Strategies of Power, Status, and Control Among Carers in Nursing Homes; Influence on Clinical Learning Environment: A Qualitative Study

Abstract

Introduction: In nursing homes, registered nurses, associate nurses along with physiotherapists and occupational therapists represent different levels and length of education which may induce a struggle for power, status, and control affecting the clinical learning environment. Objective: This study scrutinizes how closure strategies of power, status, and control among health professions may affect the clinical learning environment in nursing homes. Design and Methods: In a qualitative, explorative design a strategic sample was used to explore the experience of power, status, and control in three Norwegian nursing homes aimed at improving the clinical learning environment for healthcare students and apprentices. An interprofessional preceptor team and interprofessional learning teams were established in each of the three nursing homes, facilitating collaboration, competency development, and confidence among the preceptors. Data were collected by focus group discussions and field observations. Results: The findings revealed a formal and informal hierarchy based on status and power among the health professions which influenced the clinical learning environment. Controlling routines became a strategy for the associate nurses to gain control over one's own work, and interprofessional collaboration was replaced by parallel practices. The apprentices followed their preceptors in daily routines and care, while the nursing students followed theirs, mainly conducting professional planning and development. The clinical learning environment was affected by perceived status differences between the professions, particularly evident when the learners participated in the interprofessional learning teams. Conclusion: The findings disclosed challenges concerning interprofessional collaboration, communication, and quality in clinical practice, possibly due to a struggle for power, status, and control among health professions. This seemed to be mirrored in the clinical learning environment representing a negative impact on students’ and apprentices’ opportunities to experience interprofessional collaboration. Interprofessional preceptor teams and learning teams represent possibilities to improve learning conditions and facilitate basic nursing learning.