Shared Experiences Among BSN Students

Aggression and Intimidation in the Academic and Practice Settings

By Jennifer Reeves, DNP, APRN, FNP-BC and Cara Young, PhD, RN, FNP-C, FAANP, FAAN

What are undergraduate nursing students’ relational experiences in clinical and academic settings? Does the impact of experiences of aggression and intimidation influence student outcomes? A study seeks to find out.

Undergraduate nursing student’s experiences are heavily influenced by interactions with their learning environment (Muenks et al., 2020). This influence can be explained through relational cultural theory and the impact that relationships provide in contributing to a person’s growth and development (Sapiro, 2020). In addition, these experiences play a part in shaping a student’s perceptions of self, overall well-being, and professional identity (Oliveira Silva et al., 2021).  Aggressive behavior and intimidation within organizational learning has been associated with a decrease in psychological safety and poor student outcomes (Muenks et al., 2020). Understanding perceptions and the learning environment play a vital role in the success of a learner.

The authors of this study set out to explore undergraduate nursing students’ experiences with aggressive behavior and acts of intimidation in the clinical and academic settings and the impact of those experiences. Investigators developed a survey tool and distributed the survey to nursing students enrolled in five undergraduate nursing programs in Texas. Students provided socio-demographic data and reported if they had experienced aggressive behavior or acts of intimidation from: (1) a clinical preceptor, (2) another student, and/or (3) a faculty member while in school. Participants that reported acts of aggression were asked to report the frequency of these experiences, if they shared their experiences with anyone, and if they believed sharing their experience made a difference in the situation.

Students showed representation in all cohorts ranging from sophomore second semester to senior second semester of nursing school. They most commonly reported experiencing aggression and intimidation from faculty, followed by clinical preceptors and peers. Students reported substantial impact on emotional and mental well-being and selfesteem. Over 45% of students reported these experiences caused them to consider changing career paths from nursing. More than 81% of students reported they had shared their experiences with another. However, of those students who reported to a faculty member or administration, only four reported that it changed the situation. Students that did not share their experiences reported being afraid of retaliation or distrust in the ability to change the situation.

Within the survey, students were provided an opportunity to expand on their experiences with aggression and intimidation and themes were analyzed. One theme that emerged was that of “belonging.” Students expressed disappointment and discouragement when excluded from participating in their clinical settings. For example, one student shared that they were told to, “Sit down, shut up and don’t bother anybody.” Students shared feelings of being dismissed, unwanted, ditched or left behind by a preceptor.  Students described being received with eye-rolling, or “I don’t have time for a student.”

“Trustworthiness” emerged as a common theme, highlighting the importance of the quality of the relationship made within the learning environment.

Another student reported being told, “I was wasting my time with nursing and that it is not a good profession, especially for someone like me.” Within their peer groups, students reported feeling alienated, and viewed aggression and intimidation as “calling someone out” publicly or “making others feel stupid.”

“Trustworthiness” also emerged as a common theme, highlighting the importance of the quality of the relationship made within the learning environment. With faculty, students reported feeling intimidated and scolded. Students perceived faculty as having power over their grade, and often shared feeling a lack of control or distrust over the result of a grade. They shared a perception that their grades were heavily influenced by the subjective nature of the faculty member, and also perceived failure as a threat from faculty instead of an objective result of their work. Among peers, social media was a contributing factor for students who reported negative experiences. One student described a situation when a video was posted on social media without the student’s permission, resulting in the student feeling humiliated.

The learning environment of the undergraduate nursing student impacts students’ perceptions and academic success (Muenks et al., 2020). The civility of that environment and those involved must be considered when addressing the needs of undergraduate nurses. Increasing the nursing workforce is vital for meeting the healthcare needs of our growing population. Those involved in educating nurses should support more positive interactions between students and preceptors as well as promote a psychologically safe learning environment to improve overall contributions for a more positive nursing culture. 

Jennifer Reeves, DNP, APRN, FNP-BC is [title] at Sam Houston State University School of Nursing and Cara Young, PhD, RN, FNP-C, FAANP, FAAN is [title] at The University of Texas at Austin School of Nursing

REFERENCES

Muenks, K., Canning, E. A., LaCosse, J., Green, D. J., Zirkel, S., Garcia, J. A., & Murphy, M. C. (2020). Does my professor think my ability can change? students’ perceptions of their stem professors’ mindset beliefs predict their psychological vulnerability, engagement, and performance in class. Journal of Experimental Psychology: General 149 (11), 2119–2144. https://doi.org/10.1037/xge0000763

Oliveira Silva, G., Aredes, N., & Galdino-Júnior, H. (2021). Academic performance, adaptation and mental health of nursing students: A cross-sectional study. Nurse Education in Practice, 55 , 103145. https:// doi.org/10.1016/j.nepr.2021.103145

Sapiro, B. (2020). Assessing trustworthiness: Marginalized youth and the central relational paradox in treatment. Children and Youth Services Review 116 , 105178. https://doi.org/10.1016/j. childyouth.2020.105178