Graduation Year

2009

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Nursing

Major Professor

Mary E. Evans, Ph.D.

Keywords

Accelerated nursing program, Grounded theory, Physician migration, Physician-nurses, Transprofessional

Abstract

A unique breed of nurses for the US market is emerging-the Physician-Nurses. They are foreign-educated physicians who have retrained as nurses. The purpose of this study was to generate a theory that can explain the development of their nursing identity. Specific aims were to discover barriers that participants perceived as problematic in their transition to nursing and catalysts that influenced how they addressed the central problematic issue they articulated. Grounded theory methodology guided by the philosophical foundations of symbolic interactionism was used. Twelve Physician-Nurses were interviewed. Transcribed interviews were imported to ATLAS.ti. Text data were analyzed by constant comparative method. Concept formation, development, modification and integration were accomplished through different levels of coding. Methods were employed to ensure trustworthiness of findings.

Core categories were discovered and a central social psychological problem experiencing the burdens of a new beginning and a basic social psychological process combining the best of two worlds emerged. Further theorizing generated the substantive theory combining the best of two worlds and the beginnings of a formal theory. The substantive theory explained the three-dimensional central problem and the five-stage basic social psychological process. Dimensions of the central problem were (a) crossing cultures, (b) starting from zero, and (c) crossing professions.

Stages of the basic process were (a) letting go of professional identity as physician, (b) experiencing growing pains, (c) seeing nursing as a saving grace, (d) gaining authority to practice as a nurse, and (e) engaging self to nursing and asserting "I am a nurse." The substantive theory is a springboard toward the development of a formal theory which may be able to further explicate the development of nursing identity in Physician-Nurses. This theory named, Theory of Transprofessionalism, was initially conceptualized as having five phases namely: (a) disengagement, (b) discouragement, (c) enlightenment, (d) encouragement, and (d) engagement. These stages correspond to the five stages of the substantive theory. The key concept nursing identity was operationalized by utilizing three statements published by the American Nurses Association that describe the professional registered nurse, the knowledge base for nursing practice, and the code of ethics for nurses.

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