Abstract:
Nursing students assessed as being unsafe by nurse educators present specific
challenges in tertiary education organisations. Nurse educators and education
administrators are required by law to respect the rights of students to receive education,
if it is deemed they will benefit from it. As registered nurses, nurse educators are also
required by law to protect the public from unsafe nursing practice. The focus of this
study is the management of unsafe nursing students within the tertiary education
context. The moral dilemmas experienced by nurse educators, specifically linked to the
issue of accountability for public safety, are explored.
The theoretical framework for the thesis is informed by the two moral voices of justice
and care identified by Gilligan and further developed using the work of Hekman and
Lyotard. Case study methodology was used and data were collected from three schools
of nursing and their respective educational organisations. Interviews were conducted
with nurse educators and education administrators who had managed unsafe nursing
students. Interviews were also conducted with representatives from the Nursing Council
of New Zealand and the New Zealand Nurses Organisation to gain professional
perspectives regarding public safety, nurse education and unsafe students. Transcripts
were analysed using the strategies of categorical aggregation and direct interpretation.
Issues identified in each of the three case studies were examined using philosophical
and theoretical analyses.
This thesis explores how students come to be identified as unsafe and the challenges
this posed within three educational contexts. The justice and care moral voices of nurse
educators and administrators and the ways in which these produced different ways of
caring are made visible. Different competing and conflicting discourses of nursing and
education are revealed, including the discourse of safety - one of the language games of
nursing. The way in which participants positioned themselves and positioned others
within these discourses are identified. Overall, education administrators considered accountability for public safety to be a
specific professional, nursing responsibility and not a concern of education per se. This
thesis provides an account of how nurse educators attempted to make the educational
world safe for patients, students, and themselves. Participants experienced different
tensions and moral dilemmas in the management of unsafe students, depending upon the
moral language games they employed and the dominant discourse of the educational
organisation. Nurse educators were expected to use the discourses of education to make
their case and manage unsafe students. However, the discourses of nursing and
education were found to be incommensurable and so the moral dilemmas experienced
by nurse educators were detected as differends. This study bears witness to these
differends.