Experiences of Final Year Nursing Students in Their Preparedness to Become Registered Nurses

Curationis 28(4): 65-73 The objectives of this study were: firstly, to explore and describe the experiences of final year nursing students relating to how they experience their preparedness to fulfil the role of professional nurse; secondly, to explore and describe the experiences of novice professional nurses in the role of professional nurse; finally, to generate a model which will assist the final year nursing student to become a professional nurse. A theory-generative, qualitative, explorative, descriptive and contextual research design was utilized to reach the objectives of the study. Results indicated that final year nursing students experience a lack of confidence to take on the responsibilities of professional nursing. The results are displayed in table form and discussed in the article. This abstract forms part of a bigger study that addresses the professional maturity of the novice professional nurse for the practice of nursing. Opsomming Die doelstellings van hierdie studie was: eerstens, om die ervaringe van finale jaar verpleegstudente ten opsigte van hul gereedheid om die rol van 'n professionele verpleegkundige te vervul, te eksploreer en beskryf; tweedens, om die ervaringe van die nuw eling professionele verpleegkundiges in die rol van professionele verpleegkundige te eksploreer en beskryf; laastens, om 'n model te genereer wat tot hulp sal wees vir die finale jaar verpleegstudent om 'n professionele verpleegkundige te word, 'n Teoriegenererende, kwalitatiewe, eksplorerende, beskrywende en kontekstuele navorsingsontwerp was gebruik om die doelstellings van die studie te bereik. Die resultate het aangedui dat die finale jaar verpleegstudente 'n gebrek aan vertroue ten opsigte van die aanvaarding van die verantw oordelikhede van professionele verpleging, ervaar. Die resultate is in 'n tabelvorm weergegee en word in die artikel bespreek. Die abstrak vorm deel van 'n groter studie wat die professionele maturiteit van die nuweling verpleegkundige vir die praktyk van verpleging aanspreek.


Introduction
Graduating as a professional nurse is a special and unique event in the life of an individual who has for the past four years practised in the role of student nurse.The transition phase from student nurse to professional nurse is an exciting one, but it is also a phase hampered by certain anxieties.These anxieties could be sparked by feelings o f insufficient knowledge that the student nurse may be experiencing, the fear of making mistakes or of not being able to maintain and assert herself/himself in the health care team as a professional nurse.
As a student, the individual is expected to submit to professional socialization to be able to internalise the values, attitudes and ethics of the nursing profession (Mashaba and Brink, 1994:310).Novice professional nurses may be expected by seniors to perform activities in which they are still inexperienced.They may not always be competent or confident in all areas of their new role.They are expected to be accountable for their actions with regard to nursing care, and participate in prescribed learning situations to meet their programme outcomes.In the new role o f an em ployee the novice professional nurse now needs to conform to the conditions of service o f the employing authority.Throughout the basic programme, students are taught to develop skills and are evaluated on the ability to implement these competently in a patient situation.However, the researcher, in her accompaniment of final y ear nursing stu dents, has heard verbalizations such as "I d o n 't know where to start with management o f a w ard... " M ellish, B rink and Paton (1998:4) state that m anagem ent is, perhaps, one of the least thought about, talked about and understood facets of nursing, but one that co-determines the quality of care.The novice professional nurse will have to fulfil the management role as a major part o f her workload in the clinical environment by ensuring that health care, and not only nursing care, is given.As a p ro fessional nurse she is responsible for coordinating services and care.Furthermore, she coordinates care given by the multi-disciplinary team and uses her own initiative when deciding to consult with members of this team.

Problem statement
F inal year nursing students have verbalized to the researcher that they feel "very nervous about starting out as a professional nurse" and that they "do not know if they will be able to cope " with this new role.The following quote reflects the experience of uncertainty of these students in their anticipation of assuming the role of professional nurse: "I cannot ask the sister/Professional/ Registered nurse anymore, because 1 am the sister/Registered/Professional nurse in the ward.I w ill have a lot o f responsibilities and it is very scary".
Pilhammar Andersson ( 1995:13 1), in her study of marginality, states that clinical practice within nursing education is described by many nurses as a period in which they "stand with both fe e t in different boots".This implies that the student n u rse 's position is at the intersection of two relatively different cultures or traditions, ie academic versus professional.It can be said that the novice professional nurse experiences a "culture shock".There is a separation from a previous identity, namely that of student status, without subsequently being accepted by a new group, namely that of professional nurse.As the student qualifies as a professional nurse, she/he may experience a feeling of "homelessness" and the loss of status as a former student, at the same time adjusting to the role of professional nurse with a load of responsibilities (compare Pilhammar Andersson, ibid).
The anxieties that the final year nursing student experiences are fu rth er aggravated by the changing context of clinical learning environments that affects nursing education and practice.The researcher accompanies nursing students in the clinical learning environment and has been made aw are o f the rapid changes in the clin ical learning environment of health care institutions.This has been verbalized by students who state that they are "fin d in g it d iffic u lt to adapt to the changing c irc u m sta n c e s" of health care institutions.
The focus on com m unity-based education in South Africa has resulted in a shift away from the mainly curatively and in stitu tio n ally based nurse.Consequently, the emphasis is towards a more preventive, promotive and homebased health care approach.This approach requires students to fulfil practical hours in a community-based settin g , w hich co m plicates and significantly alters the opportunities for developing institutional management skills.Students have verbalized this to the researcher on re-entering the clinical field after exposure to the community setting, especially before preparing for practical examinations.
The above-mentioned experiences result in qualified professional nurses seeking employment elsewhere.It is a known phenomenon that South African nurses are migrating globally.There is also the implication of a heavier workload and greater responsibilities for the nursing personnel who remain behind and who are expected to competently and with dedication maintain a ward/unit, while simultaneously rendering nursing care of a high quality to patients.This is the type o f situ atio n that the novice professional nurse in South A frica currently encounters after graduation.

Research objectives
The objectives of the study were to: • Explore and describe the experiences of final year nursing students relating to how they experience their preparedness to fulfil the role of professional nurse.

•
Explore and describe the experiences of novice professional nurses in the role of professional nurse.Terminology List, 1994:5 andKotzé, 1998:10).

Student
For the purpose of this study, an individual who is in the completion phase of a basic four year nursing programme, approved by the South African Nursing Council, so as to meet the minimum req uirem ents for re g istra tio n as a p ro fessio n al/reg istere d nurse and midwife.

Clinical learning environment
The clinical learning environment is the environment in which the student is systematically exposed to learning and practice opportunities in real patient and service provider situations.It is a selected environment that will provide physical, psychological, spiritual and social support (u tiliz in g a holistic approach) to patients in order to promote and maintain safe, effective patient care and ensure that programme objectives are met (researcher's definition based on reviewed literature).

Research design and method
Research Design This research study w as a theorygenerative, qualitative, explorative, descriptive and contextual design.

Research Method
The collection of data and the analysis of data were implemented and divided into two phases.
Phase 1 involved the exploring and describing of experiences of final year nursing students and their preparedness to take on the re sp o n sib ilitie s of professional nursing.Phase 1 also included the collection of events in the form o f n arrativ es from novice professional nurses of events related to their co n fid en ce in the role of professional nurse.
Phase 2 followed the interpretation of the data and involved the development of a self-m anagem ent m odel tow ards professional maturity for the practice of nursing.

Sampling
Purposive sampling was used to recruit participants.Purposive sam pling is based on the assu m p tio n th at a re searc h er's k n o w ledge about the population can be used to handpick the cases to be included in the sample (Polit and Hungler, 1999:229).A sample of ten nursing students was drawn.The sample size was dependent upon saturation of data following the interviews and coding of data.

Sample population
The population in this study comprised, firstly, the final year nursing students and, secondly, novice p rofessional nurses.All final year nursing students (including a few of those who took part in the interviewing phase) voluntarily submitted their contact details to the researcher on completion of their fouryear programme.They were followed up by the researcher after three months of practising as a registered nurse, briefed as to what was required of them relating to the narrative writing and given a maximum of two weeks within which to post the n arrativ es back.D ufault (1990:74)  Firstly, data was collected from ten final year nursing students by interviewing them, utilizing an unstructured interview technique, and by directly observing them in the clinical field in the role of student.The final year nursing students were asked the following "Tell me how prepared you regard yourself to be to take up the resp o n sib ilities o f professional nursing Secondly, novice professional nurses were contacted telephonically as well as per written letter and asked to describe experiences related to an event where they felt they lacked confidence and an event w here they felt they had confidence to deal with a situation in the area where they were practising (as novice professional nurses).Novice p ro fessio n al nurses w ere given a framework against which they could write their narratives.Written narratives were returned to the researcher.(Exemplars of the narratives are available on request from the research eras w ell as the framework).A total return sample of 68% of written events was received from the novice professional nurses.

Data analysis
Interviews were transcribed verbatim and analysed for emergence of themes that were prevalent amongst the participants who were interviewed.The researcher reduced the data meaningfully until the central storyline, as told by the final year nursing student, emerged clearly.Data w as analysed according to the descriptive analysis method by Tesch (in Creswell, 1994:155) and themes were formulated.In the process of analysing the data, all copies of interviews and field notes were kept and reviewed for any
1.2 S tudents experien ced certain emotions related to their lack of confidence 1.3 Students experienced a need for structured, direct learning opportunities to build their confidence Students experienced: 1.2.1 Frustration when they were, due to lack of confidence, unable to confront the ward staff about poor patient care and other factors that were troubling them as students.1.2.2Despondence because they perceive themselves as wasting the professional nurse's time.

1.2.3
Feelings o f inferiority because the ward staff treated them as if they were ignorant and they did not consider themselves as members of the multi-disciplinary team.1.2.4 P ow erlessness because of lack of practice learning opportunities in the management of health care units.1.2.5 Fear o f the unknown ie of the professional role that will be expected of them.1.2.6 Gratitude and appreciation for the competencies gained through the programme and the ability to learn to improvise and be creative with the limited resources at their disposal.
Students experienced the need: 1.3.1 To be exposed to learning opportunities that would facilitate management competence.1.3.2For a period of working in a management capacity under the supervision of the professional nurse.1.3.3For guided reflection to enhance their becoming professional nurses.
additional themes related to the findings of the interviews.A copy of the analysis techniques, described by Tesch (in Creswell, 1994:155), the transcribed interview s and the field notes were handed over to an independent coder experienced in the field of research.A meeting between the researcher and the independent coder took place to discuss any recurring them es and to reach consensus regarding the central story line and themes.
Narratives were analysed using a content an alysis tech n iq u e p re scrib ed by F lanagan (1 9 5 4 :3 4 4 4 ) as novice professional nurses were requested to write about specific events relating to their co n fid en ce to p ra ctise as a Registered Nurse.

Literature control
The literature control verified and recontextualized the identified themes w ithin the ex istin g lite ratu re .On completion of the data analysis a literature control was implemented to compare findings from data with existing data in literature (De Vos, 1998:19).This process was implemented with the data collected through in terview s w ith final year nursing students, as well as the data collected from novice professional nurses through the narratives.

Trustworthiness of the study
In order to ensure trustworthiness of the study, G u b a's m odel in K refting (1991:215) was utilized.Guba identifies four criteria for trustworthiness.The criteria for trustworthiness were: Truth Value.This asks how confident the researcher is with the truth of the findings based on the research design, informants and context.The strategy for establishing truth value was credibility (compare K refting 1991:216).The researcher en sured that those particip atin g in the research w ere identified and described accurately.The actions to im prove credibility were: reflexivity, triangulation and member checking.R eflexivity ensured that extreme over-involvement did not occur between the student and the researcher.The researcher m ade use o f a field journal that reflected her thoughts, feelings and ideas after contact with respondents.In th is m anner the researcher became aware of biases and preconceived assumptions.
Applicability.Applicability refers to the degree to which the findings can be applied (fitted) to other contexts and settings or with other groups (Krefting, 1991:216).The criterion against which ap p lica b ility was assessed was fittin g n e ss or tran sferab ility .The research er determ ined w hether the content of the interviews, the written events and observed events were typical or atypical of the lives of the informants.This was identifiable, as the researcher herself has practised as a professional nurse.
Consistency.Consistency of data refers to w hether the findings w ould be consistent if the enquiry were replicated with the same subjects or in sim ilar context.This is based on the criterion of dependability (Krefting, 1991:216).The re searc h er u tilized a co d e-reco d e procedure on the data collected during the analysis phase of the study (on completion of coding a segment of data).After a week the researcher returned to the data, recoded the same data and compared the results.The researcher also consulted w ith colleagues who are m eth o d o lo g ical ex p erts, ie p ee r assessment to check the research plan and implementation thereof.This increased the dependability of the study.
Neutrality.This refers to the degree to which the findings are a function solely of the informants and the conditions of the research and not of other biases, m o tiv atio n s and p ersp ectiv es.Confirmability is the criterion against w hich n eu tra lity can be m easured (Krefting, 1991:216).Confirmability was established by triangulation o f data sources.The re searc h er provided docu m en tatio n o f each claim or interpretation to ensure that the data supported her analysis and interpretation of the findings.

Ethical considerations
The researcher considered ethical issues throughout the study.Participants were informed that, if they had any ethical problems concerning the study, they could co n tact a lectu rer w ho is a representative of the ethics committee at the N elson M andela M etro p o litan University.The principles implemented to protect the participants in the research study from harm or risk were: the right to protection from discomfort and harm based on the eth ical prin cip le o f beneficence which states that one should do good and, above all, do no harm, inform ed consent, co n fid e n tia lity , anonym ity and privacy (B urns and Grove, 1999:166).The participants were informed that they may withdraw from the study at any time.Permission was obtained from the heads of the nursing schools and health care institutions w here p rofessional nurses w ere em ployed.
S tudents and novice professional nurses were informed of the purpose of the study and were given the o p p o rtu n ity to consent or d eclin e participation in the study.All participants were assured that no information given by them would be shared with another person without their authorization.

Identified themes/results of the study relating to final year nursing students
The identified central theme and sub themes relating to the experiences of preparedness o f final year nursing students are discussed in table 2.

Discussion of the central theme and sub-themes
Central theme; Final year nursing students experienced a lack of confidence to take on the responsibilities of professional nursing Students verbalized that "although the programme is comprehensive and indepth" they "have no confidence...like I h a ve n 't had the chance to so rt of..practise things and feel confident about it...once you have confidence to solve a problem, you can solve another problem and the next problem ...you build up the confidence to get over the h u rd les...yo u can then g et into anything... " Iipinge and Malan (2000:51) indicate that, when students have an opportunity to practice what they have learnt, there is strengthening of their abilities resulting in self-confidence and a feeling of self-fulfilment.Students need to develop courage to become competent in nursing practice in order to enhance their confidence; they need to feel safe to do this, to be given the opportunity for practice and they need to receive reco g n itio n o f status as final year students.However, these opportunities are lacking as evidenced by the following sub-theme.

SUB-THEME: Students related experiences that negatively influence their confidence
The ex p erien ces w hich n egatively influenced the students' confidence are that they: Novice professional nurses are expected to be competent in problem -solving, ad m in istratio n and m anagem ent activities, applying clinical judgment, research in g p atient case studies, teaching both the patient and fellow nurses, promoting good interpersonal relationships, caring, applying ethical principles and to portray competence in psychomotor skills.A student confirmed this by saying they should work more closely with members of the health care team, especially the medical practitioners, and they should "be encouraged to stick to the doctor like glue".Balfour (1987:25) states that theories of nurse education expect students to be self-motivated, research-oriented and prepared to utilize their knowledge in an adventurous manner.Yet, in practice, they are still taught to be safe, obedient and quiet.Factors contributing towards ex p erien ces o f students not being regarded as emerging professionals by members of the multi-disciplinary team are the following:

H E xperienced personnel as antagonistic and inaccessible toward them when initially placed in the ward
The students experienced the presence of a gap between the professional nurse and themselves and it made them feel uncomfortable, especially "if she is not one that offers to ever help us, especially if I go to her fo r advice...I mean...I don't want to make mistakes and I have to ask f o r h e lp ....".Students experienced themselves as being "non-existent" and they verbalized that "no-one would notice if they were not present in the ward".Students doubted their role as student nurse and felt that it was an unimportant role.

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Experienced them selves as workforce in the units because they were only allowed to perform basic duties in the ward, observe and continuously run errands A co n cep t that em erged from the in terv iew s was that the students experienced themselves as workforce because they performed only basic duties in the ward, observed and continuously ran errands.Ashworth andMorrison (1989), Palmer (1994) and Shield (m Nolan, 1998:623) posit that learning only occurs if experiences are used productively.They state that, unfortunately, many studies on student learning in clinical placement show that time is not used effectively.Students said when they are in the wards they are expected to do "everything.We have to go to the dispensary, sometimes three times a day, take patients to X-rays and to scans.I have even driven in the ambulance to other hospitals to take patients...hut even in the wards...we just make up beds the whole time and do basic things".

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Experienced them selves as being deprived of the responsibility and the opportunity to make decisions and use initiative A further contributing factor towards the students' lack of confidence is that they experienced themselves as being given n eith er the re sp o n sib ility nor the opportunity to think critically and make their own decisions (under supervision o f the professional nurse).This is because the student is merely seen as w orkforce and not as having supernum erary status.The students stated that they would like to be given the opportunity to "take charge and to take the reins".Jolley (1987:30) states that the practice of nursing must excite the stu d e n t's im agination and enthusiasm.It must provide interest, intellectual stimulation and independent practice for these new experts and it can only be done by focusing on problem solving and decision-making.

■ Experienced them selves as deprived of the opportunity to ask questions and verbalize uncertainties about the conflicting manner in which things are done in the wards
The m anner in which the student is taught at the nursing school conflicts with the manner in which nursing actions are implemented in the wards.This compounds the student's experiences of feeling unprepared for the role o f professional nurse.Although students experienced themselves as competent in performing nursing skills, they mentioned that it is difficult for them to "keep remembering" the way they were taught, esp e cially w hen doing d re ssin g s, because the staff nurses do dressings differently.R eutter, F ield, C am pbell and Day (1997:150) acknowledge that nursing students are intensely aw are o f the d isc re p a n c ie s betw een w hat they experience in hospital practice and what they are taught in schools of nursing.Melia (1987:165) found that students coped with this discrepancy through rationalization and compaitmentalization.She states that com partm entalization happens w hen nursing stu d en ts, in moving from the world o f academic education to that of hospital clinical practice, come to terms with two versions o f nursing, each with its own standards and rules.Instead of questioning or confronting these diverse philosophies, students coped by rationalizing that they are just passing through and apparently cope by fitting in with each philosophy.

■ Experienced ward personnel as d isregarding their know ledge and experience in the clinical environment
A lthough the students were in their fourth year of study they were not asked to manage bigger responsibilities, for example administering of medication to patients.This is evident in the following quote by a student: "For one, giving out o f medicines.It always seems the sister or staff nurse !v job.They just call us and we have to take the tablets to the patient.I stand and make sure he sw allow s them...but staff nurses just leave them on lockers...and we cannot say anything".Students experienced restriction in some ro u tin es because the m ore sen io r personnel preferred to continue with the w ork and they w ere not given responsibility.Responsibility denotes an obligation to accom plish a task and accountability is accepting ownership for the results of or lack thereof (Sullivan and Decker, 1997:67).Fetters A ndersen (1999:770) states that accountability is a p rocess that needs to be n u rtu red th ro u g h o u t the nursing ed u catio n experience.A second experience of students that negatively influenced their confidence was the lack of professional nurse role models to socialize them into the profession of nursing.

Experienced a lack of professional nurse role-models in their professional socialization
From the interviews it was clear that stu d en ts ex p erien ced a lack o f professio n al ro le m odels to aid in socializing them into the profession of nursing, and that they knew who was and who was not a role-m odel.Toohey (2002:529) believes that students will pick up certain qualities by being around pro fessio n als in th e ir clin ic a l or workplace attachments.She states that the effect of working with positive rolemodels can be significant and that it is, therefore, imperative that students have role-models from whom to learn desirable, professional nursing practice.Very few students could truthfully say that they have had a role-model to whom they could look up to.They knew how they would perform as a professional nurse rolemodel as evidenced by the following quote: " I 've seen how I would like to act and how I hope / will never act from different sisters... ".Factors contributing towards the experience o f a lack of professional nurse role-models were: H Students experienced a lack of work ethic in nursing personnel Students stated that there were times in the day when no professional nurse was available and they were left on their own.They felt that they were being taken advantage of "because then once the staff come on duty, and they see OK there is two or three students then they think there' s more than enough, then they go home, disappear out o f the ward, or they take hours off, then they leave... ".

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Students experienced nursing personnel displaying an uncaring and unempathetic attitud e toward the patients Caring is the goal o f th era p eu tic communication and an attitude that enhances communication.It is the level of emotional involvement between the nurse and the p a tie n t and is the foundation o f a n u rse -p atien t relationship.It is a relationship in which the nurse uses her therapeutic skills such as genuineness, warmth, empathy, active listening, respect and acceptance of the patient to provide nursing care that will enhance his/her recovery.The uncaring and unempathetic attitude displayed by nursing personnel towards the patients was a concern o f all stu d en ts participating in the interviews.Most students had this to say: "1 want to ensure that I give the best nursing care to my patients, and I will ensure that they receive the best they can from me, and that I can do my duties to the best I can, at that moment...that is what I want to be.''

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Students experienced a lack of commitment in professional nurses to accompany them in the wards Feelings of inferiority came to the fore and students indicated that they did not deserve to be treated in this manner because they were students.

■ Students experienced feedback on their performance as mostly negative
The students verbalized that they would appreciate being given the responsibility o f p erfo rm in g m inor tasks o f the professional nurse in their final year, which would aid in developing their confidence.A student stated "I don' t exp ect them to hand o ve r a ll the responsibility to a student nurse...it is a bit o f a touchy s itu a tio n ...b u t ju s t knowing that you have done something right...if they could come to us and say "well done, I saw you do that" or "we had a good day today, things went w e ll"...th a t w ould help a lot to o ".Students experienced that if they did receive feedback, staff would always begin with the negative feedback and give very little p o sitiv e feedback (students mentioned that this was also applicable to some lecturers).

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Students experienced a lack of professional pride in nursing personnel Students verbalized that professional nurses "take time o u t" and left them alone to continue with routine work of the unit.They believed that this was because of personnel shortages resulting in time constraints because remaining personnel in the unit have to ensure that daily routines are implemented.This, however, added an extra workload to the rem aining team left in the units to complete routines.

SUB-THEME: Students experienced emotions related to their lack of confidence
The realization by the students that w ithin four m onths they w ould be p ro fessio n al nurses brought about varying degrees of emotions.A few stu d en ts m entioned th at they experienced a "reality shock in theirfirst year o f practice and it is almost as if the experience will be repeated again when they are "new " professional nurses".Emotions experienced were related to those feelings o f fru stratio n , despondence, and feelings of inferiority, fear of the unknown, powerlessness, as well as gratitude and appreciation.

SUB-THEME: Students
experienced a need for structured, direct learning opportunities to build their confidence S p ecific needs are requ ired to successfully fulfil the role of professional nurse.
Students experienced the need to be exposed to learning opportunities that would facilitate management competence D uring the in terv iew s stu dents m entioned that they did not feel comfortable with, and lacked, leadership skills, delegation skills, coping with conflict in the ward, confrontation skills, the ab ility to ex e rcise au th o rity , assertiveness skills and supervisory skills.
They stated that most of the management aspects related to nursing practice had been covered in theory alone and no o p p o rtu n ity had been given/m ade available for them to practise "hands on " and "take control".
Students expressed the need for a period of working in a management capacity under the supervision of the professional nurses It was evident from the interviews that the students felt enriched and empowered w ith a vast am ount o f th eo retical knowledge from the programme.They also felt confident in im plem enting practical skills.Three students in the in terv iew s had been given the opportunity to "act" as a professional nurse for a month and yet they expressed "it is not enough time, even fo r a month, to learn about all that goes on in a ward, especially i f you haven't been given a chance to be independent in the ward".M ellish (1985:89) states th at by organization the professional nurse in charge oils the wheels o f the work in the area and keeps them running smoothly.In order to assist in the adaptation from stu d en t to p ro fessio n al nurse, the stu d en t needs to be given the opportunity to practice this role under the sup erv isio n o f an ex p erien ced professional nurse.
The students perceived the need for guided reflection to enhance their becoming professional nurses Jenkinson (1997:60) states that reflection brings self into view.Reflection focuses on personal experience and practice, drawing on many forms of knowledge.This need is verbalized by a student saying "...in class we like to talk about the day, what we have experienced in the practical field and it really helps, esp e cia lly as f a r as em otions are concerned, if we can just talk about it, ...but we don't always have the time fo r th is...." Students said that reflection is not encouraged enough and that if they could get the opportunity to speak for fifteen to twenty minutes about the previous day's practicals and discuss this amongst each other it would be extremely meaningful for them, especially hearin g w hat th eir co lleag u es had experienced.

Identified themes/results of the study relating to novice professional nurses
The events derived from the written narratives of novice professional nurses are depicted as follows: ■ Events described by novice professional nurses which caused them to experience lack of confidence were lack of experience resulting in novice professional nurses feeling vulnerable as members of the health care team, lack of confidence to delegate duties in the unit and to m anage a unit and lack o f confidence when their self-worth was threatened.

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Events described by novice professional nurses that assured them of their confidence in performance were praise and receiving positive feedback about their performance, which resulted in the novice p ro fessio n al nurse experiencing feelings of work satisfaction and increasing confidence.F urther events assuring confidence were those re latin g to m eeting p atien t needs successfully and previous exposure to the opportunity to practise skills.

Limitations of the study
The following limitations of the study were identified: • The researcher felt that she was not able to collect as many narratives as anticipated as novice professional nurses had chosen employment in many areas of the country and some were working abroad.• Narratives collected from novice professional nurses were relatively short and not explained in as much detail as was expected.This could be attributed to lack of experience in reflective writing skills.

•
Most of the novice professional nurses were working in the operating theatre or in the intensive care unit.

Recommendations
Recommendations are related to research, nursing education and nursing practice.

Recommended Research
In the light of the limitations identified and the fin d in g s o f the study, the following is recommended for future research in this regard:

Conclusion
On completion of the nursing programme, the newly qualified nurse is expected to be co m p ete n t, in n o v ativ e and independent in decision-making and in taking responsibility in the health care in stitu tio n w here she is em ployed.Students need to be prepared for this role and for entering into the rank of qualified professional nurse with confidence in the ever changing and in cre asin g ly demanding health care environments.

Bibliography
as inaccessible and antagonistic towards them when initially placed in the ward.1.1.1.2That they are regarded as workforce in the units.1.1.1.3Themselves as being deprived of the responsibility and the opportunity to make decisions and use initiative.1.1.1.4Themselves as deprived of the opportunity to ask questions and verbalize uncertainties about the conflicting manner in which things are done in the wards compared to what they were taught at the nursing school.1.1.1.5Ward personnel as disregarding students' knowledge and experience in the clinical environment.
"I am su p p o sed to learn to becom e a professional nurse and som etim es I wonder why I am in this course.I am supposed to be taking responsibility next year and yet I still feel like... um... like in ferio r...m o st o f the s ta ff are uninterested in students, and d o n 't care if we do the right thing or no t".
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