Tratamiento del cáncer vesical superficial.

Throughout the first year of their transition the participants began to perceive themselves differently and no longer identified themselves as newly qualified. That said, towards the end of the first year they were still not at a stage where they saw themselves as the same as

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the others in the team or as children’s community nurses. The following excerpt from Jesse illustrated this point:

“I do still feel quite ... I think because I’m the only (band) 5, I do feel a bit outnumbered. And the new (band) 5 that’s starting has got loads of experience anyway ... I think in

terms of experience I’m quite outnumbered with who I work with. I don’t feel like I’m newly-qualified though, I just feel like a slightly less-experienced Band 5. I just

don’t have anything ... like they go on about past jobs and stuff and I can’t do that really, I’ve got nothing to compare other than experience as a student, but I don’t

feel newly-qualified any more” .

Pay banding was introduced within the National Health Service as a result of Agenda for Change (DH 2004). In the UK nursing staff are paid in pay bands on the basis of the knowledge, responsibility and skills needed for the job (DH 2004). Other nurses in the team were allocated to higher pay bands and therefore an explanation for Jesse’s perceptions could be that it was inevitable that she would feel less experienced given the band to which she was allocated. This was a further indication that experience continued to be perceived as a significant factor in their integration and the fact that they had less experience than the senior nurses; this was implicated in their reluctance to identify themselves as a children’s community nurse. Nonetheless, this was considered by me to be a key milestone in their transition. For Max there was difference between being a qualified staff nurse and being a qualified children’s community nurse:

“I am waiting for this moment when I stop calling myself a staff nurse and start sometimes when I’m on the phone I’ll describe myself as a children’s community nurse but when I’m writing my notes I always sign it staff nurse so I’m waiting for the defining moment when I stop writing staff nurse and write children’s community

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At the time of these disclosures, Jesse and Max had been in their post for 10-12 months. It remains uncertain when, if ever, they would perceive themselves to have achieved the identity of a children’s community nurse.

For van Gennep’s (1960) work the post liminal stage of transition is characterised by the individual taking up their new status and identity. As reported in the literature studies identified that towards the end of the first year new graduates are able to demonstrate capability, although there is some debate as to whether there is a full incorporation (van Gennep 1960) or mastery (Meleis et al.,2000) at this stage. The findings of this study are

consistent with those of Farasat (2011) for example who found that the participants at 12 to 14 months still experienced feelings of uncertainty and still felt new in relation to their emerging identity. However, what this study adds is the role that others play in this and that both newly qualified nurses, and those with whom they work are implicated as arbiters of a new professional identity.

7.8 Summary

This chapter has identified that the participants in this study had developed an emerging identity as a children’s community nurse. According to Meleis et al., (2000) an outcome of transition is reappraisal of identity. The participants began to reformulate an identity as a children’s community nurse when they experienced a change in their own and others’ perceptions of their identity. This reappraisal fluctuated as suggested by Meleis et al.,

(2000) and certain factors were implicated in this. There were circumstances that facilitated the development of their identity and in part knowledge of these is useful in informing strategies to influence an ideal experience of transition. These included wearing the same uniform as other established of the team and gaining support from their colleagues when

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they made mistakes. However there were situations that disrupted the emergence of their new identity. Both individuals and organisational structures were implicated in this and included being treated differently to other members of the team, having no desk, being viewed as nurses in training and remaining unable to administer intravenous medication. The participants were active in developing strategies to overcome these challenges and this is a new finding. This included the suggestion of a hot desk system to overcome the feeling of being marginalised, viewing themselves as part of the team and attempting to integrate into the team, recalling stories of their experiences to emulate others in the team.

Essentially, the participants were both active in developing their identity but also arbiters, along with others, in the final recognition that the new identity had been achieved.

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