Citation
The Professional socialization of nursing students

Material Information

Title:
The Professional socialization of nursing students a comparison based on types of educational programs
Creator:
Lynn, Mary Ruth, 1950-
Publication Date:
Copyright Date:
1979
Language:
English
Physical Description:
ix, 93 leaves; 28 cm.

Subjects

Subjects / Keywords:
Associate degrees ( jstor )
Nurses ( jstor )
Nursing ( jstor )
Nursing students ( jstor )
Practical nursing ( jstor )
Professional associations ( jstor )
Professional development schools ( jstor )
Professional education ( jstor )
Professional schools ( jstor )
Socialization ( jstor )
Dissertations, Academic -- Foundations of Education -- UF ( lcsh )
Foundations of Education thesis Ph. D ( lcsh )
Nursing -- Study and teaching -- United States ( lcsh )
Nursing students -- United States ( lcsh )
Professional socialization ( lcsh )
Genre:
bibliography ( marcgt )
non-fiction ( marcgt )

Notes

Thesis:
Thesis--University of Florida.
Bibliography:
Bibliography: leaves 86-91.
General Note:
Typescript.
General Note:
Vita.
Statement of Responsibility:
by Mary Ruth Lynn.

Record Information

Source Institution:
University of Florida
Holding Location:
University of Florida
Rights Management:
Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
Resource Identifier:
023296226 ( AlephBibNum )
06392863 ( OCLC )
AAL1578 ( NOTIS )

Downloads

This item has the following downloads:


Full Text












THE PROFESSIONAL SOCIALIZATION OF NURSING
STUDENTS: A COMPARISON BASED ON
TYPES OF EDUCATIONAL PROGRAMS










By

MARY RUTH LYNN


A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY


UNIVERSITY OF FLORIDA
1979
































Copyright 1979

By

Mary Ruth Lynn















ACKNOWLEDGEMENTS


The members of my doctoral committee deserve special

recognition for their assistance with this dissertation.

The chairman of my committee, Dr. Linda M. Crocker, has

my deepest admiration and gratitude for her excellent

guidance, teaching, and patience. Dr. Robert S. Soar has

also been influential during my graduate study. I appre-

ciate his sound advice and calm attitude. My sincere

appreciation goes to Dr. Molly C. Dougherty for her con-

stant support, understanding, and willingness to listen.

Dr. Faye G. Harris has always provided a willing ear

and constant moral support and for those I thank her. In

addition, I would like to extend my gratitude to the deans,

directors, and students of the schools participating in

this study.

Finally, I would like to thank my friends Barbara Boss,

Dr. Patricia D. Olmsted, and Nancy Sypert, for their prodding

and support which aided me in the completion of this study.















TABLE OF CONTENTS


Page

ACKNOWLEDGEMENTS. . . . . . . . .. iii

LIST OF TABLES. . . . . . . . .. vi

ABSTRACT. . . . . . . . .... ... vii

CHAPTER

I INTRODUCTION. . . . . . . 1

Definition of Terms. . . . . 5
Purpose of the Study . . . . 6
Rationale for the Study. . . .. 8
Significance of this Study . .. 10

II REVIEW OF THE LITERATURE. . . . 12

Historical Developments in
Nursing Education . . . .. 12

The Diploma Program . . .. 12
The Baccalaureate Program . . 15
The Associate Degree Program. . 17
Controversies in Nursing
Education. . . . . .. 20

Comparisons of the Three Educational
Programs in Nursing . . ... 25

Biographical and Cognitive
Variables. . . . . . 25
Affective and Personality
Variables. . . . . .. 29
Professional Socialization
Studies. . . . . ... 30









TABLE OF CONTENTS (Continued)


Page


Measures of Professional
Socialization . . . . .. 33
Summary. . . . . . . .. 38

III DESIGN AND PROCEDURES . . . .. 40

The Hypotheses . . . . .. 40
Subjects . . . . . . 42
Instrument . . . . . ... 44
Development of the Traditional/
Nontraditional Scoring Key. ... . 48
Development of the Practicing
Nurses Scoring Key. . . . .. 50
The Analysis of the Data . . .. 55
Summary. . . . . . . .. 55

IV RESULTS . . . . . . ... 57


Hypotheses Testing . . .
Effects on Reliability . .
Summary of the Results . .


V DISCUSSION. . . . . . .

Traditional/Nontraditional
Scoring Method. . . . .
Practicing Nurses Scoring Method
Limitations of the Study . ..
Suggestions for Future Research.
Applications in Nursing Education.
Summary and Conclusions. . . .


APPEND ICES
APPENDIX A--HOSPITAL AND EDUCATIONAL PROGRAMS
PARTICIPATING IN THIS STUDY .
APPENDIX B--SAMPLE ITEMS FROM THE NPOS. . .

REFERENCES . . . . . . . . . .


BIOGRAPHICAL SKETCH . . .


67















LIST OF TABLES


Table

1 Number of Students Participating
by Program . . . . . . . .


Page


2 Percentage of Participants in Each Pro-
gram by Sex and Race Categories. ... . 46

3 HSGPA by Program . . . . . .. 47


4 Participating Nurses by Age, Year
Licensed to Practice Nursing, and
Years Not Practiced Nursing. . . .

5 Participating Nurses by Sex, Race,
Area Employed, First Nursing Degree,
and Highest Educational Degree . .

6 Means and Standard Deviations of
Students Total Scores by Programs
and HSGPA Using the Traditional/
Nontraditional Scoring Method. . .


. 52




. 53





. 59


7 Analysis of Total NPOS Score Computed
with the Traditional/Nontraditional
Scoring Method as a Function of Program
Type, HSGPA, and the Interaction
Between Program and HSGPA. . . . .

8 Means and Standard Deviations of
Students Total Scores by Programs
and HSGPA Using the Practing Nurses
Scoring Method . . . . . . .

9 Analysis of Total NPOS Score Computed
with the Practicing Nurses Scoring Method
as a Function of Program Type, HSGPA and
the Interaction Between Program and High
School Grade Point Average . . . .










Abstract of Dissertation Presented to the Graduate Council
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree Doctor of Philosophy

THE PROFESSIONAL SOCIALIZATION OF NURSING
STUDENTS: A COMPARISON BASED ON
TYPES OF EDUCATIONAL PROGRAMS

By

Mary Ruth Lynn

August 1979

Chairman: Linda Crocker
Major Department: Foundations of Education

The assessment and development of professional

socialization in nursing students has been a concern for

many years. Several studies have been conducted in this

area but few quality instruments have been developed with

uses specific to nursing. The Nurses Professional Orienta-

tion Scale (NPOS) was an exception in that it was appro-

priately designed and was developed to be used in the

assessment of professional socialization of nursing

students.

In this study two new scoring methods, a Traditional/

Nontraditional scale and a Practicing Nurses scale were

developed for the NPOS. The internal consistencies for

these methods were .81 and .88, respectively. Each method

was then used to determine if students from different

vii








nursing curricula would differ in responses to the NPOS.

Graduating associate degree and baccalaureate degree stu-

dents in four southeastern states served as subjects for

the comparisons. The sample sizes for the associate degree

and the baccalaureate degree students were 120 and 156,

respectively.

A 2 X 3 factorial design (two program levels and three

grade point levels) was used to compare the total NPOS

scores of the students from the two programs. Because

admission criteria differ for these programs, high school

grade point average was included in each analysis. Both

main effects and interactions were tested using a classical

regression analysis. Separate analysis were conducted for

each scoring method.

Using the Traditional/Nontraditional scoring method,

significant main effects were found for both educational pro-

gram and high school grade point average. These results indi-

cated that associate degree students ware more traditional in

their professional socialization than were the baccalaureate

degree students. When the Scheffe's post hoc procedure was

employed it was concluded that students with a B high school

grade point average evidenced a more traditional orientation

than did students with other high school grade point averages.


viii










When the Practicing Nurses scoring method was used

to score the NPOS, no significant main effect for educa-

tional program or high school grade point average was

found. Finding no significant main effect for educational

program, it was concluded that either the Practicing Nurses

scoring method was not sufficiently sensitive to differ-

entiate students from different educational program types

or that there was truly no difference among the students

relative to practicing nurses. In addition, no significant

interaction was found between educational program and high

school grade point average in either scoring method.

This study demonstrated the potential for improving

available instrumentation in the area of professional

socialization in nursing. It was also found that students

in different educational programs in nursing can be dif-

ferentiated in terms of their professional socialization.

specifically in terms of a traditional or nontraditional

orientation. With improved instrumentation for assessing

professional socialization, research in this area can be

significantly advanced.















CHAPTER I


INTRODUCTION


Professional socialization is a specific portion of

adult socialization. As a process it has been defined in

several different ways. Super (1957) suggests that pro-

fessional socialization is the process by which someone

"tries the fit" of a job. Others, including Simpson (1967),

define occupational choice and socialization into a role

as a means of acquiring self-identification. Moore (1969)

asserts that professional socialization "involves acquir-

ing requisite skills and also the sense of occupational

identity and internalization of occupational norms typical

of the fully qualified practitioner" (Moore, 1969, p. 71).

Many researchers suggest that there are phases or

steps involved in professional socialization. Three phases

that have been suggested are (1) the individual shifts his

attention from broad societal goals to the goal of pro-

ficiency in the specific tasks of his chosen profession,

(2) identifying significant others in the profession as his










reference source and (3) internalizing the values, skills,

and attitudes of the occupational group and adopting the

behaviors it prescribes (Simpson, 1967).

Professional socialization has been studied in many

of the health related professions but has received more

emphasis in medical and nursing education. Medical school

has been described as one of the longest rites of passage

in our part of the world (Becker & Geer, 1958). During the

first year of medical training, medical students think of

each other and themselves primarily as students. When

medical students have begun to see patients on the clinical

units, the transition to perceiving themselves as physicians

begins. This self image change can be seen as reflecting

the expectations of others. Patients define the medical

student as a physician so the student starts to define him-

self and behave as a physician (Huntington, 1957).

Similarly professional socialization has been explored

in nursing and nursing education. Kramer (1974) asserts

that the behavioral and attitudinal changes necessary to

nursing are usually internalized during the training period

of the nursing program. She views professional socializa-

tion in nursing as a process of both internal and external










changes in an individual which result in altered "images,

expectations, skills, and norms" (Kramer, 1974, p. 38).

Olesen and Whittaker (1968) view professional socializa-

tion in nursing as the fusion of person, situation, and

institution. It is in this fusion that they believe the

heart of professional socialization lies.

Investigations into the professional socialization of

nursing students indicate that the critical issue is the

incongruence in the socialization processes between the

nursing program and the actual nursing duties as they are

defined and implemented in the various employment settings

(Corwin, 1961; Kramer, 1966, 1968, 1969, 1970, 1974).

Nursing schools and employment settings represent two

different subcultures in the nursing world. "The norms,

values and behavioral expectations are more different be-

tween school and work than they are between two different

work settings" (Kramer, 1974, p. 38). Because these sub-

cultures are so different, movement from one to the other

creates difficulties. Inadequate professional socializa-

tion has been found to result in attrition in both nursing

education and nursing practice (Williams & Williams, 1959).

Thus, it is important to examine professional socialization










in both nursing as an educational program and as an

occupation.

Because there are three different educational tracks

for prospective nurses, an important question is which

program results in greater professional socialization for

its graduates? The oldest of these programs, the hospital-

based diploma school, has rarely encountered socialization

incongruencies because the training was in the apprenticeship

mode. With the movement of nursing education into univer-

sities in the early 1900's (baccalaureate program) and into

community and junior colleges in the 1950's (associate

degree program), professional socialization became a

relevant issue. No longer are the students in nursing pro-

grams receiving extensive clinical experience and exposure

to the day-to-day realities of nursing. Rather a greater

balance between classroom learning and clinical experience

was created. Therefore, due to the education changes over

the last century, the assessment and development of pro-

fessional socialization of nursing students has become

and continues to be an area of interest.

Despite the interest that has been generated in

evaluating and comparing nursing programs (within and










across educational tracks) in terms of professional sociali-

zation, at the present time the state of measurement of

professional socialization has prevented adequate investi-

gation in this area. Few instruments have been developed

that measure professional socialization in nursing, and

those that are relevant have not been used to assess the

differences or similarities in the three educational pro-

gram's graduates. Further, the developed instruments have

not been fully tested, i.e., evidence of reliability,

validity, or both has been lacking. Finally no exist-

ing instrument has a scoring scheme based on the perceptions

of practicing clinical nurses.


Definition of Terms


For the purpose of this study, the following defini-

tions were used:

Associate Degree Program. Completion requires two

years in time and is based in a community or junior college

and occasionally in the lower division of a senior college

or university. The associate degree programs are generally

affiliated with local hospitals or health care agencies.

Graduates are licensed as registered nurses upon passing










licensing examinations and have either an Associate of

Arts (AA) or Associate of Sciences (AS) degrees.

Baccalaureate Degree Program. Contained within a

four-year college or university, this program combines a

liberal arts background with the nursing curriculum. The

actual time spent in nursing education ranges from two to

five years. The university or college grants a Bachelor

of Science in Nursing or a Bachelor of Science degree to

its graduates. Upon passing licensure examinations the

baccalaureate graduate is titled a registered nurse.

Diploma Program. Three years of study are required

for completion. The school of nursing is generally under

the control of a hospital. Each school has its own faculty,

but many of the schools are affiliated with a senior or

junior college or university for physical science, and

some social science courses. After graduating and passing

the state board licensing exam the graduate is titled a

registered nurse.


Purpose of the Study


The purpose of this study was to develop and test two

new scoring methods for a prominent instrument, the Nurses










Professional Orientation Scale (NPOS), used in the measure-

ment of professional socialization. First, a scoring

method based on a traditional/non-traditional view of

nursing was developed and employed in an effort to differ-

entiate graduates of different educational programs.

Second, a scoring method based on the perceptions of

practicing nurses was developed to assess the socializa-

tion of graduates from different educational programs.

Finally, the reliabilities yielded from the new scoring

methods were compared.

In view of the fact that the programs to be investi-

gated were located in junior colleges and senior colleges

and universities, the differences in admission criteria had

to be considered. Accordingly, the high school grade point

average (HSGPA) of each student was collected for inclusion

in the analysis. Thus, variation in the scores on the

NPOS related to differences in high school achievement

could be systematically controlled. The possibility of

an interaction between high school grades and nursing

education programs was also tested. The purpose of con-

trolling these factors was to increase the power of the

analysis, increasing the likelihood of finding any true










significant differences which might exist between the two

types of educational programs.


Rationale for the Study


The scoring methods for the NPOS have been developed

for three reasons. Although this instrument is widely

used, its original scoring scheme suffered from several

limitations. First, the original scoring method was based

on baccalaureate degree faculty responses nine years ago.

With the changes in the attitudes of women in the last few

years, a scoring method formed nine years ago is unlikely

to reflect the current feelings of a predominantly female

profession. Second, the Traditional/Nontraditional method

has been developed to ascertain if the associate degree and

baccalaureate degree programs in fact are at different

points on a traditional vs. nontraditional continuum.

Nursing educators and nurses in general have long argued

that certain types of programs produce graduates who are

more or less traditional than the graduates of other types

of programs. Additionally, some researchers have reported

that a traditional orientation is the opposite of pro-

fessional socialization (Eller, 1976; Richards, 1972).










Finally, the practicing nurses method has been derived for

two reasons: (1) there has been no scoring scheme de-

veloped for an instrument which utilized the beliefs of

practicing nurses, and (2) graduates entering nursing with

beliefs unlike those of currently practicing nurses have

experienced a reality shock which has created great job

dissatisfaction (Kramer, 1974). Therefore, the ability to

establish which students would be more likely to have an

experience of "reality shock" would provide an aid in the

decrease of attrition from nursing practice.

In this study the professional orientation (sociali-

zation) of senior associate degree nursing students is

compared to the professional orientation (socialization)

of senior baccalaureate degree nursing students. Diploma

students are not included in the study for two reasons:

(1) The number of diploma programs both nationwide and

in the selected region has decreased markedly over the

past fifteen years (less than half the programs open in

1960 remain open today), and (2) the tremendous growth of

the junior college programs (associate degree) both nation-

wide and in the selected region has diminished the impact

of diploma education for nurses.










Significance of this Study


As previously mentioned, when socialization is con-

gruent between nursing educational programs and the em-

ployment setting fewer difficulties for an individual

moving from one to the other are encountered. Much re-

search has been done investigating the effects of incon-

gruent socialization. This inadequate socialization has

been shown to produce role deprivation. Role deprivation

(role conflict), i.e., the discrepancy between what a nurse

thinks should happen and what she perceives is going on

around her (Kramer, 1970),has been found to cause attrition

in both nursing educational programs and in nursing practice

(Hegarty, 1975; Schmitt, 1968; Williams & Williams, 1959).

The investigation of the professional socialization of

graduates of the associate and baccalaureate degree pro-

grams may yield information that would be helpful in the

assessment and decrease of role deprivation, and conse-

quently attrition from the profession.

The need to study graduates of different educational

programs, specifically the associate and baccalaureate

degree programs is twofold. First, graduates of these pro-

grams have been compared on the basis of many variables










and have not been found to be essentially different. Pro-

fessional socialization has rarely been investigated using

more than one program type. Second, the American Nurses

Association has recommended that there should be two types

of nurses prepared in the United States, technical (asso-

ciate degree) and professional (baccalaureate degree)

(American Nurses Association, 1965). These two educational

programs have been ill defined or differentiated at this

time, and comparisons of the professional socialization of

their students could yield valuable information. This

information would be valuable for future efforts in cur-

riculum development, program evaluation, or research in

professional socialization as a social process.















CHAPTER II


REVIEW OF THE LITERATURE


The literature reviewed in this chapter has been

selected from three areas: historical development of the

nursing educational programs, comparisons of the three

nursing educational programs and measures of professional

socialization in nursing. The review is organized in the

following manner. First, selected literature is presented

pertinent to the historical development of nursing educa-

tional programs. Next, studies comparing graduates of the

three educational programs are discussed. Finally, measures

or professional socialization in nursing are reviewed with

emphasis on those studies in which the NPOS was used.


Historical Developments in
Nursing Education


The Diploma Program


Formal nursing education began in the United States

in 1872 with the establishment of the first hospital-based

school of nursing (diploma program) in Roxbury, Massachusetts.










The program resembled the Nightingale School of England

in that the course was twelve months in length equally

divided into medical nursing, surgical nursing, maternity

nursing, and night nursing (Dietz & Lehozky, 1967).

Numerous other schools modeled after the Nightingale

School soon developed. Each school was independent of

the hospital,having its own administration as well as bud-

get. In 1874 schools began to contract with the hospitals

so that student nurses could receive actual patient care

experiences. These contracts gave the students patient

care experiences in exchange for their providing the hos-

pital with nursing services. The hospitals realized an

increase in nursing services and therefore incorporated

the faculty of the schools under their budget and adminis-

tration (Dolan, 1973). Diploma schools have continued in

this mode.

During the period from 1872 to 1910, both the length

of the diploma program and the number of programs increased.

The duration of the educational Deriod went from the

initial one year of training to two years and then finally

to three years, which is the present length of the diploma

programs. Diploma schools' students helped to provide

staff for the hospitals in which they had their clinical










experiences. This was financially beneficial to the

hospitals as it decreased their expenditures for nursing

care. Therefore, many hospitals attempted to have nursing

schools. In 1880 there were fifteen diploma programs.

By 1910 over one thousand programs had been established

(Bridgman, 1966).

A milestone in nursing education occurred in the early

1920's when Josephine Goldmark was commissioned to study

the function and preparation of the public health nurse.

Although the study was initially directed towards the

problems of public health education for nurses, it was

soon found to be relevant to the whole of nursing educa-

tion. This report revealed that "most nursing schools

were shockingly inadequate in providing laboratories,

libraries, demonstration rooms, instructors, and head

nurses"; therefore, the nursing schools did not conform

to standards accepted in other educational institutions

(Dietz & Lehozky, 1967; Lysaught, 1970). Goldmark

recommended that

The current tendency to lower require-
ments should be discontinued and efforts
made to raise the general standards of
nursing education to the level of the best
schools. Instructors and other officers
of schools of nursing should receive special










training to fit them for their tasks.
The development of university associa-
tions with schools of nursing should be
strengthened, and schools should be given
adequate financial backing. (Griffin &
Griffin, 1973, p. 134)

Because the hospital-based diploma programs were in

the midst of a "boom," the recommendations of the Goldmark

report were not accepted or implemented. The report did,

however, stimulate the development of some university

programs and further encourage the move of nursing educa-

tion into the academic environment.


The Baccalaureate Program


In the early 1900's several nursing leaders wished

to place education for nurses into the academic environ-

ment and remove control of nursing education from the

hospital's administration. In 1909 the first independent

school of nursing was established at The University of

Minnesota. Though several collegiate programs had been

established prior to 1909, they were all under the control

of medical schools (Davis, Olesen & Whittaker, 1966).

Acceptance of collegiate nursing education was certainly

not immediate. Both the public and most nursing educators

felt that the already established diploma programs










sufficiently supplied all the education and preparation a

working nurse could possibly need (Bridgman, 1966; Davis et

al., 1966).

The initial programs developed at The University of

Minnesota and in many other universities were not different

from the numerous diploma programs in existence. The pro-

grams were three years in length and the graduates received

a diploma in nursing upon completion. It was not until ten

years later that Minnesota instituted an undergraduate

baccalaureate program for nursing students, and by that

time a number of other universities had already taken such

a step (Davis et al., 1966). During the period between

1910 and 1930 nursing leaders recognized the need for the

development of higher educational standards. Through

their efforts, the Association of Collegiate Schools of

Nursing (ACSN) was established in 1932. This association,

though not an accrediting agency, examined member schools'

programs to ascertain if they met the established stan-

dards.

Of the numerous collegiate programs in existence,

twenty schools were either full members or associate mem-

bers in the ACSN by 1935. During World War II there was a

rapid expansion in the number of collegiate nursing










programs. All of these programs were not eligible for

membership in the ACSN because they did not meet the re-

quired standards. By 1948, through the efforts of numerous

nursing educators, the National Nursing Accrediting Service

was established in an attempt to set down criteria for the

evaluation of all existing and developing nursing programs

(Kiniery, 1963).

Accreditation of programs was not firmly established

until 1952 when the National League for Nursing Accrediting

Service was formed. The establishment of an accrediting

service was a step forward because it determined the

criteria that differentiated collegiate programs from

diploma programs.


The Associate Degree Program


After World War II the public and nurses alike be-

came increasingly aware of the widening gap between the

quantity and quality of nursing services. Nursing educa-

tors were confronted with the problem of attaining and

maintaining the proper alignment of the nursing educa-

tional system with the fundamental social and economic

changes taking place in the face of rapidly developing

scientific and medical advancements. Following the war,










the United States was experiencing an explosion of technical

and medical knowledge (e.g., the discovery and refinement

of many antibiotics and antibiotic therapies). The public

demanded higher living standards and available quality

medical services (Anderson, 1966).

In an effort to explore the nature of the nursing

shortage national nursing organizations and universities

with nursing programs undertook studies of nursing prac-

tice. In the early 1950's Mildred L. Montag (Montag &

Gotkin, 1966; Montag, 1975) set up the Cooperative Re-

search Project in Junior and Community College Education

for Nursing. Under this project eight participating

schools--five two-year junior colleges, two four-year in-

stitutions of higher education, and one hospital school

of nursing--were assisted in developing programs for the

education of potential nurses. Seven of the eight pro-

grams awarded an associate degree to graduates of the

program (Bullough & Bullough, 1969). This new nurse has

been described as a "bedside nurse" to differentiate her

from nurses with broader professional preparation (Montag

& Gotkin, 1966). The assumptions underlying the develop-

ment of the associate degree nurse program were as follows:










1. The functions of nursing can and should be
differentiated into three basic categories:
the professional, the semi-professional or
technical, and the assisting.

2. The great bulk of nursing functions lie in
the intermediate category, the semi-profes-
sional or technical. Therefore the greatest
number of persons should be prepared to fill
these functions.

3. Education for nurses belongs within the or-
ganized educational framework.

4. The junior-community college, the post-high
school educational institution specifically
suited to semi-professional or technical
education, is the logical institution for
the preparation of the large group of nurses.

5. When preparation for nursing is education--
rather than service-centered, the time re-
quired may be reduced.(Montag & Gotkin,
1966, p. 34)

By design the associate degree nurse was to perform

technical (or semi-professional) functions at the regis-

tered nurse level and be prepared for beginning practi-

tioner positions (Montag & Gotkin, 1966).

The community college, being one of the fastest grow-

ing enterprises in America, readily accepted the proposi-

tion of educating nurses in associate degree programs.

In 1956 there were only the eight pilot schools but by

1975 there were 603 programs in community and junior

colleges awarding associate degrees in nursing (Facts

About Nursing 76-77, 1977).










Controversies in Nursing
Education


In 1965 the American Nurses Association's Committee

on Nursing Education published its first position paper

on nursing education. The position was as follows:

1. The education for all those who are licensed
to practice nursing should take place in in-
stitutions of higher education.

2. The minimum preparation for beginning pro-
fessional nursing practice at the present time
should be baccalaureate degree education in
nursing.

3. The minimum preparation for beginning tech-
nical nursing practice at the present time
should be the associate degree education in
nursing. (American Nurses Association, 1965,
pp. 107-108)

This position paper went on to define the components

of professional and technical practice. Professional

nursing was said to have three orientations, specifi-

cally care, cure, and coordination. The care orientation

included dealing with humans under stress, providing com-

fort, listening, evaluating, and intervening appropriately.

The cure emphasis, in contrast to the medical profession,

was the promotion of health. Finally, the coordination

aspect of professional nursing was that of dealing with the

health and welfare of those in the community.










Technical nursing was said to be skill oriented in

that it involved the application of the basic principles

of science. The nursing functions within technical prac-

tice were patient status review and planning care with

other health care team members. The position paper did

not limit the depth of technical practice but confined

the scope of practice. The technical nurse was to be

directly under the supervision of the professionally

trained nurse (American Nurses Association, 1965).

The American Nurses Association position produced

great controversy among nurses across the nation. What

would become of the diploma schools and their graduates?

Where did the Licensed Practical Nurse (LPN) fit into

the plan? How did one distinguish between technical and

professional practice? Were baccalaureate programs

affordable and accessible to those who wanted to obtain

the professional degree? What was wrong with the status

quo?

Although the American Nurses Association's position

was far from unanimously supported, there was a demon-

strable effect on nursing education. In 1965, 77 per cent

of basic nursing education took place in diploma programs;










in 1975, these programs were responsible for only 29 per

cent of the basic nursing education. During the same

time period the combined total of associate and bacca-

laureate graduates have gone from 23 per cent to 71 per

cent. The associate degree programs accounted for 44 per

cent of the total graduates and the baccalaureate degree

programs accounted for 27 per cent of the total graduates.

Additionally, in 1975 7 per cent of all students in bacca-

laureate programs were currently licensed registered

nurses who had graduated from associate and diploma pro-

grams (Facts About Nursing 76-77, 1977).

The efforts of the American Nurses Association to

define technical and professional practice have represented

an ever continuing drive on the part of the nursing pro-

fession to improve its professional status. In order for

a group to establish professional status, education of its

practitioners must take place in institutions of higher

education. Preparation for professional practice must

encompass mastery of the theory underlying its practice,

not just apprenticeship training (Moore, 1970).

Although over the next decade more research was con-

ducted investigating the nature of the graduates and

students of the three nursing educational programs,










little had been done to implement the elements of the

1965 position paper. Therefore, the 1978 convention of

the American Nurses Association established a timetable

for the implementation of the 1965 standards. The

association established that "by 1980, two categories of

nursing practice be identified" and "that the bacca-

laureate should be the minimum preparation for entry into

professional nursing practice by 1985" (American Nurses

Association, 1978). Although the resolutions of the

American Nurses Association have no legal implications,

the ramifications within nursing produced by the 1978

recommendations have only begun to be felt.

Between the 1965 American Nurses Association position

paper and the 1978 resolutions, the National Commission

for the Study of Nursing and Nursing Education was formed

with Jerome Lysaught appointed as director. The charge

to the committee was to investigate how to improve the de-

livery of health care to the American people through the

analysis of improvement of nursing and nursing education.

The following are some of the major recommendations

pertaining to nursing education:

1. Each state will have, or create, a master
planning committee that will take nursing










education under its purview, such com-
mittees to include representatives of
nursing education, other health profes-
sions, and the public, to recommend
specific guidelines, means for implementa-
tion, and deadlines to ensure that nursing
education is positioned in the mainstream
of American educational patterns with its
preparatory programs located in collegiate
institutions.

2. Those hospital schools that are strong and
vital, endowed with qualified faculty, suit-
able educational facilities, and motivated
for excellence be encouraged to seek and
obtain regional accreditation and degree
granting power.

3. All other hospital schools of nursing move
systematically and with dispatch to effect
interinstitutional arrangements with col-
legiate institutions so that graduates of
the nursing preparatory program will receive
an academic degree from the educational in-
stitution upon completion of their course
of instruction.

4. Junior and senior collegiate institutions
cooperatively develop programs and curricula
that will preserve the integrity of their
institutions and their aims while facilita-
ting the social and professional mobility
of the nursing student. (Lysaught, 1970,
pp. 109-113)

In summary, the earliest nursing schools in the United

States were diploma programs which followed the Nightin-

gale pattern. In order to relieve financial difficulties

and increase clinical experiences for their students

these schools were incorporated into the hospital structure.










As the need for medical and nursing services increased,

the diploma schools rapidly increased in size and number

of programs, where the primary educational mode was

apprenticeship training. Nursing educators spent almost

a century trying to correct this and establish nursing

as an independent profession. The effort to establish

independence prompted the upgrading of diploma schools.

Concurrently they established nursing programs in

colleges and universities to attempt to equate nursing

education with the education of the other professions.

With three different educational programs for nursing

established, controversies developed within nursing as

to which of these should be the basic education prepara-

tion for the professional nurse.


Comparisons of the Three Educational
Programs in Nursing


Before the 1965 American Nurses Association position

paper few studies had been reported comparing the three

educational programs in nursing. After the position

paper many studies were conducted, but rarely were all

the nursing program types studied. Consistently the

baccalaureate degree student and graduate was included










with only sporadic inclusion of the associate degree or

diploma student or graduate.

The reported studies can be separated into two major

divisions: specifically those studies dealing with dif-

ferentiation of programs on biographical and cognitive

variables, and those dealing with differentiation of

programs on affective and personality variables.


Biographical and
Cognitive Variables


Bayer and Schoenfeldt (1970) conducted one of the

earliest and largest studies. In this study students in

diploma programs were compared with students in bacca-

laureate degree programs. The researchers concluded that

the basic difference between students in the two program

types were only in terms of the socioeconomic variables:

number of books, magazines, and appliances in the home,

luxury items, cultural equipment, sports equipment, the

student having his own room, number of cars in the family,

number of rooms in the home of the student, the student's

father's and mother's education. Consistently for these

groups the baccalaureate students came from "advantaged"

households. When a similar study was conducted by Hartley










(1975) using associate and baccalaureate degree students,

father's education and mother's education were found to be

not significantly different in the two groups studied.

Other studies that compared socioeconomic variables in-

cluded Dustan's study (1964) where he suggested that there

was no difference in family income when studying all three

educational programs. In 1971 Wren's study of all three

programs demonstrated no difference using occupations

of the parents as well as no difference in the amount of

financial assistance the students required or utilized.

Several researchers investigated the difference in

family composition among students in the three program

types. They found that associate degree students tended

to be older, often married with children, and residents

in the community where they attended school (Dustan,

1964; Meleis & Farrell, 1974; Wren, 1971).

Most of the researchers' investigations of the edu-

cational programs included cognitive variables. The

results, however, were not consistent in this area.

Dustan (1964) found that associate degree students had

higher aptitudes than either baccalaureate or diploma

students. Using the Scholastic Aptitude Test, Wren (1971)

demonstrated that baccalaureate degree students scored










highest with the diploma students the next highest. When

looking at State Board Examination scores, Counts (1975)

concluded that there was no difference in associate

degree graduates' state board scores and those of bacca-

laureate degree graduates. An examination of the state

board scores by Bain (1974) yielded another set of results.

The highest scores were among baccalaureate degree gradu-

ates. The diploma graduates' scores were next followed

by the associate degree graduates' scores.

Other cognitive or biographical variables that have

been examined by one researcher have not been replicated

by other investigators. Meleis and Farrell (1974) found

that diploma students placed a higher value on research

than did associate degree or baccalaureate degree stu-

dents. When looking at previous health care experience

Wren (1971) suggested that associate degree students

were more likely to have had some previous experience

than either the diploma or baccalaureate degree students.

Other differences in variables of this nature were found

in almost every study in this area (Bain, 1974; Hartley,

1975).










Affective and Per-
sonality Variables


Bayer and Schoenfeldt (1970) concluded that there

was a difference between baccalaureate and diploma stu-

dents in terms of artistic ability, verbal ability and

goal direction. The baccalaureate program students were

higher in artistic and verbal ability, but less goal-

directed than the diploma students. Hoover (1975) who

also looked at baccalaureate and diploma students found

that baccalaureate students were more restrictive in the

patients they preferred to care for, placed a higher

value on ability to function, and were more interested in

promotion in the facility in which they were employed

after graduation.

In a comparison of all three educational programs

Davis (1973) concluded that baccalaureate graduates were

more involved in prestigious function, i.e., teaching,

team leading, etc., while associate degree nurses tended

to do more non-prestigious nursing functions, i.e.,

treatments and medications. Baccalaureate students have

been shown to focus more on the psychological needs of

patients (Gray, Murray, Noy and Sawyer, 1977), to be more

care oriented as defined by the American Nurses Association










in 1965, to possess better leadership abilities (Gold-

stein, 1978; Gray et al., 1977) and communication skills

(Nelson, 1978). Diploma students, on the other hand,

evidenced a higher self-perception of themselves as

nurses and nursing administrators (Nelson, 1978). Asso-

ciate degree nurses felt excluded by graduates of the

other two program types (Davis, 1973), were not focused

on the physical needs of patients, and were more cure

oriented (Gray et al., 1977).


Professional Socializa-
tion Studies


In 1964 Davis and Olesen surveyed changes in stu-

dent's imagery, consensus, and consonance at the con-

clusion of one year's study in a baccalaureate nursing

program. They found that the first year of nursing educa-

tion was the time during which the greatest change took

place in student imagery. Although they found a trend

toward innovative and individualistic images of nursing

and away from bureaucratic images of nursing, they were

surprised to find no significant increase in consensus

among nursing students with respect to their images of

nursing. They reported that students' rating of traits










relative to nursing were influenced by their instructors'

emphasis on these same traits. Two follow up studies

confirmed these findings (Brown, Swift & Oberman, 1974;

Olesen & Davis, 1966).

A similar study was conducted by Siegel (1968).

Using the same trait scale as was used in the previous

studies, Siegel reported that senior nursing students in

two baccalaureate programs shared common perceptions of

nursing with their faculty. The students in the study

did not, however, reach consensus among themselves in

their characterization of nursing as they advanced in

class rank. Although the results concurred with those of

Davis and Olesen (1964), the weakness in all of these

studies was that no standardized instrument had been de-

veloped for the assessment of changes in students' views

of the nursing role. Without the development of a

standardized instrument, different studies do not increase

knowledge in the area of professional socialization. An

instrument which has been properly developed can be used

by other researchers pursuing the same area.

Richards (1972) reported that baccalaureate degree

students were more professionally socialized than

associate degree or diploma students were found to be.










Eller (1976) conducted a similar study and reported the

same findings. In both of these studies a basic assump-

tion was that professional socialization and a tradi-

tional view of nursing are at opposite extremes of the

same continuum. This assumption has not been accepted

by other researchers working in this area.

The previously reported studies of professional

socialization have demonstrated several weaknesses. The

most consistent exploration has focused on baccalaureate

students exclusively (Brown et al., 1974; Davis & Olesen,

1964; Olesen & Davis, 1966; Siegel, 1968; Tetreault, 1976).

Because nursing has been comprised of relatively few

baccalaureate nurses, the majority of nurses have there-

fore not been studied. Secondly, the instruments employed

have demonstrated weaknesses which are reviewed in the

next section. Finally, the basic assumption on which at

least two of the studies are based must be questioned.

To summarize, many studies have been conducted which

compare the students and graduates of the three nursing

educational programs. Many types of variables have been

employed that differentiated or identified similar

aspects of the programs. Few of these studies have been










replicated and therefore can be seen only as preliminary

investigations.

Professional socialization has been studied only

sporadically. A lack of adequate socialization into a

profession has been shown to produce job dissatisfaction re-

sulting in attrition from nursing practice (Williams &

Williams, 1959). The origins of professional socializa-

tion are in the educational program, yet little is known

about its development. Less has been devised for its

assessment. Because professional socialization is vital

to the development of the nursing practitioner, this area

should receive further study. It is necessary that future

studies in this area be based on acceptable assumptions,

compare products of different educational programs, and

improve instrumentation in this area. These are the

emphases of the present study.


Measures of Professional
Socialization


Few instruments have been developed for the measure-

ment of professional socialization in nursing. One of

the first instruments was the one used in the 1964 Davis

and Olesen study. This same instrument was also used in










Olesen and Davis (1966), Siegel (1968), and Brown et al.

(1974). This instrument was a 19-item checklist containing

broad, short statements relevant to nursing. Participants

were to check items they felt were important to nursing

and those important to themselves. Rather than develop-

ing individual total scores, totals were derived for each

item. The results were then reported in terms of the per-

centage of students checking each item.

Use of this questionnaire for the assessment of pro-

fessional socialization in nursing is limited. Some of

its weaknesses are (1) there is no method for deriving

individual scores established, (2) the items are no more

relevant to nursing than most other occupational groups,

and (3) there has been no investigation on the question-

naire's reliability and/or validity.

The instruments used in the studies by Richards (1972)

and Eller (1976) were not available for review nor dis-

cussed in their studies. In neither case was reliability

and/or validity discussed or mentioned.

In 1974 Crocker and Brodie developed the NPOS. Their

purpose in developing the NPOS was to construct a unidimen-

sional scale that would measure congruence between student

nurses' perceptions and faculty's views of the professional










nursing role. The initial pool of 112 items was comprised

of behaviors and traits frequently displayed by nurses

as wall as myths about nurses. After item analysis the

final pool of 59 items was tested for reliability and

validity.

The internal consistency of the NPOS, using Cronbach's

Alpha and calculated on a cross-validation group was

r = .89. Construct validity for the scale was demonstrated

empirically by showing that as nursing students advanced

in class rank, their scores became more congruent with

faculty views. Class means, i.e., freshman, sophomore,

junior, and senior, were significantly different (F /_3,240_7

= 34.7, p < .01). Using Scheffe's test for pairwise com-

parisons it was found that the mean score (total) of each

class was significantly greater than that of the lower

class.

Scoring weights for the items were derived by adminis-

tering the scale to 94 nursing faculty members of three

universities and using the per cent of endorsement of each

response as the item weight. The percentage of faculty

who endorsed a particular response was rounded to the

nearest tenth, which replaced the original five choice

item weight. For example, if 82 per cent of the










faculty chose option three on item 16, option three on

item 16 would now have a scoring weight of eight, not

three. This method of scoring was developed so that the

only way a student could receive a high score was to

respond to the NPOS in a manner similar to that of the

faculty (Crocker & Brodie, 1974).

Among the instruments reviewed, the NPOS was the

only scale for the measurement of professional socializa-

tion that was based on appropriate procedures for instru-

ment development. Additionally, the instrument was the

first one that enabled the user to identify consensus

among students. Finally, the NPOS was based on assump-

tions congruent with professional socialization theory

and research. For these reasons the NPOS was chosen for

this study.

At least two researchers have utilized the NPOS in

their studies. Rodeghero (1975) investigated the con-

gruence of student and faculty views of nursing in a

diploma program. The results reported were that students

adopt professional views similar to those of their faculty.

Additionally, factor analysis was employed which yielded

four factors, two of which differentiated levels of










students. These two factors were identified as the Tradi-

tional/Structured factor and the Empathic/Moralistic

factor.

In 1978 Thomas utilized the NPOS in a study comparing

the professional socialization of associate degree, bacca-

laureate degree and diploma students. Thomas found no

differences in the professional socialization of students

from the three educational programs.

Both of these studies were conducted with the

original scoring method developed by Crocker and Brodie.

This method, developed over eight years ago, is question-

able for use at the present time. Additionally, both of

these studies were conducted using programs in one city

(Rodeghero, 1975) or one state (Thomas, 1978).

With the development of the NPOS, advances have been

made towards better assessment of professional socializa-

tion. Crocker (1978) has had numerous requests for the

use of the NPOS for past, present, and future research in

the area of professional socialization. Further develop-

ment of this instrument, by broadening its application

and strengthening its scoring methods can be an aid to

research in professional socialization.










Summary


Nursing education has developed rapidly in the

United States. The first program implemented was the

hospital-based diploma program followed by the bacca-

laureate and associate degree programs. These programs

co-existed relatively peacefully until the 1965 American

Nurses Association position paper was released. Each

program then began to offer justification for its exis-

tence and continuation.

Several studies have been conducted comparing the

three educational programs. Few major differences have been

found in the reported comparisons of the three educational

programs. One area in which program comparisons are

needed is the area of professional socialization. Studies

which have been reported were too limited in scope,

were based on weak assumptions, or utilized inadequate

instruments for the assessment of professional sociali-

zation.

One promising instrument for assessing professional

socialization in nursing is the NPOS. Use of this in-

strument for research and evaluation in nursing educa-

tion is growing, but the original scoring scheme is now






39


outdated. Revision of the scoring scheme of the NPOS is

needed before the potential usefulness can be realized

in measuring professional socialization.














CHAPTER III


DESIGN AND PROCEDURES


This study was designed for two reasons. First, the

area of professional socialization in nursing requires

further study specifically in terms of different educa-

tional programs. Second, available instrumentation in

the area of professional socialization is for the most

part inadequate. The NPOS has shown promise in studies

of professional socialization and with further testing

for improvement it may prove to be of more use in the

future. This study was designed in two phases: (1)

establishing the two new scoring methods for the NPOS, and

(2) administering the NPOS to students from associate

degree and baccalaureate degree nursing programs for the

analysis of program effect on professional socialization.


The Hypotheses


The following hypotheses were formulated to be

tested in the present study. These hypotheses were










divided into subsets according to the scoring method of

interest.


Subset 1


Hypothesis 1:






Hypothesis 2:






Hypothesis 3:






Subset 2

Hypothesis 4:


Hypothesis 5:





Hypothesis 6:


When using the Traditional/Nontradi-
tional scoring method, there is no dif-
ference between the mean total NPOS
score of the associate degree students
and the baccalaureate degree students.

When using the Traditional/Nontra-
ditional scoring method, there is no
difference in total NPOS scores among
students with different levels of
HSGPA.

There is no interaction between edu-
cational program and HSGPA which
affects student scores on the NPOS,
using the Traditional/Nontraditional
scoring method.



When using the Practicing Nurses
scoring method, there is no difference
between the mean total NPOS scores of
the associate degree students and the
baccalaureate degree students.

When using the Practicing Nurses scor-
ing method, there is no difference
in total NPOS scores among students
with different levels of HSGPA.

There is no interaction between
educational program and HSGPA which
affects student scores on the NPOS
using the Practicing Nurses scoring
method.










In addition, the following question was formulated

to be investigated in the study.

Question 1: What will be the effect of two
different scoring schemes on
reliability (internal consistency)?


Subjects


For the present study nursing programs were selected

from the National League for Nursing accredited associate

and baccalaureate degree programs in six southeastern

states. The initial states chosen were Alabama, Florida,

Georgia, North Carolina, South Carolina, and Tennessee.

These states were chosen for several reasons.

1. Taken as a group these stats form a contiguous
geographical area,

2. These states are approximately equidistant from
the site of the study, and

3. Nursing educational programs in these states
all belong to the same regional agency (the
Southern Regional Educational Board) and there-
fore meet the same educational standards.

From each of these states one associate and one

baccalaureate degree program were selected. The following

criteria were used in the selection:

1. Both the associate and baccalaureate degree
programs were in close geographical proximity
to each other.









2. Each program was state supported, and

3. No program was racially or sexually
segregated.

The dean or director of each nursing program was

contacted by mail in March or April of 1978 requesting the

participation of the entire class of graduating seniors.

In one instance the school's institutional review board

for reviewing research proposals was also contacted. If

a dean wrote that her program or students were unable to

participate and a substitute school could be found that

met the aforementioned criteria, the substituted school

was then contacted. Of the original six states chosen,

programs in four states were in the final analysis. The

two states and their programs had to be deleted because

either no programs were able to participate or a com-

panion program could not be found for a participating

school.

All of the schools contacted responded to the initial

contact letter. Of the programs contacted, 62 per cent of

the associate degree and 55 per cent of the baccalaureate

degree schools agreed to participate in the study. Schools

agreeing to participate are listed in Appendix A.










Once the dean or director returned the completed

consent form the total number of requested scales was

mailed. The dean or director distributed the question-

naires to all of the graduating seniors and when completed

returned the questionnaires. A total of 557 questionnaires

was distributed and 332 returned for a 60 per cent return

rate. Sixteen questionnaires were completed by previously

licensed registered nurses and thus were omitted from the

analysis. Additionally, in one state there was no partici-

pating baccalaureate program so the paired associate degree

program had to be dropped. This resulted in a total of

276 completed scales. All questionnaires were handled

confidentially and no identifying information was col-

lected. Demographic data for the participating students

are shown in Tables 1, 2 and 3.


Instrument


The NPOS was used as the measure of professional

socialization in this study. The NPOS, a rating scale,

is composed of 59 items representing a portion of the

domain of professional socialization in nursing. Re-

spondents were asked to judge the importance of each

trait (item) for the practicing, professional nurse in


~











Table 1

Number of Students Participating by Program
(n = 276)



Program n

Associate degree

Jefferson State Junior College 62
Georgia State University 11
Fayetteville Technical Institute 38*
Florence-Darlington Technical College 20
Columbia State Community College 27

Baccalaureate degree

University of Alabama in Birmingham 40
Valdosta State College 45
University of South Carolina 41
University of Tennessee 30


*Dropped from the final analysis












Table 2

Percentage of Participants in Each Program
by Sex and Race Categories
(n = 276)


Sex
% %


Race
% % %


Program Male Female BlacK wnlie urienJal

Associate degree 7.5 92.5 10.0 89.2 .8
(n = 120)

Baccalaureate degree 13.5 86.5 4.5 94.2 1.3
(n = 156)

Total 10.9 89.1 6.9 92.0 1.0







47




Table 3

HSGPA By Program
(n = 276)


HSGPA
A B C
Program n % n % n %

Associate degree 32 27 76 63 12 10

Baccalaureate degree 72 46 72 46 12 8










her occupation and role as a nurse. They rated each item

from extremely important to undesirable on a five point

scale. Sample items and the directions are shown in

Appendix B. This scale is self-administered and takes

approximately 25 minutes to complete. The participating

students were asked to supply the following biographical

data while completing the NPOS: age, sex, ethnic group,

licensure status prior to enrollment in their present pro-

gram, and HSGPA.


Development of the Traditional/
Nontraditional Scoring Key


From the University of Florida College of Nursing 32

nursing faculty members were selected, due to their

accessibility, to provide the data on which to develop

the Traditional/Nontraditional scoring method. Each faculty

member was given the 59-item NPOS and asked to determine

for each item whether a nurse would be traditionally or non-

traditionally oriented if she endorsed it. A 90 per cent

return rate was achieved. This is probably due to per-

sonal distribution of the instrument to each participant.

The percentage of faculty choosing each option, either

traditional or untraditional, was tabulated. A 67 per cent










agreement was determined to be the minimum endorsement an

option must have for an item to be considered either tra-

ditionally or nontraditionally oriented (standard error

of this percentage = .08). For example, if for an item

72 per cent of the faculty chose the traditional option

as their belief about the orientation of that item, the

item would be considered a traditionally oriented item.

If, however, 52 per cent of the faculty chose the tradi-

tional option on an item (leaving 48% that chose nontra-

ditional), the item was dropped from this scoring method as

its orientation was not determined when a 67 per cent cut

off was established. If 32 per cent chose traditional

and 68 per cent chose nontraditional on an item, that item

would be considered nontraditionally oriented. Thirteen

items were deleted because there was not an endorsement

of either option (traditional or nontraditional) by 67

per cent of the respondents. The remaining 46 items were

divided into those items with a traditional orientation

(16 items) and those with a nontraditional orientation

(30 items). It was decided that a high score should

represent a traditional orientation, so the item weights

(1 through 5) were reversed on the 30 nontraditional

items. Using this manipulation, the only way an individual










could achieve a high score would be to rate the behaviors

described in traditional items as "important" or "ex-

tremely important" and rate the traits described in non-

traditional items as "unimportant" or "undesirable." The

decision for a traditional orientation to receive a high

score was an arbitrary one.


Development of the Practicing
Nurses Scoring Key


To develop a scoring key based on practitioners'

views, a different method was used. Six directors of

nursing services were contacted in five states in the

southeast to request participation in this portion of the

study. These directors were chosen because the hospitals

in which they were employed were in the same geographical

region as the universities and community colleges that

were in the data collection. The nurses in these hospitals

tend to have graduated from the nursing schools in the

immediate vicinity and therefore would better represent

the views of nursing in that area. Five directors of nurs-

ing agreed to participate, though all responded to the

original contact letter, for an 83 per cent return rate.

The participating hospitals are shown in Appendix A.










After receiving consent to participate the specified

number of scales was sent to the nursing director for

dispersal to the nurses. A total of 565 questionnaires

were mailed out and 226 returned for a return rate of

40 par cent. The scoring weights were then calculated in

a manner identical to that of the original NPOS scoring

weights. The percentage of nurses endorsing a particular

response was rounded to the nearest tenth, which replaced

the original five possible responses. For example, if

68 per cent of the nurses endorsed option 2 on an item,

option 2 would have a new scoring weight of seven. Each

option for the 59 items was reweighted in this manner.

This was done so the only way an individual could achieve

a high score using this method would be to answer the

item in a manner similar to that of practicing nurses.

The nurses supplied the following biographical data:

age, sex, ethnic group, clinical area where employed,

year initially licensed, years since initial licensure

when not employed in nursing, basic educational prepara-

tion in nursing, and highest level of education attained.

These data were not considered in the analysis but were

collected for a demographic description of the partici-

pating nurses. This information is shown in Tables 4 and 5.











Table 4

Participating Nurses by Age, Year Licensed
to Practice Nursing, and Years Not
Practiced Nursing
(n = 226)


Year licensed to Years not prac-
Age practice nursing ticed nursing

Mean 31.90 1967.89 1.00

Median 29.72 1971.85 .19

Mode 24.00 1975 .00

SD 9.40 11.35 2.39










Table 5

Participating Nurses by Sex, Race, Area
Employed, First Nursing Degree, and
Highest Educational Degree
(n = 226)


Variable Frequency Percentage

Sex
Male 4 1.8
Female 222 98.2

Race
Black 29 12.8
Hispanic 1 .4
White 195 86.3
Oriental 1 .4

Area Employed
Medical-Surgical 97 42.9
Pediatrics 13 5.8
Obstetrics 26 11.5
Intensive care 48 21.2
Emergency room 4 1.8
Psychiatrics 22 9.7
Inservice 8 3.5
Administration 5 2.2
Admissions 1 .4
None 2 .9

First Nursing Degree
Diploma 79 35.0
Associate degree 67 29.6
Baccalaureate degree 78 34.5
Other 2 .9

Highest Educational Degree
Diploma 55 24.3
Associate degree 54 23.9
Baccalaureate degree 82 36.3










Table 5 (Continued)


Variable Frequency Percentage

Baccalaureate (Non-nursing) 10 4.4
Master's in nursing 21 9.3
Master (Non-nursing) 3 1.3
Other 1 .4










The Analysis of the Data


The hypotheses for each scoring method were tested,

using a 2 X 3 factorial design, treating educational pro-

gram and HSGPA as independent variables and score on the

NPOS as the dependent variable. A classical regression

solution was used for determining significance of the mean

program differences, variation due to HSGPA and the inter-

action of program and HSGPA (Overall & Spiegel, 1969).

The level of significance for each hypothesis tested was

set at p < .05. Question 1 was explored by investigating

the internal consistency using Cronbach's Coefficient Alpha

for each scoring scheme.


Summary


A total of 276 associate degree and baccalaureate

degree students participated in this study. Each student

respondent read a list of traits or characteristics relevant

to nursing and rated the importance of each trait for a

professional nurse on a five point scale ranging from

"undesirable" to"extremely important." Two scoring methods

were developed with the participation of 29 nursing faculty

members and 226 practicing nurses. These scoring methods






56


were used to compute professionalization scores for each

student nurse.

The data were analyzed separately for each scoring

method using a 2 X 3 factorial design. The classical re-

gression solution was used to test the effect of educa-

tional program, HSGPA, and the interaction of program and

HSGPA on professional socialization (Overall & Spiegel,

1969). Reliability estimates for each scoring method were

calculated using Cronbach's Coefficient Alpha (Nie, Hull,

Jenkins, Steinbrenner & Bent, 1975).















CHAPTER IV


RESULTS


In this study professional socialization of students

in two types of nursing educational programs was analyzed

using two new scoring methods for the NPOS. Scoring

weights for the NPOS were derived using the two tech-

niques described in Chapter III. These new scoring weights

were then utilized in comparisons of the students' total

scores on the NPOS. The results of the statistical tests

for the previously stated hypotheses are presented in this

chapter. Finally, the reliabilities for each scoring

method were estimated.


Hypotheses Testing


Hypothesis 1;






Hypothesis 2:


When using the Traditional/Nontra-
ditional scoring method, there is no
difference between the mean total NPOS
score of the associate degree and
baccalaureate degree students.

When using the Traditional/Nontra-
ditional scoring methods, there is no
difference in total NPOS scores among
students with different levels of
HSGPA.










Hypothesis 3: There is no interaction between educa-
tional program and HSGPA which affects
student scores on the NPOS, using the
Traditional/Nontraditional scoring
method.

Data were analyzed using a 2 X 3 factorial design

with educational program and high school grade point

average as independent variables and total score with the

Traditional/Nontraditional method as the dependent vari-

able. Due to unequal cell sizes and the possibility of a

significant program-grade point interaction the classical

regression solution was used (Overall & Spiegel, 1969) to

test the hypotheses. The means and standard deviations

are shown in Table 6. The results of this analysis are

presented in Table 7. Significant main effects for educa-

tional program and high school grade point average were

found (F /1.270_7 = 4.39, p < .05; F / 2,270_7 = 5.12,

p < .05).

The interaction of educational programs and high

school grade point average did not result in a significant

F value. When the Scheffe's procedure for pairwise post

hoc comparisons was employed, students with a B HSGPA

were found to have the highest mean total NPOS score.

Thus, Hypothesis 1 was rejected, indicating there

is a significant difference between associate and











Table 6

Means and Standard Deviations of Students Total
Scores by Programs and HSGPA Using the
Traditional/Nontraditional Scoring Method
(n = 276)


HSGPA
Program A B C Row Total

Associate degree

Mean 170.13 177.53 176.67 175.47

SD 15.23 17.04 17.93 16.84

Baccalaureate degree

Mean 167.79 174.32 165.25 170.61

SD 18.05 15.21 13.65 16.76

Column total

Mean 168.51 175.97 170.96

SD 17.20 16.20 16.64











Table 7

Analysis of Total NPOS Score Computed with the
Traditional/Nontraditional Scoring Method as
a Function of Program Type, HSGPA, and the
Interaction Between Program and HSGPA
(n = 276)


Source SS df MS F

Program (A) 1203.82 1 1203.82 4.39*

HSGPA (B) 2808.63 2 1404.32 5.12*

A X B 407.58 2 203.79 .74

Residual 74110.89 270 274.49


*p < .05










baccalaureate degree students in their scores on the NPOS

using the Traditional/Nontraditional scoring method. On

the average, students in the associate degree programs

held a more traditional view of nursing than did students

in the baccalaureate degree programs. Hypothesis 2 was

rejected indicating there is also a difference among levels

of HSGPA across programs. Hypothesis 3, relating the

effects of interaction of educational program and HSGPA

with total NPOS score using the Traditional/Nontraditional

method cannot be rejected.

Hypothesis 4: When using the Practicing Nurses
scoring method, there is no dif-
ference between the mean total NPOS
scores of the associate degree stu-
dents and the baccalaureate degree
students.

Hypothesis 5: When using the Practicing Nurses
scoring method, there is no dif-
ference in total NPOS scores among
students with respect to levels
of HSGPA.

Hypothesis 6: There is no interaction between educa-
tional program and HSGPA which affects
student scores on the NPOS when using
the Practicing Nurses scoring method.

These data were analyzed using a 2 X 3 factorial

design with educational program and HSGPA as independent

variables and total score with the Practicing Nurses

method as the dependent variable. Due to unequal cell










sizes and the possibility of a significant program-grade

point average interaction, the classical regression

approach was used (Overall & Spiegel, 1969). The means

and standard deviations are presented in Table 8. The

results of this analysis are presented in Table 9. No

significant main effect for educational program or HSGPA

was found. Additionally the interaction between HSGPA

and educational program was not significant. Thus,

Hypotheses 4, 5 and 6 cannot be rejected.


Effects on Reliability


The reliability of the NPOS scores derived from the

new scoring schemes was estimated by calculating Cronbach's

Coefficient Alpha. Using the Traditional/Nontraditional

scoring scheme, the internal consistency of the NPOS was

r = .81. When calculated on the practicing nurses scoring

scheme the NPOS internal consistency was r = .88. These

results indicate that the new scoring systems for the

NPOS have acceptable internal consistencies.


Summary of the Results


For the Traditional/Nontraditional scoring scheme

a 2 X 3 factorial analysis of variance (program and HSGPA)












Table 8

Means and Standard Deviations of Students Total
Scores by Programs and HSGPA Using the
Practicing Nurses Scoring Method
(n = 276)


HSGPA
Program A B C Row Total

Associate degree

Mean 199.06 210.93 199.42 206.62

SD 42.73 22.26 44.45 31.67

Baccalaureate degree

Mean 205.92 201.50 208.75 204.10

SD 25.40 35.18 18.18 29.87

Column total

Mean 203.81 206.34 204.08

SD 31.69 29.55 33.55












Table 9

Analysis of Total NPOS Score Computed with the
Practicing Nurses Scoring Method as a Function
of Program Type, HSGPA and the Interaction
Between Program and High School
Grade Point Average
(n = 276)



Source SS df MS F

Program (A) 190.94 1 190.94 .20

HSGPA (B) 781.77 2 390.88 .42

A X B 4549.08 2 2274.54 2.43

Residual 252787.21 270 936.25










indicated a significant main effect for educational pro-

gram and HSGPA. The Practicing Nurses scoring method

yielded no significant main effects. In neither scoring

scheme did the interaction between program and HSGPA

yield a significant F value. These results can be inter-

preted as follows: (1) the Traditional/Nontraditional

scoring scheme is sensitive to differences in types of

educational programs; the associate degree students were

more traditional than the baccalaureate students, and (2)

the Practicing Nurses scoring scheme was either not

sensitive enough to differentiate the educational programs

or in fact there is no difference between the educational

programs when compared to practicing nurses.

The internal consistency estimates calculated for the

NPOS using the two new scoring schemes were such that

either scoring scheme could potentially be used for the

assessment of professional socialization.















CHAPTER V


DISCUSSION


The two major purposes of this study were (1) to fur-

ther refine the scoring methods of the NPOS and thereby

broaden its applications, and (2) to compare the mean

total scores on the NPOS of associate and baccalaureate

degree students using the two scoring methods developed.

In this chapter the results will be discussed, limitations

identified, and suggestions for future research offered.

The internal consistencies of the scoring methods

developed for the NPOS, r = .81 for the Traditional/Non-

traditional scoring method and r = .88 for the Practicing

Nurses scoring method,are sufficient to suggest that either

scoring scheme could be used for individual or group assess-

ment. Both of these scoring methods allow new applications

of the NPOS for the assessment of professional socializa-

tion. Prior to this study the NPOS had only been used in

measurement of consensus of student and faculty views of

the nursing profession. Though this instrument was an im-

provement over other available instruments, its applications










were limited. With the development of these additional

methods for scoring the NPOS, the potential usefulness

of this instrument has been broadened. This will cer-

tainly promote further research in the area of professional

socialization in nursing.


Traditional/Nontraditional
Scoring Method


When the Traditional/Nontraditional scoring method

was applied to the NPOS, educational program type and

HSGPA had a significant relationship to total NPOS score.

The associate degree students expressed a more traditional

orientation on the NPOS than the baccalaureate degree

students. This finding does not reflect on the degree of

professional socialization either of these groups of stu-

dents have attained, but rather identifies the orientation

of that socialization. The fact that the associate degree

students were found to have a more traditional orientation

only indicates that their view of nursing is more "tradi-

tional" as judged by the nursing faculty who rated the

items.

It is interesting that these preliminary results lend

credence to the American Nurses Association position paper










on the two types of nurses (American Nurses Association,

1965). The function of technical or associate degree

graduate nurse would be by definition more traditional.

That is, being the care giver she would tend to follow a

more traditional pattern in providing nursing care. Al-

though new knowledge relevant to patient care would be

incorporated, she would still fulfill a nursing role as

it has been characterized for many years. The bacca-

laureate degree graduate, defined by the ANA as the pro-

fessional nurse, would tend to be more nontraditional.

The need to incorporate the cure emphasis in patient care

as well as the promotion of the health and welfare of

those in the community necessitates an alternative or non-

traditional approach to patient care. While other inter-

pretations are possible, this finding is evidence of con-

struct validity of this scoring method.

The significant main effect for high school grade

point average illustrates the importance of considering

this variable in analyzing data of this nature. Including

high school grade point average as a variable allows for

its consideration as both a main effect and as one part

of an interaction. Each student having a particular grade

point average may interact with the professional










socialization process in many ways. It is possible that

students with certain grade point averages may incor-

porate the aspects of professional socialization differently

or to a greater degree. Utilizing the Scheffe's post hcc

procedure for pairwise comparisons it was concluded that

students with a B HSGPA expressed the most traditional

orientations on the NPOS. No explanation can be offered

for this finding.

In any event, control of this important variable may

have enabled detection of a "program" effect that would

have gone unnoticed if HSGPA had not been included as a

factor in this design. This suggests that this variable

should be included in other comparison studies of nursing

education programs.

A significant interaction between educational program

and HSGPA was not found. This lack of a significant inter-

action was surprising and no set explanation can be offered

for this finding. Possibly admission criteria may have

changed to equalize entrance to junior and senior colleges.

Additionally, the schools included in this study may be

different from other programs of similar types in their

student HSGPA composition.


I









Practicing Nurses Scoring Method


When the Practicing Nurses scoring method was applied

to the NPOS neither educational program or high school

grade point average had a significant relationship to total

NPOS score. Associate and baccalaureate degree students

were found not to differ in their perceptions of profes-

sional nursing from the beliefs of practicing nurses. There

are at least two contending interpretations for this lack

of significant main effect. First, the NPOS, when scored

with this method, may not be sensitive enough to detect

differences that do exist. Considering that the nurses

included in this scoring method were from four different

educational programs (diploma, associate degree, bacca-

laureate degree, and foreign based), varied broadly in the

number of years practiced, and types of practice settings,

the definition of practicing nurses may need to be more

narrowly defined to produce a scoring method sufficiently

sensitive to detect possible differences in these educa-

tional programs.

Second, there may in fact be no differences in these

educational programs when students are compared with prac-

ticing nurses on the NPOS. This does not imply that these


I










students carry out the practice of nursing in a manner

identical to or even closely similar to that of currently

practicing nurses but rather that they view the fully pro-

fessional, practicing nurse in the same manner.

Although there was no significant main effect for

HSGPA when the Practicing Nurses scoring method was em-

ployed for scoring the NPOS, inclusion of this variable

remains important in preliminary studies of the assessment

of professional socialization. As was previously mentioned,

inclusion of this variable may enable detection of dif-

ferences that would otherwise go undetected.

As in the Traditional/Nontraditional scoring method

there was no significant program by HSGPA interaction.

This finding again remains unexplainable.


Limitations of the Study


There are several limitations to this study. Be-

cause the educational programs were chosen as a mechanism

for testing the scoring methods, the primary limitation

involves sample selection. The results of this study are

not generalizable to associate and baccalaureate degree

students nationwide. They are applicable only to the

eight schools participating. However, the fact that the










scoring schemes worked so effectively for these schools

is promising for their future applications. The demon-

stration of their usefulness in this preliminary study

makes it possible for the development of broader national

norms in the area of professional socialization in nursing.

The second area is that of the groups chosen for the

development of the scoring methods. The faculty employed

for development of the Traditional/Nontraditional scoring

method were from a baccalaureate degree nursing program

and may not represent the traditional or nontraditional

views of other nurses or faculty. Finally, the practicing

nurses may not have accurately represented the population

of nurses in the United States.


Suggestions for Future Research


In terms of the development of alternate scoring

methods for the NPOS one important suggestion for future

work in this area would be to utilize a broader sample for

the basis of the scoring methods. This would entail

(1) defining practicing nurses and sampling to satisfy

the definition for the Practicing Nurses scoring method,

and (2) utilize faculty from each educational program of

interest as well as practicing nurses to establish the










Traditional/Nontraditional scoring method. By incorporating

both of these methods several scoring schemes could be

utilized for very specific purposes in the assessment

of professional socialization.

When comparing students and graduates of educational

programs relative to their professional socialization as

measured by the NPOS a random national sample should be

used for the generalizability of the findings. It is im-

portant that local or regional studies be used only for

preliminary investigations. The methods and instruments

should then be employed at a national level for the develop-

ment of national norms. Such norms would be useful for

further application of the NPOS in nursing educational

program evaluation as well as assessment of professional

socialization in nursing practice.

Of interest would also be the investigation of

practicing nurses and their scores on the NPOS relative

to their basic nurses education. Although a preliminary

study was conducted in this area (Rodeghero, 1975), there

were limited implications for the data due to an overly

simplistic sampling strategy. In future research prac-

ticing nurses should be investigated using the NPOS in

relationship to the area of their nursing practice and

additional nursing degrees acquired.









The final suggestion for future research concerns

longitudinal studies. As mentioned earlier, it takes from

months to years to become socialized into a profession.

It is possible that as the length of time in the practice

of nursing increases, there may be a decrease in an

individual's NPOS scores or the scores may in fact remain

the same or increase. Insight into the reason why some

nurses remain in practice while others leave could possibly

be gained from such a longitudinal study.


Applications in Nursing Education


The NPOS with its newly developed scoring methods

has several applications for nursing education. These

applications are primarily focused on program evaluation,

If objectives have been established for a nursing educa-

tional program that have aspects of a traditional or

nontraditional orientation towards nursing or congruence

with beliefs of currently practicing nurses the NPOS

could be employed for the assessment of the attainment

of the objectivess. Secondly, the faculty's goals for

the graduates of a nursing program could be evaluated by

use of the NPOS with its different scoring methods.

Finally, the NPOS has applications in the current









educational programs for previously licensed registered

nurses at the baccalaureate level. If students' profes-

sional socialization were assessed upon entering the pro-

gram with the NPOS, upon completion of the program the

change in their socializations could be reinvestigated

with the NPOS.

Before utilizing either of the two new scoring methods

for the NPOS in studies of professional socialization or

program evaluation, the objectives of the investigation

must be clearly defined. These two scoring methods have

virtually no relationship with each other (r = .01) and

therefore will produce different results as they did in

this study. The scoring method most appropriate to the

objectives established should be selected.


Summary and Conclusions


This study examined the application of new scoring

methods to an established instrument for the assessment

of professional socialization. The two scoring methods

developed were the Traditional/Nontraditional method and

the Practicing Nurses method. These new scoring methods

were then used to differentiate between baccalaureate and

associate nursing educational programs. Reliabilities of

the two scoring methods were also investigated.










A total of 156 student nurses from four baccalaureate

program and 120 from four associate degree programs com-

pleted the professional socialization scale. Their re-

sponses were scored using both scoring schemes. Associate

degree students were found to be more traditional in their

orientation than baccalaureate degree students, but no

difference was found between students from the two pro-

grams when their professional socialization was determined

relative to practicing nurses. Utilizing the Traditional/

Nontraditional scoring method HSGPA had a significant

effect on the mean total NPOS score, but there was no

significant interaction between educational program and

HSGPA with either scoring method. Both scoring methods

yielded high internal consistency coefficients, indicating

that these scoring schemes are sufficiently reliable for

individual or group assessment.

This study demonstrated the potential of improving

available instrumentation in professional socialization

in nursing. When assessing professional socialization in

nursing educational programs consideration should be given

to admission criteria for the programs, since HSGPA was

related to professional socialization. As shown in this






77


study, it is not necessary to limit the application of

an instrument only to its original designated purpose.

New scoring methods and new norm groups may expand the

usefulness of well-developed, existing instruments.



































APPENDICES































APPENDIX A

HOSPITALS AND EDUCATIONAL PROGRAMS
PARTICIPATING IN THIS STUDY















HOSPITALS PARTICIPATING IN THE STUDY


Hospital

University of Alabama
in Birmingham Hospitals

Bayfront Medical Center

Parkwood Hospital

North Carolina Memorial Hospital

Richland Memorial Hospital


State

Alabama


Florida

Georgia

North Carolina

South Carolina













ASSOCIATE DEGREE PROGRAMS PARTICIPATING
IN THE STUDY


School

Jefferson State Junior College

Georgia State University

Fayetteville Technical Institute

Florence-Darlington Technical
College

Columbia State Community
College


State

Alabama

Georgia

North Carolina


South Carolina


Tennessee












BACCALAUREATE PROGRAMS PARTICIPATING
IN THE STUDY


School

University of Alabama in
Birmingham

Valdosta State College

Georgia State University

University of South Carolina

University of Tennessee


State


Alabama

Georgia

Georgia*

South Carolina

Tennessee


*All students were registered nurses and had to be deleted.


































APPENDIX B


SAMPLE ITEMS FROM THE NPOS










SAMPLE ITEMS FROM THE NPOS


Professional Trait Rating Scale


Instructions:


This questionnaire is composed of a list of
descriptive characteristics and behaviors.
You are asked to judge how essential each
trait is for the practicing, professional
nurse in fulfilling her role.


If you judge this trait to be:


EXTREMELY IMPORTANT
IMPORTANT
SLIGHTLY IMPORTANT
NOT AT ALL IMPORTANT
UNDESIRABLE


Mark 5
Mark 4
Mark 3
Mark 2
Mark 1


There are no right or wrong answers for these
items. Judge each one in accordance with
your own personal opinion.

Please note that you have been asked to rate
these traits for the nurse as a practicing
professional only. DO NOT RATE THEIR IM-
PORTANCE FOR STUDENT NURSES.


1. Quietly
orders.


and obediently takes doctor's


1 2 3 4 5


2. Questions instructions when the reason
for them is not clear. 1 2 3 4 5

3. Can usually think of several alterna-
tive solutions to a problem. 1 2 3 4 5

4. Learns to accept the death of a
patient with no overt emotional signs. 1 2 3 4 5

5. Enjoys working with children. 1 2 3 4 5










6. Likes to be kept busy.

7. Always gets a doctor's order before
she initiates care for a patient.

8. Is willing to function as a counselor
for a patient who wants to discuss his
troubles.

9. Enjoys working with patients of
all ages.

10. Punctual and prompt in carrying
out duties.

11. Quickly rises to the defense of
medical or hospital practices when
they are criticized by laymen.


1 2 3 4 5


1 2 3 4 5




1 2 3 4 5


1 2 3 4 5


1 2 3 4 5




1 2 3 4 5


I















REFERENCES


American Nurses Association (ANA). ANA convention '78:
tomorrow's health/today's challenge. American
Journal of Nursing, 1978, 78, 1231-1246.

American Nurses Association (ANA). American nurses asso-
ciation position on education for nurses. American
Journal of Nursing, 1965, 65, 106-111.

Anderson, B. F. Nursing education in community junior
colleges. Philadelphia: J. B. Lippincott Co.,
1966.

Bain, R. N. A study of the effect of several factors on
the performance of nurses on the state board examina-
tion (Doctoral dissertation, New Mexico State Univer-
sity, 1974). Dissertation Abstracts International,
1974, 35, 3320-A. (University Microfilms No. 74-27,
515).

Bayer, A. E., & Schoenfeldt, L. F. Student interchange-
ability in three year and four year nursing programs.
Journal of Human Resources, 1970, 5, 71-88.

Becker, H. S., & Geer, B. The fate of idealism in medical
school. American Sociological Review, 1958, 23, 50-56.

Bridgman, M. Collegiate education for nursing. In B.
Bullough & V. Bullouch (Eds.), Issues in nursing.
New York: Springer Publishing Co., Inc., 1966.

Brown, J. S., Swift, Y. B., & Oberman, M. L. Baccalaureate
students' images of nursing: a replication. Nursing
Research, 1974, 23, 53-59.

Bullough, V. F., & Bullough, B. The emergence of modern
nursing. London: The MacMillian Co., 1969.










Corwin, R. G. Professional employee: a study in conflict
in nursing roles. American Journal of Sociology,
1961, 66, 604-615.

Counts, M. M. An analysis of a selected associate degree
and baccalaureate degree nursing curriculum as re-
lated to graduates' performance of functions in the
medical-surgical area (Doctoral dissertation, The
University of Texas at Austin, 1975). Dissertation
Abstracts International, 1975, 36, 2152-A. (Univer-
sity Microfilms No. 75-24, 855).

Crocker, L. M. Personal communication, January 20, 1978.

Crocker, L. M., & Brodie, B. J. Development of a scale
to assess student nurses' views of the professional
nursing role. Journal of Applied Psychology, 1974,
59, 233-235.

Davis, F., & Olesen, V. L. Baccalaureate students'
images of nursing. Nursing Research, 1964, 13,
8-15.

Davis, F., Olesen, V. L., & Whittaker, E. W. Problems
and issues in collegiate nursing education. In
F. Davis (Ed.) The nursing profession: Five
sociological essays. New York: John Wiley & Sons,
Inc., 1966.

Davis, G. C. Differentiation of nursing education programs
through identification of nursing functions (Doctoral
dissertation, Texas Technological University, 1972).
Dissertation Abstracts International, 1973, 34,
132-A. (University Microfilms No. 73-16, 267).

Dietz, L., & Lehozky, A. R. History and modern nursing.
Philadelphia: F. A. Davis Co., 1967.

Dolan, J. Nursing in society: A historical perspective.
New York: W. B. Saunders Co., 1973.

Dustan, L. C. Characteristics of students in three types
of nursing education programs. Nursing Research,
1964, 13, 159-166.










Eller, V. M. Role orientation toward professional nursing
of students completing associate degree, diploma,
and baccalaureate nursing education programs (Doctoral
dissertation, North Carolina State University at
Raleigh, 1976). Dissertation Abstracts International,
1977, 37, 2770-B. (University microfilms No. 76-28,
474).

Facts about nursing 76-77. Kansas City: American Nurses
Association, 1977.

Goldstein, J. D. Comparison of selected characteristics
of graduating nursing students of associate degree
and baccalaureate degree programs (Doctoral disserta-
tion, Northern Illinois University, 1977). Disserta-
tion Abstracts International, 1978, 38, 194-A.
(University Microfilms No. 7811176).

Gray, J., Murray, B., Noy, J., & Sawyer, J. Do graduates
of technical and professional nursing programs differ
in practice?. Nursing Research, 1977, 26, 368-373.

Griffin, G., & Griffin, J. History and trends of pro-
fessional nursing. St. Louis: C. V. Mosby Co.,
1973.

Hartley, G. E. A comparison of baccalaureate and associate
degree nursing students on selected personality charac-
teristics (Doctoral dissertation, Washington State
University, 1974). Dissertation Abstracts Inter-
national, 1975, 35, 4963-B. (University Microfilms
No. 75-7642).

Hegarty, W. H. Organizational and sociological factors
affecting attrition in collegiate schools of nursing.
International Journal of Nursing Studies, 1975, 12,
217-220.

Hoover, J. Diploma vs degree nurses: Are they alike?.
Nursing Outlook, 1975, 23, 684-687.

Huntington, M. J. The development of a professional self-
image. In R. K. Merton, G. G. Reader & P. L. Kendall
(Eds.), The student-physician. Cambridge: Harvard
University Press, 1957.










Kiniery, G. The evaluation and characteristics of bacca-
laureate education in nursing. In S. C. M. Frank
& L. E. Herdgerken (Eds.), Perspectives in nursing
education. Washington, D. C.: The Catholic Univer-
sity of America Press, 1963.

Kramer, M. The new graduate speaks. American Journal of
Nursing, 1966, 66, 2420-2424.

Kramer, M. Role models, role conceptions and role depriva-
tion. Nursing Research, 1968, 17, 115-120.

Kramer, M. The new graduate speaks again. American
Journal of Nursing, 1969, 69, 1903-1907.

Kramer, M. Role conceptions of baccalaureate nurses and
success in hospital nursing. Nursing Research,
1970, 19, 428-439.

Kramer, M. Reality shock: Why nurses leave nursing. St.
Louis: C. V. Mosby Co., 1974.

Lysaught, J. P. An abstract for action. New York:
McGraw-Hill Book Co., 1970.

Meleis, A. I., & Farrell, K. H. Operation concern: A
study of senior nursing students in three nursing
programs. Nursing Research, 1974, 23, 461-468.

Montag, M. L. Where is nursing going?. New York:
National League for Nursing, 1975.

Montag, M. L., & Gotkin, L. G. Community college educa-
tion for nursing. In B. Bullough & V. Bullough
(Eds.), Issues in nursing. New York: Springer
Publishing Co., Inc., 1966.

Moore, W. E. Occupational socialization. In D. Goslin
(Ed.), Handbook of socialization theory and research.
Chicago: Rand McNally & Co., 1969.

Moore, W. E. The professions: Roles and rules. New
York: Russell Sage Foundation, 1970.










Nelson, L. F. Competence of nursing graduates in tech-
nical, communicative, and administrative skills.
Nursing Research, 1978, 27, 121-125.

Nie, N. H., Hull, C. H., Jenkins, J. G., Steinbrenner, K.,
& Bent, D. H. Statistical package for the social
sciences. New York: McGraw-Hill Book Co., 1975,
(Second edition).

Olesen, V. L., & Davis, F. Baccalaureate students' images
of nursing: A follow up report. Nursing Research,
1966, 15, 151-158.

Olesen, V. L., & Whittaker, E. W. The silent dialogue.
San Francisco: Josey-Bass Inc., 1968.

Overall, J. E., & Spiegel, D. K. Concerning the least
squares analysis of experimental data. Psychological
Bulletin, 1969, 71, 311-322.

Richards, M. A. A study of differences in psychological
characteristics of students graduating from three
types of basic nursing programs. Nursing Research,
1972, 21, 258-261.

Rodeghero, J. A., Jr. Socialization and professional
orientations of nursing students, faculty and
practicing nurses. Unpublished master's thesis,
Bowling Green State University, 1975.

Schmitt, M. H. Role conflict in nursing. American
Journal of Nursing, 1968, 68, 2348-2350.

Siegel, H. Professional socialization in two bacca-
laureate programs. Nursing Research, 1968, 17,
403-407.

Simpson, I. H. Patterns of socialization into pro-
fessions: The case of student nurses. Sociological
Inquiry, 1967, 37, 47-54.

Super, D. E. The psychology of careers. New York: Harper,
1957.







91


Tetreault, A. I. Selected factors associated with pro-
fessional attitudes of baccalaureate nursing stu-
dents. Nursing Research, 1976, 25, 49-53.

Thomas, J. T. Professional socialization of students in
four types of nursing education programs (Doctoral
dissertation, University of Florida, 1978). Disserta-
tion Abstracts International, 1979, 39, 5966-A.
(University Microfilms No. 7907801).

Williams, T., & Williams, M. Socialization of the student
nurse. Nursing Research, 1959, 8, 18-25.

Wren, G. R. Some characteristics of freshman students
in baccalaureate, diploma and associate degree
nursing programs. Nursing Research, 1971, 20,
167-172.




Full Text

PAGE 1

THE PROFESSIONAL SOCIALIZATION OF NURSING STUDENTS: A COMPARISON BASED ON TYPES OF EDUCATIONAL PROGRAMS By MARY RUTH LYNN A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 1979

PAGE 2

Copyright 1979 By Mary Ruth Lynn

PAGE 3

ACKNOWLEDGEMENTS The members of my doctoral committee deserve special recognition for their assistance with this dissertation. The chairman of my committee, Dr. Linda M. Crocker, has my deepest admiration and gratitude for her excellent guidance, teaching, and patience. Dr. Robert S. Soar has also been influential during my graduate study. I appreciate his sound advice and calm attitude. My sincere appreciation goes to Dr. Molly C. Dougherty for her constant support, understanding, and willingness to listen. Dr. Faye G. Harris has always provided a willing ear and constant moral support and for those I thank her. In addition, I would like to extend my gratitude to the deans, directors, and students of the schools participating in this study. Finally, I would like to thank my friends Barbara Boss, Dr. Patricia D. Olmsted, and Nancy Sypert, for their prodding and support which aided me in the completion of this study.

PAGE 4

TABLE OF CONTENTS Page ACKNOWLEDGEMENTS iii LIST OF TABLES vi ABSTRACT vii CHAPTER I INTRODUCTION 1 Definition of Terras 5 Purpose of the Study 6 Rationale for the Study 8 Significance of this Study 10 II REVIEW OF THE LITERATURE 12 Historical Developments in Nursing Education 12 The Diploma Program 12 The Baccalaureate Program .... 15 The Associate Degree Program. . . 17 Controversies in Nursing Education 20 Comparisons of the Three Educational Programs in Nursing 25 Biographical and Cognitive Variables 25 Affective and Personality Variables 29 Professional Socialization Studies 30 iv

PAGE 5

TABLE OF CONTENTS (Continued) Measures of Professional Socialization 33 Summary 38 III DESIGN AND PROCEDURES 40 The Hypotheses 40 Subjects 42 Instrument 44 Development of the Traditional/ Nontraditional Scoring Key 48 Development of the Practicing Nurses Scoring Key 50 The Analysis of the Data 55 Summary 55 IV RESULTS 57 Hypotheses Testing 57 Effects on Reliability 62 Summary of the Results 62 V DISCUSSION 66 Traditional/Nontraditional Scoring Method 67 Practicing Nurses Scoring Method . . 70 Limitations of the Study 71 Suggestions for Future Research. . . 72 Applications in Nursing Education. . 74 Summary and Conclusions 75 APPENDICES APPENDIX A — HOSPITAL AND EDUCATIONAL PROGRAMS PARTICIPATING IN THIS STUDY ... 80 APPENDIX B— SAMPLE ITEMS FROM THE NPOS . ... 84 REFERENCES BIOGRAPHICAL SKETCH 86 92

PAGE 6

Table LIST OF TABLES Number of Students Participating by Program 45 Percentage of Participants in Each Program by Sex and Race Categories 46 HSGPA by Program 47 Participating Nurses by Age, Year Licensed to Practice Nursing, and Years Not Practiced Nursing 52 Participating Nurses by Sex, Race, Area Employed, First Nursing Degree, and Highest Educational Degree 53 Means and Standard Deviations of Students Total Scores by Programs and HSGPA Using the Traditional/ Nontraditional Scoring Method 59 Analysis of Total NPOS Score Computed with the Traditional/Nontraditional Scoring Method as a Function of Program Type, HSGPA, and the Interaction Between Program and HSGPA 60 Means and Standard Deviations of Students Total Scores by Programs and HSGPA Using the Practing Nurses Scoring Method 63 Analysis of Total NPOS Score Computed with the Practicing Nurses Scoring Method as a Function of Program Type , HSGPA and the Interaction Between Program and High School Grade Point Average 64

PAGE 7

Abstract of Dissertation Presented to the Graduate Council of the University of Florida in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy THE PROFESSIONAL SOCIALIZATION OF NURSING STUDENTS: A COMPARISON BASED ON TYPES OF EDUCATIONAL PROGRAMS By Mary Ruth Lynn August 1979 Chairman: Linda Crocker Major Department: Foundations of Education The assessment and development of professional socialization in nursing students has been a concern for many years. Several studies have been conducted in this area but few quality instruments have been developed with uses specific to nursing. The Nurses Professional Orientation Scale (NPOS) was an exception in that it was appropriately designed and was developed to be used in the assessment of professional socialization of nursing students . In this study two new scoring methods, a Traditional/ Nontraditional scale and a Practicing Nurses scale were developed for the NPOS. The internal consistencies for these methods were .81 and .88, respectively. Each method was then used to determine if students from different

PAGE 8

nursing curricula would differ in responses to the NPOS . Graduating associate degree and baccalaureate degree students in four southeastern states served as subjects for the comparisons. The sample sizes for the associate degree and the baccalaureate degree students were 120 and 156, respectively. A 2 X 3 factorial design (two program levels and three grade point levels) was used to compare the total NPOS scores of the students from the two programs. Because admission criteria differ for these programs, high school grade point average was included in each analysis. Both main effects and interactions were tested using a classical regression analysis. Separate analysis were conducted for each scoring method. Using the Traditional/Nontraditional scoring method, significant main effects were found for both educational program and high school grade point average. These results indicated that associate degree students ware more traditional in their professional socialization than were the baccalaureate degree students. When the Scheffe's post hoc procedure was employed it was concluded that students with a B high school grade point average evidenced a more traditional orientation than did students with other high school grade point averages.

PAGE 9

When the Practicing Nurses scoring method was used to score the NPOS , no significant main effect for educational program or high school grade point average was found. Finding no significant main effect for educational program, it was concluded that either the Practicing Nurses scoring method was not sufficiently sensitive to differentiate students from different educational program types or that there was truly no difference among the students relative to practicing nurses. In addition, no significant interaction was found between educational program and high school grade point average in either scoring method. This study demonstrated the potential for improving available instrumentation in the area of professional socialization in nursing. It was also found that students in different educational programs in nursing can be differentiated in terms of their professional socialization, specifically in terms of a traditional or nontraditional orientation. With improved instrumentation for assessing professional socialization, research in this area can be significantly advanced. IX

PAGE 10

CHAPTER I INTRODUCTION Professional socialization is a specific portion of adult socialization. As a process it has been defined in several different ways. Super (1957) suggests that professional socialization is the process by which someone "tries the fit" of a job. Others, including Simpson (1967), define occupational choice and socialization into a role as a means of acquiring self-identification. Moore (1969) asserts that professional socialization "involves acquiring requisite skills and also the sense of occupational identity and internalization of occupational norms typical of the fully qualified practitioner" (Moore, 1969, p. 71) . Many researchers suggest that there are phases or steps involved in professional socialization. Three phases that have been suggested are (1) the individual shifts his attention from broad societal goals to the goal of proficiency in the specific tasks of his chosen profession, (2) identifying significant others in the profession as his

PAGE 11

reference source, and (3) internalizing the values, skills, and attitudes of the occupational group and adopting the behaviors it prescribes (Simpson, 1967) . Professional socialization has been studied in many of the health related professions but has received more emphasis in medical and nursing education. Medical school has been described as one of the longest rites of passage in our part of the world (Becker & Geer, 1958) . During the first year of medical training, medical students think of each other and themselves primarily as students. When medical students have begun to see patients on the clinical units, the transition to perceiving themselves as physicians begins. This self image change can be seen as reflecting the expectations of others. Patients define the medical student as a physician so the student starts to define himself and behave as a physician (Huntington, 1957) . Similarly professional socialization has been explored in nursing and nursing education. Kramer (1974) asserts that the behavioral and attitudinal changes necessary to nursing are usually internalized during the training period of the nursing program. She views professional socialization in nursing as a process of both internal and external

PAGE 12

changes in an individual which result in altered "images, expectations, skills, and norms" (Kramer, 1974, p. 38). Olesen and Whittaker (1968) view professional socialization in nursing as the fusion of person, situation, and institution. It is in this fusion that they believe the heart of professional socialization lies. Investigations into the professional socialization of nursing students indicate that the critical issue is the incongruence in the socialization processes between the nursing program and the actual nursing duties as they are defined and implemented in the various employment settings (Corwin, 1961; Kramer, 1966, 1968, 1969, 1970, 1974) . Nursing schools and employment settings represent two different subcultures in the nursing world. "The norms, values and behavioral expectations are more different between school and work than they are between two different work settings" (Kramer, 1974, p. 38). Because these subcultures are so different, movement from one to the other creates difficulties. Inadequate professional socialization has been found to result in attrition in both nursing education and nursing practice (Williams & Williams, 1959). Thus, it is important to examine professional socialization

PAGE 13

in both nursing as an educational program and as an occupation. Because there are three different educational tracks for prospective nurses, an important question is which program results in greater professional socialization for its graduates? The oldest of these programs, the hospitalbased diploma school, has rarely encountered socialization incongruencies because the training was in the apprenticeship mode. With the movement of nursing education into universities in the early 1900' s (baccalaureate program) and into community and junior colleges in the 1950' s (associate degree program), professional socialization became a relevant issue. No longer are the students in nursing programs receiving extensive clinical experience and exposure to the day-to-day realities of nursing. Rather a greater balance between classroom learning and clinical experience was created. Therefore, due to the education changes over the last century, the assessment and development of professional socialization of nursing students has become and continues to be an area of interest. Despite the interest that has been generated in evaluating and comparing nursing programs (within and

PAGE 14

across educational tracks) in terms of professional socialization, at the present time the state of measurement of professional socialization has prevented adequate investigation in this area. Few instruments have been developed that measure professional socialization in nursing, and those that are relevant have not been used to assess the differences or similarities in the three educational program's graduates. Further, the developed instruments have not been fully tested, i.e., evidence of reliability, validity, or both has been lacking. Finally no existing instrument has a scoring scheme based on the perceptions of practicing clinical nurses. Definition of Terms For the purpose of this study, the following definitions were used: Associate Degree Program . Completion requires two years in time and is based in a community or junior college and occasionally in the lower division of a senior college or university. The associate degree programs are generally affiliated with local hospitals or health care agencies. Graduates are licensed as registered nurses upon passing

PAGE 15

licensing examinations and have either an Associate of Arts (AA) or Associate of Sciences (AS) degrees. Baccalaureate Degree Program . Contained within a four-year college or university, this program combines a liberal arts background with the nursing curriculum. The actual time spent in nursing education ranges from two to five years. The university or college grants a Bachelor of Science in Nursing or a Bachelor of Science degree to its graduates. Upon passing licensure examinations the baccalaureate graduate is titled a registered nurse. Diploma Program . Three years of study are required for completion. The school of nursing is generally under the control of a hospital. Each school has its own faculty, but many of the schools are affiliated with a senior or junior college or university for physical science, and some social science courses. After graduating and passing the state board licensing exam the graduate is titled a registered nurse. Purpose of the Study The purpose of this study was to develop and test two new scoring methods for a prominent instrument, the Nurses

PAGE 16

Professional Orientation Scale (NPOS) , used in the measurement of professional socialization. First, a scoring method based on a traditional/non-traditional view of nursing was developed and employed in an effort to differentiate graduates of different educational programs. Second, a scoring method based on the perceptions of practicing nurses was developed to assess the socialization of graduates from different educational programs. Finally, the reliabilities yielded from the new scoring methods were compared. In view of the fact that the programs to be investigated were located in junior colleges and senior colleges and universities, the differences in admission criteria had to be considered. Accordingly, the high school grade point average (HSGPA) of each student was collected for inclusion in the analysis. Thus, variation in the scores on the NPOS related to differences in high school achievement could be systematically controlled. The possibility of an interaction between high school grades and nursing education programs was also tested. The purpose of controlling these factors was to increase the power of the analysis, increasing the likelihood of finding any true

PAGE 17

significant differences which might exist between the two types of educational programs. Rationale for the Study The scoring methods for the NPOS have been developed for three reasons. Although this instrument is widely used, its original scoring scheme suffered from several limitations. First, the original scoring method was based on baccalaureate degree faculty responses nine years ago. With the changes in the attitudes of women in the last few years, a scoring method formed nine years ago is unlikely to reflect the current feelings of a predominantly female profession. Second, the Traditional/Nontraditional method has been developed to ascertain if the associate degree and baccalaureate degree programs in fact are at different points on a traditional vs. nontraditional continuum. Nursing educators and nurses in general have long argued that certain types of programs produce graduates who are more or less traditional than the graduates of other types of programs. Additionally, some researchers have reported that a traditional orientation is the opposite of professional socialization (Eller, 1976; Richards, 1972).

PAGE 18

Finally, the practicing nurses method has been derived for two reasons: (1) there has been no scoring scheme developed for an instrument which utilized the beliefs of practicing nurses, and (2) graduates entering nursing with beliefs unlike those of currently practicing nurses have experienced a reality shock which has created great job dissatisfaction (Kramer, 1974). Therefore, the ability to establish which students would be more likely to have an experience of "reality shock" would provide an aid in the decrease of attrition from nursing practice. In this study the professional orientation (socialization) of senior associate degree nursing students is compared to the professional orientation (socialization) of senior baccalaureate degree nursing students. Diploma students are not included in the study for two reasons: (1) The number of diploma programs both nationwide and in the selected region has decreased markedly over the past fifteen years (less than half the programs open in 1960 remain open today) , and (2) the tremendous growth of the junior college programs (associate degree) both nationwide and in the selected region has diminished the impact of diploma education for nurses .

PAGE 19

10 Significance of this Study As previously mentioned, when socialization is congruent between nursing educational programs and the employment setting fewer difficulties for an individual moving from one to the other are encountered. Much research has been done investigating the effects of incongruent socialization. This inadequate socialization has been shown to produce role deprivation. Role deprivation (role conflict), i.e., the discrepancy between what a nurse thinks should happen and what she perceives is going on around her (Kramer, 1970), has been found to cause attrition in both nursing educational programs and in nursing practice (Hegarty, 1975; Schmitt, 1968; Williams & Williams, 1959). The investigation of the professional socialization of graduates of the associate and baccalaureate degree programs may yield information that would be helpful in the assessment and decrease of role deprivation, and consequently attrition from the profession. The need to study graduates of different educational programs, specifically the associate and baccalaureate degree programs is twofold. First, graduates of these programs have been compared on the basis of many variables

PAGE 20

11 and have not been found to be essentially different. Professional socialization has rarely been investigated using more than one program type. Second, the American Nurses Association has recommended that there should be two types of nurses prepared in the United States, technical (associate degree) and professional (baccalaureate degree) (American Nurses Association, 1965) . These two educational programs have been ill defined or differentiated at this time, and comparisons of the professional socialization of their students could yield valuable information. This information would be valuable for future efforts in curriculum development, program evaluation, or research in professional socialization as a social process.

PAGE 21

CHAPTER II REVIEW OF THE LITERATURE The literature reviewed in this chapter has been selected from three areas: historical development of the nursing educational programs, comparisons of the three nursing educational programs and measures of professional socialization in nursing. The review is organized in the following manner. First, selected literature is presented pertinent to the historical development of nursing educational programs. Next, studies comparing graduates of the three educational programs are discussed. Finally, measures or professional socialization in nursing are reviewed with emphasis on those studies in which the NPOS was used. Historical Developments in Nursing Education The Diploma Program Formal nursing education began in the United States in 1872 with the establishment of the first hospital-based school of nursing (diploma program) in Roxbury, Massachusetts 12

PAGE 22

13 The program resembled the Nightingale School of England in that the course was twelve months in length equally divided into medical nursing, surgical nursing, maternity nursing, and night nursing (Dietz & Lehozky, 1967) . Numerous other schools modeled after the Nightingale School soon developed. Each school was independent of the hospital, having its own administration as well as budget. In 1874 schools began to contract with the hospitals so that student nurses could receive actual patient care experiences. These contracts gave the students patient care experiences in exchange for their providing the hospital with nursing services. The hospitals realized an increase in nursing services and therefore incorporated the faculty of the schools under their budget and administration (Do Ian, 1973) . Diploma schools have continued in this mode . During the period from 1872 to 1910, both the length of the diploma program and the number of programs increased. The duration of the educational period went from the initial one year of training to two years and then finally to three years, which is the present length of the diploma programs. Diploma schools' students helped to provide staff for the hospitals in which they had their clinical

PAGE 23

14 experiences. This was financially beneficial to the hospitals as it decreased their expenditures for nursing care. Therefore, many hospitals attempted to have nursing schools . In 1880 there were fifteen diploma programs . By 1910 over one thousand programs had been established (Bridgman, 1966) . A milestone in nursing education occurred in the early 1920 's when Josephine Goldmark was commissioned to study the function and preparation of the public health nurse. Although the study was initially directed towards the problems of public health education for nurses, it was soon found to be relevant to the whole of nursing education. This report revealed that "most nursing schools were shockingly inadequate in providing laboratories, libraries, demonstration rooms, instructors, and head nurses"; therefore, the nursing schools did not conform to standards accepted in other educational institutions (Dietz & Lehozky, 1967; Lysaught, 1970). Goldmark recommended that The current tendency to lower requirements should be discontinued and efforts made to raise the general standards of nursing education to the level of the best schools. Instructors and other officers of schools of nursing should receive special

PAGE 24

15 training to fit them for their tasks. The development of university associations with schools of nursing should be strengthened, and schools should be given adequate financial backing. (Griffin & Griffin, 1973, p. 134) Because the hospital-based diploma programs were in the midst of a "boom," the recommendations of the Goldmark report were not accepted or implemented. The report did, however, stimulate the development of some university programs and further encourage the move of nursing education into the academic environment. The Baccalaureate Program In the early 1900' s several nursing leaders wished to place education for nurses into the academic environment and remove control of nursing education from the hospital's administration. In 1909 the first independent school of nursing was established at The University of Minnesota. Though several collegiate programs had been established prior to 1909, they were all under the control of medical schools (Davis, Olesen & Whittaker, 1966) . Acceptance of collegiate nursing education was certainly not immediate. Both the public and most nursing educators felt that the already established diploma programs

PAGE 25

16 sufficiently supplied all the education and preparation a working nurse could possibly need (Bridgman, 1966; Davis et al., 1966). The initial programs developed at The University of Minnesota and in many other universities were not different from the numerous diploma programs in existence. The programs were three years in length and the graduates received a diploma in nursing upon completion. It was not until ten years later that Minnesota instituted an undergraduate baccalaureate program for nursing students, and by that time a number of other universities had already taken such a step (Davis et al . , 1966). During the period between 1910 and 1930 nursing leaders recognized the need for the development of higher educational standards. Through their efforts, the Association of Collegiate Schools of Nursing (ACSN) was established in 1932. This association, though not an accrediting agency, examined member schools 1 programs to ascertain if they met the established standards . Of the numerous collegiate programs in existence, twenty schools were either full members or associate members in the ACSN by 1935. During World War II there was a rapid expansion in the number of collegiate nursing

PAGE 26

17 programs. All of these programs were not eligible for membership in the ACSN because they did not meet the required standards. By 1948, through the efforts of numerous nursing educators, the National Nursing Accrediting Service was established in an attempt to set down criteria for the evaluation of all existing and developing nursing programs (Kiniery, 1963) . Accreditation of programs was not firmly established until 1952 when the National League for Nursing Accrediting Service was formed. The establishment of an accrediting service was a step forward because it determined the criteria that differentiated collegiate programs from diploma programs . The Associate Degree Program After World War II the public and nurses alike became increasingly aware of the widening gap between the quantity and quality of nursing services. Nursing educators were confronted with the problem of attaining and maintaining the proper alignment of the nursing educational system with the fundamental social and economic changes taking place in the face of rapidly developing scientific and medical advancements. Following the war,

PAGE 27

18 the United States was experiencing an explosion of technical and medical knowledge (e.g., the discovery and refinement of many antibiotics and antibiotic therapies) . The public demanded higher living standards and available quality medical services (Anderson, 1966) . In an effort to explore the nature of the nursing shortage national nursing organizations and universities with nursing programs undertook studies of nursing practice, in the early 1950' s Mildred L. Montag (Montag & Gotkin, 1966; Montag, 1975) set up the Cooperative Research Project in Junior and Community College Education for Nursing. Under this project eight participating schools — five two-year junior colleges, two four-year institutions of higher education, and one hospital school of nursing — were assisted in developing programs for the education of potential nurses. Seven of the eight programs awarded an associate degree to graduates of the program (Bullough & Bullough, 1969) . This new nurse has been described as a "bedside nurse" to differentiate her from nurses with broader professional preparation (Montag & Gotkin, 1966) . The assumptions underlying the development of the associate degree nurse program were as follows:

PAGE 28

19 1. The functions of nursing can and should be differentiated into three basic categories: the professional, the semi-professional or technical, and the assisting. 2. The great bulk of nursing functions lie in the intermediate category, the semi-professional or technical. Therefore the greatest number of persons should be prepared to fill these functions. 3. Education for nurses belongs within the organized educational framework. 4. The junior-community college, the post-high school educational institution specifically suited to semi-professional or technical education, is the logical institution for the preparation of the large group of nurses. 5. When preparation for nursing is education — rather than service-centered, the time required may be reduced. (Montag & Gotkin, 1966, p. 34) By design the associate degree nurse was to perform technical (or semi-professional) functions at the registered nurse level and be prepared for beginning practitioner positions (Montag & Gotkin, 1966) . The community college, being one of the fastest growing enterprises in America, readily accepted the proposition of educating nurses in associate degree programs. In 1956 there were only the eight pilot schools but by 1975 there were 603 programs in community and junior colleges awarding associate degrees in nursing ( Facts About Nursing 76-77 , 1977) .

PAGE 29

20 Controversies in Nursing Education In 1965 the American Nurses Association's Committee on Nursing Education published its first position paper on nursing education. The position was as follows: 1. The education for all those who are licensed to practice nursing should take place in institutions of higher education. 2. The minimum preparation for beginning professional nursing practice at the present time should be baccalaureate degree education in nursing . 3. The minimum preparation for beginning technical nursing practice at the present time should be the associate degree education in nursing. (American Nurses Association, 1965, pp. 107-108) This position paper went on to define the components of professional and technical practice. Professional nursing was said to have three orientations, specifically care, cure, and coordination. The care orientation included dealing with humans under stress, providing comfort, listening, evaluating, and intervening appropriately. The cure emphasis, in contrast to the medical profession, was the promotion of health. Finally, the coordination aspect of professional nursing was that of dealing with the health and welfare of those in the community.

PAGE 30

21 Technical nursing was said to be skill oriented in that it involved the application of the basic principles of science. The nursing functions within technical practice were patient status review and planning care with other health care team members. The position paper did not limit the depth of technical practice but confined the scope of practice. The technical nurse was to be directly under the supervision of the professionally trained nurse (American Nurses Association, 1965) . The American Nurses Association position produced great controversy among nurses across the nation. What would become of the diploma schools and their graduates? Where did the Licensed Practical Nurse (LPN) fit into the plan? How did one distinguish between technical and professional practice? Were baccalaureate programs affordable and accessible to those who wanted to obtain the professional degree? What was wrong with the status quo? Although the American Nurses Association's position was far from unanimously supported, there was a demonstrable effect on nursing education. In 1965, 77 per cent of basic nursing education took place in diploma programs;

PAGE 31

22 in 1975, these programs were responsible for only 29 percent of the basic nursing education. During the same time period the combined total of associate and baccalaureate graduates have gone from 23 per cent to 71 per cent. The associate degree programs accounted for 44 per cent of the total graduates and the baccalaureate degree programs accounted for 27 per cent of the total graduates . Additionally, in 1975 7 per cent of all students in baccalaureate programs were currently licensed registered nurses who had graduated from associate and diploma programs ( Facts About Nursing 76-77 , 1977) . The efforts of the American Nurses Association to define technical and professional practice have represented an ever continuing drive on the part of the nursing profession to improve its professional status. in order for a group to establish professional status, education of its practitioners must take place in institutions of higher education. Preparation for professional practice must encompass mastery of the theory underlying its practice, not just apprenticeship training (Moore, 1970). Although over the next decade more research was conducted investigating the nature of the graduates and students of the three nursing educational programs,

PAGE 32

23 little had been done to implement the elements of the 1965 position paper. Therefore, the 1978 convention of the American Nurses Association established a timetable for the implementation of the 1965 standards. The association established that "by 1980, two categories of nursing practice be identified" and "that the baccalaureate should be the minimum preparation for entry into professional nursing practice by 1985" (American Nurses Association, 1978) . Although the resolutions of the American Nurses Association have no legal implications, the ramifications within nursing produced by the 1978 recommendations have only begun to be felt. Between the 1965 American Nurses Association position paper and the 1978 resolutions, the National Commission for the Study of Nursing and Nursing Education was formed with Jerome Lysaught appointed as director. The charge to the committee was to investigate how to improve the delivery of health care to the American people through the analysis of improvement of nursing and nursing education. The following are some of the major recommendations pertaining to nursing education: 1. Each state will have, or create, a master planning committee that will take nursing

PAGE 33

24 education under its purview, such committees to include representatives of nursing education, other health professions, and the public, to recommend specific guidelines, means for implementation, and deadlines to ensure that nursing education is positioned in the mainstream of American educational patterns with its preparatory programs located in collegiate institutions . 2. Those hospital schools that are strong and vital, endowed with qualified faculty, suitable educational facilities, and motivated for excellence be encouraged to seek and obtain regional accreditation and degree granting power. 3. All other hospital schools of nursing move systematically and with dispatch to effect interinstitutional arrangements with collegiate institutions so that graduates of the nursing preparatory program will receive an academic degree from the educational institution upon completion of their course of instruction. 4. Junior and senior collegiate institutions cooperatively develop programs and curricula that will preserve the integrity of their institutions and their aims while facilitating the social and professional mobility of the nursing student. (Lysaught, 1970, pp. 109-113) In summary, the earliest nursing schools in the United States were diploma programs which followed the Nightingale pattern. In order to relieve financial difficulties and increase clinical experiences for their students these schools were incorporated into the hospital structure

PAGE 34

25 As the need for medical and nursing services increased, the diploma schools rapidly increased in size and number of programs, where the primary educational mode was apprenticeship training. Nursing educators spent almost a century trying to correct this and establish nursing as an independent profession. The effort to establish independence prompted the upgrading of diploma schools. Concurrently they established nursing programs in colleges and universities to attempt to equate nursing education with the education of the other professions. With three different educational programs for nursing established, controversies developed within nursing as to which of these should be the basic education preparation for the professional nurse. Comparisons of the Three Educational Programs in Nursing Before the 1965 American Nurses Association position paper few studies had been reported comparing the three educational programs in nursing. After the position paper many studies were conducted, but rarely were all the nursing program types studied. Consistently the baccalaureate degree student and graduate was included

PAGE 35

26 with only sporadic inclusion of the associate degree or diploma student or graduate. The reported studies can be separated into two major divisions: specifically those studies dealing with differentiation of programs on biographical and cognitive variables, and those dealing with differentiation of programs on affective and personality variables. Biographical and Cognitive variables Bayer and Schoenfeldt (1970) conducted one of the earliest and largest studies. In this study students in diploma programs were compared with students in baccalaureate degree programs. The researchers concluded that the basic difference between students in the two program types were only in terms of the socioeconomic variables: number of books, magazines, and appliances in the home, luxury items, cultural equipment, sports equipment, the student having his own room, number of cars in the family, number of rooms in the home of the student, the student's father's and mother's education. consistently for these groups the baccalaureate students came from "advantaged" households. When a similar study was conducted by Hartley

PAGE 36

27 (1975) using associate and baccalaureate degree students, father's education and mother's education were found to be not significantly different in the two groups studied. Other studies that compared socioeconomic variables included Dustan's study (1964) where he suggested that there was no difference in family income when studying all three educational programs. In 1971 Wren's study of all three programs demonstrated no difference using occupations of the parents as well as no difference in the amount of financial assistance the students required or utilized. Several researchers investigated the difference in family composition among students in the three program types. They found that associate degree students tended to be older, often married with children, and residents in the community where they attended school (Dustan, 1964; Meleis & Farrell, 1974; Wren, 1971) . Most of the researchers' investigations of the educational programs included cognitive variables. The results, however, were not consistent in this area. Dustan (1964) found that associate degree students had higher aptitudes than either baccalaureate or diploma students. Using the Scholastic Aptitude Test, Wren (1971) demonstrated that baccalaureate degree students scored

PAGE 37

28 highest with the diploma students the next highest. When looking at State Board Examination scores, Counts (1975) concluded that there was no difference in associate degree graduates ' state board scores and those of baccalaureate degree graduates . An examination of the state board scores by Bain (1974) yielded another set of results. The highest scores were among baccalaureate degree graduates. The diploma graduates' scores were next followed by the associate degree graduates' scores. Other cognitive or biographical variables that have been examined by one researcher have not been replicated by other investigators. Meleis and Farrell (1974) found that diploma students placed a higher value on research than did associate degree or baccalaureate degree students. When looking at previous health care experience Wren (1971) suggested that associate degree students were more likely to have had some previous experience than either the diploma or baccalaureate degree students. Other differences in variables of this nature were found in almost every study in this area (Bain, 1974; Hartley, 1975) .

PAGE 38

29 Affective and Personality Variables Bayer and Schoenfeldt (1970) concluded that there was a difference between baccalaureate and diploma students in terras of artistic ability, verbal ability and goal direction. The baccalaureate program students were higher in artistic and verbal ability, but less goaldirected than the diploma students. Hoover (1975) who also looked at baccalaureate and diploma students found that baccalaureate students were more restrictive in the patients they preferred to care for, placed a higher value on ability to function, and were more interested in promotion in the facility in which they were employed after graduation. In a comparison of all three educational programs Davis (1973) concluded that baccalaureate graduates were more involved in prestigious function, i.e., teaching, team leading, etc., while associate degree nurses tended to do more non-prestigious nursing functions, i.e., treatments and medications. Baccalaureate students have been shown to focus more on the psychological needs of patients (Gray, Murray, Nov and Sawyer, 1977), to be more care oriented as defined by the American Nurses Association

PAGE 39

30 in 1965, to possess better leadership abilities (Goldstein, 1978; Gray et al., 1977) and communication skills (Nelson, 1978). Diploma students, on the other hand, evidenced a higher self-perception of themselves as nurses and nursing administrators (Nelson, 1978) . Associate degree nurses felt excluded by graduates of the other two program types (Davis, 1973), were not focused on the physical needs of patients, and were more cure oriented (Gray et al., 1977). Professional Socialization Studies In 1964 Davis and Olesen surveyed changes in student's imagery, consensus, and consonance at the conclusion of one year's study in a baccalaureate nursing program. They found that the first year of nursing education was the time during which the greatest change took place in student imagery. Although they found a trend toward innovative and individualistic images of nursing and away from bureaucratic images of nursing, they were surprised to find no significant increase in consensus among nursing students with respect to their images of nursing. They reported that students' rating of traits

PAGE 40

31 relative to nursing were influenced by their instructors emphasis on these same traits. Two follow up studies confirmed these findings (Brown, Swift & Obemnan, 1974; Olesen & Davis, 1966). A similar study was conducted by Siegel (1968) . Using the same trait scale as was used in the previous studies, Siegel reported that senior nursing students in two baccalaureate programs shared common perceptions of nursing with their faculty. The students in the study did not, however, reach consensus among themselves in their characterization of nursing as they advanced in class rank. Although the results concurred with those of Davis and Olesen (1964), the weakness in all of these studies was that no standardized instrument had been developed for the assessment of changes in students' views of the nursing role. Without the development of a standardized instrument, different studies do not increase knowledge in the area of professional socialization. An instrument which has been properly developed can be used by other researchers pursuing the same area. Richards (1972) reported that baccalaureate degree students were more professionally socialized than associate degree or diploma students were found to be.

PAGE 41

32 Eller (1976) conducted a similar study and reported the same findings. in both of these studies a basic assumption was that professional socialization and a traditional view of nursing are at opposite extremes of the same continuum. This assumption has not been accepted by other researchers working in this area. The previously reported studies of professional socialization have demonstrated several weaknesses. The most consistent exploration has focused on baccalaureate students exclusively (Brown et al. , 1974; Davis & Olesen, 1964; Olesen & Davis, 1966; Siegel, 1968; Tetreault, 1976). Because nursing has been comprised of relatively few baccalaureate nurses, the majority of nurses have therefore not been studied. Secondly, the instruments employed have demonstrated weaknesses which are reviewed in the next section. Finally, the basic assumption on which at least two of the studies are based must be questioned. To summarize, many studies have been conducted which compare the students and graduates of the three nursing educational programs. Many types of variables have been employed that differentiated or identified similar aspects of the programs . Few of these studies have been

PAGE 42

33 replicated and therefore can be seen only as preliminary investigations . Professional socialization has been studied only sporadically. A lack of adequate socialization into a profession has been shown to produce job dissatisfaction resulting in attrition from nursing practice (Williams & Williams, 1959). The origins of professional socialization are in the educational program, yet little is known about its development. Less has been devised for its assessment. Because professional socialization is vital to the development of the nursing practitioner, this area should receive further study. It is necessary that future studies in this area be based on acceptable assumptions, compare products of different educational programs, and improve instrumentation in this area. These are the emphases of the present study. Measures of Professional Socialization Few instruments have been developed for the measurement of professional socialization in nursing. One of the first instruments was the one used in the 1964 Davis and Olesen study. This same instrument was also used in

PAGE 43

34 Olesen and Davis (1966), Siegel (1968), and Brown et al. (1974) . This instrument was a 19-item checklist containing broad, short statements relevant to nursing. Participants were to check items they felt were important to nursing and those important to themselves. Rather than developing individual total scores, totals were derived for each item. The results were then reported in terms of the percentage of students checking each item. Use of this questionnaire for the assessment of professional socialization in nursing is limited. Some of its weaknesses are (1) there is no method for deriving individual scores established, (2) the items are no more relevant to nursing than most other occupational groups, and (3) there has been no investigation on the questionnaire's reliability and/or validity. The instruments used in the studies by Richards (1972) and Eller (1976) were not available for review nor discussed in their studies. In neither case was reliability and/or validity discussed or mentioned. In 1974 Crocker and Brodie developed the NPOS . Their purpose in developing the NPOS was to construct a unidimensional scale that would measure congruence between student nurses' perceptions and faculty's views of the professional

PAGE 44

35 nursing role. The initial pool of 112 items was comprised of behaviors and traits frequently displayed by nurses as wall as myths about nurses. After item analysis the final pool of 59 items was tested for reliability and validity. The internal consistency of the NPOS, using Cronbach's Alpha and calculated on a cross-validation group was r_ = .89. Construct validity for the scale was demonstrated empirically by showing that as nursing students advanced in class rank, their scores became more congruent with faculty views, class means, i.e., freshman, sophomore, junior, and senior, were significantly different (F £" 3 , 240_J7" = 34.7, £ < .01). Using Scheffe's test for pairwise comparisons it was found that the mean score (total) of each class was significantly greater than that of the lower class . Scoring weights for the items were derived by administering the scale to 94 nursing faculty members of three universities and using the per cent of endorsement of each response as the item weight. The percentage of faculty who endorsed a particular response was rounded to the nearest tenth, which replaced the original five choice item weight. For example, if 82 per cent of the

PAGE 45

36 faculty chose option three on item 16, option three on item 16 would now have a scoring weight of eight, not three. This method of scoring was developed so that the only way a student could receive a high score was to respond to the NPOS in a manner similar to that of the faculty (Crocker & Brodie, 1974). Among the instruments reviewed, the NPOS was the only scale for the measurement of professional socialization that was based on appropriate procedures for instrument development. Additionally, the instrument was the first one that enabled the user to identify consensus among students. Finally, the NPOS was based on assumptions congruent with professional socialization theory and research. For these reasons the NPOS was chosen for this study. At least two researchers have utilized the NPOS in their studies. Rodeghero (1975) investigated the congruence of student and faculty views of nursing in a diploma program. The results reported were that students adopt professional views similar to those of their faculty. Additionally, factor analysis was employed which yielded four factors, two of which differentiated levels of

PAGE 46

37 students. These two factors were identified as the Traditional/Structured factor and the Empathic/Moralistic factor . In 1978 Thomas utilized the NPOS in a study comparing the professional socialization of associate degree, baccalaureate degree and diploma students. Thomas found no differences in the professional socialization of students from the three educational programs. Both of these studies were conducted with the original scoring method developed by Crocker and Brodie. This method, developed over eight years ago, is questionable for use at the present time. Additionally, both of these studies were conducted using programs in one city (Rodeghero, 1975) or one state (Thomas, 1978). With the development of the NPOS, advances have been made towards better assessment of professional socialization. Crocker (1973) has had numerous requests for the use of the NPOS for past, present, and future research in the area of professional socialization. Further development of this instrument, by broadening its application and strengthening its scoring methods can be an aid to research in professional socialization.

PAGE 47

38 Summary Nursing education has developed rapidly in the United States. The first program implemented was the hospital-based diploma program followed by the baccalaureate and associate degree programs. These programs co-existed relatively peacefully until the 1965 American Nurses Association position paper was released. Each program then began to offer justification for its existence and continuation. Several studies have been conducted comparing the three educational programs. Few major differences have been found in the reported comparisons of the three educational programs. One area in which program comparisons are needed is the area of professional socialization. Studies which have been reported were too limited in scope, were based on weak assumptions, or utilized inadequate instruments for the assessment of professional socialization. One promising instrument for assessing professional socialization in nursing is the NPOS . Use of this instrument for research and evaluation in nursing education is growing, but the original scoring scheme is now

PAGE 48

39 outdated. Revision of the scoring scheme of the NPOS is needed before the potential usefulness can be realized in measuring professional socialization.

PAGE 49

CHAPTER III DESIGN AND PROCEDURES This study was designed for two reasons. First, the area of professional socialization in nursing requires further study specifically in terms of different educational programs. Second, available instrumentation in the area of professional socialization is for the most part inadequate. The NPOS has shown promise in studies of professional socialization and with further testing for improvement it may prove to be of more use in the future. This study was designed in two phases: (1) establishing the two new scoring methods for the NPOS, and (2) administering the NPOS to students from associate degree and baccalaureate degree nursing programs for the analysis of program effect on professional socialization. The Hypotheses The following hypotheses were formulated to be tested in the present study. These hypotheses were 40

PAGE 50

41 divided into subsets according to the scoring method of interest . Subset 1 Hypothesis 1 : When using the Traditional/Nontraditional scoring method, there is no difference between the mean total NPOS score of the associate degree students and the baccalaureate degree students. Hypothesis 2 Hypothesis 3 When using the Traditional/Ncntraditional scoring method, there is no difference in total NPOS scores among students with different levels of HSGPA. There is no interaction between educational program and HSGPA which affects student scores on the NPOS, using the Traditional/Nontraditional scoring method. Subset 2 Hypothesis 4: When using the Practicing Nurses scoring method, there is no difference between the mean total NPOS scores of the associate degree students and the baccalaureate degree students. Hypothesis 5: When using the Practicing Nurses scoring method, there is no difference in total NPOS scores among students with different levels of HSGPA. Hypothesis 6: There is no interaction between educational program and HSGPA which affects student scores on the NPOS using the Practicing Nurses scoring method.

PAGE 51

42 In addition, the following question was formulated to be investigated in the study. Question 1: What will be the effect of two different scoring schemes on reliability (internal consistency)? Subjects For the present study nursing programs were selected from the National League for Nursing accredited associate and baccalaureate degree programs in six southeastern states. The initial states chosen were Alabama, Florida, Georgia, North Carolina, South Carolina, and Tennessee. These states were chosen for several reasons. 1. Taken as a group these states form a contiguous geographical area, 2. These states are approximately equidistant from the site of the study, and 3. Nursing educational programs in these states all belong to the same regional agency (the Southern Regional Educational Board) and therefore meet the same educational standards. From each of these states one associate and one baccalaureate degree program were selected. The following criteria were used in the selection: 1. Both the associate and baccalaureate degree programs were in close geographical proximity to each other.

PAGE 52

43 2. Each program was state supported, and 3. No program was racially or sexually segregated. The dean or director of each nursing program was contacted by mail in March or April of 1978 requesting the participation of the entire class of graduating seniors. In one instance the school's institutional review board for reviewing research proposals was also contacted. If a dean wrote that her program or students were unable to participate and a substitute school could be found that met the aforementioned criteria, the substituted school was then contacted. Of the original six states chosen, programs in four states were in the final analysis. The two states and their programs had to be deleted because either no programs were able to participate or a companion program could not be found for a participating school. All of the schools contacted responded to the initial contact letter. Of the programs contacted, 62 per cent of the associate degree and 55 per cent of the baccalaureate degree schools agreed to participate in the study. Schools agreeing to participate are listed in Appendix A.

PAGE 53

44 Once the dean or director returned the completed consent form the total number of requested scales was mailed. The dean or director distributed the questionnaires to all of the graduating seniors and when completed returned the questionnaires. A total of 557 questionnaires was distributed and 332 returned for a 60 per cent return rate. Sixteen questionnaires were completed by previously licensed registered nurses and thus were omitted from the analysis. Additionally, in one state there was no participating baccalaureate program so the paired associate degree program had to be dropped. This resulted in a total of 276 completed scales. All questionnaires were handled confidentially and no identifying information was collected. Demographic data for the participating students are shown in Tables 1, 2 and 3. Instrument The NPOS was used as the measure of professional socialization in this study. The NPOS, a rating scale, is composed of 59 items representing a portion of the domain of professional socialization in nursing. Respondents were asked to judge the importance of each trait (item) for the practicing, professional nurse in

PAGE 54

45 Table 1 Number of Students Participating by Program (n = 276) Program Associate degree Jefferson State Junior College 62 Georgia State University 11 Fayetteville Technical Institute 38* Florence-Darlington Technical College 20 Columbia State Community College 27 Baccalaureate degree University of Alabama in Birmingham 40 Valdosta State College 45 University of South Carolina 41 University of Tennessee 30 *Dropped from the final analysis

PAGE 55

46 Table 2 Percentage of Participants in Each Program by Sex and Race Categories (n = 276) Sex Race % % % % % Program Male Female Black White Oriental Associate degree 7.5 92.5 10.0 89.2 .8 (n = 120) Baccalaureate degree 13.5 86.5 4.5 94.2 1.3 (n = 156) Total 10.9 89.1 6.9 92.0 1.0

PAGE 56

Table 3 HSGPA By Program (n = 276) HSGPA A B 47 Program n % n % n % Associate degree 32 27 76 63 12 10 Baccalaureate degree 72 46 72 46 12 8

PAGE 57

48 her occupation and role as a nurse. They rated each item from extremely important to undesirable on a five point scale. Sample items and the directions are shown in Appendix B. This scale is self -administered and takes approximately 25 minutes to complete. The participating students were asked to supply the following biographical data while completing the NPOS : age, sex, ethnic group, licensure status prior to enrollment in their present program, and HSGPA. Development of the Traditional/ Nontraditional Scoring Key From the University of Florida College of Nursing 32 nursing faculty members were selected, due to their accessibility, to provide the data on which to develop the Traditional/Nontraditional scoring method. Each faculty member was given the 59-item NPOS and asked to determine for each item whether a nurse would be traditionally or nontraditionally oriented if she endorsed it. A 90 per cent return rate was achieved. This is probably due to personal distribution of the instrument to each participant. The percentage of faculty choosing each option, either traditional or untraditional, was tabulated. A 67 per cent

PAGE 58

49 agreement was determined to be the minimum endorsement an option must have for an item to be considered either traditionally or nontraditionally oriented (standard error of this percentage = .08). For example, if for an item 72 per cent of the faculty chose the traditional option as their belief about the orientation of that item, the item would be considered a traditionally oriented item. If, however, 52 per cent of the faculty chose the traditional option on an item (leaving 48% that chose nontraditional) , the item was dropped from this scoring method as its orientation was not determined when a 67 per cent cut off was established. If 32 per cent chose traditional and 68 per cent chose nontraditional on an item, that item would be considered nontraditionally oriented. Thirteen items were deleted because there was not an endorsement of either option (traditional or nontraditional) by 67 per cent of the respondents. The remaining 46 items were divided into those items with a traditional orientation (16 items) and those with a nontraditional orientation (30 items) . It was decided that a high score should represent a traditional orientation, so the item weights (1 through 5) were reversed on the 30 nontraditional items. Using this manipulation, the only way an individual

PAGE 59

50 could achieve a high score would be to rate the behaviors described in traditional items as "important" or "extremely important" and rate the traits described in nontraditional items as "unimportant" or "undesirable." The decision for a traditional orientation to receive a high score was an arbitrary one. Development of the Practicing Nurses Scoring Key To develop a scoring key based on practitioners' views, a different method was used. Six directors of nursing services were contacted in five states in the southeast to request participation in this portion of the study. These directors were chosen because the hospitals in which they were employed were in the same geographical region as the universities and community colleges that were in the data collection. The nurses in these hospitals tend to have graduated from the nursing schools in the immediate vicinity and therefore would better represent the views of nursing in that area. Five directors of nursing agreed to participate, though all responded to the original contact letter, for an 83 per cent return rate. The participating hospitals are shewn in Appendix A.

PAGE 60

51 After receiving consent to participate the specified number of scales was sent to the nursing director for dispersal to the nurses. A total of 565 questionnaires were mailed out and 226 returned for a return rate of 40 par cent. The scoring weights were then calculated in a manner identical to that of the original NPOS scoring weights. The percentage of nurses endorsing a particular response was rounded to the nearest tenth, which replaced the original five possible responses. For example, if 68 per cent of the nurses endorsed option 2 on an item, option 2 would have a new scoring weight of seven. Each option for the 59 items was reweighted in this manner. This was done so the only way an individual could achieve a high score using this method would be to answer the item in a manner similar to that of practicing nurses. The nurses supplied the following biographical data: age, sex, ethnic group, clinical area where employed, year initially licensed, years since initial licensure when not employed in nursing, basic educational preparation in nursing, and highest level of education attained. These data were not considered in the analysis but were collected for a demographic description of the participating nurses. This information is shown in Tables 4 and 5

PAGE 61

52 Table 4 Participating Nurses by Age, Year Licensed to Practice Nursing, and Years Not Practiced Nursing (n = 226) Year licensed to Years not pracAge practice nursing ticed nursing Mean 31.90 1967.89 1.00 Median 29.72 1971.85 .19 Mode 24.00 1975 .00 SD 9.40 11.35 2.39

PAGE 62

53 Table 5 Participating Nurses by Sex, Race, Area Employed, First Nursing Degree, and Highest Educational Degree (n = 226) Variable Frequency

PAGE 63

Table 5 (Continued) 54 Variable Frequency

PAGE 64

55 The Analysis of the Data The hypotheses for each scoring method were tested, using a 2 X 3 factorial design, treating educational program and HSGPA as independent variables and score on the NPOS as the dependent variable. A classical regression solution was used for determining significance of the mean program differences, variation due to HSGPA and the interaction of program and HSGPA (Overall & Spiegel, 1969) . The level of significance for each hypothesis tested was set at £ < .05. Question 1 was explored by investigating the internal consistency using Cronbach's coefficient Alpha for each scoring scheme. Summary A total of 276 associate degree and baccalaureate degree students participated in this study. Each student respondent read a list of traits or characteristics relevant to nursing and rated the importance of each trait for a professional nurse on a five point scale ranging from "undesirable" to"extremely important." Two scoring methods were developed with the participation of 29 nursing faculty members and 226 practicing nurses. These scoring methods

PAGE 65

56 were used to compute profess ionalization scores for each student nurse. The data were analyzed separately for each scoring method using a 2 X 3 factorial design. The classical regression solution was used to test the effect of educational program, HSGPA, and the interaction of program and HSGPA on professional socialization (Overall & Spiegel, 1969) . Reliability estimates for each scoring method were calculated using Cronbach's Coefficient Alpha (Nie, Hull, Jenkins, Steinbrenner & Bent, 1975).

PAGE 66

CHAPTER IV RESULTS In this study professional socialization of students in two types of nursing educational programs was analyzed using two new scoring methods for the NPOS . Scoring weights for the NPOS were derived using the two techniques described in Chapter III. These new scoring weights were then utilized in comparisons of the students ' total scores on the NPOS. The results of the statistical tests for the previously stated hypotheses are presented in this chapter. Finally, the reliabilities for each scoring method were estimated. Hypotheses Testing Hypothesis 1; When using the Traditional/Nontraditional scoring method, there is no difference between the mean total NPOS score of the associate degree and baccalaureate degree students. Hypothesis 2 : When using the Traditional/Nontraditional scoring methods, there is no difference in total NPOS scores among students with different levels of HSGPA. 57

PAGE 67

58 Hypothesis 3: There is no interaction between educational program and HSGPA which affects student scores on the NPOS, using the Traditional/Nontraditional scoring method. Data were analyzed using a 2 X 3 factorial design with educational program and high school grade point average as independent variables and total score with the Traditional/Nontraditional method as the dependent variable. Due to unequal cell sizes and the possibility of a significant program-grade point interaction the classical regression solution was used (Overall & Spiegel, 1969) to test the hypotheses . The means and standard deviations are shown in Table 6. The results of this analysis are presented in Table 7. Significant main effects for educational program and high school grade point average were found (F /"l.270_7 = 4.39, p < .05; F /~2,270_7 = 5.12, P < -05) . The interaction of educational programs and high school grade point average did not result in a significant F value. When the Scheffe's procedure for pairwise post hoc comparisons was employed, students with a B HSGPA were found to have the highest mean total NPOS score. Thus, Hypothesis 1 was rejected, indicating there is a significant difference between associate and

PAGE 68

59 Table 6 Means and Standard Deviations of Students Total Scores by Programs and HSGPA Using the Traditional/Nontraditional Scoring Method (n = 276) HSGPA Program Row Total Associate degree Mean 170.13 177.53 176.67 175.47 SD 15.23 17.04 17.93 16.84 Baccalaureate degree Mean 167.79 174.32 165.25 170.61 SD 18.05 15.21 13.65 16.76 Column total Mean 168.51 175.97 170.96 SD 17.20 16.20 16.64

PAGE 69

60 Table 7 Analysis of Total NPOS Score Computed with the Traditional/Nontraditional Scoring Method as a Function of Program Type, HSGPA, and the Interaction Between Program and HSGPA (n = 276) Source

PAGE 70

61 baccalaureate degree students in their scores on the NPOS using the Traditional/Nontraditional scoring method. On the average, students in the associate degree programs held a more traditional view of nursing than did students in the baccalaureate degree programs. Hypothesis 2 was rejected indicating there is also a difference among levels of HSGPA across programs. Hypothesis 3, relating the effects of interaction of educational program and HSGPA with total NPOS score using the Traditional/Nontraditional method cannot be rejected. Hypothesis 4: When using the Practicing Nurses scoring method, there is no difference between the mean total NPOS scores of the associate degree students and the baccalaureate degree students . Hypothesis 5: When using the Practicing Nurses scoring method, there is no difference in total NPOS scores among students with respect to levels of HSGPA. Hypothesis 6: There is no interaction between educational program and HSGPA which affects student scores on the NPOS when using the Practicing Nurses scoring method. These data were analyzed using a 2 X 3. factorial. design with educational program and HSGPA as independent variables and total score with the Practicing Nurses method as the dependent variable. Due to unequal cell

PAGE 71

62 sizes and the possibility of a significant program -grade point average interaction, the classical regression approach was used (Overall & Spiegel, 1969) . The means and standard deviations are presented in Table 8. The results of this analysis are presented in Table 9. No significant main effect for educational program or HSGPA was found. Additionally the interaction between HSGPA and educational program was not significant. Thus, Hypotheses 4, 5 and 6 cannot be rejected. Effects on Reliability The reliability of the NPOS scores derived from the new scoring schemes was estimated by calculating Cronbach's Coefficient Alpha. Using the T raditional/Nontraditional scoring scheme, the internal consistency of the NPOS was £ = .81. When calculated on the practicing nurses scoring scheme the NPOS internal consistency was £ = .88. These results indicate that the new scoring systems for the NPOS have acceptable internal consistencies. Summary of the Results For the Traditional/Nontraditional scoring scheme a 2 X 3 factorial analysis of variance (program and HSGPA)

PAGE 72

63 Table 8 Means and Standard Deviations of Students Total Scores by Programs and HSGPA Using the Practicing Nurses Scoring Method (n = 276) HSGPA Program A B C Row Total Associate degree Mean 199.06 210.93 199.42 206.62 SD 42.73 22.26 44.45 31.67 Baccalaureate degree Mean 205.92 201.50 208.75 204.10 SD 25.40 35.18 18.18 29.87 Column total Mean 203.81 206.34 204.08 SD 31.69 29.55 33.55

PAGE 73

64 Table 9 Analysis of Total NPOS Score Computed with the Practicing Nurses Scoring Method as a Function of Program Type, HSGPA and the Interaction Between Program and High School Grade Point Average (n = 276) Source

PAGE 74

65 indicated a significant main effect for educational program and HSGPA. The Practicing Nurses scoring method yielded no significant main effects. In neither scoring scheme did the interaction between program and HSGPA yield a significant F value. These results can be interpreted as follows: (1) the Traditional/Non traditional scoring scheme is sensitive to differences in types of educational programs; the associate degree students were more traditional than the baccalaureate students, and (2) the Practicing Nurses scoring scheme was either not sensitive enough to differentiate the educational programs or in fact there is no difference between the educational programs when compared to practicing nurses. The internal consistency estimates calculated for the NPOS using the two new scoring schemes were such that either scoring scheme could potentially be used for the assessment of professional socialization.

PAGE 75

CHAPTER V DISCUSSION The two major purposes of this study were (1) to further refine the scoring methods of the NPOS and thereby broaden its applications, and (2) to compare the mean total scores on the NPOS of associate and baccalaureate degree students using the two scoring methods developed. In this chapter the results will be discussed, limitations identified, and suggestions for future research offered. The internal consistencies of the scoring methods developed for the NPOS, r = .81 for the Traditional/Nontraditional scoring method and r_ = .88 for the practicing Nurses scoring method, are sufficient to suggest that either scoring scheme could be used for individual or group assessment. Both of these scoring methods allow new applications of the NPOS for the assessment of professional socialization. Prior to this study the NPOS had only been used in measurement of consensus of student and faculty views of the nursing profession. Though this instrument was an improvement over other available instruments, its applications 66

PAGE 76

67 were limited. With the development of these additional methods for scoring the NPOS , the potential usefulness of this instrument has been broadened. This will certainly promote further research in the area of professional socialization in nursing. Traditional/Nontraditional Scoring Method When the Traditional/Nontraditional scoring method was applied to the NPOS, educational program type and HSGPA had a significant relationship to total NPOS score. The associate degree students expressed a more traditional orientation on the NPOS than the baccalaureate degree students. This finding does not reflect on the degree of professional socialization either of these groups of students have attained, but rather identifies the orientation of that socialization. The fact that the associate degree students were found to have a more traditional orientation only indicates that their view of nursing is more "traditional" as judged by the nursing faculty who rated the items . It is interesting that these preliminary results lend credence to the American Nurses Association position paper

PAGE 77

68 on the two types of nurses (American Nurses Association, 1965) . The function of technical or associate degree graduate nurse would be by definition more traditional. That is, being the care giver she would tend to follow a more traditional pattern in providing nursing care. Although new knowledge relevant to patient care would be incorporated, she would still fulfill a nursing role as it has been characterized for many years. The baccalaureate degree graduate, defined by the ANA as the professional nurse, would tend to be more nontraditional . The need to incorporate the cure emphasis in patient care as well as the promotion of the health and welfare of those in the community necessitates an alternative or nontraditional approach to patient care. While other interpretations are possible, this finding is evidence of construct validity of this scoring method. The significant main effect for high school grade point average illustrates the importance of considering this variable in analyzing data of this nature. Including high school grade point average as a variable allows for its consideration as both a main effect and as one part of an interaction. Each student having a particular grade point average may interact with the professional

PAGE 78

69 socialization process in many ways. It is possible that students with certain grade point averages may incorporate the aspects of professional socialization differently or to a greater degree. Utilizing the Scheffe's post hoc procedure for pairwise comparisons it was concluded that students with a B HSGPA expressed the most traditional orientations on the NPOS . No explanation can be offered for this finding. In any event, control of this important variable may have enabled detection of a "program" effect that would have gone unnoticed if HSGPA had not been included as a factor in this design. This suggests that this variable should be included in other comparison studies of nursing education programs. A significant interaction between educational program and HSGPA was not found. This lack of a significant interaction was surprising and no set explanation can be offered for this finding. Possibly admission criteria may have changed to equalize entrance to junior and senior colleges. Additionally, the schools included in this study may be different from other programs of similar types in their student HSGPA composition.

PAGE 79

70 Practicing Nurses Scoring Method When the Practicing Nurses scoring method was applied to the NPOS neither educational program or high school grade point average had a significant relationship to total NPOS score. Associate and baccalaureate degree students ware found not to differ in their perceptions of professional nursing from the beliefs of practicing nurses. There are at least two contending interpretations for this lack of significant main effect. First, the NPOS, when scored with this method, may not be sensitive enough to detect differences that do exist. Considering that the nurses included in this scoring method were from four different educational programs (diploma, associate degree, baccalaureate degree, and foreign based) , varied broadly in the number of years practiced, and types of practice settings, the definition of practicing nurses may need to be more narrowly defined to produce a scoring method sufficiently sensitive to detect possible differences in these educational programs. Second, there may in fact be no differences in these educational programs when students are compared with practicing nurses on the NPOS. This does not imply that these

PAGE 80

71 students carry out the practice of nursing in a manner identical to or even closely similar to that of currently practicing nurses but rather that they view the fully professional, practicing nurse in the same manner. Although there was no significant main effect for HSGPA when the Practicing Nurses scoring method was employed for scoring the NPOS, inclusion of this variable remains important in preliminary studies of the assessment of professional socialization. As was previously mentioned, inclusion of this variable may enable detection of differences that would otherwise go undetected. As in the Traditional/Nontraditional scoring method there was no significant program by HSGPA interaction. This finding again remains unexplainable . Limitations of the Study There are several limitations to this study. Because the educational programs were chosen as a mechanism for testing the scoring methods, the primary limitation involves sample selection. The results of this study are not generalizable to associate and baccalaureate degree students nationwide. They are applicable only to the eight schools participating. However, the fact that the

PAGE 81

72 scoring schemes worked so effectively for these schools is promising for their future applications. The demonstration of their usefulness in this preliminary study makes it possible for the development of broader national norms in the area of professional socialization in nursing. The second area is that of the groups chosen for the development of the scoring methods. The faculty employed for development of the Traditional/Nontraditional scoring method were from a baccalaureate degree nursing program and may not represent the traditional or nontraditional views of other nurses or faculty. Finally, the practicing nurses may not have accurately represented the population of nurses in the United States . Suggestions for Future Research In terms of the development of alternate scoring methods for the NPOS one important suggestion for future work in this area would be to utilize a broader sample for the basis of the scoring methods. This would entail (1) defining practicing nurses and sampling to satisfy the definition for the Practicing Nurses scoring method, and (2) utilize faculty from each educational program of interest as well as practicing nurses to establish the

PAGE 82

73 Traditional/Nontraditional scoring method. By incorporating both of these methods several scoring schemes could be utilized for very specific purposes in the assessment of professional socialization. When comparing students and graduates of educational programs relative to their professional socialization as measured by the NPOS a random national sample should be used for the generalizability of the findings. It is important that local or regional studies be used only for preliminary investigations. The methods and instruments should then be employed at a national level for the development of national norms. Such norms would be useful for further application of the NPOS in nursing educational program evaluation as well as assessment of professional socialization in nursing practice. Of interest would also be the investigation of practicing nurses and their scores on the NPOS relative to their basic nurses education. Although a preliminary study was conducted in this area (Rodeghero , 1975), there were limited implications for the data due to an overly simplistic sampling strategy. In future research practicing nurses should be investigated using the NPOS in relationship to the area of their nursing practice and additional nursing degrees acquired.

PAGE 83

74 The final suggestion for future research concerns longitudinal studies. As mentioned earlier, it takes from months to years to become socialized into a profession. It is possible that as the length of time in the practice of nursing increases, there may be a decrease in an individual's NPOS scores or the scores may in fact remain the same or increase. Insight into the reason why some nurses remain in practice while others leave could possibly be gained from such a longitudinal study. Applications in Nursing Education The NPOS with its newly developed scoring methods has several applications for nursing education. These applications are primarily focused on program evaluation. If objectives have been established for a nursing educational program that have aspects of a traditional or nontraditional orientation towards nursing or congruence with beliefs of currently practicing nurses the NPOS could be employed for the assessment of the attainment of the objective (s) . Secondly, the faculty's goals for the graduates of a nursing program could be evaluated by use of the NPOS with its different scoring methods. Finally, the NPOS has applications in the current

PAGE 84

75 educational programs for previously licensed registered nurses at the baccalaureate level. If students' professional socialization were assessed upon entering the program with the NPOS, upon completion of the program the change in their socializations could be reinvestigated with the NPOS. Before utilizing either of the two new scoring methods for the NPOS in studies of professional socialization or program evaluation, the objectives of the investigation must be clearly defined. These two scoring methods have virtually no relationship with each other (r_ = .01) and therefore will produce different results as they did in this study. The scoring method most appropriate to the objectives established should be selected. Summary and Conclusions This study examined the application of new scoring methods to an established instrument for the assessment of professional socialization. The two scoring methods developed were the Traditional/Nontraditional method and the Practicing Nurses method. These new scoring methods were then used to differentiate between baccalaureate and associate nursing educational programs. Reliabilities of the two scoring methods were also investigated.

PAGE 85

76 A total of 156 student nurses from four baccalaureate program and 120 from four associate degree programs completed the professional socialization scale. Their responses were scored using both scoring schemes. Associate degree students were found to be more traditional in their orientation than baccalaureate degree students, but no difference was found between students from the two programs when their professional socialization was determined relative to practicing nurses. Utilizing the Traditional/ Nontraditional scoring method HSGPA had a significant effect on the mean total NPOS score, but there was no significant interaction between educational program and HSGPA with either scoring method. Both scoring methods yielded high internal consistency coefficients, indicating that these scoring schemes are sufficiently reliable for individual or group assessment. This study demonstrated the potential of improving available instrumentation in professional socialization in nursing. When assessing professional socialization in nursing educational programs consideration should be given to admission criteria for the programs, since HSGPA was related to professional socialization. As shown in this

PAGE 86

77 study, it is not necessary to limit the application of an instrument only to its original designated purpose. New scoring methods and new norm groups may expand the usefulness of well-developed, existing instruments.

PAGE 87

APPENDICES

PAGE 88

APPENDIX A HOSPITALS AND EDUCATIONAL PROGRAMS PARTICIPATING IN THIS STUDY

PAGE 89

HOSPITALS PARTICIPATING IN THE' STUDY Hospital University of Alabama in Birmingham Hospitals Bayfront Medical Center Parkwood Hospital North Carolina Memorial Hospital Richland Memorial Hospital State Alabama Florida Georgia North Carolina South Carolina 80

PAGE 90

ASSOCIATE DEGREE PROGRAMS PARTICIPATING IN THE STUDY 81 School Jefferson State Junior College Georgia State University Fayetteville Technical Institute Florence-Darlington Technical College Columbia State Community College State Alabama Georgia North Carolina South Carolina Tennessee

PAGE 91

BACCALAUREATE PROGRAMS PARTICIPATING IN THE STUDY 82 School University of Alabama in Birmingham Valdosta State College Georgia State UniversityUniversity of South Carolina University of Tennessee State Alabama Georgia Georgia* South Carolina Tennessee *A11 students were registered nurses and had to be deleted.

PAGE 92

APPENDIX B SAMPLE ITEMS FROM THE NPOS

PAGE 93

SAMPLE ITEMS FROM THE NPOS Professional Trait Rating Scale Instructions: This questionnaire is composed of a list of descriptive characteristics and behaviors. You are asked to judge how essential each trait is for the practicing , professional nurse in fulfilling her role. If you judge this trait to be: EXTREMELY IMPORTANT Mark 5 IMPORTANT Mark 4 SLIGHTLY IMPORTANT Mark 3 NOT AT ALL IMPORTANT Mark 2 UNDESIRABLE Mark 1 There are no right or wrong answers for these items. Judge each one in accordance with your own personal opinion. Please note that you have been asked to rate these traits for the nurse as a practicing professional only. DO NOT RATE THEIR IMPORTANCE FOR STUDENT NURSES. Quietly and obediently takes doctor's orders. 1 2 3 4 5 Questions instructions when the reason for them is not clear. 1 2 3 4 5 Can usually think of several alternative solutions to a problem. 1 2 3 4 5 Learns to accept the death of a patient with no overt emotional signs. 1 2 3 4 5 Enjoys working with children 84 2 3 4 5

PAGE 94

85 6. Likes to be kept busy. 1 2 3 4 5 7. Always gets a doctor's order before she initiates care for a patient. 1 2 3 4 5 8. Is willing to function as a counselor for a patient who wants to discuss his troubles. 1 2 3 4 5 9. Enjoys working with patients of all ages. 12 3 4 5 10. Punctual and prompt in carrying out duties . 12 3 4 5 11. Quickly rises to the defense of medical or hospital practices when they are criticized by laymen. 1 2 3 4 5

PAGE 95

REFERENCES American Nurses Association (ANA). ANA convention '78: tomorrow's health/today's challenge. American Journal of Nursing , 1978, 78_» 1231-1246. American Nurses Association (ANA) . American nurses association position on education for nurses. American Journal of Nursing , 1965, _65, 106-111. Anderson, B. F. Nursing education in community junior colleges . Philadelphia: J. B. Lippincott Co., 1966 . Bain, R. N. A study of the effect of several factors on the performance of nurses on the state board examination (Doctoral dissertation, New Mexico State University, 1974) . Dissertation Abstracts International , 1974, 35_, 3320-A. (University Microfilms No. 74-27, 515) . Bayer, A. E., &. Schoenfeldt, L. F. Student interchangeability in three year and four year nursing programs. Journal of Human Resources , 1970, 5_, 71-88. Becker, H. S., & Geer , B. The fate of idealism in medical school. American Sociological Review , 1958, 23_, 50-56. Bridgman, M. Collegiate education for nursing. In B. Bullough & V. Bullouch (Eds.), Issues in nursing . New York; Springer Publishing Co., Inc., 1966. Brown, J. S., Swift, Y. B., & Oberman, M. L. Baccalaureate students' images of nursing: a replication. Nursing Research , 1974, 2_3, 53-59. 3ullough, V. F., & Bullough, B. The emergence of modern nursing. London: The MacMillian Co., 1969. 86

PAGE 96

87 Corwin, R. G. Professional employee: a study in conflict in nursing roles. American Journal of Sociology , 1961, 66, 604-615. Counts, M. M. An analysis of a selected associate degree and baccalaureate degree nursing curriculum as related to graduates' performance of functions in the medical-surgical area (Doctoral dissertation, The University of Texas at Austin, 1975) . Dissertation Abstracts International , 1975, 36.' 2152-A. (University Microfilms No. 75-24, 855) Crocker, L. M. Personal communication, January 20, 1978. Crocker, L. M., & Brodie, B. J. Development of a scale to assess student nurses' views of the professional nursing role. Journal of Applied Psychology , 1974, 59, 233-235. Davis, F., & Olesen, V. L. Baccalaureate students' images of nursing. Nursing Research , 1964, 13 , 8-15. Davis, P., Olesen, V. L. , & Whittaker, E. W. Problems and issues in collegiate nursing education. In F. Davis (Ed.) The nursing profession: Five sociological essays . New York: John Wiley & Sons, Inc., 1966. Davis, GC. Differentiation of nursing education programs through identification of nursing functions (Doctoral dissertation, Texas Technological University, 1972) . Dissertation Abstracts International , 1973, 34 , 132-A. (University Microfilms No. 73-16, 267). Dietz, L., & Lehozky, A. R. History and modern nursing . Philadelphia: F. A. Davis Co., 1967. Dolan, J. Nursing in society: A historical perspective. New York: W. B. Saunders Co., 1973. Dustan, L. C. Characteristics of students in three types of nursing education programs. Nursing Research , 1964, 13, 159-166.

PAGE 97

88 Eller, V. M. Role orientation toward professional nursing of students completing associate degree, diploma, and baccalaureate nursing education programs (Doctoral dissertation, North Carolina State University at Raleigh, 1976) . Dissertation Abstracts International , 1977, 3_7, 2770-B. (University microfilms No. 76-28, 474) . Facts about nursing 76-77 . Kansas City: American Nurses Association, 1977. Goldstein, J. D. Comparison of selected characteristics of graduating nursing students of associate degree and baccalaureate degree programs (Doctoral dissertation, Northern Illinois University, 1977) . Dissertation Abstracts International , 1978, 3_8, 194-A. (University Microfilms No. 7811176) . Gray, J., Murray, B., Noy, J., & Sawyer, J. Do graduates of technical and professional nursing programs differ in practice?. Nursing Research , 1977, _26, 368-373. Griffin, G. , & Griffin, J. History and trends of professional nursing . St. Louis : C. V. Mosby Co., 1973. Hartley, G. E. A comparison of baccalaureate and associate degree nursing students on selected personality characteristics (Doctoral dissertation, Washington State University, 1974) . Dissertation Abstracts International , 1975, 3_5, 4963-B. (University Microfilms No. 75-7642) . Hegarty, W. H. Organizational and sociological factors affecting attrition in collegiate schools of nursing. International Journal of Nursing Studies , 1975, 12 , 217-220. Hoover, J. Diploma vs degree nurses: Are they alike?. Nursing Outlook , 1975, 23_, 684-687. Huntington, M. J. The development of a professional selfimage. In R. K. Merton, G. G. Reader & P. L. Kendall (Eds.), The student-physician . Cambridge: Harvard University Press, 1957.

PAGE 98

89 Kiniery, G. The evaluation and characteristics of baccalaureate education in nursing. In S . C. M. Frank & L. E. Herdgerken (Eds.), Perspectives in nursing education . Washington, D. C: The Catholic University of America Press, 1963. Kramer, M. The new graduate speaks. American Journal of Nursing , 1966, 66, 2420-2424. Kramer, M. Role models, role conceptions and role deprivation. Nursing Research , 1968, 17, 115-120. Kramer, M. The new graduate speaks again. American Journal of Nursing , 1969, 69, 1903-1907. Kramer, M. Role conceptions of baccalaureate nurses and success in hospital nursing. Nursing Research , 1970, lj3, 428-439. Kramer, M. Reality shock; Why nurses leave nursing . St. Louis: C. V. Mosby Co., 1974. Lysaught, J. P. An abstract for action . New York: McGraw-Hill Book Co., 1970. Meleis, A. I., & Farrell, K. H. Operation concern: A study of senior nursing students in three nursing programs. Nursing Research , 1974, 2_3' 461-468. Montag, M. L. Where is nursing going? . New York: National League for Nursing, 1975. Montag, M. L. , & Gotkin, L. G. Community college education for nursing. In B. Bullough & V. Bullough (Eds.), issues in nursing . New York: Springer Publishing Co., Inc., 1966. Moore, W. E. Occupational socialization. In D. Goslin (Ed.), Handbook of socialization theory and research . Chicago: Rand McNally & Co., 1969. Moore, W. E. The professions: Roles and rules . New York: Russell Sage Foundation, 1970.

PAGE 99

90 Nelson, L. F. Competence of nursing graduates in technical, communicative, and administrative skills. Nursing Research , 1978, 21_, 121-125. Nie, N. H. , Hull, C. H. , Jenkins, J. G., Steinbrenner , K. , & Bent, D. H. Statistical package for the social sciences . New York: McGraw-Hill Book Co., 1975, (Second edition) . Olesen, V. L., & Davis, F. Baccalaureate students' images of nursing: A follow up report. Nursing Research , 1966, 15, 151-158. Olesen, V. L., & Whittaker, E. W. The silent dialogue . San Francisco: Josey-Bass Inc., 1968. Overall, J. E., & Spiegel, D. K. Concerning the least squares analysis of experimental data. Psychological Bulletin , 1969, 71, 311-322. Richards, M. A. A study of differences in psychological characteristics of students graduating from three types of basic nursing programs. Nursing Research , 1972, 2JL, 258-261. Rodeghero, J. A., Jr. Socialization and professional orientations of nursing students, faculty and practicing nurses . Unpublished master's thesis, Bowling Green State University, 1975. Schmitt, M. H. Role conflict in nursing. American Journal of Nursing , 1968, 68, 2348-2350. Siegel, H. Professional socialization in two baccalaureate programs. Nursing Research , 1968, 17 , 403-407. Simpson, I. H. Patterns of socialization into professions: The case of student nurses. Sociological Inquiry , 1967, 3J_, 47-54. Super, D. E. The psychology of careers . New York: Harper. 1957 .

PAGE 100

91 Tetreault, A. I. Selected factors associated with professional attitudes of baccalaureate nursing students. Nursing Research , 1976, 25 , 49-53. Thomas, J. T. Professional socialization of students in four types of nursing education programs (Doctoral dissertation, University of Florida, 1978). Disserta tion Abstracts International , 1979, 29_, 5966-A. (University Microfilms No. 7907801) . Williams, T . , & Williams, M. Socialization of the student nurse. Nursing Research , 1959, 8_, 18-25. Wren, G. R. Some characteristics of freshman students in baccalaureate, diploma and associate degree nursing programs. Nursing Research , 1971, 20 , 167-172. -—-*---

PAGE 101

BIOGRAPHICAL SKETCH Mary Ruth Lynn was born in Seattle, Washington, on June 2, 1950. She was adopted by Howard and Ruth Lynn in September of 1950. In June 1968, she graduated from Clearwater High School in Clearwater, Florida, and entered Orange Memorial Hospital School of Nursing in August of the same year. She graduated from Orange Memorial Hospital School of Nursing in 1971 with a diploma in nursing. Following this she was employed as a staff nurse in pediatrics and pediatrics intensive care at Orange Memorial Hospital for two years. In 1973, she entered the University of Florida and received a Bachelor of Science in Nursing in August 1974, and a Master of Nursing in August 1975. Mary began doctoral study in the Foundations of Education Department at the University of Florida in the fall of 1975. While in graduate school she became a graduate teaching assistant in the College of Nursing and has continued to work there until the present time coordinating the Individualized Learning Center . 92

PAGE 102

93 She is currently a member of Sigma Theta Tau (National Nursing Honor Society) , Phi Kappa Phi (National Honor Society) , Pi Lambda Theta (National Education Honor Society) , Kappa Delta Pi (National Education Honor Society) , the American Nurses 1 Association, the American Educational Research Association, and the National Council for Measurement in Education. Mary will be moving to Jackson, Mississippi, where she has accepted a teaching position at The University of Mississippi, School of Nursing , starting in August 1979.

PAGE 103

I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. Linda M. Crocker, Chairman Associate Professor of Foundations of Education I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy //. / f m\i /ff
PAGE 104

UNIVERSITY OF FLORIDA 3 1262 08553 0763


xml version 1.0 encoding UTF-8
REPORT xmlns http:www.fcla.edudlsmddaitss xmlns:xsi http:www.w3.org2001XMLSchema-instance xsi:schemaLocation http:www.fcla.edudlsmddaitssdaitssReport.xsd
INGEST IEID EY9UQYQ14_QVVOEW INGEST_TIME 2017-07-17T20:30:59Z PACKAGE UF00098841_00001
AGREEMENT_INFO ACCOUNT UF PROJECT UFDC
FILES


THE PROFESSIONAL SOCIALIZATION OF NURSING
STUDENTS: A COMPARISON BASED ON
TYPES OF EDUCATIONAL PROGRAMS
By
MARY RUTH LYNN
A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1979

Copyright 1979
By
Mary Ruth Lynn

ACKNOWLEDGEMENTS
The members of my doctoral committee deserve special
recognition for their assistance with this dissertation.
The chairman of my committee, Dr. Linda M. Crocker, has
my deepest admiration and gratitude for her excellent
guidance, teaching, and patience. Dr. Robert S. Soar has
also been influential during my graduate study. I appre¬
ciate his sound advice and calm attitude. My sincere
appreciation goes to Dr. Molly C. Dougherty for her con¬
stant support, understanding, and willingness to listen.
Dr. Faye G. Harris has always provided a willing ear
and constant moral support and for those I thank her. In
addition, I would like to extend my gratitude to the deans,
directors, and students of the schools participating in
this study.
Finally, I would like to thank my friends Barbara Boss,
Dr. Patricia D. Olmsted, and Nancy Sypert, for their prodding
and support which aided me in the completion of this study.
iii

TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS iii
LIST OF TAB IES vi
ABSTRACT
vii
CHAPTER
I INTRODUCTION
Definition of Terms
Purpose of the Study
Rationale for the Study
Significance of this Study
II REVIEW OF THE LITERATURE
Historical Developments in
Nursing Education
The Diploma Program
The Baccalaureate Program . . . .
The Associate Degree Program. . .
Controversies in Nursing
Educa tion
Comparisons of the Three Educational
Programs in Nursing
Biographical and cognitive
Variables
Affective and Personality
Variables
Professional socialisation
Studies
1
5
6
8
10
12
12
12
15
17
20
25
29
30
iv

TABIE OF CONTENTS (Continued)
Page
Measures of Professional
Socialization 33
Summary . 38
III DESIGN AND PROCEDURES 40
The Hypotheses 40
Subjects 42
Instrument 44
Development of the Traditional/
Nontraditional Scoring Key 48
Development of the Practicing
Nurses Scoring Key 50
The Analysis of the Data 55
Summary 55
IV RESULTS 57
Hypotheses Testing 57
Effects on Reliability 62
Summary of the Results 62
V DISCUSSION 66
Traditional/Nontraditional
Scoring Method 67
Practicing Nurses Scoring Method . . 70
Limitations of the Study 71
Suggestions for Future Research. . . 72
Applications in Nursing Education. . 74
Summary and Conclusions 75
APPENDICES
APPENDIX A—HOSPITAL AND EDUCATIONAL PROGRAMS
PARTICIPATING IN THIS STUDY ... 30
APPENDIX B—SAMPLE ITEMS FROM THE NPOS. ... 84
REFERENCES 86
BIOGRAPHICAL SKETCH 92
v

LIST OF TABLES
Table Page
1 Number of Students Participating
by Program 45
2 Percentage of Participants in Each Pro¬
gram by Sex and Race Categories 46
3 HSGPA by Program 47
4 Participating Nurses by Age, Year
Licensed to Practice Nursing, and
Years Not Practiced Nursing 52
5 Participating Nurses by Sex, Race,
Area Employed, First Nursing Degree,
and Highest Educational Degree 53
6 Means and Standard Deviations of
Students Total Scores by Programs
and HSGPA Using the Traditional/
Nontraditional Scoring Method 59
7 Analysis of Total NPOS Score Computed
with the Traditional/Nontraditional
Scoring Method as a Function of Program
Type, HSGPA, and the interaction
Between Program and HSGPA 60
8 Means and Standard Deviations of
Students Total Scores by Programs
and HSGPA Using the Practing Nurses
Scoring Method 63
9 Analysis of Total NPOS Score Computed
with the Practicing Nurses Scoring Method
as a Function of Program Type, HSGPA and
the Interaction Between Program and High
School Grade Point Average 64
vi

Abstract of Dissertation Presented to the Graduate Council
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree Doctor of Philosophy
THE PROFESSIONAL SOCIALIZATION OF NURSING
STUDENTS: A COMPARISON BASED ON
TYPES OF EDUCATIONAL PROGRAMS
By
Mary Ruth Lynn
August 1979
Chairman: Linda Crocker
Major Department; Foundations of Education
The assessment and development of professional
socialization in nursing students has been a concern for
many years. Several studies have been conducted in this
area but few quality instruments have been developed with
uses specific to nursing. The Nurses Professional Orienta¬
tion Scale (NPOS) was an exception in that it was appro¬
priately designed and was developed to be used in the
assessment of professional socialization of nursing
students.
In this study two new scoring methods, a Traditional/
Nontraditional scale and a Practicing Nurses scale were
developed for the NPOS. The internal consistencies for
these methods were .81 and .38, respectively. Each method
was then used to determine if students from different
vii

HlW
• V<*
nursing curricula would differ in responses to the NPOS.
Graduating associate degree and baccalaureate degree stu¬
dents in four southeastern states served as subjects for
the comparisons. The sample sizes for the associate degree
and the baccalaureate degree students were 120 and 156,
respectively.
A 2 X 3 factorial design (two program levels and three
grade point levels) was used to compare the total NPOS
scores of the students from the two programs. Because
admission criteria differ for these programs, high school
grade point average was included in each analysis. Both
main effects and interactions were tested using a classical
regression analysis. Separate analysis were conducted for
each scoring method.
Using the Traditiona1/Nontraditional scoring method,
significant main effects were found for both educational pro¬
gram and high school grade point average. These results indi¬
cated that associate degree students were more traditional in
their professional socialization than were the baccalaureate
degree students. When the Scheffe's post hoc procedure was
employed it was concluded that students with a B high school
grade point average evidenced a more traditional orientation
than did students with other high school grade point averages.
viii

When the Practicing Nurses scoring method was used
to score the NPOS, no significant main effect for educa¬
tional program or high school grade point average was
found. Finding no significant main effect for educational
program, it was concluded that either the Practicing Nurses
scoring method was not sufficiently sensitive to differ¬
entiate students from different educational program types
or that there was truly no difference among the students
relative to practicing nurses. In addition, no significant
interaction was found between educational program and high
school grade point average in either scoring method.
This study demonstrated the potential for improving
available instrumentation in the area of professional
socialization in nursing. It was also found that students
in different educational programs in nursing can be dif¬
ferentiated in terms of their professional socialization*
specifically in terms of a traditional or nontraditional
orientation. With improved instrumentation for assessing
professional socialization, research in this area can be
significantly advanced.
IX

CHAPTER I
INTRODUCTION
Professional socialization is a specific portion of
adult socialization. As a process it has been defined in
several different ways. Super (1957) suggests that pro¬
fessional socialization is the process by which someone
"tries the fit" of a job. Others, including Simpson (1967),
define occupational choice and socialization into a role
as a means of acquiring self-identification. Moore (1969)
asserts that professional socialization "involves acquir¬
ing requisite skills and also the sense of occupational
identity and internalization of occupational norms typical
of the fully qualified practitioner" (Moore, 1969, p. 71).
Many researchers suggest that there are phases or
steps involved in professional socialization. Three phases
that have been suggested are (1) the individual shifts his
attention from broad societal goals to the goal of pro¬
ficiency in the specific tasks of his chosen profession,
(2) identifying significant others in the profession as his
1

2
reference source and (3) internalizing the values, skills,
and attitudes of the occupational group and adopting the
behaviors it prescribes (Simpson, 1967).
Professional socialization has been studied in many
of the health related professions but has received more
emphasis in medical and nursing education. Medical school
has been described as one of the longest rites of passage
in our part of the world (Becker & Geer, 1958). During the
first year of medical training, medical students think of
each other and themselves primarily as students. When
medical students have begun to see patients on the clinical
units, the transition to perceiving themselves as physicians
begins. This self image change can be seen as reflecting
the expectations of others. Patients define the medical
student as a physician so the student starts to define him¬
self and behave as a physician (Huntington, 1957) .
Similarly professional socialization has been explored
in nursing and nursing education. Kramer (1974) asserts
that the behavioral and attitudinal changes necessary to
nursing are usually internalized during the training period
of the nursing program. She views professional socializa¬
tion in nursing as a process of both internal and external

3
changes in an individual which resulc in altered "images,
expectations, skills, and norms" (Kramer, 1974, p. 38).
Olesen and Whittaker (1968) view professional socializa¬
tion in nursing as the fusion of person, situation, and
institution. It is in this fusion that they believe the
heart of professional socialization lies.
Investigations into the professional socialization of
nursing students indicate that the critical issue is the
incongruence in the socialization processes between the
nursing program and the actual nursing duties as they are
defined and implemented in the various employment settings
(Corwin, 1961; Kramer, 1966, 1968, 1969, 1970, 1974).
Nursing schools and employment settings represent two
different subcultures in the nursing world. "The norms,
values and behavioral expectations are more different be¬
tween school and work than they are between two different
work settings" (Kramer, 1974, p. 38). Because these sub¬
cultures are so different, movement from one to the other
creates difficulties. Inadequate professional socializa¬
tion has been found to result in attrition in both nursing
education and nursing practice (Williams & Williams, 1959).
Thus, it is important to examine professional socialization

4
in both nursing as an educational program and as an
occupation.
Because there are three different educational tracks
for prospective nurses, an important question is which
program results in greater professional socialization for
its graduates? The oldest of these programs, the hospital-
based diploma school, has rarely encountered socialization
incongruencies because the training was in the apprenticeship
mode. With the movement of nursing education into univer¬
sities in the early 1900's (baccalaureate program) and into
community and junior colleges in the 1950's (associate
degree program), professional socialization became a
relevant issue. No longer are the students in nursing pro¬
grams receiving extensive clinical experience and exposure
to the day-to-day realities of nursing. Rather a greater
balance between classroom learning and clinical experience
was created. Therefore, due to the education changes over
the last century, the assessment and development of pro¬
fessional socialization of nursing students has become
and continues to be an area of interest.
Despite the interest that has been generated in
evaluating and comparing nursing programs (within and

5
across educacional tracks) in terns of professional sociali¬
zation, at the present time the state of measurement of
professional socialization has prevented adequate investi¬
gation in this area. Few instruments have been developed
that measure professional socialization in nursing, and
those that are relevant have not been used to assess the
differences or similarities in the three educational pro¬
gram's graduates. Further, the developed instruments have
not been fully tested, i.e., evidence of reliability,
validity, or both has been lacking. Finally no exist¬
ing instrument has a scoring scheme based on the perceptions
of practicing clinical nurses.
Definition of Terms
For the purpose of this study, the following defini¬
tions were used:
Associate Degree Program. Completion requires two
years in time and is based in a community or junior college
and occasionally in the lower division of a senior college
or university. The associate degree programs are generally
affiliated with local hospitals or health care agencies.
Graduates are licensed as registered nurses upon passing

6
licensing examinations and have either an Associate of
Arts (AA) or Associate of Sciences (AS) degrees.
Baccalaureate Degree Program. Contained within a
four-year college or university, this program combines a
liberal arts background with the nursing curriculum. The
actual time spent in nursing education ranges from two to
five years. The university or college grants a Bachelor
of Science in Nursing or a Bachelor of Science degree to
its graduates, upon passing licensure examinations the
baccalaureate graduate is titled a registered nurse.
Diploma Program. Three years of study are required
for completion. The school of nursing is generally under
the control of a hospital. Each school has its own faculty,
but many of the schools are affiliated with a senior or
junior college or university for physical science, and
some social science courses. After graduating and passing
the state board licensing exam the graduate is titled a
registered nurse.
Purpose of the Study
The purpose of this study was to develop and test two
new scoring methods for a prominent instrument, the Nurses

7
Professional Orientation Scale (NPOS), used in the measure¬
ment of professional socialization. First, a scoring
method based on a traditional/non-traditional view of
nursing was developed and employed in an effort to differ¬
entiate graduates of different educational programs.
Second, a scoring method based on the perceptions of
practicing nurses was developed to assess the socializa¬
tion of graduates from different educational programs.
Finally, the reliabilities yielded from the new scoring
methods were compared.
In view of the fact that the programs to be investi¬
gated were located in junior colleges and senior colleges
and universities, the differences in admission criteria had
to be considered. Accordingly, the high school grade point
average (HSGPA) of each student was collected for inclusion
in the analysis. Thus, variation in the scores on the
NPOS related to differences in high school achievement
could be systematically controlled. The possibility of
an interaction between high school grades and nursing
education programs was also tested. The purpose of con¬
trolling these factors was to increase the power of the
analysis, increasing the likelihood of finding any true

8
significant differences which might exist between the two
types of educational programs.
Rationale for the Study
The scoring methods for the NPOS have been developed
for three reasons. Although this instrument is widely
used, its original scoring scheme suffered from several
limitations. First, the original scoring method was based
on baccalaureate degree faculty responses nine years ago.
With the changes in the attitudes of women in the last few
years, a scoring method formed nine years ago is unlikely
to reflect the current feelings of a predominantly female
profession. Second, the Traditional/Nontraditional method
has been developed to ascertain if the associate degree and
baccalaureate degree programs in fact are at different
points on a traditional vs. nontraditional continuum.
Nursing educators and nurses in general have long argued
that certain types of programs produce graduates who are
more or less traditional than the graduates of other types
of programs. Additionally, some researchers have reported
that a traditional orientation is the opposite of pro¬
fessional socialization (Eller, 1976; Richards, 1972).

9
Finally, the practicing nurses method has been derived for
two reasons: (1) there has been no scoring scheme de¬
veloped for an instrument which utilized the beliefs of
practicing nurses, and (2) graduates entering nursing with
beliefs unlike those of currently practicing nurses have
experienced a reality shock which has created great job
dissatisfaction (Kramer, 1974). Therefore, the ability to
establish which students would be more likely to have an
experience of "reality shock" would provide an aid in the
decrease of attrition from nursing practice.
In this study the professional orientation (sociali¬
zation) of senior associate degree nursing students is
compared to the professional orientation (socialization)
of senior baccalaureate degree nursing students. Diploma
students are not included in the study for two reasons;
(1) The number of diploma programs both nationwide and
in the selected region has decreased markedly over the
past fifteen years (less than half the programs open in
1960 remain open today), and (2) the tremendous growth of
the junior college programs (associate degree) both nation¬
wide and in the selected region has diminished the impact
of diploma education for nurses.

10
Significance of this Study
As previously mentioned, when socialization is con¬
gruent between nursing educational programs and the em¬
ployment setting fewer difficulties for an individual
moving from one to the other are encountered. Much re¬
search has been done investigating the effects of incon-
gruent socialization. This inadequate socialization has
been shown to produce role deprivation. Role deprivation
(role conflict), i.e., the discrepancy between what a nurse
thinks should happen and what she perceives is going on
around her (Kramer, 1970), has been found to cause attrition
in both nursing educational programs and in nursing practice
(Hegarty, 1975; Schmitt, 1968; Williams & Williams, 1959).
The investigation of the professional socialization of
graduates of the associate and baccalaureate degree pro¬
grams may yield information that would be helpful in the
assessment and decrease of role deprivation, and conse¬
quently attrition from the profession.
The need to study graduates of different educational
programs, specifically the associate and baccalaureate
degree programs is twofold. First, graduates of these pro¬
grams have been compared on the basis of many variables

11
and have not been found to be essentially different. Pro¬
fessional socialization has rarely been investigated using
more than one program type. Second, the American Nurses
Association has recommended that there should be two types
of nurses prepared in the United States, technical (asso¬
ciate degree) and professional (baccalaureate degree)
(American Nurses Association, 1965). These two educational
programs have been ill defined or differentiated at this
time, and comparisons of the professional socialization of
their students could yield valuable information. This
information would be valuable for future efforts in cur¬
riculum development, program evaluación, or research in
professional socialization as a social process.

CHAPTER I!
REVIEW OF THE LITERATURE
The literature reviewed in this chapter has been
selected from three areas: historical development of the
nursing educational programs, comparisons of the three
nursing educational programs and measures of professional
socialization in nursing. The review is organized in the
following manner. First, selected literature is presented
pertinent to the historical development of nursing educa¬
tional programs. Next, studies comparing graduates of the
three educational programs are discussed. Finally, measures
or professional socialization in nursing are reviewed with
emphasis on those studies in which the NPOS was used.
Historical Developments in
Nursing Education
The Diploma Program
Formal nursing education began in the United States
in 1872 with the establishment of the first hospital-based
school of nursing (diploma program) in Roxbury, Massachusetts.
12

13
The program resembled the Nightingale School of England
in that the course was twelve months in length equally
divided into medical nursing, surgical nursing, maternity
nursing, and night nursing (Dietz & Lehozky, 1967).
Numerous other schools modeled after the Nightingale
School soon developed. Each school was independent of
the hospital,having its own administration as well as bud¬
get. In 1874 schools began to contract with the hospitals
so that student nurses could receive actual patient care
experiences. These contracts gave the students patient
care experiences in exchange for their providing the hos¬
pital with nursing services. The hospitals realized an
increase in nursing services and therefore incorporated
the faculty of the schools under their budget and adminis¬
tration (Dolan, 1973) . Diploma schools have continued in
this mode.
During the period from 1872 to 1910, both the length
of the diploma program and the number of programs increased.
The duration of the educational period went from the
initial one year of training to two years and then finally
to three years, which is the present length of the diploma
programs. Diploma schools' students helped to provide
staff for the hospitals in which they had their clinical

14
experiences. This was financially beneficial to the
hospitals as it decreased their expenditures for nursing
care. Therefore, many hospitals attempted to have nursing
schools. In 1880 there were fifteen diploma programs.
By 1910 over one thousand programs had been established
(Bridgman, 1966).
A milestone in nursing education occurred in the early
1920's when Josephine Goldmark was commissioned to study
the function and preparation of the public health nurse.
Although the study was initially directed towards the
problems of public health education for nurses, it was
soon found to be relevant to the whole of nursing educa¬
tion. This report revealed that "most nursing schools
were shockingly inadequate in providing laboratories,
libraries, demonstration rooms, instructors, and head
nurses"; therefore, the nursing schools did not conform
to standards accepted in other educational institutions
(Dietz & Lehozky, 1967; Lysaught, 1970). Goldmark
recommended that
The current tendency to lower require¬
ments should be discontinued and efforts
made to raise the general standards of
nursing education to the level of the best
schools. Instructors and other officers
of schools of nursing should receive special

15
training to fit them for their tasks.
The development of university associa¬
tions with schools of nursing should be
strengthened, and schools should be given
adequate financial backing. (Griffin &
Griffin, 1973, p. 134)
Because the hospital-based diploma programs were in
the midst of a "boom," the recommendations of the Goldmark
report were not accepted or implemented. The report did,
however, stimulate the development of some university
programs and further encourage the move of nursing educa¬
tion into the academic environment.
The Baccalaureate Program
In the early 1900's several nursing leaders wished
to place education for nurses into the academic environ¬
ment and remove control of nursing education from the
hospital's administration. In 1909 the first independent
school of nursing was established at The University of
Minnesota. Though several collegiate programs had been
established prior to 1909, they were all under the control
of medical schools (Davis, Olesen & Whittaker, 1966) .
Acceptance of collegiate nursing education was certainly
not immediate. Both the public and most nursing educators
felt that the already established diploma programs

16
sufficiently supplied all the education and preparation a
working nurse could possibly need (Bridgman, 1966; Davis et
al., 1966).
The initial programs developed at The University of
Minnesota and in many other universities were not different
from the numerous diploma programs in existence. The pro¬
grams were three years in length and the graduates received
a diploma in nursing upon completion. It was not until ten
years later that Minnesota instituted an undergraduate
baccalaureate program for nursing students, and by that
time a number of other universities had already taken such
a step (Davis et al., 1966). During the period between
1910 and 1930 nursing leaders recognized the need for the
development of higher educational standards. Through
their efforts, the Association of Collegiate Schools of
Nursing (ACSN) was established in 1932. This association,
though not an accrediting agency, examined member schools'
programs to ascertain if they met the established stan¬
dards .
Of the numerous collegiate programs in existence,
twenty schools were either full members or associate mem¬
bers in the ACSN by 1935. During World War II there was a
rapid expansion in the number of collegiate nursing

17
programs. All of these programs were not eligible for
membership in the ACSN because they did not meet the re¬
quired standards. By 1948, through the efforts of numerous
nursing educators, the National Nursing Accrediting Service
was established in an attempt to set down criteria for the
evaluation of all existing and developing nursing programs
(Kiniery, 1963).
Accreditation of programs was not firmly established
until 1952 when the National League for Nursing Accrediting
Service was formed. The establishment of an accrediting
service was a step forward because it determined the
criteria that differentiated collegiate programs from
diploma programs.
The Associate Degree Program
After World War II the public and nurses alike be¬
came increasingly aware of the widening gap between the
quantity and quality of nursing services. Nursing educa¬
tors were confronted with the problem of attaining and
maintaining the proper alignment of the nursing educa¬
tional system with the fundamental social and economic
changes taking place in the face of rapidly developing
scientific and medical advancements. Following the war,

18
the United States was experiencing an explosion of technical
and medical knowledge (e.g., the discovery and refinement
of many antibiotics and antibiotic therapies). The public
demanded higher living standards and available quality
medical services (Anderson, 1966).
In an effort to explore the nature of the nursing
shortage national nursing organizations and universities
with nursing programs undertook studies of nursing prac¬
tice. In the early 1950's Mildred L. Montag (Montag &
Gotkin, 1966; Montag, 1975) set up the Cooperative Re¬
search Project in Junior and Community College Education
for Nursing. Under this project eight participating
schools—five two-year junior colleges, two four-year in¬
stitutions of higher education, and one hospital school
of nursing—were assisted in developing programs for the
education of potential nurses. Seven of the eight pro¬
grams awarded an associate degree to graduates of the
program (Bullough & Bullough, 1969). This new nurse has
been described as a "bedside nurse" to differentiate her
from nurses with broader professional preparation (Montag
& Gotkin, 1966) . The assumptions underlying the develop¬
ment of the associate degree nurse program were as follows;

19
1. The functions of nursing can and should be
differentiated into three basic categories;
the professional, the semi-professional or
technical, and the assisting,
2. The great bulk of nursing functions lie in
the intermediate category, the semi-profes¬
sional or technical. Therefore the greatest
number of persons should be prepared to fill
these functions.
3. Education for nurses belongs within the or¬
ganized educational framework.
4. The junior-community college, the post-high
school educational institution specifically
suited to semi-professional or technical
education, is the logical institution for
the preparation of the large group of nurses.
5. When preparation for nursing is education—
rather than service-centered, the time re¬
quired may be reduced.(Montag & Gotkin,
1966, p. 34)
By design the associate degree nurse was to perform
technical (or semi-professional) functions at the regis¬
tered nurse level and be prepared for beginning practi¬
tioner positions (Montag & Gotkin, 1966).
The community college, being one of the fastest grow¬
ing enterprises in America, readily accepted the proposi¬
tion of educating nurses in associate degree programs.
In 1956 there were only the eight pilot schools but by
1975 there were 603 programs in community and junior
colleges awarding associate degrees in nursing (Facts
About Nursing 76-77, 1977).

20
Controversies in Nursing
Education
In 1965 the American Nurses Association's Committee
on Nursing Education published its first position paper
on nursing education. The position was as follows;
1. The education for all those who are licensed
to practice nursing should take place in in¬
stitutions of higher education.
2. The minimum preparation for beginning pro¬
fessional nursing practice at the present time
should be baccalaureate degree education in
nursing.
3. The minimum preparation for beginning tech¬
nical nursing practice at the present time
should be the associate degree education in
nursing. (American Nurses Association, 1965,
pp. 107-108)
This position paper went on to define the components
of professional and technical practice. Professional
nursing was said to have three orientations, specifi¬
cally care, cure, and coordination. The care orientation
included dealing with humans under stress, providing com¬
fort, listening, evaluating, and intervening appropriately.
The cure emphasis, in contrast to the medical profession,
was the promotion of health. Finally, the coordination
aspect of professional nursing was that of dealing with the
health and welfare of those in the community.

21
Technical nursing was said to be skill oriented in
that it involved the application of the basic principles
of science. The nursing functions within technical prac¬
tice were patient status review and planning care with
other health care team members. The position paper did
not limit the depth of technical practice but confined
the scope of practice. The technical nurse was to be
directly under the supervision of the professionally
trained nurse (American Nurses Association, 1965).
The American Nurses Association position produced
great controversy among nurses across the nation. What
would become of the diploma schools and their graduates?
Where did the Licensed Practical Nurse (LPN) fit into
the plan? How did one distinguish between technical and
professional practice? Were baccalaureate programs
affordable and accessible to those who wanted to obtain
the professional degree? What was wrong with the status
quo?
Although the American Nurses Association's position
was far from unanimously supported, there was a demon¬
strable effect on nursing education. In 1965, 77 per cent
of basic nursing education took place in diploma programs;

22
in 1975, these programs were responsible for only 29 per
cent of the basic nursing education. During the same
time period the combined total of associate and bacca¬
laureate graduates have gone from 23 per cent to 71 per
cent. The associate degree programs accounted for 44 per
cent of the total graduates and the baccalaureate degree
programs accounted for 27 per cent of the total graduates.
Additionally, in 1975 7 per cent of all students in bacca¬
laureate programs were currently licensed registered
nurses who had graduated from associate and diploma pro¬
grams (Facts About Nursing 76-77, 1977).
The efforts of the American Nurses Association to
define technical and professional practice have represented
an ever continuing drive on the part of the nursing pro¬
fession to improve its professional status. in order for
a group to establish professional status, education of its
practitioners must take place in institutions of higher
education. Preparation for professional practice must
encompass mastery of the theory underlying its practice,
not just apprenticeship training (Moore, 1970).
Although over the next decade more research was con¬
ducted investigating the nature of the graduates and
students of the three nursing educational programs,

23
little had been done to implement the elements of the
1965 position paper. Therefore, the 1978 convention of
the American Nurses Association established a timetable
for the implementation of the 1965 standards. The
association established that "by 1980, two categories of
nursing practice be identified" and "that the bacca¬
laureate should be the minimum preparation for entry into
professional nursing practice by 1985" (American Nurses
Association, 1978). Although the resolutions of the
American Nurses Association have no legal implications,
the ramifications within nursing produced by the 1978
recommendations have only begun to be felt.
Between the 1965 American Nurses Association position
paper and the 1978 resolutions, the National Commission
for the Study of Nursing and Nursing Education was formed
with Jerome Lysaught appointed as director. The charge
to the committee was to investigate how to improve the de¬
livery of health care to the American people through the
analysis of improvement of nursing and nursing education.
The following are some of the major recommendations
pertaining to nursing education:
1. Each state will have, or create, a master
planning committee that will take nursing

24
education under its purview, such com¬
mittees to include representatives of
nursing education, other health profes¬
sions, and the public, to recommend
specific guidelines, means for implementa¬
tion, and deadlines to ensure that nursing
education is positioned in the mainstream
of American educational patterns with its
preparatory programs located in collegiate
institutions.
2. Those hospital schools that are strong and
vital, endowed with qualified faculty, suit¬
able educational facilities, and motivated
for excellence be encouraged to seek and
obtain regional accreditation and degree
granting power.
3. All other hospital schools of nursing move
systematically and with dispatch to effect
interinstitutional arrangements with col¬
legiate institutions so that graduates of
the nursing preparatory program will receive
an academic degree from the educational in¬
stitution upon completion of their course
of instruction.
4. Junior and senior collegiate institutions
cooperatively develop programs and curricula
that will preserve the integrity of their
institutions and their aims while facilita¬
ting the social and professional mobility
of the nursing student. (Lysaught, 1970,
pp. 109-113)
In summary, the earliest nursing schools in the United
States were diploma programs which followed the Nightin¬
gale pattern. In order to relieve financial difficulties
and increase clinical experiences for their students
these schools were incorporated into the hospital structure.

25
As the need for medical and nursing services increased,
the diploma schools rapidly increased in size and number
of programs, where the primary educational mode was
apprenticeship training. Nursing educators spent almost
a century trying to correct this and establish nursing
as an independent profession. The effort to establish
independence prompted the upgrading of diploma schools.
Concurrently they established nursing programs in
colleges and universities to attempt to equate nursing
education with the education of the other professions.
With three different educational programs for nursing
established, controversies developed within nursing as
to which of these should be the basic education prepara¬
tion for the professional nurse.
Comparisons of the Three Educational
Programs in Nursing
Before the 1965 American Nurses Association position
paper few studies had been reported comparing the three
educational programs in nursing. After the position
paper many studies were conducted, but rarely were all
the nursing program types studied. Consistently the
baccalaureate degree student and graduate was included

26
with only sporadic inclusion of the associate degree or
diploma student or graduate.
The reported studies can be separated into two major
divisions: specifically those studies dealing with dif¬
ferentiation of programs on biographical and cognitive
variables, and those dealing with differentiation of
programs on affective and personality variables.
Biographical and
Cognitive variables
Bayer and Schoenfeldt (1970) conducted one of the
earliest and largest studies. in this study students in
diploma programs were compared with students in bacca¬
laureate degree programs. The researchers concluded that
the basic difference between students in the two program
types were only in terms of the socioeconomic variables:
number of books, magazines, and appliances in the home,
luxury items, cultural equipment, sports equipment, the
student having his own room, number of cars in the family,
number of rooms in the home of the student, che student's
father's and mother's education, consistently for these
groups the baccalaureate students came from "advantaged"
households. When a similar study was conducted by Hartley

27
(1975) using associate and baccalaureate degree students,
father's education and mother's education were found to be
not significantly different in the two groups studied.
Other studies that compared socioeconomic variables in¬
cluded Dustan's study (1964) where he suggested that there
was no difference in family income when studying all three
educational programs. In 1971 Wren's study of all three
programs demonstrated no difference using occupations
of the parents as well as no difference in the amount of
financial assistance the students required or utilized.
Several researchers investigated the difference in
family composition among students in the three program
types. They found that associate degree students tended
to be older, often married with children, and residents
in the community where they attended school (Dustan,
1964; Meleis & Farrell, 1974; Wren, 1971).
Most of the researchers' investigations of the edu¬
cational programs included cognitive variables. The
results, however, were not consistent in this area.
Dustan (1964) found that associate degree students had
higher aptitudes than either baccalaureate or diploma
students, using the Scholastic Aptitude Test, Wren (1971)
demonstrated that baccalaureate degree students scored

28
highest with the diploma students the next highest. When
looking at State Board Examination scores, Counts (1975)
concluded that there was no difference in associate
degree graduates' state board scores and those of bacca¬
laureate degree graduates. An examination of the state
board scores by Bain (1974) yielded another set of results.
The highest scores were among baccalaureate degree gradu¬
ates. The diploma graduates' scores were next followed
by the associate degree graduates' scores.
Other cognitive or biographical variables that have
been examined by one researcher have not been replicated
by other investigators. Meleis and Farrell (1974) found
that diploma students placed a higher value on research
than did associate degree or baccalaureate degree stu¬
dents. When looking at previous health care experience
Wren (1971) suggested that associate degree students
were more likely to have had some previous experience
than either the diploma or baccalaureate degree students.
Other differences in variables of this nature were found
in almost every study in this area (Bain, 1974; Hartley,
1975) .

29
Affective and Per¬
sonality Variables
Bayer and Schoenfeldt (1970) concluded that there
was a difference between baccalaureate and diploma stu¬
dents in terms of artistic ability, verbal ability and
goal direction. The baccalaureate program students were
higher in artistic and verbal ability, but less goal-
directed than the diploma students. Hoover (1975) who
also looked at baccalaureate and diploma students found
that baccalaureate students were more restrictive in the
patients they preferred to care for, placed a higher
value on ability to function, and were more interested in
promotion in the facility in which they were employed
after graduation.
In a comparison of all three educational programs
Davis (1973) concluded that baccalaureate graduates were
more involved in prestigious function, i.e., teaching,
team leading, etc., while associate degree nurses tended
to do more non-prestigious nursing functions, i.e.,
treatments and medications. Baccalaureate students have
been shown to focus more on the psychological needs of
patients (Gray, Murray, Noy and Sawyer, 1977), to be more
care oriented as defined by the American Nurses Association

30
in 1965, to possess better leadership abilities (Gold¬
stein, 1978; Gray et al., 1977) and communication skills
(Nelson, 1978). Diploma students, on the other hand,
evidenced a higher self-perception of themselves as
nurses and nursing administrators (Nelson, 1978). Asso¬
ciate degree nurses felt excluded by graduates of the
other two program types (Davis, 1973), were not focused
on the physical needs of patients, and were more cure
oriented (Gray et al., 1977).
Professional Socializa¬
tion Studies
In 1964 Davis and Olesen surveyed changes in stu¬
dent's imagery, consensus, and consonance at the con¬
clusion of one year's study in a baccalaureate nursing
program. They found that the first year of nursing educa¬
tion was the time during which the greatest change took
place in student imagery. Although they found a trend
toward innovative and individualistic images of nursing
and away from bureaucratic images of nursing, they were
surprised to find no significant increase in consensus
among nursing students with respect to their images of
nursing. They reported that students' rating of traits

31
relative to nursing were influenced by their instructors '
emphasis on these same traits. Two follow up studies
confirmed these findings (Brown, Swift & Oberman, 1974;
Olesen & Davis, 1966).
A similar study was conducted by Siegel (1968).
Using the same trait scale as was used in the previous
studies, Siegel reported that senior nursing students in
two baccalaureate programs shared common perceptions of
nursing with their faculty. The students in the study
did not, however, reach consensus among themselves in
their characterization of nursing as they advanced in
class rank. Although the results concurred with those of
Davis and Olesen (1964), the weakness in all of these
studies was that no standardized instrument had been de¬
veloped for the assessment of changes in students' views
of the nursing role. Without the development of a
standardized instrument, different studies do not increase
knowledge in the area of professional socialization. An
instrument which has been properly developed can be used
by other researchers pursuing the same area.
Richards (1972) reported that baccalaureate degree
students were more professionally socialized than
associate degree or diploma students were found to be.

32
Eller (1976) conducted a similar study and reported the
same findings. in both of these studies a basic assump¬
tion was that professional socialization and a tradi¬
tional view of nursing are at opposite extremes of the
same continuum. This assumption has not been accepted
by other researchers working in this area.
The previously reported studies of professional
socialization have demonstrated several weaknesses. The
most consistent exploration has focused on baccalaureate
students exclusively (Brown et al., 1974; Davis & Olesen,
1964; Olesen & Davis, 1966; Siegel, 1968; Tetreault, 1976).
Because nursing has been comprised of relatively few
baccalaureate nurses, the majority of nurses have there¬
fore not been studied. Secondly, the instruments employed
have demonstrated weaknesses which are reviewed in the
next section. Finally, the basic assumption on which at
least two of the studies are based must be questioned.
To summarize, many studies have been conducted which
compare the students and graduates of the three nursing
educational programs. Many types of variables have been
employed that differentiated or identified similar
aspects of the programs. Few of these studies have been

33
replicated and therefore can be seen only as preliminary
investigations.
Professional socialization has been studied only
sporadically. A lack of adequate socialization into a
profession has been shown to produce job dissatisfaction re¬
sulting in attrition from nursing practice (Williams &
Williams, 1959). The origins of professional socializa¬
tion are in the educational program, yet little is known
about its development. Less has been devised for its
assessment. Because professional socialization is vital
to the development of the nursing practitioner, this area
should receive further study. It is necessary that future
studies in this area be based on acceptable assumptions,
compare products of different educational programs, and
improve instrumentation in this area. These are the
emphases of the present study.
Measures of Professional
Socialization
Few instruments have been developed for the measure¬
ment of professional socialization in nursing. One of
the first instruments was the one used in the 1964 Davis
and Olesen study. This same instrument was also used in

34
Olesen and Davis (1966), Siegel (1968), and Brown et al.
(1974). This instrument was a 19-item checklist containing
broad, short statements relevant to nursing. Participants
were to check items they felt were important to nursing
and those important to themselves. Rather than develop¬
ing individual total scores, totals were derived for each
item. The results were then reported in terms of the per¬
centage of students checking each item.
Use of this questionnaire for the assessment of pro¬
fessional socialization in nursing is limited. Some of
its weaknesses are (1) there is no method for deriving
individual scores established, (2) the items are no more
relevant to nursing than most other occupational groups,
and (3) there has been no investigation on the question¬
naire's reliability and/or validity.
The instruments used in the studies by Richards (1972)
and Eller (1976) were not available for review nor dis¬
cussed in their studies. in neither case was reliability
and/or validity discussed or mentioned.
In 1974 Crocker and Brodie developed the NPOS. Their
purpose in developing the NPOS was to construct a unidimen¬
sional scale that would measure congruence between student
nurses' perceptions and faculty's views of the professional

35
nursing role. The initial pool of 112 items was comprised
of behaviors and traits frequently displayed by nurses
as wall as myths about nurses. After item analysis the
final pool of 59 items was rested for reliability and
validity.
The internal consistency of the NPOS, using Cronbach's
Alpha and calculated on a cross-validation group was
£ = .89. Construct validity for the scale was demonstrated
empirically by showing that as nursing students advanced
in class rank, their scores became more congruent with
faculty views. Class means, i.e., freshman, sophomore,
junior, and senior, were significantly different (F 3,240J
= 34.7, £ < .01). Using Scheffe's test for pairwise com¬
parisons it was found that the mean score (total) of each
class was significantly greater than that of the lower
class.
Scoring weights for the items were derived by adminis¬
tering the scale to 94 nursing faculty members of three
universities and using the per cent of endorsement of each
response as the item weight. The percentage of faculty
who endorsed a particular response was rounded to the
nearest tenth, which replaced the original five choice
item weight. For example, if 82 per cent of the

36
faculty chose option three on item 16, option three on
item 16 would now have a scoring weight of eight, not
three. This method of scoring was developed so that the
only way a student could receive a high score was to
respond to the NPOS in a manner similar to that of the
faculty (Crocker & Brodie, 1974).
Among the instruments reviewed, the NPOS was the
only scale for the measurement of professional socializa¬
tion that was based on appropriate procedures for instru¬
ment development. Additionally, the instrument was the
first one that enabled the user to identify consensus
among students. Finally, the NPOS was based on assump¬
tions congruent with professional socialization theory
and research. For these reasons the NPOS was chosen for
this study.
At least two researchers have utilized the NPOS in
their studies. Rodeghero (1975) investigated the con¬
gruence of student and faculty views of nursing in a
diploma program. The results reported were that students
adopt professional views similar to those of their faculty.
Additionally, factor analysis was employed which yielded
four factors, two of which differentiated levels of

37
students. These twc factors were identified as the Tradi¬
tional/Structured factor and the Empathic/Moralistic
factor.
In 1978 Thomas utilized the NPOS in a study comparing
the professional socialization of associate degree, bacca¬
laureate degree and diploma students. Thomas found no
differences in the professional socialization of students
from the three educational programs.
Both of these studies were conducted with the
original scoring method developed by Crocker and Brodie.
This method, developed over eight years ago, is question¬
able for use at the present time. Additionally, both of
these studies were conducted using programs in one city
(Rodeghero, 1975) or one state (Thomas, 1978).
With the development of the NPOS, advances have been
made towards better assessment of professional socializa¬
tion. Crocker (1973) has had numerous requests for the
use of the NPOS for past, present, and future research in
the area of professional socialization. Further develop¬
ment of this instrument, by broadening its application
and strengthening its scoring methods can be an aid to
research in professional socialization.

38
Summary
Nursing education has developed rapidly in the
United States. The first program implemented was the
hospital-based diploma program followed by the bacca¬
laureate and associate degree programs. These programs
co-existed relatively peacefully until the 1965 American
Nurses Association position paper was released. Each
program then began to offer justification for its exis¬
tence and continuation.
Several studies have been conducted comparing the
three educational programs. Few major differences have been
found in the reported comparisons of the three educational
programs. One area in which program comparisons are
needed is the area of professional socialization. Studies
which have been reported were too limited in scope,
were based on weak assumptions, or utilized inadequate
instruments for the assessment of professional sociali¬
zation .
One promising instrument for assessing professional
socialization in nursing is the NPOS. Use of this in¬
strument for research and evaluation in nursing educa¬
tion is growing, but the original scoring scheme is now

39
outdated. Revision of the scoring scheme of the NPOS is
needed before the potential usefulness can be realized
in measuring professional socialization.

CHAPTER III
DESIGN AND PROCEDURES
This study was designed for two reasons. First, the
area of professional socialization in nursing requires
further study specifically in terms of different educa¬
tional programs. Second, available instrumentation in
the area of professional socialization is for the most
part inadequate. The NPOS has shown promise in studies
of professional socialization and with further testing
for improvement it may prove to be of more use in the
future. This study was designed in two phases; (1)
establishing the two new scoring methods for the NPOS, ana
(2) administering the NPOS to students from associate
degree and baccalaureate degree nursing programs for the
analysis of program effect on professional socialization.
The Hypotheses
The following hypotheses were formulated to be
nested in the present study. These hypotheses were
40

41
divided into subsets according to the scoring method of
interest.
Subset 1
Hypothesis 1; When using the Traditiona1/Nontradi-
tional scoring method, there is no dif¬
ference between the mean total NPOS
score of the associate degree students
and the baccalaureate degree students.
Hypothesis 2: When using the Traditional/Ncntra-
ditional scoring method, there is no
difference in total NPOS scores among
students with different levels of
HSGPA.
Hypothesis 3: There is no interaction between edu¬
cational program and HSGPA which
affects student scores on the NPOS,
using the Traditional/Nontraditional
scoring method.
Subset 2
Hypothesis 4: When using the Practicing Nurses
scoring method, there is no difference
between the mean total NPOS scores of
the associate degree students and the
baccalaureate degree students.
Hypothesis 5: When using the Practicing Nurses scor¬
ing method, there is no difference
in total NPOS scores among students
with different levels of HSGPA.
Hypothesis 6: There is no interaction between
educational program and HSGPA which
affects student scores on the NPOS
using the Practicing Nurses scoring
method.

42
In addition, the following question was formulated
to be investigated in the study.
Question 1: What will be the effect of two
different scoring schemes on
reliability (internal consistency)?
Subjects
For the present study nursing programs were selected
from the National League for Nursing accredited associate
and baccalaureate degree programs in six southeastern
states. The initial states chosen were Alabama, Florida,
Georgia, North Carolina, South Carolina, and Tennessee.
These states were chosen for several reasons.
1. Taken as a group these stat® form a contiguous
geographical area,
2. These states are approximately equidistant from
the site of the study, and
3. Nursing educational programs in these states
all belong to the same regional agency (the
Southern Regional Educational Board) and there¬
fore meet the same educational standards.
From each of these states one associate and one
baccalaureate degree program were selected. The following
criteria were used in the selection:
1. Both the associate and baccalaureate degree
programs were in close geographical proximity
to each other.

43
2. Each program was state supported, and
3. No program was racially or sexually
segregated.
The dean or director of each nursing program was
contacted by mail in March or April of 1978 requesting the
participation of the entire class of graduating seniors.
In one instance the school's institutional review board
for reviewing research proposals was also contacted. If
a dean wrote that her program or students were unable to
participate and a substitute school could be found that
met the aforementioned criteria, the substituted school
was then contacted. Of the original six states chosen,
programs in four states were in the final analysis. The
two states and their programs had to be deleted because
either no programs were able to participate or a com¬
panion program could not be found for a participating
school.
All of the schools contacted responded to the initial
contact letter. Of the programs contacted, 62 per cent of
the associate degree and 55 per cent of the baccalaureate
degree schools agreed to participate in the study. Schools
agreeing to participate are listed in Appendix A.

44
Once the dean or director returned the completed
consent form the total number of requested scales was
mailed. The dean or director distributed the question¬
naires to all of the graduating seniors and when completed
returned the questionnaires. A total of 557 questionnaires
was distributed and 332 returned for a 60 per cent return
rate. Sixteen questionnaires were completed by previously
licensed registered nurses and thus were omitted from the
analysis. Additionally, in one state there was no partici¬
pating baccalaureate program so the paired associate degree
program had to be dropped. This resulted in a total of
276 completed scales. All questionnaires were handled
confidentially and no identifying information was col¬
lected. Demographic data for the participating students
are shown in Tables 1, 2 and 3.
Instrument
The NPOS was used as the measure of professional
socialization in this study. The NPOS, a rating scale,
is composed of 59 items representing a portion of the
domain of professional socialization in nursing. Re¬
spondents were asked to judge the importance of each
trait (item) for the practicing, professional nurse in

45
Table 1
Number of Students Participating by Program
(n = 276)
Program£
Associate degree
Jefferson State Junior College 62
Georgia State University 11
Fayetteville Technical Institute 38*
Florence-Darlington Technical College 20
Columbia State Community College 27
Baccalaureate degree
University of Alabama in Birmingham 40
Valdosta State College 45
University of South Carolina 41
University of Tennessee 30
*Dropped from the final analysis

46
Table 2
Percentage of Participants in Each Program
by Sex and Race Categories
(n = 276)
Program
Associate degree
(n = 120)
Baccalaureate degree
(n = 156)
Sex
% %
Male Female
7.5 92.5
13.5 86.5
10.9 89.1
Race
% %
Black White
10.0 89.2
4.5 94.2
6.9 92.0
%
Oriental
.8
1.3
Total
1.0

47
Table 3
HSGPA By Program
(n = 276)
Program
Associate degree
HSGPA
A
B
n
%
n
%
n
32
27
76
63
12
72
46
72
46
12
Baccalaureate degree
8

48
her occupation and role as a nurse. They rated each item
from extremely important to undesirable on a five point
scale. Sample items and the directions are shown in
Appendix B. This scale is self-administered and takes
approximately 25 minutes to complete. The participating
students were asked to supply the following biographical
data while completing the NPOS: age, sex, ethnic group,
licensure status prior to enrollment in their present pro¬
gram, and HSGPA.
Development of the Traditional/
Nontraditional Scoring Key
From the University of Florida College of Nursing 32
nursing faculty members were selected, due to their
accessibility, to provide the data on which to develop
the Traditional/Nontraditional scoring method. Each faculty
member was given the 59-item NPOS and asked to determine
for each item whether a nurse would be traditionally or non-
traditionally oriented if she endorsed it. A 90 per cent
return rate was achieved. This is probably due to per¬
sonal distribution of the instrument to each participant.
The percentage of faculty choosing each option, either
traditional or untraditional, was tabulated. A 67 per cent

49
agreement was determined to be the minimum endorsement an
option must have for an item to be considered either tra¬
ditionally or nontraditionally oriented (standard error
of this percentage = .08). For example, if for an item
72 per cent of the faculty chose the traditional option
as their belief about the orientation of that item, the
item would be considered a traditionally oriented item.
If, however, 52 per cent of the faculty chose the tradi¬
tional option on an item (leaving 48% that chose nontra-
ditional), the item was dropped from this scoring method as
its orientation was not determined when a 67 per cent cut
off was established. If 32 per cent chose traditional
and 68 per cent chose nontraditional on an item, that item
would be considered nontraditionally oriented. Thirteen
items were deleted because there was not an endorsement
of either option (traditional or nontraditional) by 67
per cent of the respondents. The remaining 46 items were
divided into those items with a traditional orientation
(16 items) and those with a nontraditional orientation
(30 items). it was decided that a high score should
represent a traditional orientation, so the item weights
(1 through 5) were reversed on the 30 nontraditional
items. Using this manipulation, the only way an individual

50
could achieve a high score would be to rate the behaviors
described in traditional items as "important" or "ex¬
tremely important" and rate the traits described in non-
traditional items as "unimportant" or "undesirable." The
decision for a traditional orientation to receive a high
score was an arbitrary one.
Development of the Practicing
Nurses Scoring Key
To develop a scoring key based on practitioners'
views, a different method was used. Six directors of
nursing services were contacted in five states in the
southeast to request participation in this portion of the
study. These directors were chosen because the hospitals
in which they were employed were in the same geographical
region as the universities and community colleges that
were in the data collection. The nurses in these hospitals
tend to have graduated from the nursing schools in the
immediate vicinity and therefore would better represent
the views of nursing in that area. Five directors of nurs¬
ing agreed to participate, though all responded to the
original contact letter, for an 83 per cent return rate.
The participating hospitals are shewn in Appendix A.

51
After receiving consent to participate the specified
number of scales was sent to the nursing director for
dispersal to the nurses. A total of 565 questionnaires
were mailed out and 226 returned for a return rate of
40 per cent. The scoring weights were then calculated in
a manner identical to that of the original NPOS scoring
weights. The percentage of nurses endorsing a particular
response was rounded to the nearest tenth, which replaced
the original five possible responses. For example, if
68 per cent of the nurses endorsed option 2 on an item,
option 2 would have a new scoring weight of seven. Each
option for the 59 items was reweighted in this manner.
This was done so the only way an individual could achieve
a high score using this method would be to answer the
item in a manner similar to that of practicing nurses.
The nurses supplied the following biographical data;
age, sex, ethnic group, clinical area where employed,
year initially licensed, years since initial licensure
when not employed in nursing, basic educational prepara¬
tion in nursing, and highest level of education attained.
These data were not considered in the analysis but were
collected for a demographic description of the partici¬
pating nurses. This information is shown in Tables 4 and 5.

52
Table 4
Participating Nurses by Age, Year Licensed
to Practice Nursing, and Years Not
Practiced Nursing
(n = 226)
Age
Year licensed to Years not prac-
practice nursing ticed nursing
Mean
31.90
1967.89
1.00
Median
29.72
1971.85
.19
Mode
24.00
1975
.00
SD
9.40
11.35
2.39

53
Table 5
Participating Nurses by Sex, Race, Area
Employed, First Nursing Degree, and
Highest Educational Degree
(n = 226)
Variable
Frequency Percentage
Sex
Male
Female
4
222
1.8
98.2
Race
Black
Hispanic
29
1
12.
White
195
86.3
Oriental
1
.4
Area Employed
Medical-Surgical
97
42.9
Pediatrics
13
5.8
Obstetrics
26
11.5
Intensive care
48
21.2
Emergency room
4
1.8
Psychiatrics
22
9.7
Inservice
8
3.5
Administration
5
2.2
Admissions
1
.4
None
2
.9
First Nursing Degree
Diploma
79
35.0
Associate degree
67
29.6
Baccalaureate degree
78
34.5
Other
2
.9
Hiahest Educational Degree
Diploma
55
24.3
Associate degree
54
23.9
Baccalaureate degree
82
36.3
4^ CO

54
Table 5 (Continued)
Variable
Frequency
Percentage
Baccalaureate (Non-nursing) 10 4.4
Master's in nursing 21 9.3
Master (Non-nursing) 3 1.3
Other 1 .4

55
The Analysis of the Data
The hypotheses for each scoring method were tested,
using a 2 X 3 factorial design, treating educational pro¬
gram and HSGPA as independent variables and score on the
NPOS as the dependent variable. A classical regression
solution was used for determining significance of the mean
program differences, variation due to HSGPA and the inter¬
action of program and HSGPA (Overall & Spiegel, 1969).
The level of significance for each hypothesis tested was
set at £ < .05. Question 1 was explored by investigating
the internal consistency using Cronbach’s Coefficient Alpha
for each scoring scheme.
Summary
A total of 276 associate degree and baccalaureate
degree students participated in this study. Each student
respondent read a list of traits or characteristics relevan
to nursing and rated the importance of each trait for a
professional nurse on a five point scale ranging from
"undesirable" to"extremely important." Two scoring methods
were developed with the participation of 29 nursing faculty
members and 226 practicing nurses. These scoring methods

56
were used to compute professionalization scores for each
student nurse.
The data were analyzed separately for each scoring
method using a 2 X 3 factorial design. The classical re¬
gression solution was used to test the effect of educa¬
tional program, HSGPA, and the interaction of program and
HSGPA on professional socialization (Overall & Spiegel,
1969). Reliability estimates for each scoring method were
calculated using Cronbach's Coefficient Alpha (Nie, Hull,
Jenkins, Steinbrenner & Bent, 1975).

CHAPTER IV
RESULTS
In this study professional socialization of students
in two types of nursing educational programs was analyzed
using two new scoring methods for the NPOS. Scoring
weights for the NPOS were derived using the two tech¬
niques described in Chapter III. These new scoring weights
were then utilized in comparisons of the students 1 total
scores on the NPOS. The results of the statistical tests
for the previously stated hypotheses are presented in this
chapter. Finally, the reliabilities for each scoring
method were estimated.
Hypotheses Testing
Hypothesis 1; When using the Traditional/Nontra-
ditional scoring method, there is no
difference between the mean total NPOS
score of the associate degree and
baccalaureate degree students.
Hypothesis 2; When using the Traditional/Nontra-
ditional scoring methods, there is no
difference in total NPOS scores among
students with different levels of
HSGPA.
57

58
Hypothesis 3: There is no interaction between educa¬
tional program and HSGPA which affects
student scores on the NPOS, using the
Traditional/Nontraditional scoring
me thod.
Data were analyzed using a 2 x 3 factorial design
with educational program and high school grade point
average as independent variables and total score with the
Traditional/Nontraditional method as the dependent vari¬
able. Due to unequal cell sizes and the possibility of a
significant program-grade point interaction the classical
regression solution was used (Overall & Spiegel, 1969) to
test the hypotheses. The means and standard deviations
are shown in Table 6. The results of this analysis are
presented in Table 7. Significant main effects for educa¬
tional program and high school grade point average were
found (F /“l.270_7 = 4.39, p < .05; F /~2,270_7 = 5.12,
P < -05).
The interaction of educational programs and high
school grade point average did not result in a significant
F value. When the Scheffe's procedure for pairwise post
hoc comparisons was employed, students with a B HSGPA
were found to have the highest mean total NPOS score.
Thus, Hypothesis 1 was rejected, indicating there
is a significant difference between associate and

59
Table 6
Means and Standard Deviations of Students Total
Scores by Programs and HSGPA Using the
Traditional/Nontraditional Scoring Method
(n = 276)
Program
Associate degree
Mean
SD
Baccalaureate degree
Mean
SD
Column total
Mean
SD
HSGPA
A B C
170.13 177.53 176.67
15.23 17.04 17.93
167.79 174.32 165.25
18.05 15.21 13.65
168.51 175.97 170.96
17.20 16.20 16.64
Row Total
175.47
16.84
170.61
16.76

60
Table 7
Analysis of Total MPOS Score Computed with the
Traditional/Nontraditional Scoring Method as
a Function of Program Type, HSGPA, and the
Interaction Between Program and HSGPA
(n = 276)
Source
SS
df
MS
F
Program (A)
1203.82
1
1203.82
4.39*
HSGPA (B)
2808.63
2
1404.32
5.12*
A X B
407.58
2
203.79
.74
Residua 1
74110.89
270
274.49
*p < .05

61
baccalaureate degree students in their scores on the NPOS
using the Traditional/Nontraditiona1 scoring method. On
the average, students in the associate degree programs
held a more traditional view of nursing than did students
in the baccalaureate degree programs. Hypothesis 2 was
rejected indicating there is also a difference among levels
of HSGPA across programs. Hypothesis 3, relating the
effects of interaction of educational program and HSGPA
with total NPOS score using the Traditional/Nontraditiona1
method cannot be rejected.
Hypothesis 4: When using the Practicing Nurses
scoring method, there is no dif¬
ference between the mean total NPOS
scores of the associate degree stu¬
dents and the baccalaureate degree
students.
Hypothesis 5: When using the Practicing Nurses
scoring method, there is no dif¬
ference in total NPOS scores among
students with respect to levels
of HSGPA.
Hypothesis 6: There is no interaction between educa¬
tional program and HSGPA which affects
student scores on the NPOS when using
the Practicing Nurses scoring method.
These data were analyzed using a 2 X 3 factorial.
design with educational program and HSGPA as independent
variables and total score with the Practicing Nurses
method as the dependent variable. Due to unequal cell

62
sizes and the possibility of a significant program-grade
point average interaction, the classical regression
approach was used (Overall & Spiegel, 1969). The means
and standard deviations are presented in Table 8. The
results of this analysis are presented in Table 9. No
significant main effect for educational program or HSGPA
was found. Additionally the interaction between HSGPA
and educational program was not significant. Thus,
Hypotheses 4, 5 and 6 cannot be rejected.
Effects on Reliability
The reliability of the NPOS scores derived from the
new scoring schemes was estimated by calculating Cronbach's
Coefficient Alpha. Using the Traditional/uontraditional
scoring scheme, the internal consistency of the NPOS was
£ = .81. When calculated on the practicing nurses scoring
scheme the NPOS internal consistency was £ = .88. These
results indicate that the new scoring systems for the
NPOS have acceptable internal consistencies.
Summary of the Results
For the Traditional/Nontraditional scoring scheme
a 2 X 3 factorial analysis of variance (program and HSGPA)

63
Table 8
Means and Standard Deviations of Students Total
Scores by Programs and HSGPA Using the
Practicing Nurses Scoring Method
(n = 276)
HSGPA
Program A B C Row Total
Associate degree
Mean 199.06
SD 42.73
Baccalaureate degree
Mean 205.92
SD 25.40
Column total
Mean 203.81
SD 31.69
210.93 199.42 206.62
22.26 44.45 31.67
201.50 208.75 204.10
35.18 18.18 29.87
206.34 204.08
29.55 33.55

64
Table 9
Analysis of Total NPOS Score Computed with the
Practicing Nurses Scoring Method as a Function
of Program Type, HSGPA and the Interaction
Between Program and High School
Grade Point Average
(n = 276)
Source
SS
df
MS
F
Program (A)
190.94
1
190.94
.20
HSGPA (B)
781.77
2
390.88
.42
A X B
4549.08
2
2274.54
2.43
Residual
252787.21
270
936.25

65
indicated a significant main effect for educational pro¬
gram and HSGPA. The Practicing Nurses scoring method
yielded no significant main effects. In neither scoring
scheme did the interaction between program and HSGPA
yield a significant F value. These results can be inter¬
preted as follows; (1) the Traditional/Nontraditional
scoring scheme is sensitive to differences in types of
educational programs; the associate degree students were
more traditional than the baccalaureate students, and (2)
the Practicing Nurses scoring scheme was either not
sensitive enough to differentiate the educational programs
or in fact there is no difference between the educational
programs when compared to practicing nurses.
The internal consistency estimates calculated for the
NPOS using the two new scoring schemes were such that
either scoring scheme could potentially be used for the
assessment of professional socialization.

CHAPTER V
DISCUSSION
The two major purposes of this study were (1) to fur¬
ther refine the scoring methods of the NPOS and thereby
broaden its applications, and (2) to compare the mean
total scores on the NPOS of associate and baccalaureate
degree students using the two scoring methods developed.
In this chapter the results will be discussed, limitations
identified, and suggestions for future research offered.
The internal consistencies of the scoring methods
developed for the NPOS, r_ = .81 for the Traditional/Non-
traditional scoring method and r_ = .88 for the practicing
Nurses scoring method,are sufficient to suggest that either
scoring scheme could be used for individual or group assess¬
ment. Both of these scoring methods allow new applications
of the NPOS for the assessment of professional socializa¬
tion. Prior to this study the NPOS had only been used in
measurement of consensus of student and faculty views of
the nursing profession. Though this instrument was an im¬
provement over other available instruments, its applications
66

67
were limited. With the development of these additional
methods for scoring the NPOS, the potential usefulness
of this instrument has been broadened. This will cer¬
tainly promote further research in the area of professional
socialization in nursing.
Traditional/Nontraditional
Scoring Method
When the Traditional/Nontraditional scoring method
was applied to the NPOS, educational program type and
HSGPA had a significant relationship to total NPOS score.
The associate degree students expressed a more traditional
orientation on the NPOS than the baccalaureate degree
students. This finding does not reflect on the degree of
professional socialization either of these groups of stu¬
dents have attained, but rather identifies the orientation
of that socialization. The fact that the associate degree
students were found to have a more traditional orientation
only indicates that their view of nursing is more "tradi¬
tional" as judged by the nursing faculty who rated the
items.
It is interesting that these preliminary results lend
credence to the American Nurses Association position paper

68
on the two types of nurses (American Nurses Association,
1965). The function of technical or associate degree
graduate nurse would be by definition more traditional.
That is, being the care giver she would tend to follow a
more traditional pattern in providing nursing care. Al¬
though new knowledge relevant to patient care would be
incorporated, she would still fulfill a nursing role as
it has been characterized for many years. The bacca¬
laureate degree graduate, defined by the ANA as the pro¬
fessional nurse, would tend to be more nontraditional.
The need to incorporate the cure emphasis in patient care
as well as the promotion of the health and welfare of
those in the community necessitates an alternative or non¬
traditional approach to patient care. While other inter¬
pretations are possible, this finding is evidence of con¬
struct validity of this scoring method.
The significant main effect for high school grade
point average illustrates the importance of considering
this variable in analyzing data of this nature. Including
high school grade point average as a variable allows for
its consideration as both a main effect and as one part
of an interaction. Each student having a particular grade
point average may interact with the professional

69
socialization process in many ways. It is possible that
students with certain grade point averages may incor¬
porate the aspects of professional socialization differently
or to a greater degree. Utilizing the Scheffe's post hcc
procedure for pairwise comparisons it was concluded that
students with a B HSGPA expressed the most traditional
orientations on the NPOS. No explanation can be offered
for this finding.
In any event, control of this important variable may
have enabled detection of a "program" effect that would
have gone unnoticed if HSGPA had not been included as a
factor in this design. This suggests that this variable
should be included in other comparison studies of nursing
educaticn programs.
A significant interaction between educational program
and HSGPA was not found. This lack of a significant inter¬
action was surprising and no set explanation can be offered
for this finding. Possibly admission criteria may have
changed to equalize entrance to junior and senior colleges.
Additionally, the schools included in this study may be
different from other programs of similar types in their
student HSGPA composition.

70
Practicing Nurses Scoring Method
When the Practicing Nurses scoring method was applied
to the NPOS neither educational program or high school
grade point average had a significant relationship to total
NPOS score. Associate and baccalaureate degree students
ware found not to differ in their perceptions of profes¬
sional nursing from the beliefs of practicing nurses. There
are at least two contending interpretations for this lack;
of significant main effect. First, the NPOS, when scored
with this method, may not be sensitive enough to detect
differences that do exist. Considering that the nurses
included in this scoring method were from four different
educational programs (diploma, associate degree, bacca¬
laureate degree, and foreign based), varied broadly in the
number of years practiced, and types of practice settings,
the definition of practicing nurses may need to be more
narrowly defined to produce a scoring method sufficiently
sensitive to detect possible differences in these educa¬
tional programs.
Second, there may in fact be no differences in these
educational programs when students are compared with prac¬
ticing nurses on the NPOS. This does not imply that these

71
students carry out the practice of nursing in a manner
identical to cr even closely similar to that of currently
practicing nurses but rather that they view the fully pro¬
fessional practicing nurse in the same manner.
Although there was no significant main effect for
HSGPA when the Practicing Nurses scoring method was em¬
ployed for scoring the NPOS, inclusion of this variable
remains important in preliminary studies of the assessment
of professional socialization. As was previously mentioned,
inclusion of this variable may enable detection of dif¬
ferences that would otherwise go undetected.
As in the Traditional/Nontraditional scoring method
there was no significant program by HSGPA interaction.
This finding again remains unexplainable.
Limitations of the Study
There are several limitations to this study. Be¬
cause the educational programs were chosen as a mechanism
for testing the scoring methods, the primary limitation
involves sample selection. The results of this study are
not generalizadle to associate and baccalaureate degree
students nationwide. They are applicable only to the
eight schools participating. However, the fact that the

72
scoring schemes worked so effectively for these schools
is promising for their future applications. The demon¬
stration of their usefulness in this preliminary study
makes it possible for the development of broader national
norms in the area of professional socialization in nursing.
The second area is that of the groups chosen for the
development of the scoring methods. The faculty employed
for development of the Traditional/Nontraditional scoring
method were from a baccalaureate degree nursing program
and may not represent the traditional or nontraditional
views of other nurses or faculty. Finally, the practicing
nurses may not have accurately represented the population
of nurses in the United States.
Suggestions for Future Research
In terms of the development of alternate scoring
methods for the NPOS one important suggestion for future
work in this area would be to utilize a broader sample for
the basis of the scoring methods. This would entail
(1) defining practicing nurses and sampling to satisfy
the definition for the Practicing Nurses scoring method,
and (2) utilize faculty from each educational program of
interest as well as practicing nurses to establish the

73
Traditional/Nontraditional scoring method. By incorporating
both of these methods several scoring schemes could be
utilized for very specific purposes in the assessment
of professional socialization.
When comparing students and graduates of educational
programs relative to their professional socialization as
measured by the NPOS a random national sample should be
used for the generalizability of the findings. It is im¬
portant that local or regional studies be used only for
preliminary investigations. The methods and instruments
should then be employed at a national level for the develop¬
ment of national norms. Such norms would be useful for
further application of the NPOS in nursing educational
program evaluation as well as assessment of professional
socialization in nursing practice.
Of interest would also be the investigation of
practicing nurses and their scores on the NPOS relative
to their basic nurses education. Although a preliminary
study was conducted in this area (Rodeghero, 1975), there
were limited implications for the data due to an overly
simplistic sampling strategy. In future research prac¬
ticing nurses should be investigated using the NPOS in
relationship to the area of their nursing practice and
additional nursing degrees acquired.

74
The final suggestion for future research concerns
longitudinal studies. As mentioned earlier, it takes from
months to years to become socialized into a profession.
It is possible that as the length of time in the practice
of nursing increases, there may be a decrease in an
individual's NPOS scores or the scores may in fact remain
the same or increase. Insight into the reason why some
nurses remain in practice while others leave could possibly
be gained from such a longitudinal study.
Applications in Nursing Education
The NPOS with its newly developed scoring methods
has several applications for nursing education. These
applications are primarily focused on program evaluation.
If objectives have been established for a nursing educa¬
tional program that have aspects of a traditional or
nontraditional orientation towards nursing or congruence
with beliefs of currently practicing nurses the NPOS
could be employed for the assessment of the attainment
of the objective (s). Secondly, the faculty's goals for
the graduates of a nursing program could be evaluated by
use of the NPOS with its different scoring methods.
Finally, the NPOS has applications in the current

75
educational programs for previously licensed registered
nurses at the baccalaureate level. If students' profes¬
sional socialization were assessed upon entering the pro¬
gram with the NPOS, upon completion of the program the
change in their socializations could be reinvestigated
with the NPOS.
Before utilizing either of the two new scoring methods
for the NPOS in studies of professional socialization or
program evaluation, the objectives of the investigation
must be clearly defined. These two scoring methods have
virtually no relationship with each other (r_ = .01) and
therefore will produce different results as they did in
this study. The scoring method most appropriate to the
objectives established should be selected.
Summary and Conclusions
This study examined the application of new scoring
methods to an established instrument for the assessment
of professional socialization. The two scoring methods
developed were the Traditional/Nontraditional method and
the Practicing Nurses method. These new scoring methods
were then used to differentiate between baccalaureate and
associate nursing educational programs. Reliabilities of
the two scoring methods were also investigated.

76
A total of 156 student nurses from four baccalaureate
program and 120 from four associate degree programs com¬
pleted the professional socialization scale. Their re¬
sponses were scored using both scoring schemes. Associate
degree students were found to be more traditional in their
orientation than baccalaureate degree students, but no
difference was found between students from the two pro¬
grams when their professional socialization was determined
relative to practicing nurses. Utilizing the Traditional/
Nontraditional scoring method HSGPA had a significant
effect on the mean total NPOS score, but there was no
significant interaction between educational program and
HSGPA with either scoring method. Both scoring methods
yielded high internal consistency coefficients, indicating
that these scoring schemes are sufficiently reliable for
individual or group assessment.
This study demonstrated the potential of improving
available instrumentation in professional socialization
in nursing. When assessing professional socialization in
nursing educational programs consideration should be given
to admission criteria for the programs, since HSGPA was
related to professional socialization. As shown in this

77
study, it is not necessary to limit the application of
an instrument only to its original designated purpose.
New scoring methods and new norm groups may expand the
usefulness of we11-developed, existing instruments.

APPENDICES

APPENDIX A
HOSPITALS AND EDUCATIONAL PROGRAMS
PARTICIPATING IN THIS STUDY

HOSPITALS PARTICIPATING IN THE' STUDY
Hospital State
University of Alabama
in Birmingham Hospitals
Alabama
Bayfront Medical Center
Florida
Parkwood Hospital
Georgia
North Carolina Memorial Hospital
North Carolina
Richland Memorial Hospital
South Carolina
80

81
ASSOCIATE DEGREE PROGRAMS PARTICIPATING
IN THE STUDY
School State
Jefferson State Junior College
Alabama
Georgia State University
Georgia
Fayetteville Technical Institute
North Carolina
Florence-Darlington Technical
College
South Carolina
Columbia State Community
College
Tennessee

82
BACCALAUREATE PROGRAMS PARTICIPATING
IN THE STUDY
School
State
University of Alabama in
Birmingham
Alabama
Valdosta State College
Georgia
Georgia State University
Georgia*
University of South Carolina
South Carolina
University of Tennessee
Tennessee
*A11 students were registered nurses and had to be deleted.

APPENDIX B
SAMPIE ITEMS FROM THE NPOS

SAMPLE ITEMS FROM THE NPOS
Professional Trait Rating Scale
Instructions: This questionnaire is composed of a list of
descriptive characteristics and behaviors.
You are asked to judge how essential each
trait is for the practicing, professional
nurse in fulfilling her role.
If you judge this trait to be:
EXTREMELY IMPORTANT Mark 5
IMPORTANT Mark 4
SLIGHTLY IMPORTANT Mark 3
NOT AT ALL IMPORTANT Mark 2
UNDESIRABLE Mark 1
There are no right or wrong answers for these
items. Judge each one in accordance with
your own personal opinion.
Please note that you have been asked to rate
these traits for the nurse as a practicing
professional only. DO NOT RATE THEIR IM¬
PORTANCE FOR STUDENT NURSES.
1.Quietly and obediently takes doctor's
orders. 1
2 3
2. Questions instructions when the reason
for them is not clear. 1
3. Can usually think of several alterna¬
tive solutions to a problem. 1
4. Learns to accept the death of a
patient with no overt emotional signs. 1 2345
5. Enjoys working with children. 1 2345
84

85
6.Likes to be kept busy.
1 2 3 4 5
7.Always gets a doctor's order before
she initiates care for a patient.
1 2 3 4 5
8.Is willing to function as a counselor
for a patient who wants to discuss his
troubles. 1 2345
9.Enjoys working with patients of
all ages.
10.Punctual and prompt in carrying
out duties.
1 2 3 4 5
1 2 3 4 5
11.Quickly rises to the defense of
medical or hospital practices when
they are criticized by laymen. 1
2
3
4 5

REFERENCES
American Nurses Association (ANA). ANA convention '78:
tomorrow's health/today's challenge. American
Journal of Nursing, 1978, 7_8, 1231-1246.
American Nurses Association (ANA). American nurses asso¬
ciation position on education for nurses. American
Journal of Nursing, 1965, _6!5, 106-111.
Anderson, B. F. Nursing education in community junior
colleges. Philadelphia: J. B. Lippincott Co.,
1966.
Bain, R. N. A study of the effect of several factors on
the performance of nurses on the state board examina¬
tion (Doctoral dissertation. New Mexico State Univer¬
sity, 1974). Dissertation Abstracts International,
1974, 35_, 3320-A. (University Microfilms No. 74-27,
515) .
Bayer, A. E., & Schoenfeldt, L. F. Student interchange-
ability in three year and four year nursing programs.
Journal of Human Resources, 1970, _5, 71-88.
Becker, H. S., & Geer, B. The fate of idealism in medical
school. American Sociological Review, 1958, 23_, 50-56.
Bridgman, M. Collegiate education for nursing. In B.
Bullough & V. Bullouch (Eds.), Issues in nursing.
New York: Springer Publishing Co., Inc., 1966.
Brown, J. S., Swift, Y. B., & Oberman, M. L. Baccalaureate
students' images of nursing: a replication. Nursing
Research, 1974, 2_3, 53-59.
Bullough, V. F., & Bullough, B. The emergence of modern
nursing. London; The MacMillian Co., 1969.
86

87
Corwin, R. G. Professional employee: a study in conflict
in nursing roles. American Journal of Sociology,
1961, 66, 604-615.
Counts, M. M. An analysis of a selected associate degree
and baccalaureate degree nursing curriculum as re¬
lated to graduates' performance of functions in the
medical-surgical area (Doctoral dissertation. The
University of Texas at Austin, 1975). Dissertation
Abstracts International, 1975, 3_6, 2152-A. (Univer¬
sity Microfilms No. 75-24, 855) .
Crocker, L. M. Personal communication, January 20, 1978.
Crocker, L. M., & Brodie, B. J. Development of a scale
to assess student nurses' views of the professional
nursing role. Journal of Applied Psychology, 1974,
_59, 233-235.
Davis, F., & Olesen, V. L. Baccalaureate students'
images of nursing. Nursing Research, 1964, 13,
8-15.
Davis, F., Olesen, V. L. , St Whittaker, E. W. Problems
and issues in collegiate nursing education. In
F. Davis (Ed.) The nursing profession; Five
sociological essays. New York: John Wiley St Sons,
Inc., 1966 .
Davis, G. C. Differentiation of nursing education programs
through identification of nursing functions (Doctoral
dissertation, Texas Technological University, 1972).
Dissertation Abstracts International, 1973, 34,
132-A. (University Microfilms No. 73-16, 267).
Dietz, L., & Lehozky, A. R. History and modern nursing.
Philadelphia; F. A. Davis Co., 1967.
Dolan, J. Nursing in society; A historical perspective.
New York: W. B. Saunders Co., 1973.
Dustan, L. C. Characteristics of students in three types
of nursing education programs. Nursing Research,
1964, 13, 159-166.

as
Eller, V. M. Role orientation toward professional nursing
of students completing associate degree, diploma,
and baccalaureate nursing education programs (Doctoral
dissertation, North Carolina State University at
Raleigh, 1976) . Dissertation Abstracts International,
1977, 3J7, 2770-B. (University microfilms No. 76-2S,
474) .
Facts about nursing 76-77. Kansas City: American Nurses
Association, 1977.
Goldstein, J. D. Comparison of selected characteristics
of graduating nursing students of associate degree
and baccalaureate degree programs (Doctoral disserta¬
tion, Northern Illinois University, 1977). Disserta¬
tion Abstracts International, 1978, _38, 194-A.
(University Microfilms No. 7811176).
Gray, J., Murray, B., Noy, J., & Sawyer, J. Do graduates
of technical and professional nursing programs differ
in practice?. Nursing Research, 1977, _26, 368-373.
Griffin, G., & Griffin, J. History and trends of pro¬
fessional nursing. St. Louis: C. V. Mosby Co.,
1973.
Hartley, G. E. A comparison of baccalaureate and associate
degree nursing students on selected personality charac¬
teristics (Doctoral dissertation, Washington State
University, 1974). Dissertation Abstracts Inter¬
national, 1975, 3_5, 4963-B. (University Microfilms
No. 75-7642).
Hegarty, W. H. Organizational and sociological factors
affecting attrition in collegiate schools of nursing.
International Journal of Nursing Studies, 1975, 12,
217-220.
Hoover, J. Diploma vs degree nurses: Are they alike?.
Nursing Outlook, 1975, _23_, 684-687.
Huntington, M. J. The development of a professional self-
image. In R. K. Merton, G. G. Reader & P. L. Kendall
(Eds.), The student-physician. Cambridge; Harvard
University Press, 1957.

89
Kiniery, G. The evaluation and characteristics of bacca¬
laureate education in nursing. In S. C. M. Frank
& L. E. Herdgerken (Eds.), Perspectives in nursing
education. Washington, D. C.: The Catholic Univer¬
sity of America Press, 1963.
Kramer, M. The new graduate speaks. American Journal of
Nursing, 1966, 66., 2420-2424.
Kramer, M. Role models, role conceptions and role depriva¬
tion. Nursing Research, 1968, 17, 115-120.
Kramer, M. The new graduate speaks again. American
Journal of Nursing, 1969, 69, 1903-1907.
Kramer, M. Role conceptions of baccalaureate nurses and
success in hospital nursing. Nursing Research,
1970, 19, 428-439.
Kramer, M. Reality shock: Why nurses leave nursing. St.
Louis; C. V. Mosby Co., 1974.
Lysaught, J. P. An abstract for action. New York:
McGraw-Hill Book Co., 1970.
Meleis, A. I., & Farrell, K. H. Operation concern: A
study of senior nursing students in three nursing
programs. Nursing Research, 1974, 2_3, 461-468.
Montag, M. L. Where is nursing going?. New York:
National League for Nursing, 1975.
Montag, M. L., & Gotkin, L. G. Community college educa¬
tion for nursing. In B. Bullough & V. Bullough
(Eds.), Issues in nursing. New York; Springer
Publishing Co., Inc., 1966.
Moore, W. E. Occupational socialization. In D. Goslin
(Ed.), Handbook of socialization theory and research.
Chicago: Rand McNally Sc Co., 1969.
Moore, W. E. The professions: Roles and rules. New
York: Russell Sage Foundation, 1970.

90
Nelson, L. F. Competence of nursing graduates in tech¬
nical, communicative, and administrative skills.
Nursing Research, 1978, 27_, 121-125.
Nie, N. H., Hull, C. H., Jenkins, J. G., Steinbrenner, K.,
& Bent, D. H. Statistical package for the social
sciences. New York: McGraw-Hill Book Co., 1975,
(Second edition).
Olesen, V. L., & Davis, F. Baccalaureate students' images
of nursing: A follow up report. Nursing Research,
1966, _15, 151-158.
Olesen, V. L., & Whittaker, E. W. The silent dialogue.
San Francisco: Josey-Bass Inc., 1968.
Overall, J. E., & Spiegel, D. K. Concerning the least
squares analysis of experimental data. Psychological
Bulletin, 1969, 71, 311-322.
Richards, M. A. A study of differences in psychological
characteristics of students graduating from three
types of basic nursing programs. Nursing Research,
1972, 21, 258-261.
Rodeghero, J. A., Jr. Socialization and professional
orientations of nursing students, faculty and
practicing nurses. Unpublished master's thesis.
Bowling Green State University, 1975.
Schmitt, M. H. Role conflict in nursing. American
Journal of Nursing, 1968, 68, 2348-2350.
Siegel, H. Professional socialization in two bacca¬
laureate programs. Nursing Research, 1968, 17,
403-407.
Simpson, I. H. Patterns of socialization into pro¬
fessions: The case of student nurses. Sociological
Inquiry, 1967, 37, 47-54.
Super, D. E. The psychology of careers. New York: Harper,
1957 .

91
Tetreault, A. X. Selected factors associated with pro¬
fessional attitudes of baccalaureate nursing stu¬
dents. Nursing Research, 1976, _25, 49-53.
Thomas, J. T. Professional socialization of students in
four types of nursing education programs (Doctoral
dissertation, University of Florida, 1978). Disserta¬
tion Abstracts International, 1979, 3_9, 5966-A.
(University Microfilms No. 7907801).
Williams, T., & Williams, M. Socialization of the student
nurse. Nursing Research, 1959, 8_, 18-25.
Wren, G. R. Some characteristics of freshman students
in baccalaureate, diploma and associate degree
nursing programs. Nursing Research, 1971, 20,
167-172.

BIOGRAPHICAL SKETCH
Mary Ruth Lynn was born in Seattle, Washington, on
June 2, 1950. She was adopted by Howard and Ruth Lynn in
September of 1950.
In June 1968, she graduated from Clearwater High
School in Clearwater, Florida, and entered Orange Memorial
Hospital School of Nursing in August of the same year. She
graduated from Orange Memorial Hospital School of Nursing
in 1971 with a diploma in nursing. Following this she was
employed as a staff nurse in pediatrics and pediatrics
intensive care at Orange Memorial Hospital for two years.
In 1973, she entered the University of Florida and
received a Bachelor of Science in Nursing in August 1974,
and a Master of Nursing in August 1975. Mary began doc¬
toral study in the Foundations of Education Department at
the University of Florida in the fall of 1975. While in
graduate school she became a graduate teaching assistant
in the College of Nursing and has continued to work there
until the present time coordinating the Individualized
Learning Center.
92

93
She is currently a member of Sigma Theta Tau
(National Nursing Honor Society), Phi Kappa Phi (National
Honor Society), Pi Lambda Theta (National Education Honor
Society), Kappa Delta Pi (National Education Honor Society),
the American Nurses' Association, the American Educational
Research Association, and the National Council for Measure¬
ment in Education.
Mary will be moving to Jackson, Mississippi, where she
has accepted a teaching position at The University of
Mississippi, School of Nursing,starting in August 1979.

I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
Linda M. Crocker, Chairman
Associate Professor of
Foundations of Education
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy
Soar
Professor of Foundations of Education
I certify that I have read this study and that in my
opinion it conforms to acceptable standards of scholarly
presentation and is fully adequate, in scope and quality,
as a dissertation for the degree of Doctor of Philosophy.
Molly G4 Dougherty'
Associate Professor of Nursing
This dissertation was submitted to the Graduate Faculty of
the Department of Foundations of Education in the College
of Education and the Graduate Council, and was accepted as
partial fulfillment of the requirements for the degree of
Doctor of Philosophy.
August 1979
n A
_ i i 1
Chairman-,- Foundations of Education
*â– > p ,
Dean, Graduate School

— Y OF FLORIDA
3 1262 08553 olli^