Will You Stay or Will You Go?: The Role of Incidental Learning within a Liminal Space in Shaping Student Nurses' Perceptions of Nursing

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Will you stay or will you go?: The role of incidental learning within a liminal space in shaping student nurses' perceptions of nursing 

INTRODUCTION AND CONTEXT

Currently, in Ireland, there is a high rate of attrition among newly qualified student nurses. This paper specifically seeks to provide insights into this issue through an exploration of the experiences and perceptions of clinical placement from a sample of student nurses and preceptors in Ireland through the conceptual lenses of both incidental learning and liminality. We conclude that the power of incidental learning on students transversing a liminal space should not be underestimated and that in our study the surrounding context of support (particularly from preceptors) was critical. Incidental learning around aspects of organization culture and hierarchy that caused dissonance for students emerged as a consistent outcome. So too did time and resource pressure on preceptors due to staffing shortages which, in turn, impacted negatively on workplace learning opportunities beyond routine incidental learning and support available to students to constructively make sense of their experiences. We argue that results from this study can inform not just nurse education but may also give pause for thought to those responsible for professions which have substantial work placement aspects as part of their qualifying route such as apprenticeships.

The healthcare system in Ireland has for a number of years been experiencing challenges in attracting and retaining nurses (Jilani, [28]; McDermid et al., [42]), a problem acknowledged as a global one (Bakker et al., [4]). In Ireland, there was a sharp decline by 27% in applications for places on nursing programmes in 2022 (O'Brien, [48]), followed by smaller but consistent falls in applications up to 2024. Even more worrying are high rates of attrition among student nurses and newly qualified nurses who either leave the profession or leave Ireland to pursue careers in healthcare environments abroad (Humphries et al., [23]; Malone, [38]). A survey of preregistration nurses carried out by the Irish Midwives and Nursing Organisation (INMO) in 2023 found that 73% of nursing and midwifery graduates approaching qualification were considering emigrating upon graduation (Irish Nurses and Midwives Organisation, [26]). These figures indicate a perceptual problem of the profession as students emerge from their lengthy educational and development journey of qualification. From a research perspective, the underlying factors that help to understand the formation of students and newly qualified nurses' perceptions of their profession during their educational period are under researched. In Ireland, 'becoming' a nurse involves a 4‐year degree programme interspersed with clinical placements. The context has changed significantly in the last 30 years. Until 1994, nurses in Ireland were trained under a 3‐year apprenticeship system and were employed throughout their clinical experience. This transitioned to a diploma model in 1994 and, finally, a university‐based degree model interspersed with clinical placements in 2002. Research has indicated that the university element of student nurses' education instils students with a professional identity based on research, evidence‐based practice and professionalism (Browne et al., [9]). However, clinical placements can be a source of dissonance for students between their perceptions of the profession and the reality (Grainger & Bolan, [20]). In seeking to interrogate this issue, researchers in the field of nurse education have suggested that analysing preregistration nurse education through the conceptual lens of liminality may provide useful insights into attrition (Crane & Abbott, [11]). Liminality, which is discussed in more detail below, describes a state of indeterminacy and in betweenness (Gadoin & Ramel, [18]). More specifically, liminal spaces in the context of nursing have been more specifically defined as spaces of uncertainty, socialisation and in a sense reshaping of students in order that they can become accepted into the nursing profession (Land et al., [31]). We further posit that adding another conceptual lens, that of incidental learning within the liminal space may shed light on student nurses' perceptions of the profession. Incidental learning has been defined as a subset of informal learning whereby learning occurs through conscious and, at times, unconscious, interaction within an experience, situated in a context (Marsick et al., [41]). Incidental learning is associated with more intangible aspects of the workplace such as culture, and social interaction and thus what student nurses learn in this respect may provide insights into issues of strengthening alignment with or conversely prompting early attrition from the profession. There remains a dearth of research on incidental learning that takes place within the work placement of Irish student nurses (i.e., other than formal clinical learning) and which shapes student nurses' experiences and perceptions. This paper therefore seeks to make a contribution in this regard. More specifically, we ask What evidence is there of incidental learning within the liminal space of Irish nursing clinical placements? And, second, what are the implications of our findings the quality of nurse education and students perceptions of their chosen profession? Using reflections of student nurses on their lived experience of their incidental learning, we identify several key factors that students perceived as influential as they transverse the liminal space. We include reflections and observations of preceptors. We argue that results from this study can inform not just nurse education but may also give pause for thought to those responsible for professions which have substantial work placement aspects as part of their qualifying route such as apprenticeships.

LIMINALITY AND THE LIMINAL SPACE

Liminality, derived from the Latin for threshold, is defined by Larson ([32]) as a psychological process of transitioning across boundaries and borders. Individuals experiencing liminality are said to 'stand at the threshold' between their previous way of structuring their identity, time or community, and a new way, which completing the process establishes. The transitioning process involves a period of ambiguity or a rite of passage whereby individuals step away from their original status, enter the 'liminal' or uncertain space and experience a transition from one set of social norms and practices to another (Taylor, [55]). This process starts with separation from normal social life, a letting go/detaching from original subjectivities, social norms and familiar practices and norms (Land et al., [31]). The transition process concludes with aggregation, where individuals are anchored into new social norms and practices (Turner, [59]; Van Gennep, [19]). Acceptance and belonging within this new community is a critical outcome. (Beech, [5]). The final stage involves moving towards a new identity position or the reauthoring of self. It has been acknowledged that the subject is not completely passive during this transition and that the liminal space is a 'liquid' space, simultaneously transforming and being transformed by the learner, as they move through it' (Meyer & Land, [44], p. 3).

Liminality in academic research originated in anthropology (Cross et al., [13]), but in more recent years, it has been adapted and provides a useful lens for aspects of work and organisation research (Ryan, [50]). It is more specifically relevant to the emergence and shaping of professional/preprofessional identity (Ibarra & Obodaru, [25]; Ryan & McAllister, [51]). With respect to nursing students, Crane and Abbott ([11]) re‐evaluate earlier discussions by authors such as Van Gennep and Turner in applying a liminal lens to their exploration of student nurse attrition, identifying specific rites of passage. While they engage in a broader scope application of liminality to student nurses experience, we explore specifically the clinical placement.

The structure of a student nurse's education involves a number of transitions between their higher education institute (HEI) and clinical placements. These are widely recognised as a key component of preregistration nurse education and assimilation and work readiness (Arreciado Marañón & Isla Pera, [2]). Irish nursing students are well used to academic settings, as in the initial phase of their professional education they move from a highly academicized school setting to university. The work placements, however, represent a new and relatively unknown environment for many of them, and when they start placements, they cross a border or boundary (Suchman, [54]) leaving behind identity and status developed during their formal university education. Placements may thus be viewed as entering a liminal space (Attenborough, [3]; Crane & Abbott, [11]) during which students can gain understanding of and connection to the qualities, conduct, culture and ideology of their intended profession (Browne et al., [9]; Sather, [52]; Wenger, [60]). The student must endeavour to achieve a sense of belonging and acceptance within the community (Levett‐Jones et al., [33]; Maginnis, [37]).

Incidental learning in the liminal space of work placement

Incidental learning has been defined as learning which is unplanned (Foley, [15]) is spontaneous in nature and can happen within any type of learning situation serendipitously as part of another activity. Previous studies on trainee teachers (Turner, [57]) have found that incidental learning is something that occurs when the learner is involved in periods of disjuncture such as when a problem or gap arises that must be resolved (Marsick & Watkins, [40]) and forces the individual to question their position or prior knowledge of a subject (Turner, [58]). Through critical reflection on the incident, insights and meaning are developed. Incidental learning primarily occurs through everyday events and experiences such as conversations (van den Tillaart et al., [56]), sensing the culture (Marsick & Watkins, [40]) observation, reflection, repetition and social interaction and may not be conscious learning (Marsick and Watkins, [40]). These characteristics have earned it the nomenclature of 'the hidden curriculum' (Marsick et al., [41]). It is more likely to occur in environments rife with challenges and uncertainty (Turner, [57]). Clinical settings are characterized by complexity consisting of interacting and intertwined components (personal, social, organizational, physical, and virtual) that magnify uncertainty in everyday clinical practice (Papanagnou et al., [49], p. 1137) and as such typify the type of work context where incidental learning occurs. Incidental learning can result in valuable individual outcomes for professional development. It facilitate individuals in developing creative problem solving ability relevant to their profession and allows them to 'bank' knowledge gleaned from everyday experiences.

Apart from the practice oriented outcomes, an often overlooked outcome is the exposure of individuals to tacit, hidden, taken‐for‐granted norms and institutional values/culture within the work setting (Browne et al., [9]; Marsick & Watkins, [40]), described in other studies as 'karma in the walls and halls'. Individuals or in this case, students may be faced with pressure to integrate through a process of acculturation (Berry, [6]) into these existing accepted social structures and systems and rules (Wenger, [60]). A key element of incidental learning is the process of experience, reflection and reconciling (or not) personal values with those of the chosen profession (Moir, [46]). This, in turn, can lead to turning points on the part of students whereby they take stock, re‐evaluate, develop their own identity within their profession or even rejudge career decisions (Hodkinson & Sparkes, [21]). Thus, how students engage with incidental learning events is a critical part of the development of their individual professional identity as well as team identities (Turner, [58]).

The dilemma, however, in this regard is the ability of students, within the liminal space of a placement to navigate incidental learning in a meaningful and constructive way both from the practice and culture elements. A recognized aspect of this form of learning is that it can occur without much external facilitation or structure (McGuire & Garavan, [43]). However, while this may be appropriate for more experienced professionals, it may not be so for students. Student nurses could be said to exist within a highly asymmetric power relationship (Anderson & Brion, [1]). Work placements are accredited by universities but for the most part while on placement, the biggest influence on students derives from key personnel within the workplace (Kligyte et al., [30]). While this may provide a fertile ground for positive incidental learning, there are a number of caveats. First, students are highly dependent on those within the clinical placement who decide whether they are successful or not and as such may not feel confident to question or resist aspects of culture and practice, which presents them with personal dissonance (Liljedahl et al., [34]). Other research asserts that experiences associated with incidental learning can be stressful for individuals without the confidence and experience to engage appropriately (Crawford & Machemer, [12]; Esmond, [14]). Recent research makes recommendations for such learning to be beneficial. Key recommendations are that formal learning structures, and guidance should be present within placements to scaffold incidental learning events. Such recommendations are premised on a recognition that trainees may lack ability to reflect meaningfully on spontaneous experiences; thus, access to supportive mentors and guided reflective practice has been described as crucial (Janssens et al., [27]; Turner, [58]), and placements need to have structured learning and practice affordances in place for trainees beyond relying on passive incidental learning (Esmond, [14]). Otherwise, only certain students (e.g., those with pre‐existing reflective ability and confidence) will benefit from placements. Esmond ([14]) also found that placements where there was overreliance on passive incidental learning resulted in students only being exposed to routine practice, thus limiting the potential benefits to them. A critical factor is the mentor relationship. A number of studies (Kaur, [29]; Lin et al., [35]) highlight the importance of mentors (or in the case of student nurses; preceptors) who can influence students navigation of a space and developing agency both positively and negatively.

We posit that the liminal space of placement is a fertile ground for incidental learning around culture and practice as students grapple with disjuncture (Turner, [58]) uncertainty, potential dissonance and culture shock when they step away from the context of the university learning context. Through our data, we seek to provide insights into incidental learning in Irish nursing placements and the effect (if any) of such learning within the liminal space in shaping student nurses' perceptions of their chosen profession.

METHODOLOGY

For this paper, the objective was to discover insights into incidental learning with regard to student nurses during the liminal space of clinical placement and implications for their perceptions of their chosen profession. According to Silverman ([53]), qualitative methodologies are appropriate for exploring the particular situations and experiences of individuals. Furthermore, qualitative approaches to research help to gain an 'understanding of the social world though examination of the interpretation of that world by its participants' (Bryman, [10], p. 392) and to capture the real lives of those involved (Miles et al., [45]). As incidental learning is said to be a very individual event (Forrester & McTigue, [16]) and the key aim was to capture and make sense of people's experiences, it was thus deemed that a qualitative approach would be most appropriate.

The sample

A purposive sampling method was employed, inviting those with certain characteristics relevant to the study, that is, nursing students. A total of 24 nursing students volunteered to complete diaries and interviews as part of the research. All the students came from one educational establishment, but their placements were across varying medical institutions. Of the students that participated, 15 were studying for the BSc in General Nursing and 9 were studying for the BSc in Mental Health Nursing. Participants were given codes to protect their anonymity where S1‐S24 referred to students. Eleven preceptors also volunteered to participate. Preceptors are experienced nurse within the clinical placement setting who are tasked with supervising and working with the students. Codes P25‐P35 referred to preceptors.

Data collection

The preceptors were interviewed for this research, while the students completed diaries and were also interviewed. The research was carried out across two placements over a period of 2 years. Students completed their diary entries on a bi‐weekly basis. Interviews conducted with students ranged from 1 to 1.5 h while preceptor interviews tended to be an average of 1 h. The diary‐interview method offered an observation by proxy approach to source data (Hyers, [24]). This diary approach enabled the researcher to isolate and identify the real‐time, lived experience of students' day‐to‐day interactions, experiences, feelings and activities as they navigated the liminal space of their placement. Unlike methods which rely on retrospection, diaries reduce the risk of forgetting or inaccurate recollection (Mackrill, [36]; Williamson et al., [61]). Diaries were conducted via Qualtrics which was then uploaded to nVivo. Interviews were conducted after the diaries were administered to students.

Analysis

Following the data collection, thematic analysis (Braun & Clarke, [8]) was adopted for the research. Both preceptors and students' data were analysed simultaneously. In line with Braun and Clarke ([8]), six broad stages were followed. (1): Familiarisation with data, (2): Generating initial codes, (3): Searching for themes, (4): Reviewing themes, (5): Defining and naming themes and (6): Writing the piece. Initial thematic areas were identified using nVivo (v11), which assisted in this analysis where queries were utilized to explore subsets of the data, and searches for keywords were conducted. Features within the data were coded, and these codes informed key themes. NVivo was useful for thematic ordering of the diaries, but subsequent analysis was conducted manually by the researchers. First, using the key thematic areas identified through nVivo, the data from the diaries and then the interviews were subsequently thematically ordered and analysed. The authors searched the data for consistent narratives, and the key themes that emerged were culture, power and perceived support. Subthemes that emerged consistently from the data were perceptions of hierarchical culture, perceptions of asymmetric power, 'them and us' attitudes by many older nurses, preceptors as signalers of culture, support of preceptors, perceived impact of staffing on student experiences and perceived positive cultures where affordance, teamwork and support existed. All three researchers scanned and reviewed the data and themes to reduce bias and ensure consistency. Participant quotes were selected by the team for use in the paper on the basis of their representativeness and consistency in aligning with the themes and subthemes. The actual words used by participants were retained. The study findings were peer‐reviewed by an external researcher familiar with qualitative research but not involved in the actual study. The themes and resultant discussion are reflected in the subheadings of the results section.

Ethical approval

The ethical approval process proved quite complex in that the researchers had to obtain approval across a number of areas. One of the researchers worked in the institution where the sample of students studied but did not work within that faculty. The other two researchers worked in a different educational institution and not in the nursing faculty. Thus, there was no existing relationship between the research participants and the researchers. The researchers first gained approval by the educational institution where the students were studying, to conduct presentations to students and then advertise for students to volunteer to participate in the study. Following this, the researchers gained ethical approval from the Clinical Research Ethics Committees (CREC) across a number of public and private hospitals and healthcare facilities in which the participants worked. The researchers were also asked to liaise with Data Protection Officers in the institutions to gain approval which was granted. Also, as the researchers themselves worked in two different HEIs, submissions were made to research ethics committees in both and were secured. Finally, informed consent from both students and preceptors who participated in the research was also obtained.

Findings: Incidental learning in the liminal space

The student nurses who participated in the study, while not explicitly referring to their experiences as 'liminality', reported experiences that aligned with the sense of uncertainty associated with traversing a liminal space. Students reported a sense of 'culture shock' when they left university and entered their placement. It appeared from the responses that this was a result of a gap between the university experience and the reality of the working lives of nurses: 'they are teaching us one thing here [in university] and it is so different in placement. It isn't the reality when we go out' (S9, Interview). 'I find it tough, I find the placement and the stress on the wards and sometimes it worries me that I am after getting into this'. (S13). One student reflected that 'you are looked at more like a pair of hands' (S22). At times, students felt like 'a bit of a nuisance' (S11) to other healthcare professionals or that they were not taken seriously or that they were 'treated more like a health care assistant' (S13). Reflections from some preceptors indicated a perceived lack of preparedness on the part of the students on entering the work placement: 'They come in with all sorts of ideas. They have no idea of what it is...it is ignorance on their behalf... they have no idea of the sort of thing they will be meeting' (P34), which potentially highlights a disconnect between the university setting and the work setting. However, the most consistent observation from preceptors was that staff shortages was a significant issue impacting negatively on the preceptor/student relationship. In particular, preceptors perceived that this was leading to inconsistencies with regard to student/preceptor pairings and also students being 'tolerated' rather than welcomed in some placements: 'I have worked in certain environments that I think sometimes they [students] might be seen as a kind of nuisance, and I know it is more the busier areas' (P27); 'Staffing and inconsistency in staffing...there is no continuity in...there might be a different preceptor in every day...you have no idea about the levels the student is achieving their goals because you mightn't have met the person or had a decent handover' (P26)... and another indicated that 'you can't blame it on the nurse because it is so busy...that are so many constraints...there isn't enough staff, there isn't enough time...and it is unfair on the student as they can get the back lash of that, even doctors if they are to the pin of their collars they [students] can get the back lash of that' (P29).

One of the issues of concern to preceptors was that for them actively engaging with student learning was difficult due to staffing and time pressure, and many were only getting exposure to incidental learning of routine tasks ... 'if a ward is extremely busy and the staff patient ratio is very high...how could a student even learn in that environment because the nurse doesn't have time to prioritise for the patient not to mind extra time for the student. So I suppose in today's environment it can be quiet difficult. Busyness is a huge...one of the biggest barriers to learning' (P32); 'I think on some of the busy medical wards they see the student coming as an extra pair of hands instead of someone who is embarking on a professional degree' (P26)... 'It is harder for them in one sense because they are not allowed to do so much...and they kind of feel a nuisance sometimes, especially if you are busy' (P34).

It was evident that the students learned very quickly about the hierarchical nature of the Irish healthcare workplace within their placements. Students reflected on the existence of hierarchical norms and predetermined roles within various work environments, which they had to navigate. Students perceived that they were 'at the bottom of the pecking order' (S12) indicating an acknowledgement of their asymmetric power position (Anderson & Brion, [1]). The reflections of the students showed how boundaries between professions were signalled and learned through everyday actions: 'The doctors say what is wrong with x,y,z, but it is the nurses who deliver the care afterwards. Doctors don't stay to administer the medication, they prescribe' (S12). There was evidence that existing hierarchies between professions caused them some internal dissonance, where one student acknowledged that 'there sometimes exists a seemingly gaping chasm between doctors and nurses with blatant signs of disrespect form doctors towards nurses and their role on the ward' (S3).

Added to the experiences of a culturally accepted imbalance of power between professions, the students also reported some dissonance with respect to their experiences during placement regarding their own chosen profession. Their reflections spoke of a cultural clash between the students who study nursing at college and older nurses who trained largely on the job: 'they might see you as the young chick coming out of the college and they're thinking that we think we know it all' (S10). A number of students highlighted negative and dismissive perceptions voiced by long serving nurses of the current education model and attempts to subsume them into more traditional practices sometimes at odds with current nurse education practice: 'They [older nurses] were given more responsibility and I think they expect that from us. Sometimes the nurses have said "you are too mollycoddled, you need to put yourself out there or you need to be more assertive"' (S6). Preceptors also acknowledged the prevailing culture: 'That culture or that mind set is alive and well in nursing...this kind of junior/senior and experience is everything' (P27).

In spite of the data pointing to students experiencing dissonance with the aspects of existing culture, they generally appeared to feel that if they did not conform they would not progress towards acceptance within the clinical (liminal) space: 'I did conform to this whole thing that the doctor is higher' (S9). Submission to the dominant norms occurred even where the students felt that actions were wrong: 'You feel that you have to get into things their way, whether it is right or wrong' (S16). It was clear that students were learning the cultural norms, their position within it and their perceived lack of power to resist or evince change. One reflected 'Should I at some stage figure out a better or more efficient way for conducting any particular procedure I would probably hesitate from suggesting it out of a fear of looking foolish or irritating those whom I depend on for success during my internship' (S12).

Students reflected that they 'found that conformity to ward culture and routine will make your life a lot easier' (S3) and they learned 'not to stand out...don't be in the way...not to be a person who is rocking the boat, things are fine as it is' (S12). One student observed that 'they're all clique together [nurses].... so you kind of have to switch off your own personality and adapt the personality that they like to fit in' (S9). Another reflected that 'I don't want to rock the boat so I don't come up with ideas. I have seen it with other girls where they were shot down and I don't want to bring that conflict on myself. I might do something among the patients themselves, but I would be terrified of putting an idea towards the staff in case they would say 'oh this one' (S12). Thus, it appeared that there was continuous reinforcement of the status quo by individuals and groups, and a key element of incidental learning was evidenced by students acknowledging that conformity facilitated acceptance.

This, in turn, served as a force for cultural reproduction and acceptance of existing norms among the 'fledgling' nurses. It was also evident that the level of support on the part of preceptors in the initial placements was highlighted as exercising a powerful positive or negative impact on the students incidental learning and subsequent perceptions of the profession and sense of belonging. Some more negative feedback included: 'I know immediately if I should keep my mouth shut [depending on the preceptor]' (S11). Yet another explained that the preceptor 'rolled her eyes and walked away from me...that was particularly demoralising' (S3). However, in other instances preceptor support exercised a powerful positive force on student perceptions, agency and sense of belonging: 'the following day was still quite daunting so she [the preceptor] was extremely patient and understanding. The following week I was certainly more confident and comfortable' (S12) and 'I receive support every day from the preceptor, she is the kindest nurse I have ever met' (S13). Another student reflected that 'If it wasn't for that preceptor and that team, I would have walked out the door and never come back. It was the fact I had their support and I could cry if I wanted to' (S9). Preceptors themselves indicated that some preceptors were not overly positive regarding their role: 'I see colleagues and you are disappointed with their attitude "Oh I have a student and that is going to take up my time"' (P27). Another reflected that 'You would hope that they are kind of somebody that they could go to...or a go to person...but having worked with students you are not always getting that feedback...that sometimes they (preceptors) are a source of stress for students as opposed to being a source of support' (P35). Another explained that 'sometimes nurses become preceptors and...I suppose they are not as comfortable with it and that can be off putting I suppose for students...and they are so eager to learn...so if you meet somebody who is not that interested in the learning it can be hard I suppose' (P32).

It was interesting that a number of preceptors themselves commented on existing power dynamics and didn't always agree with them, 'there was still a kind of hierarchy that I could see...your managers would be at that table...you were really put in your place like...I think in this day and age those boundaries should be erased really...we are all human beings' (P27). Or as one preceptor observed '[we are] caught up in seniority and "I am senior and you are junior"' (P25). However, interviews with preceptors did not indicate that they themselves were willing or felt able to change existing cultural norms. Such resignation by more senior qualified staff to the status quo even where it is not agreed with can only serve to influence the outcome of incidental learning of students towards perceptions that hierarchical cultures are a permanent fixture within the community of the clinical setting.

Prevailing cultures were not always perceived as negative and students reflected on placements where they experienced what they felt were cultures characterised by more structured support, inclusion and affordance. They learned from this: 'the nurse in charge speaks to me like a colleague as opposed to the student under her care' (S12) and another reflected that 'being taken into consideration as an equal member of the ward staff largely generates a feeling of being respected in my role' (S3). In such environments students learned to push themselves: 'I felt I had control and I went out of my comfort zone...apart from doing mundane tasks' (S12) and another indicated that 'I feel encouraged and empowered to learn in this environment' (S11) and that 'they were really, really supportive. They really want you to float and be your own person' (S8). Such affordances were acknowledged by students as being linked with positive professional alignment by the students themselves: 'having such an involvement in patient care really made me feel like a mental health nurse' (S13) and 'that definitely makes me feel like a nurse because now I feel they trust me' (S9).

In some placements, students experienced strong interdisciplinary team dynamics and its effect on their learned perceptions of effective practice was clear: 'it is a whole team environment, the consultant, the Registrar is there, the nurse and the occupational therapist seeing a team work so well. Exercising the true meaning of MDT (Multi‐disciplinary Team)' (S12). A number of preceptors also noted the importance of support for students: 'I suppose in the morning before we start I would make sure I am including them as part of the team and that they are not just figuring it out for themselves' (P28) and 'I think if you could involve the students at that level that they feel they are important and that they are really part of a team instead of someone who is extra' (P31).

DISCUSSION

In this study, we sought to explore the work placement of student nurses through the lens of incidental learning in a liminal space. As such, we explored the experiences of Irish nursing students stepping away from their initial nurse education experiences in a university setting and into the liminal space of the clinical setting (Attenborough, [3]). We were seeking to understand, discover and interpret the incidental learning of student nurses during the liminal space of clinical placement and to discover key aspects that affected the students and their perceptions of their chosen profession. Previous research (Crane & Abbott, [11]; Markey et al., [39]) has highlighted that the juxtapositional effects of university education interspersed with apprentice style clinical placements as something which may cause dissonance and doubt for preregistration nursing students and that the workplaces (liminal spaces) which host the clinical placements may not live up to students' expectations (Ten Hoeve et al., [22]). This may be particularly pertinent in Ireland where the initial phase of a nurse's career has changed dramatically from an apprenticeship on‐the‐job training model to a university degree model, whereby student nurses develop expectations and the beginnings of self‐identity as professional clinicians. The reflections of the students who participated demonstrated that placements presented a betwixt and between space, a situation of uncertainty and disjuncture (Fuller et al., [17]) for them, where they often felt vulnerable and experienced dissonance. Their reflections on their initial entry to clinical placement demonstrated feelings of culture and practice shock which, in turn, created a fertile ground for incidental learning (Papanagnou et al., [49]) as students sought to fill the 'gap' of uncertainty.

The study brings to the fore a number of key findings: Our results demonstrated how incidental learning can lead to both positive and negative outcomes. The study showed that students did, at times, find the prevailing cultures, many practices and attitudes towards them frustrating and often at odds with what they had learned as 'good practice' in university. However, a consistent outcome of acculturation aspects of incidental learning as reported by our student sample was a reluctance to question or indeed suggest potential solutions to situations, thus limiting their ability to constructively utilise potentially developmental events within the placement context. Experienced and supportive mentors can be crucial at this juncture (Kaur, [29]). Conversely, where scaffolding in the form of structured guidance affordances and support are not present/are underresourced in placements, this can result in overreliance on passive incidental learning (Esmond, [14]). Furthermore, without support and guidance many students may not have the agency to make constructive sense of incidental learning events, and this in turn can impact on their own personal identity within their profession. Feedback by both students and preceptors indicated that students were often not supported in making sense of their incidental learning. This occurred because of inconsistencies with respect to who was the preceptor and simply lack of time and availability of preceptors. Preceptor reflections were particularly insightful. They highlighted how staffing shortages impact negatively on two aspects of student experience. Preceptors observed that meaningful and supported learning often suffered as a result of time constraints and inconsistencies. This in turn resulted in more passive incidental learning limited to routine aspects of practice. Preceptors themselves highlighted issues as to their own ability to engage meaningfully in a consistent and structured way with students in workplaces rife with staff shortages. They acknowledged that students can be viewed as 'nuisances' by nursing and other clinical staff who are grappling with time and resource pressures and that this in turn impacts student experience and resultant incidental learning. This would seem a missed opportunity with regard to placements where students could gain invaluable development though interactions with more experienced and knowledgeable professionals when presented with context‐related incidents. On the other hand, where students experienced structured support and affordances, this had a very positive effect on their learned perceptions of what 'being a nurse' meant and their own alignment with the profession of nursing.

The study highlights the importance of supporting preceptors as mentors and raises questions as to the extent to which the role of the preceptor is taken into account by those who design and resource the placement system within the health services. Our results also support recent research into clinical settings which posits that the initial education of health professionals should incorporate into formal education a prepreparation of students for the uncertainty that is intrinsic to clinical practice and 'openly embrace it' rather than trying to eliminate it in curricula (Papanagnou et al., [49]), thus preparing students for the liminal space and enabling them to make sense of less formal learning opportunities. In summary, the paper supports work by authors such as Turner ([58]) that the power of incidental learning should not be underestimated.

Our results also raised another issue facing not just student nurses but the profession: As Moir ([47]) points out, the development of preregistration nurses must extend to becoming a professional capable of questioning poor practice and speaking up on behalf of an 'ethics of compassion and care' (Moir, [47], p. 9). It was evident from the study that many of the students concluded that passive conformity to prevailing culture was essential for acceptance into the healthcare working environment—even where they experienced dissonance or at times felt disrespected. Thus, they themselves became participants of cultural reproduction (Bourdieu, [7]). Perhaps with more confident ability to reflect on such dissonance, bolstered by supportive mentoring students would not be so passive.

STRENGTHS AND LIMITATIONS

A key strength of this paper is that it explores the work placement of the student nurse through the lens of liminality and highlights the power of incidental learning within the liminal space and the importance of structured support and guidance. This pertains to both students who may not have the confidence, agency or ability to constructively engage with incidental learning and also to preceptors who themselves need support and resources. We would recommend that the nonclinical aspect of work placement may need to be highlighted as well as the clinical aspects for students before they begin work placement. There are a number of limitations that we feel could be addressed by future research. First, the study is a qualitative one, and there is provision for other researchers to conduct quantitatively oriented studies on a larger sample. Second, while we captured the views of students and preceptors within the placements, we did not include data from educational providers. We also feel that a limitation of this study was not to follow‐up on participants to ascertain attrition and reflections postregistration, but this may yet form the basis of an extension to our work.

CONCLUSION

The research contributes to the area of nurse education from both theoretical and practical ways. From a theoretical perspective, we explored nursing placements through the lens of liminality and incidental learning. This study set in the Irish context demonstrated that incidental learning in a liminal space through which the student nurses transition is often overlooked and unsupported and that this can impact both the quality of the placement experience and students perceptions of their profession. From a practice point of view, the study points to a need for the system of nurse education in Ireland to consider the existence and power of incidental learning and its potential for both positive and negative outcomes. In doing this, nurse educators also need to consider the cultural and normative aspects of the placement and the preparedness of nursing students in this regard. Given the crucial role of preceptors, there may also be a case for examining the development of preceptors and the recognition and resources given to this role.

ACKNOWLEDGEMENTS

Open access funding provided by IReL.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

By Louise Nagle; Juliet Mc Mahon and Mary Fitzpatrick

Reported by Author; Author; Author