Walking on unstable ground: exploring registered nurses’ and licensed practical nurses’ experiences of learning to work together using a methodologically plural approach




Butcher, Diane

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My own experiences of disjuncture sparked questions related to how practical nursing education is situated within the larger nursing disciplinary landscape. On acute care nursing units, work relationships are changing between RNs and LPNs as new collaborative care models are introduced, creating ambiguity and confusion with increasingly overlapping scopes of practice. Gaps remain in knowing how RNs and LPNs experience changes in these intra-professional team contexts, and how patient care, nursing work, and nursing education may be influenced by these new collaborative models. This has been the foundation for the journey towards graduate study and this dissertation work. In this dissertation I address the overarching research question: How are registered and practical nurses’ experiences of learning to work together being organized by educational and work contexts? This question consists of two sub-questions: 1) What are the experiences of pre-licensure health professional students and educators learning to work in intra-professional teams? and, 2) How are institutional texts organizing post-licensure nurses’ experiences of learning to practice on intra-professional teams? The first sub-question is addressed using the Joanna Briggs Institute (JBI) qualitative systematic review methodology to reveal what is currently known about how pre-licensure health professional students learn to work on intra-professional teams. The second question is approached using an institutional ethnographic analytic lens to explore how post-licensure nurses’ (RNs and LPNs) work is socially organized via educational, union, health authority, and regulatory texts and how this social organization impacts intra-professional relationships. Taking a plural approach to knowledge construction allows for a multi-perspectival view of RNs and LPNs experiences and the role of educational and work contexts in shaping how they learn to work together. Incorporating methodologies as diverse as a JBI systematic review and institutional ethnography raises methodological tensions. Each has its own philosophical assumptions, reflecting particular strengths and limitations in the production of knowledge. The challenges of employing a plural approach are explored alongside new knowledge and possibilities for exploring and understanding how best to care for patients and educate students within complex, collaborative environments.



systematic review, methodological plurality, qualitative research, intraprofessional learning, philosophical inquiry