1992; Melia, 1987; Wilson & Startup, 1991), none of these studies have examined students across an educational program. Moreover, many of these studies have been conducted in other than baccalaureate programs.
In this article, we will describe how both the functionalist and interactionist approaches are exemplified in the learning experiences of nursing students in a 4-year baccalaureate program. The results reported in this article are part of a larger study exploring how students become socialized into nursing. The methodology of the study will be discussed briefly before describing more specifically the characteristics of students as learners.
Sample and Setting
In this study, a qualitative longitudinal exploratory design was employed. The setting for the study was a 4year baccalaureate nursing program in a faculty of nursing in a large western Canadian university. The study protocol was approved by the Ethics Review Committee of the educational institution. The primary informants, comprising 50 nursing students across all 4 years of the program, were interviewed using a semi-structured interview guide. In addition, 81 students completed open-ended questionnaires. The total sample constituted about one-third of the student population. Of the 50 students interviewed, the majority were unmarried (80%), female (90%), less than 25 years of age (74%); 40% were admitted from high school and 42% were transferred from other programs. The demographic data of the sample revealed that students were representative of the general nursing student population in terms of age, gender, and education prior to entry.
Students in each year of the program were made aware of the study through class presentations by two of the researchers. Students were given an information sheet outlining the research project and were invited to telephone the research assistant if they were willing to participate. In addition, some students, who were randomly selected from class lists, received a personal letter inviting them to participate. In total, 44 primary informants volunteered to be interviewed during the first year of the study. Open-ended questionnaires were also distributed in class; those students who had volunteered to be interviewed were asked not to respond to the questionnaire.
In the second year of the study, an additional six first year students were added to obtain better representation of the group of students who had entered nursing directly from high school. As well, all the students who had been interviewed were re-interviewed; that is, first year students were re-interviewed in their second year, second year students were re-interviewed in their third year, and so on.
The semi-structured, open-ended interviews were conducted by research assistants not affiliated with the educational program. The initial interview guide was based on Melia's (1987) research. Students were asked about their perceptions of the most important things that nurses do; the nursing student role, including difficulties encountered and how these were handled; others' perceptions of nursing; students' perceptions of and interactions with other nurses; influence of nursing professors on students' beliefs about nursing; and the role of fellow students. Questions were identical for all years of the program, except first year, in which questions relating to the nursing of patients were omitted as students had not yet been in the clinical area. The guide was revised between the first and second year of the study to explore and elaborate on themes that were emerging from the data. All interviews were tape recorded and transcribed. The questionnaires contained the same open-ended questions as the interviews, without the benefit of probe questions.
Data were analyzed within the framework of symbolic interactionism and professional socialization. Analysis occurred in two phases. In the first phase, content analysis was employed to group data which shared common characteristics. The grouped data were identified into six broad categories: shaping (factors which shaped student identities); becoming (movement from "student" to "nurse"); beliefs (global definitions of what students believe nursing to be); doing nursing (student) (what the student actually does); doing nursing (hospital or community) (what the student sees other nurses doing); and role (instructor, student, nurse) (the part played by the various actors in socialization). Two subcategories, which occurred across the major categories, were student culture and image.
The second phase involved team analysis of the data. The four researchers, the project director, and three graduate nursing students reanalyzed all the categories to identify the dimensions of the initial categories and to identify further categories and processes. Data were analyzed by comparing data from students within the same year for similarities and differences in their perspectives. Comparisons were also made between years, that is, comparisons between all the students in first year and all the students in second year, and so on. Finally, for those students who were interviewed twice, the data were examined to see what changes could be observed in students as they progressed from year to year.
The data reported in this article were drawn primarily from the category of doing nursing (student), with particular emphasis on how the learning characteristics of students changed from year to year.
First Year: "Learning the Ideal." In the first year, socialization is of a more functionalist nature in which the professional culture is transmitted primarily in classroom and laboratory settings. For some students, this constitutes the internalization of "new" professional values; for others, reinforcement of values already held. Two values repeatedly articulated by students were "caring" and a "scientific knowledge base." Caring involved the dimensions of holism, which meant attending to the patient's physical, mental, and spiritual needs, and individualizing to the patient's unique situation. For some students, embracing the importance of a scientific knowledge base for nursing practice meant overcoming the perceptions of others (and even of themselves) that nursing (and being a nursing student) is not very intellectually challenging. Through their course work, students soon realize that being a nursing student requires much hard work and is intellectually demanding. Although students are able to delineate values of the profession, they are still limited in their abilities to elaborate their views in a way that indicates these values have been fully internalized. That is, they are unable to describe how the values are played out in the practice setting.
Student activities in first year are oriented toward learning theoretical concepts, observing role models (primarily instructors in classroom and laboratory settings), and practicing basic skills. In addition to learning psychomotor skills, students also place high value on becoming comfortable communicating with patients. Indeed, for some students, patient communication and interaction is seen as the "essence of nursing." Despite initial anxieties about clinical practice, students look forward to and view as crucial the opportunity to practice their skills in the clinical setting because, as one student pointed out, "Knowledge comes through practice." Another student substantiated the view that classroom learning is necessary but not sufficient in acquiring knowledge:
All the stuff that we do in class is good background, but it's kind of pointless if you're not in the hospital too. Because no matter how much you memorize and how much you read, you really don't understand it until you do it.
In short, students appear to be saying that while norms (what is expected), values, and even skills may be learned in the classroom, the internalization of knowledge takes place when the skills are practiced in the clinical setting.
In their beginning clinical practice, students tend to be fairly passive learners, meaning that they follow the rules as presented to them, with less evidence of questioning than in later years. Perhaps, because of the nature of the practice setting (that is, practicing skills in a predictable highly structured situation even in the clinical area), there is less need to "adapt" to the particularities of the situation. That is, in keeping with a more functionalist perspective, students are still able to play out a more or less "assigned" script (Stryker & Statham, 1985).
Second Year: "Confronting Reality." In contrast to the first year where students' primary focus is on learning theoretical concepts underpinning nursing practice and the values and norms of the profession, in second year, there is a greater emphasis on applying theory to practice and on the performance aspect of socialization. As students become more involved in the clinical setting, they are faced with exigencies that lead to a more interactionist approach to learning. They are now required to cope with "real" rather than "ideal* situations. That is, the context in which care is delivered becomes more important.
Several dimensions of the "real" versus "ideal" dichotomy emerge as students become aware of the need to adapt their classroom learning to take into account a variety of factors related to both the patient and the unit environment. This "situation (or reality) negotiating" includes individualizing care to the patient's own personal situation as well as adapting to the policies and procedures of the unit. In their interaction with patients, students become aware not only of their limited knowledge base, "that there is so much to learn," but also of the responsibility attached to the performance of skills they had previously practiced in a structured laboratory setting. The awareness of limited knowledge and experience may lead to a feeling of inadequacy, which is particularly stressful given the students' perceptions of the potentially serious consequences their inadequate knowledge poses for patients. In contrast to their earlier perception of more distinct roles, students perceive a blurring of the roles of student and nurse because there is little margin for error. "Even though you're a student, you're still a nurse."
Another aspect of the ideal versus real dichotomy is students' realization that they require more than knowledge and skills from the classroom to practice nursing. They become aware of the importance of organizational skills because the nursing skills learned in first year now need to be performed in the context of time constraints, ward routines, and the patient's unique situation. Moreover, adhering to the expectations of the nursing unit may at times be discrepant with carrying out what students perceive to be "optimal care."
The ideal versus real is also reflected in students' observations that staff nurses do not always practice nursing as the students have been taught. Students perceive that the primary ideals inculcated through their nursing education- holistic caring and scientific knowledge-are not always reflected in nursing practice. Rather than a "consensual value system" between faculty and practitioners as purported by a functionalist perspective of professional socialization, the values to which students are socialized in the faculty may be discrepant with what they observe on the unit. Moreover, students perceive that some nurses do not value them or their nursing program. Almost all commented that one of the difficult aspects of being a student is coping with the implicit and explicit negative feedback received from staff nurses about the Bachelor of Science in Nursing (BScN) program. One student said:
As soon as they find out that we're in the BScN program, you can feel the walls going up- when you ask a question, it's like how come you don't know... you guys know everything over there.
Others pointed out that the uncertainty of staff response adds to the stress: "You either [are expected to] know nothing or they expect a lot." This stress may be accentuated by the students' recognition that staff nurses on the unit have the potential to contribute very positively to the students' learning experiences. Students, therefore, do not wish to jeopardize these opportunities.
The relationship between the students and staff nurses clearly points out that the professional school, practitioners, and students do not necessarily constitute a system bound together by mutual interest and shared outlooks. From an interactionist perspective, the uncertainty of staff nurses' behaviors and expectations means that students need to "create" appropriate responses to the particularities of each situation.
Students respond to the "reality" demands by placing great value on clinical practice. As one student said, "the first year I'm learning things, now I'm learning nursing." Students' learning activities are characterized by both observation and practice. Observation in second year, however, becomes more active as students begin to "process" rather than merely "imitate" behaviors of students, faculty, and staff nurses. That is, students begin to critically evaluate their observations and to discriminate between role models. Because of their perceived need to master skills, students are somewhat more self-centered than in later years in that patients are perceived as "opportunities" to meet students' learning needs. In later years, patients' needs take priority over students' learning needs, as students are now seen as the means to meet patients' needs.
Because of their limited knowledge and (perhaps more importantly) their limited experience, students are still very dependent on their instructors. While students are beginning to develop clinical judgment, they do not yet trust their judgments. "Seeking validation" just to "make sure" is an important aspect of their learning:
Sometimes... you ask a question and it's thrown back at you like well you should think through it. [But] you already have of course. But you're asking a question because you're not sure... You can say I know what it is but maybe you're totally wrong because you haven't had enough experience yet. It's the lack of experience.
Because they are still developing a sense of their own competence, students are very vulnerable to feedback. Negative comments from others about their work decrease the students' professional self-esteem. This dependence on others for appraisal of their performance is further reflected in the students' comments that they are always having to "prove" themselves, particularly to instructors. "Proving oneself" often means accommodating to each instructor's different expectations as students change clinical rotations frequently. The student's reliance on the feedback of others demonstrates that the development of a self-concept or identity as a nurse occurs through ongoing interaction with others in which the responses of others help shape the self. Differing expectations among faculty means that students need to adjust their own behavioral responses based on their anticipated responses of others.
A further consequence of the students' feelings of inadequacy is their response to the "less than ideal" care that they observe on the unit. Most students, because of their inexperience, do not feel comfortable "rocking the boat" by confronting other staff members about practices that could be modified. Moreover, they realize that speaking out could jeopardize their own (and subsequent students') learning experiences. Instead, they use this "nonexemplar" care to reaffirm their own ideals about what it is they want to be and discuss with peers and instructors how they themselves would provide care. This suggests that students may "fit in" to "get through," but do not "give in" to the norms and values of the unit. Instead, students retain and perhaps reaffirm their concept of what good nursing should look like. A comment by one student that "good nurses do what we've been taught" conveys internalization of the norms and values of the professional school, rather than of the nursing unit.
Third Year: "Becoming Comfortable with Reality." In third year, interactionist learning dominates as students learn from their clinical practice. This learning is characterized by what one student termed "fine tuning," which involves developing the art of nursing by incorporating a variety of role models, critically analyzing their own and others' experiences, and developing their own formulation and style. This reflects an interactionist approach in which the self is reflective and active in "role-making." Students continue to adapt to the reality of the situation. As they are confronted with more complex, less stable situations, organizational skills become increasingly important in implementing "optimal" rather than "ideal" care.
Because they now have a greater repertoire of skills, students begin to feel more like nurses rather than "just students." Many state that they are able to give the same quality of care as does an RN; perhaps even better, because students still have the luxury of being a learner and therefore have more time to deliver "holistic care." Students not only feel that they have much to offer patients, but also see themselves as being of value to the staff nurses by assisting them in tasks and by "bringing a fresh outlook to the unit" because of their up-to-date knowledge. In discussing her role, one student said:
You're there to get clinical experience.. .and a lot of time to bring a fresh outlook; "cause you're going through a program which is really current and a lot of times you'll learn something new and... it might help in the care of one patient... We're quick references because we're more current... and we can look it up if we don't know.
Another commented that because students change rotations frequently, they may act as a "liaison" between units whereby they share information about one unit with another unit. In spite of feeling that they are valuable to staff members, however, students continue to comment about the staff nurses' negative responses toward the baccalaureate program. And in spite of increased confidence in their knowledge and skills, students still do not feel comfortable confronting staff about the less than optimal care they observe. Nevertheless, when unit policies and procedures interfere with the students' capabilities to carry out what they believe to be optimal care, they are generally more assertive.
One of the difficulties of the student role is the need to adapt to a variety of nursing units. While some students view this as advantageous, most convey that continually adjusting to a "new reality" is stressful. "It's like starting a new job every 6 weeks," a continuous orientation wherein students need to learn both the formal and informal norms of the unit, and to first determine and then seek out those staff nurses who are supportive of students. Again, this clearly reflects situation "negotiating" behavior, so characteristic of an interactionist approach.
Overall, students in third year are less dependent on their instructors, looking to other students and staff for guidance. In contrast to second year, there is less dependence on others for appraisal about the quality of one's nursing care. Students are now able to make self-judgments about their own worth. In short, students in third year are much more confident about their knowledge and skills and some are "getting ready to fly."
At the end of third year, students may be viewed as "active evaluating trainees," who have acquired a "sense of mastery," which enables them to selectively choose elements of the program and to confidently validate their own choices (Bucher & Stelling, 1977).
Fourth Year: "Extending Beyond the Reality of Student Practice." In fourth year, students take advantage of their "learner" role to prepare for their future status as graduate nurses. The student nurse status is seen as a justification for being able to admit that "I don't know." In speaking of her senior practicum, one student said:
This is my last chance, my last year, my last term to be able to still use my student status as an excuse or justification for why I don't know certain things... I [would] much rather suffer the embarrassment and the mortification now than be on my first job and being oriented and... having to tell someone that I need to be told or shown how to do such and such.
Learning now becomes focused on the skills needed for the "real" world. Even though students have incorporated a broad holistic concept of nursing, and even though instructors reassure students that psychomotor skills that they have not yet mastered can be learned quickly, students perceive that being proficient is necessary for their emergence into the graduate nurse role. One student said, "I'm trying to use [my senior practicum] as an orientation so that by the time I graduate 111 be ready to work." The fact that students use their student status to actively prepare for the work they envision as graduate nurses suggests that their main focus is not one of merely "getting through" their student days.
The need to prepare for graduate nurse status leads students to become active in seeking out experiences that will increase their confidence. "Observation" experiences, therefore, are not viewed favorably because students feel that these experiences will not prepare them for the work world and may even connote a lack of confidence in the student. Overall, in fourth year, students are less dependent on instructors and more dependent on nurse preceptors in the field.
In fourth year, there is evidence of functionalist learning as reflected in the students' perceptions about the scope of nursing. Their view of nursing broadens to incorporate issues that go beyond the reality of their particular student practice situations. For example, students see political action strategies as legitimate nursing interventions, and they comment on the need to understand (and even restructure) the health care system and to increase public awareness of nursing's expanding role. In one sense, fourth year students espouse a broader, more futuristic view of nursing that goes beyond their direct-care experiences to incorporate a broad range of knowledge and skills. On the other hand, they use their learner role to become proficient in those tasks that will enhance their credibility in the nursing roles they will occupy upon graduation.
The findings from this research support other work which suggests that student learning reflects a combination of functionalist and interactionist approaches (Bucher & Stelling, 1977; Light, 1988; Simpson, 1979). That is, there is both internalization of professional values from the faculty and situational adjustment to the requirements of the clinical practice world. This supports Bucher and Stelling's (1977) thesis that not only does the professional school influence the shaping of students, but students also actively construct their own identities. Bucher and Stelling (1977) contend that the concepts "active evaluating trainee" and "sense of mastery" (also identified in this study) provide the theoretical link between the functionalist and interactionist approach. The relative emphasis of each approach varied over the students' 4 years in the program. In the first year, functionalist learning predominates as students learn the "ideal" norms and values of the profession. Students are characterized as passive learners. In second year, they are confronted with reality that requires a more interactionist approach as they adapt their learning to the exigencies of the situation. They are dependent learners as they require validation of their knowledge and skills. In third year, students continue to develop their own perspective of nursing. They become more confident in their knowledge and skills, which makes them more independent of their instructors. In a sense, they have shaped their own identities. Fourth year students look beyond their practice situation, in terms of both their perspective of nursing and their anticipation of a reality beyond the student world. They are active in seeking out learning experiences that will prepare them for this new reality as graduate nurses.
The differences encountered between professional nursing schools and the work of practicing nurses might lead one to expect an emphasis on "reactive behavior." Although students were required to negotiate reality and adapt their behavior to the exigencies of the situation, they did not seem to abandon the professional values inculcated by the professional school; that is, contrary to Simpson's (1979) findings, but supporting those of Olesen and Whittaker (1968), students do not assume the "bureaucratic" values of the organization. They may attempt to "fit in" (Kelly, 1991; Mackenzie, 1992; Melia, 1987) but do not "give in" to the norms and values of the nursing unit when these are discrepant with the values and norms conveyed by the faculty. Weiler, Harrison, and Ka tz (1988) found that the longer the students were in the program, the more congruent became their view of nursing with that of the faculty. Kelly (1991) also found that, although students valued "fitting in" and "going along," they retained their own ideals.
Davis (1975) has suggested that the "ideological affinity" between students and faculty is increased because students identify instructors as positive role models, with negative role models tending to be practicing registered nurses. The students in this study did perceive their instructors as positive role models (Campbell, Larrivee, Field, Day, & Reutter, 1994), as mentors to be "emulated" (Merton, Reader, & Kendall, 1957). Perhaps this affinity is also enhanced because, in the clinical area, faculty are with the students on a continuing basis, particularly for the first 3 years. Moreover, faculty "control" the appraisal and evaluation of student performance; that is, they have the capacity to selectively reward and sanction student behavior. That students and faculty have similar values and objectives is supportive of a functionalist perspective of professional socialization; in contrast, the interactionist perspective of Becker and colleagues (1961) contends that the faculty and students may have different objectives, resulting in a student subculture with countervailing norms and strategies to cope with faculty expectations.
Although this study provides evidence of a dual role of "learner" and "worker" (Melia, 1987), in which students must adjust to the clinical situation by trying to adapt to the expectations of both the faculty and the norms of the unit, students did not become a part of the unit nursing team to the same degree as may occur in a more apprenticeship approach to nursing education, such as that described by Melia (1987). Therefore, the role of "worker" is less evident than the role of "learner." In other words, there may be less need for the student to manage the "segmentation" (Bucher & Stelling, 1977) or "compartmentalization" between service and education (Melia, 1987). This may further assist students to "retain" the values of the professional school.
Students do not, however, accept uncritically the values of the professional school, but instead reflect on and examine how these values can be applied to the reality of nursing practice. They derive for themselves a bedside model of reality. Mackenzie (1992) suggests that students, while being aware of the differences between the "reality of practice" and the "ideal of college," do not perceive this as problematic. She maintains that the discrepancy is more of a stumbling block for teachers than it is for students. Ashworth and Morrison (1989) go so far as to say that the ambiguity of the student role brought about by differences in education and practice is essential and provides important learning opportunities for reflection and the development of experiential knowledge.
Of practical significance is the finding, supported by others (Ashworth & Morrison, 1989; Wilson & Startup, 1991), that students perceive a conflict between staff nurses and students. The rift between baccalaureate nursing students and those nurses without baccalaureate preparation may be diminished with the implementation of the baccalaureate degree as the entry into practice. Meanwhile, students who feel that they are "outsiders" may not derive the full benefits of role modeling by expert practitioners. A positive staff student relationship may be particularly important in the first years of the program when students are at a "dependency stage" (Cohen, 1981; Windsor, 1987) and, as pointed out in this study, when approval is important in validating student competence.
The students' perceptions that the staff nurses' practice does not always reflect the values they perceive as central to nursing presents an interesting aspect of the "functionalist-interactionist" debate in professional socialization. Have these staff nurses adjusted their practice (and even their values) to the situational demands of the unit (Freidson, 1970), or alternatively (but probably less likely) were they socialized to different values in their professional education? Or is their behavior the result of a combination of factors?
In terms of implications for nursing education, an understanding of the process of learning may assist in the development of appropriate teaching strategies to guide student learning. In first year, students require considerable input from teachers. In the second and third years, students need to be engaged in active learning situations. In the fourth year, students require independence from their instructors in order to develop the confidence needed to enter the graduate nurse role.
In conclusion, this study suggests that nursing students' socialization involves two interrelated but different processes: socialization to the student role and socialization to the nursing role. Socialization to the professional nursing role involves a more functionalist approach, relating to professional values, norms, and behaviors. Socialization to the student role involves learning how to nurse when one has minimal knowledge and experience and includes responding to the expectations of others, gaining their approval, and finally developing one's own self-identity as a nurse. It is based on an interactionist approach that includes coming to terms with the differences between the world of academic nursing and the practical world of the clinical area (Ashworth & Morrison, 1989). The situational adjustment that students experience during their student days may prepare them to better cope with the uncertainty and structural change they will encounter with health care reform. It is reasonable to expect that this challenge will require considerable "rolenegotiating" and "role-making."
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