Kath M.

IVIeUa
Student nurses' construction of
occupational socialisation^

Abstract This paper examines the occupational socialisation of British nurses.

It uses Bucher and Strauss's notion of segmentation and considers two
major segments within nursing: the education segment wiiich, through
the colleges of nursing, promotes a 'professional' version of nursing, and
the service segment which is concerned with getting nursing work done.
Students' accounts of their training were obtained by means of 40
informal interviews. On the basis of these accounts it is argued that the
students leam neither the education nor the service segment's version of
nursing, rather they leam to recognise when one version is appropriate
and the other not and 'fit in' accordingly. ITie organisation of nurse
training is based on a compromise between the two segments whereby
the students move between clinical placements and the college of
nursing; in this way both versions of nursing are enforceable on the
students. The paper argues that nursing as an occupation, by its
organisation and compromise solution to the training of its recruits,
supports a transient approach to nursing work itself and so implicitly
supports a lack of commitment to nursing as an occupation.

Introduction

It is hardly a novel observation that there are differences between the

idealised version of the work of a profession, as it is portrayed to
recruits during the process of training,'and the day-to-day work of its
practitioners. Such discontinuities have been well documented, notably
by Freidson (1970) and Becker et al. (1961) and, in the case of nursing,
Olesen and Whittaker (1968). Becker (1972) has gone so far as to say
that 'School is a lousy place to leam anything', although his tongue is
presumably somewhere near his cheek for it would be naive to suppose
that students do not learn at least a version of the supposed subject
matter of training, be it medicine, nursing, liberal arts or door-to-door
selling. At a commonsensical level, too, most practising nurses, for
instance, will agree that the way in which nursing is taught in the college

Sociology of Health and Illness Vol. 6 No. 2 1984

©R.K.P. 1984 0141-9889/84/0602.-0132 $1.50/1
 Student nuraes' construction of occupational socialisation 133
is a far cry from the practices on the ward. Leaders in the profession^
of nursing make this same observation, and they make it as a com-
plaint. They complain about the sorts of nurses the training programme
produces; and, to some extent, blame the training programme for all
the ills of nursing. So we have the situation where, whenever difficulties
arise in the profession or with the service it provides, its leaders seek to
solve the problem by some tinkering with the training programme.
Freidson (1970) has noted that:
Deficient behaviour on the part of a professional tends to be explained as
the result of being a deficient kind of person, or at least of having been in-
adequately or improperly 'socialised'. Tlie most commonly suggested remedy
for such behaviour is reformation of the professional curriculum rather than
of the circumstances of professional work.

Segmentation of a Professional Group

Bucher and Strauss (1961) have suggested that it is not entirely useful
to assume a relative homogeneity within a profession. They point out
that there are 'many entities, many values and many interests', and
go on to develop the idea of professions as 'loose amalgamations of
segments pursuing different objectives in different manners'. On this
definition, then, the different segments of a profession may produce
different definitions concerning what work should be done and how it
should be done. In the case of nursing two such segments are service
and education. These segments can be identified by the nature of the
complaints which the occupational leaders make. There are two types
of this leadership complaint, although both use the same rhetoric,
that is that training and work do not fit.
First, then, is the complaint of the managers of the service, namely,
that nurses do not stay available for work, as they are constantly on
the move taking courses and collecting certificates; they use nursing as
a meal ticket for world travel or they leave to have families. Second,
there is a group comprising, in the main, academic nurses, who are
seeking to elevate nursing to the status of a profession and so complain
that some nurses do not take a sufficiently committed view of the
work. For example, at a recent Royal College of Nursing Congress one
delegate called for a training course for sisters and charge nurses. She
said: 'Sisters and charge nurses need a comprehensive training course
before they even begin working in the clinical areas'; and went on,
'students should be under the guidance of appropriately trained per-
sonnel, ward sisters are not adequately trained'. This does not mean
that ward sisters do not meet the then General Nursing Council^
134 Kath M. Melia
standards, rather that they are not adequately trained according to
some reconstructed version of professional nursing which this faction
is seeking to promote.
The first complaint has to do with nurses not taking the work
seriously; the second is about their not taking the occupation seriously.
The two complaints about nurse training can be taken as an indication
that the service and education segments are in competition for the
definition of 'nursing'; one of the points of struggle between these two
is the control of the curriculum. Following Freidson's analysis, we
might argue that each segment has an interest in the organisation and
content of the training programme in an effort to ensure that it pro-
duces the 'right' kind of nurse.
Bucher (1970), in her study of power in a medical school, makes a
distinction between clinical and basic science departments within the
school and points out that they have differing interests in the curri-
culum. Clinical faculty members view the basic sciences in terms of
their service relationship to medicine; their function in the medical
school is to teach medical students and to keep the clinical staff up to
date with the latest information and techniques. The undergraduate
teaching and the information should be 'clinically relevant'. Bucher
makes clear the nature of the relationship between pre-clinical and
clinical faculty members when she says, 'The clinicians tend to take
for granted a right to scrutinise what the basic scientists are doing
and offer advice for which the basic scientists surely will be grateful.'
The basic scientists, Bucher says, resented being seen in terms of
'belonging' to medicine, and whenever changes in the medical school
curriculum were raised the basic scientists took care to see that the
clinicians did not manage events in such a way as could be interpreted
as 'binding them more closely to the goals of medicine at the expense
of their own goals'. This tension arises by and large when theoretical
knowledge is harnessed in the service of practice.
Reid (1982) found a similar situation in general practice departments
within medical schools in Scotland. Academic general practitioners,
according to Reid, occupy a socially marginal position insofar as they
are seen by medical school staff as service general practitioners rather
than academics, whilst general practitioners in the community see tiiem
as academics. Reid takes up Elliott's (1972) suggestion that there is a
trend towards a 'coming together' of vocational and formally taught
courses in modern professional education; and says that this might lead
to 'greater interaction between the service and academic elements, and
the possibility of greater social mobility within the group'. The problems
which the academic general practitioners encountered might in time,
Reid argues, prove to be problems for the semi-professionals.
 Student nurses' construction of occupational socialisation 135
The problems of the integration of theory and practice are not
peculiar to medical training. Thorne (1973), in a discussion of pro-
fessional education in law, notes that the move towards drawing the
legal training closer to the world of practice 'involves issues familiar in
the history of professional education: the conflict between advocates
of isolated, university-based training and those favouring education
which is rooted in practical experience.' Hughes and De Baggis (1973)
make much the same point in relation to theological education: 'Mini-
sters and priests consider theology the theoretical base of their calling.
In the theological seminary there is the same difficulty as in all pro-
fessional schools to establish a balance between theory and practice.'
Atkinson (1983) points out that little attention (aside from in
Bucher's work) has been paid to the notion of segmentation within
the medical school and comparable settings. Atkinson suggests that
the Chicago school interactionists' failure to follow up segmentation as
a line of enquiry, 'derives from their emphasis on "situation learning"
and their desire to treat the educational experience as divorced from
issues of "the profession" in a wider sense'. Atkinson goes on to say,
'one has little sense, for instance, that the medical school has anything
ultimately to do with any other aspects of the occupation of medidne.'
This last comment might easily have been made in connection with
colleges of nursing.
Segmentation within nursing is apparent to the students; according
to them there exists a gulf between the education and service sectors
of nursing. The education segment, through the college of nursing, puts
forward what we might call the 'professional' version of nursing. This
version represents, too, the official aims of the three-year training
programme; that is the production of a competent registered nurse
capable of independent practice and professional judgement, insofar as
this is possible given nursing's relationship to medicine. The managers
of the service segment, on the other hand, are far more concemed with
'getting the work done', and are therefore interested in having students
who are competent, but compliant.
This apparent compartmentalisation of nursing clearly presents
problems for the student nurse who, by the very organisation of her
training, has to cross from one segment to another. This, in turn, raises
questions for the occupation as a whole. How is the potential conflict
over curriculum institutionally contained? How do the students cope
with this? What are the effects of segmentation on students' socialisation?
We know, then, that professional socialisation does not provide
straightforward initiation into a profession and would therefore not
necessarily expect student nurse training to be a comprehensive pre-
paration for doing the work of a qualified nurse. As Atkinson argues.
136 KathM.Melia
there is no ideal "law", "medicine", "theology" or whatever "out there"
to which the curriculum corresponds as a mere reflection or copy.' It
must, however, be the case that students leam something during their
three-year programme. It is my intention in this paper to look at what
this something might be. I shall draw upon student nurses' accounts* of
their work and training in order to shed some light on what it is that
student nurses learn in those three years. After a brief description of
the study from which this paper arose, the segmentation of the occu-
pation of nursing is discussed. This is followed by an analysis of the
students' response to the existence of two discrepant versions of
nursing. Lastly, the possible consequences of this segmentation of
nursing are examined.

The data

The data arise from informal interviews which I undertook with student
nurses in a study concerned with the student view of nursing. I tape
recorded 40 informal interviews^ with student nurses. The interviews
were organised around an agenda, which was followed in varying order,
and not always completed depending upon how the student responded
to the opening stages of the interview and upon where the conversation
led. The agenda was concemed with ward organisation, talking with
patients and the students' socialisation. The last topic was approached
via a general question about where students felt that they had been
most influenced in nursing. The fieldwork was carried out following
Glaser and Strauss (1967) and their notion of the 'generation of
grounded theory'. This approach had the appeal of flexibility, insofar
as the emerging conceptual categories direct the data collection in such
a way that unforeseen lines of enquiry can be pursued.
I transcribed the tapes, making theoretical notes as I went along, in
the manner described by Schatzman and Strauss (1973). In this way,
the data were treated as a body of information, continually being
revised and added to, rather than data collected now, as it were, to
be analysed later.
A brief outline of the mechanics of British nurses' training is perhaps
appropriate here. The majority of British nurses obtain their status as
qualified registered nurses by following a three-year programme of
training, which is based in a college of nursing (attached to one or a
group of hospitals). A much smaller number take degree courses and
achieve registration and a degree either in nursing or in some relevant
discipline.* During their clinical experience, the students on degree
programmes are subject to similar constraints as those on the
 Student nurses' construction of occupational socialisation 137
conventional college of nursing courses. This fact is noteworthy as it
shows just how important the service segment is in the process of
occupational socialisation into nursing, for even when the theoretical
aspects of nursing are taught within university departments, at a uni-
versity educational level, it remains the case that the students have to
leam ways of nursing which are compatible with those of the service
segment.
The students in the study upon which this paper draws were under-
taking the three-year college of nursing based training. The programme
is organised in such a way that students spend periods of six to eight
weeks gaining experience, as workers, in vadous hospital wards and
departments, plus a short time with the community services. This
practical experience is supported by pedods of time in the college of
nursing, dudng which they have a full-time student existence with
lectures, tutorials and the like. The whole programme is, then, charac-
terised by constant movement as the students go from one clinical area
to another and to and from the college of nursing.

Students as Learners and Workers

The present structure of nurse training is an historical compromise

between service and education in which students are both learners
and workers. The compromise is sustained because the same segmen-
tation is internally reproduced in the organisation of training, insofar
as the students come under the influence of both the education and the
service segments. This compromise is rooted in the way in which
nursing operates in Bdtain, that is by employing large numbers of
students who work under the direction of much smaller numbers of
qualified staff. So while, on the one hand, the students receive an
idealised version of nursing from the nurse educators, they are, on the
other, expected to work in a rather different manner on the wards
alongside untrained auxiliary staff under the direction of the qualified
staff.'
The segmentation within nursing means that the students have two
sets of expectations to meet, two groups of powerful people to satisfy.
A closer examination of the two segments' diffedng versions of nursing,
to which the students are exposed, is perhaps useful here. The 'pro-
fessional' version of nursing is, as we have said, the one which the
college upholds. Its advocates have it that nursing is a quasi-scientific
process, indeed they call it the 'nursing process', which takes a problem-
solving approach to planning, effecting and evaluating nursing care.
Those concemed with the provision of a nursing service have a rather
138 KathM.Melia
different version of nursing — the 'workload approach' — which is to be
found in practice on the wards. This involves a much more pragmatic
approach to patient care than the 'professional' version offers. The
'workload approach' to nursing involves the recognition of the sum
needs of 30 or so patients on a ward as a workload to be got through.
This work is then carried out by a group of staff comprising qualified,
untrained and unqualified nurses. Hence, the work must be divided
among the available staff on the basis of their ability. The students
are presented to the service as an unqualified labour force and the
trained staff have to find ways of making this work; ways which in-
variably involve the deskilling of nursing care and its implementation
by means of tasks and routines.
Thus, we have, on the one hand, a training programme devised by
nurse educators which sets out to produce a registered nurse, capable
of planning and effecting patient care. On the other, we have the
permanent nursing staff of the hospital responsible for providing the
service; the service which hosts the students during their clinical ex-
perience. Qualified staff direct the work of learners and auxiliaries.®
There are two problems with this compromise solution to the question
of who should control the curriculum for nurse training. The com-
promise, remember, lies in the fact that both the educators and the
service managers have some control over the students' programme.
First, the students find that they spend most of their clinical ex-
perience working either with other students or nursing auxiliaries.
Second, the students pass through the clinical areas, from ward to
ward, at a rate of a move every six to eight weeks. Thus, even if there
were more qualified staff available, the students really do not stay in
any one place for long enough for any sustained education to go on.
How, then, do the students make sense of their training programme
which contains such a tension between the education and service aspects?
The students move between the worlds of education and service;
they therefore have to come to terms with two versions of nursing,
each with its own rationality and its owh structural constraints. These
two versions of nursing can both exist at once because each segment
is able to work within its own structural compartment of the occupation
as a whole. By and large, this compartmentalisation is successful as the
rationale for the practice of one or other version of nursing makes
sense within the confines of the structure in which it was conceived.
Thus, the service segment's mode of nursing works insofar as it ensures
that nursing work gets done; the education segment's 'professional'
version of nursing is most credible when it does not have to contend
with the realities of the clinical settings.
The two versions of nursing are enforceable on students. The
 Student nurses' construction of occupational socialisation 139
education segment controls the written work whilst the service segment
controls the students' behaviour. Evidence of the students' under-
standing and ability to reproduce the 'professional' version of nursing,
which the educators support, is obtained via the written examination.
The service controls the students' behaviour in the clinical areas.
The fact that the students cross the boundaries and pass between
the service and the education segments of nursing makes training a
point at which the structural compartmentalisation may break down.
It is because these segments are structurally separate that it is possible
for two versions of nursing to exist simultaneously. One of the interests
in looking at occupational socialisation of nurses, then, has to do with
how students manage the structural compartmentalisation which
confronts them.

'Fitting In'

Merton (1957) defined socialisation as: 'the process by which people

selectively acquire the values and attitudes, the interests, skills and
knowledge — in short the culture — current in the group of which they
are, or seek to become, a member' and suggested that socialisation takes
place primarily through interaction with people who are significant for
the individual. In the case of the medical students he studied, significant
people were the medical school staff, fellow students and other hospital
personnel. In the case of the student nurses in this study, the permanent
staff on the wards and other student nurses appear to have been sig-
nificant people in this respect. One student, when asked how much she
felt the college influenced her compared with what she saw on the
wards, replied:
' . . . you get taught in school (the college of nursing) the proper way for every-
thing, but you've never got the time to do the proper way in the wards. I think
you should, you know you don't really have that much time in school; I mean
the theory is good (. . .) you need it, they just sort of teach you the basics in
the school and the proper way to do it so that when you go in to the wards,
I mean, you've got, well, you know what should be done, what's going on,
so that you're not totally ignorant of what's getting done.'

This student had no difficulty in recognising and accepting the fact that
the style of nursing taught in the college did not resemble exactly that
found in the wards. Although she sees that the college teaches the
'proper' way of nursing, her later comment about knowing 'what's
going on' when she is on the ward indicates a more important function
of the college. This has to do with introducing the students to sufficient
140 KathM.Melia
theory to enable them to function as part of the ward staff. Clearly, if a
student nurse was entirely unaware of the possible range of events
which might surround different categories of patients, she would not
make a useful member of the ward staff. Thus, although there is not
deemed to be time on the ward for nurses to carry out procedures in
the 'college way', the college teaching seems to fumish the background
information which enables the students to function on the wards.
On the whole the students seemed to sanction the 'ward way' of
doing things because it was efficient and it worked, even though it was
not entirely correct according to the college. This kind of work organ-
isation, where there are rules which must be seen to be obeyed, yet
which are broken frequently, is not peculiar to nursing. Rule-breaking
has been shown to be a necessary part of the smooth functioning of
work organisation; new members must be socialised into this legitimated
breaking of the rules if the system is to work (cf. Bensman and Gerver,
1963;Ditton, 1977).
As was the case with Merton's medical students, fellow students are
significant in the socialisation of student nurses. The students were
sensitive to the views not only of the permanent staff on the wards, but
also to those of their fellow students. As one student put it:
'If you are sitting chatting to someone and your fellow student goes into the
sluice, you keep thinking "I wonder wdiat she is doing, I wonder what she is
stocking up or cleaning". You feel you should be helping with the hard work.
It's OK if two of you are standing talking but then a patient is not so much at
ease with two people, it's better one to one (. ..). It is true if your friend is
working you should be helping her and not sitting down talking to a patient.
You feel chatting to a patient is not working, it's more pleasure — yet, each
nurse knows that to talk to a patient is very important.'

This student's comments typify the view that was often expressed in
the study, namely that there were certain modes of behaviour expected
of students on the wards. This behaviour did not always put the interests
of the patients first, but social pressure from the permanent staff and
other students ensured conformity.
Following Olesen and Whittaker (1968) and Becker et al. (1961), it
seems reasonable to suppose that the students concem themselves with
adapting to current situations rather than preparing in an anticipatory
sense to take on the role of a trained nurse at some future date. The
students have to sort out some way of dealing with the situation in
which they find themselves, and they appear to do this by accepting
that there are two versions of nursing, each with its own rationality.
These versions of nursing do not sit happily together; one is appro-
priate to the college setting, the other to the clinical areas. The students
 Student nurses' cotistruction of occupational socialisation 141

are, then, able to recognise when one version is appropriate and the
other not, and act accordingly. In other words, they can produce either
version for the appropriate audience as and when the occasion arises.
As one student put it:
'I don't like it but that's the way they are (i.e. practical ward nursing and college
teaching are different), there is nothing you can do to change it, unless you go
to Miss . . . (tutor), knock on her door and have it out with her. I'm sure she'd
be very chuffed' (with sarcasm).
The students, on their own admission, learnt to 'fit in' with what-
ever seemed to be expedient at the time. Their main concem was to
meet the expectations of those with whom they worked, especially
those in authority. The students do not see their training from either
the education or the service perspective, rather they see it in terms of
a series of hurdles to be got over. They must attain passes in their
examinations and acquire a satisfactory report from each ward on
which they work.
Fitting in constitutes a major part of the students' negotiation of
their way through training. They concentrate their efforts firstly on
meeting the expectations of the permanent staff, qualified and un-
qualified, and only secondly on the actual business of patient care, as
evidenced by this student's remarks:

'As a new student on the ward you really get depressed because, I think, even
before you begin to think about the patients and how you are going to treat
the patients - you begin to think "just as long as I settle into the ward, get
on with the stafP. That's the most important thing. You become very two-
faced you know, really, you're doing things and doing other things just to
get on with the staff; once you've been accepted by them then you begin to
think more about the wards, and the patient care and everything else.'
The students were very much aware of the fact that if their time on
a particular ward was to be trouble-free, they would not have to make
waves. The ward sisters,' the students knew, have at their disposal a
potential sanction in the form of the student's ward report.
In a different way, the auxiliaries occupy a powerful position in the
wards by virtue of their stability as a workforce and consequent fami-
liarity with the wards.
This student's remarks illustrate the point:
'They (the auxiliaries) have so much got into the way of doing things that they
do it a certain way and you have just got to fit in with them. That is very much
so on night duty. There is no way you are going to change their routine on night
duty, you just have to play along with it. You are only there for six weeks,
there is not much point in stirring things up.'
142 Kath M. Melia

Or, as another student said:

'I think there is nothing wrong with auxiliaries apart from the fact that when
something technical does come along, they think that because they have been
there for years they have the expertise and start telling you what to do — "Vou
shouldn't be doing it like that nurse" — that sort of thing. It gets you quite
annoyed because you think, I know you've been here for years but you haven't
done any theoretical side of it and you dont reaUy know what you're doing,
just because you've seen other people doing it'.

The students relied on the auxiliaries for guidance in their first few
days on a ward; they knew that if they were to antagonise the auxi-
haries their position might become uncomfortable. One student described
the relationship between the auxiliaries and the trained staff:
Student: It's bad for the students, the fact that the same staff have been in the
ward for years and years. It's very clannish, they might be very nice
to you but still this three or four people who are the best of friends,
been there for ages, and you are still an outsider.
KM Who are these?
Student: Trained staff, or auxiliaries as well. Usually they are very much in with
the sister, very friendly - the sister tends to go to the auxiliary rather
than the student.

The students were suspicious of the close relationship which often

existed between the sister and the auxiliary and felt that unfavourable
comment might find its way into their ward reports.
The control which the service segment has over the students' be-
haviour explains in large part the students' preoccupation with 'fitting
in' and perfecting styles of behaviour which satisfy the ward staff. How-
ever, the balance of the relationship between the education and service
segments is, in fact, rather one-sided insofar as the students determine
where to place their effort and soon discover that they can function on
the wards with very little recourse to the ideologies of the education
segment. In fact to 'fit in' with the staff on the ward is the surest way
the students know of getting through and obtaining satisfactory ward
reports. On their accounts, there is nothing to be gained by a student
introducing ideas from the college into the ward setting.

Apprenticeship or what?

The nature of the nursing training programme, which results from the
compromise between the education and the service segments, renders
difficult any attempts to characterise the socialisation process in nursing
 Student nurses' construction of occupational socialisation 143
as an apprenticeship. The medical students in Becker's (1961) study
were seen to develop apprentice roles in their second year:

The student does cUnical rather than academic work. That is he gets his training
primarily by working with patients rather than through lectures and laboratory
work . . . . Though he remains in many senses a student, he becomes much more
of an apprentice, imitating full-fledged practitioners at their work and leaming
what he will need to know to become one of them by practising it under their
supervision.

The medical students were working with qualified doctors dudng this
apprenticeship. The terms of the student nurses' so-called apprentice-
ship are somewhat different from those of the traditional apprentices
to craftsmen. The students move around frequently and cannot be said
to be apprenticed to 'masters', firstly because of this mobility, and,
secondly, because it seems that much of their time is spent working
with auxiliades. Similar complaints were made by the apprentice
butchers who rarely got the chance to work with joumeymen dudng
their training (Marshall, 1972).
There are, then, sedous doubts to be cast on any apprenticeship
system which involves leamer teaching learner, or worse, the untrained
instructing the unqualified. The students' accounts suggest that the
qualified staff expected the students to become efficient workers in
a short space of time; also, that the staff judged the students by their
ability to function efficiently as workers. The trained staff, it seems,
expect the students to pick up the 'job' and fill in the vacant slot on
the ward. The students gained the impression that trained staff did not
make distinctions between individual students and dealt in stereotypes
of first, second and third level workers according to a generalised
notion of progress through training. This students' comments make
the point:

'You certainly feel that you ought to have done, say, so many catheterizations
by the time you become a red-stripe (3rd year student), because you will be
sent off to do them by yourself. If you never manned to get in on the action
before your third year (...) you feel a bit of a fool to have to say "actually
I've never done one before, it's never cropped up", which does happen (. ..)
or you just read up your little blue nursing procedure book and you bash on
regardless — which does happen, I'm sure.'

It is interesting to note, in passing, the students' difficulty in all this;

the very fact that the students move from ward to ward militates
against their becoming efficient workers, because each time they
achieve this state they are moved on.
144 KathM. Melia
The students complain that they did not often get a chance to work
with trained staff. One student said:
'I was shocked when I came to the wards and saw all the work done by
students. I think that even if you are a trained nurse you should be able to
come down and do the basic tasks, that's what I see nursing as (. . .). I thought
that the ward sister and staff nurse would muck in with you, I didn't realise
they were separate.'

This is consistent with the de-skilling'° argument, insofar as trained

staff are seen by the students to be exonerated from simple forms of
labour which are left, by and large, to the students. This is how nursing
has been made to work. Throughout their training, the students have
been used to the existence of a nursing hierarchy on each ward. Those
at the top are seen to be able to do what work they wish while those at
the bottom must 'get the work done'. Becker (1972) points out that
apprentices' labour is often used for 'necessary work of the total enter-
prise that no one else wants to do'. The work is not always without
educational value, but this is not, Becker says, why the apprentices do
it, rather they do so 'because people want them done and the appren-
tice, lowest man on the totem pole, gets the honour'. This system is
perpetuated and justified by the fact that each student passes up
through the system to a position where she may, eventually, be more
selective in the work she does. It is then, perhaps, no surprise that the
student nurses are expected to come and go in the de-skilled sector of
the division of labour. Nor is it surprising, in the light of this analysis,
that the students felt themselves to be evaluated according to their
capacity to become efficient workers, indeed one might even say that
they saw themselves being judged as members of the workforce accord-
ing to their competence as nursing auxiliaries.
In short, then, it can be said that, having mastered the professional
nursing rhetoric of the education segment and the practicalities of the
service way of nursing, the students discover that, by and large, the
best way to get through the training programme is to fit in with the
permanent staff on the wards. So, while the educators might have the
edge on the service segment insofar as they, the educators, are seen
to be largely responsible for the control of the training, it seems that,
in the students' view, there is more to be gained from accommodating
the needs of the service segment.

Just passing through

I want now to consider the notion of transience which pervades the

 Student nurses' construction of occupational socialisation 145
training programme and to examine its importance for both the service
and the education segments. As we have seen, the training programme
is characterised by the students constantly moving from one clinical
experience to another, from the college of nursing to the hospital
wards and back again. The original reason for building this transience
into the training programme might have had to do with providing
students with the experience of different kinds of nursing. This would
be a reasonable arrangement before medicine, and nursing in its wake,
developed quite so many specialities. Now transience is important in
that it helps sustain the education/service compromise, and the seg-
mentation. In this way, the service gets compliant pairs of hands with
which to effect patient care. The fact that the students are 'just passing
through' means that they are not around the ward for long enough to
present a problem to the permanent staff; they do not draw upon the
educators' 'professional' version of nursing in order to question the
service 'workload' approach to effecting nursing care, they simply
'fit in'. The education segment, also, can use transience in order to
sustain the credibility of their 'professional' version of nursing and
patient care. They can tell the students that while they might not have
found the ideal ward yet, i.e. one with an approach to patient care
which is acceptable in 'professional' nursing terms, they might go on
to discover just such a form of patient care in their next placement.
So the students are launched on a quest for some grail of ideal, in-
dividualised, process-based ward nursing. Transience delays the students'
recognition of the futility of their search; or at least it delays their
bringing it to the notice of the education segment — hopefully by three
years!

What do students learn?

Becker (1972) says that 'schools tell us that people learn in them some-
thing they would not otherwise know. Teachers, who know that
something, teach it to their pupils.' In this study of student nurses
it seems that they are learning something which is neither the education
nor service version of nursing. What, then, is it that they leam? In
distinct contrast to the official version of nurse training, the students'
accounts suggest that they do not feel that they are being prepared for
the work of qualified nurses; namely, to manage patient care. Rather,
they spend three years 'fitting in', or as one student put it: 'You spend
three years being told what to do, and suddenly you swap roles.' The
final transition from student to staff nurse presents the real problem,
because thus far the training has been about negotiating their way
146 KathM. Melia
through the training programme and presenting the right version of
nursing on the right occasion. Becker et al. (1961) suggest that students
come into a profession with an idealised view of the attitudes, values
and knowledge of its members. By means of interaction with members
of the profession, and an exposure to its teachings, the students can
adjust their ideals by reference to what they see around them.
The students I interviewed did not seem to have much difficulty
in relating to the kind of nursing that they encountered as students;
in their view the major problem was the one which would face them
on qualifying, namely how to function as staff nurses. The students,
on the whole, seemed to think that they spent three years doing the
work in order to gain staff nurse status and, ipso facto, supervise the
work. This view of nursing could be seen as the result of the three years
spent as a member of an unqualified workforce dealing in fragments
rather than in wholes. When faced with questions about how they
might deal with the situation when they were staff nurses, they tended
to take a 'cross that bridge when we come to it' approach. This can
be taken as an example of the students' tried and tested method of
'getting through'. That is to say, a student, upon entering a new situ-
ation, finds out all there is to know about it, and on the basis of the
facts as she sees them, determines her action. To be sure, she will build
up a stock of responses to situations which she knows will work, but
these come from experience rather than any attempt to anticipate
events and her reactions to them. This situational approach to learning
to function as a student nurse is consistent with behaviour of the
medical students in Becker et al.'s (1961) work. The dictates of the
situation and meeting of the day requirements are the real priorities
of the student's world. In the words of Becker et al. (1961):

He adapts his behaviour to the situation as he sees it, ignoring possible lines
of action which seem pre-ordained to fail or unworkable, discarding those
which may cause conflict - in short, choosing the action which seems
reasonable and expedient.

Conclusions

When the student qualifies she will no longer move between the two
worlds — the education and the service segments — she will be per-
manently located in the latter. From the position of a worker under-
taking tasks allocated to her, she moves to the position of a qualified
member of staff, allocating the work. I have already suggested that the
ward sister adopts a bureaucratic rather than a professional solution to
her problem of supervision of unqualified and untrained staff. That is
 Student nurses' construction of occupational socialisation 147
to say, she splits up the work of caring for patients into tasks which
can be accomplished by her workforce, a workforce whose members
have varying degrees of experience and skill. The student has had the
opportunity to see this style of management in action but has not
practised it herself.
There are difficulties with the bureaucratic solution to the super-
vision of work which lie in the de-skilling of the work. These diffi-
culties arise with the question of professional socialisation, in terms
of the students learning to apply their knowledge in order to make
professional judgements. As we have seen, trained staff solve the
problem of having to achieve nursing work through unqualified and
untrained workers by resorting to splitting up the nursing work into
tasks; this restilts in nursing by routines. Also, I have suggested, that
the students have some notion of how to function as staff nurses be-
cause they have observed staff nurses at work. The students do not,
however, get a chance to see how the education segment's notion of
professional judgement is translated into the bureaucratic organisation
of care on the ward. In other words, where the ward sister determines
the patients' care, on the basis of her professional judgement, and then
translates the overall plan into a set of routines to be undertaken by
the students and auxiliaries, the students can only observe the resultant
bureaucratic model (the one with which she has learned to 'fit in').
The professional judgement was an invisible process which the sister
used to produce her plans for the care of the patients.
There is, of course, a possibility that not all sisters go through the
professional judgement stage when using a bureaucratic approach to
supervision. The bureaucratic solution to the delivery of care assumes
that the 'manager' is working on the basis of professional judgement.
A newly qualified staff nurse, however, has not had the opportunity
to practise nor the experience; she cannot, therefore, transfer her
working premise from the routine service version of nursing to pro-
fessional judgement overnight. It might be that this transition never
actually occurs; in which case nursing would be practised on the basis
of tried and tested routines handed down from the days of their formu-
lation, when the ward sisters were women of longstanding experience.
If this is the case, the three years spent in training can almost be seen
in terms of the student working her way up from the ranks in order
that she might assume command when she has put in the requisite
number of years and achieved registration. This, it could be argued, is
an expensive use of personnel. The army, for instance, recruits its
leaders, by and large, from a different population from the one pro-
viding recruits to the ranks. Nursing, it seems, uses its future 'officers'
along with auxiliary staff to carry out a large part of the nursing work.
148 Kath M. Melia
The emphasis which the students themselves placed upon 'fitting in'
and 'getting through' suggests that the three years are seen in terms of
short spells in different clinical areas; the students are constantly aware
of their next move. This approach to their student experiences is con-
sistent with the little value which they ascribed to the 'theoretical'
content of training. Also, transience and the workload approach to
nursing does not make anticipatory socialisation possible. For this to
occur the students would need to spend longer periods of time in one
place and to take more responsibility than is at present the case; in
this way their work would more closely resemble that of the staff nurse
and their training more of an apprenticeship. Indeed, at present, it is
almost the opposite state of affairs in that the students become used to
being highly mobile and taking little responsibility; they are then faced
with settling down in one ward and having to play a part in 'running it'.
The students' accounts suggest that one can conceive of 'nursing
work' as distinct from 'student work'. The central activity, patient
care, is common to both forms of work, the difference lies in the time
scale and location of the work. 'Nursing work' is the province of
qualified staff who settle in one area and become permanent staff.
'Student work', on the other hand, is carried out in short spells of
duty in a variety of wards; the distinguishing feature of its organ-
isation is transience. When students come to the end of the period of
student work and become eligible to move on to do nursing work,
many prefer to continue with student work and go on to do further
courses and thus continue as student workers. Parallels can be drawn
between the student worker and the perpetual student in academic
life. Both share a carefree existence, being responsible only for their
own certificate collection. The constant moving and lack of settling
down in any one clinical area, I would argue, does not offer the
student a realistic preparation for the work of a qualified nurse.
It seems that, by and large, their three years of transiency give the
students an appetite for moving on, rather than a yearning to settle
down. 'Just passing through' and the attendant activity, 'fitting in',
are features of the socialisation process which make it possible for
students to cross back and forth between the education and service
segments without disturbing the segmentation, or the rationalities
upon which it rests. So long as the training programme continues to
produce nurses who have commitment neither to a 'professional' nor
a 'workload' version of nursing but merely a capacity to adapt to a
given work organisation, nursing is likely to retain these somewhat
contradictory segments. Their existence alone is not problematic, on
Bucher and Strauss's analysis that segments exist is inevitable, it is the
competition for curriculum control which might cause concern. The
 Student nurses' construction of occupational socialisation 149
notion that students are prepared for neither segment might provide a
further explanation for the tendency of staff nurses not to settle.
There is evidence which suggests that nurses take further courses, in-
tensive care, etc., in order to gain confidence and proficiency in the
care of patients (Rodgers, 1983). This is, perhaps, suggestive of a third
complaint within the 'training doesn't fit work' rhetodc; this time a
consumer complaint made by those who have expedenced the training
programme.
The three-year training programme could be said to prepare students
to 'pass' in either segment. Nursing as an occupational group, by its
organisation and its compromise solution to the training of its recruits,
supports a transient approach to nursing work itself, and so implicitly
supports a lack of commitment to nursing as an occupation. So while
transience makes the present organisation of nurse training sustainable,
it also constitutes a block to any re-formulation of the programme (in
favour of either segment) and the consequences which such a re-
formulation might carry with it for the occupation as a whole. These
consequences merit further attention for, as Bucher and Stelling (1977)
note: 'Segment members share a professional fate: events have similar
effects on, or implications for, those in a given segment, while those
same events may have quite different consequences for others in the
profession.'

Department of Nursing Studies

University of Edinburgh
40 George Square
Edinburgh EH8 9LL, U.K.

Acknowledgment

I am grateful to Robert Dingwall for his careful reading of earlier drafts

of this paper and for his suggestions for revision. The anonymous
reviewers' comments and discussions with Anne Murcott were enor-
mously helpful — thank you.

Notes

1. An earlier version of this paper was presented at the BSA Medical Sociology
Group's 13th Annual Conference in Durham in September 1982.
2. I use the term 'profession' loosely, in the way nurses themselves might use it,
not in any ambitious sense.
ISO KathM. MeUa
3. The General Nursing Council's functions were taken over in 1983 by the
United Kingdom Central Council for Nursing, Midwifery and Health Visiting.
4. For a full discussion of the students' accounts, see Melia (1981).
5. The students involved in this study were included on a voluntary basis, and are
not held to be systematically sought out or a representative group. The
students in the group interviewed were compared with the rest of the class on
the variables age and educational achievement, in order to deternune whether
those interviewed were demonstrably different from their peers. The volunteers
had significantly more ' 0 ' level certificates than their peers, whereas the peer
group had more higher level certificates than the volunteers.
6. There are now, in the UK, fifteen such degree courses in nursing and nursing
studies and a further seven degree-linked nursing courses. These courses are
based in universities, polytechnics and colleges of technology. In 1981, there
were 400 places offered on these degree courses. Nevertheless, this amounts
to less than 2% of nurses registering as qualified nurses in one year. Even at
2% the figure is probably an overestimate, as it does not take account of
failure and attrition; however, neither does it take account of nurses who
undertake nurse training before reading for a degree and vice versa. Indeed,
it is not known how many graduates there are in nursing because at present
the registers do not detail qualifications other than those in nursing (Montague
and Herbert, 1982).
7. Registered nurses comprise about one-third of the total number of nursing
staff in UK hospitals (Hayward, 1982).
8. This is similar to Braverman's (1974) notion of degradation of work; scientific
managers plan the work which is then split up into simple tasks which can be
undertaken by a less skilled workforce.
9. The title 'ward sister' is used as the students in the study referred, in the main,
to ward sisters. The arguments stand for charge nurses. Similarly, as the
students in the study were all female, when nurses are referred to in this paper
the female pronoun is used.
10. Cf. Braverman (1974).

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