Background: Patient safety is of paramount importance in healthcare delivery. Following the inquiry into the Mid Staffordshire Health Trust (Francis 2013, 2015), there has been an increasing demand for nurses and other healthcare professionals to be open and candid in a transparent culture where harm and error are minimised. Despite this drive for openness, there is evidence that health care professionals remain reluctant to raise concerns and this includes student nurses as well as registrants. There is however paucity in research focusing upon the underlying factors which prevent student nurses from raising concerns about suboptimal practice. In an attempt to contribute to the discussion, this study will focus upon student nurses. Aim: The overall aim of this research is to understand student nurses’ perception of what they believe is a patient safety incident in their practice placements and understand the reasons that influence their willingness or reluctance to raise concerns about patient safety. Findings: Four main themes emerged from analysing the data: the context of patient safety; team culture; hierarchy and fear of retribution. Analysis and discussion of the data revealed that students were driven to raise concerns as they possessed strong moral and ethical beliefs to uphold patient safety. However, they had an overwhelming desire to fit in with their clinical colleagues and feared retribution and failure if they voiced concerns regarding care. This demonstrated that student nurses were subject to a fluctuating moral compass which was determined by psychological and sociological determinants. Conclusion: This research study has provided information which contributes to our understanding of student nurses’ beliefs about patient safety. It also helps us to recognise the factors that influence student nurses’ willingness or reluctance to speak up. This is important because with an increased understanding of their experiences and beliefs, we are better informed to broaden our teaching on this topic and develop effective policies to protect student nurses who raise concerns.

Professionalism can be a complex concept to define (McLachlan et al. 2002; Finn et al. 2009). Within nursing, the majority of studies have explored professionalism within the clinical environment, and very few examine how student nurses construct their talk regarding professionalism while they study at university, highlighting this as a distinct gap in the knowledge and understanding. The aim of this study was to uncover the discourses used by student nurses and lecturers, and offer insight into the influences on student professional language from within and outside of the nursing profession and offer an appreciation of the processes of language (discourse) adoption. The theoretical position adopted was social constructionism, where it is assumed we jointly construct our world on shared assumptions and that language is central to this process (Potter and Wetherell 2009). The methodological approach employed was Discourse and Social Psychology (DASP) (Potter and Wetherell 1987). Seventeen (17) interviews were conducted. Eight (8) of which were one-off interviews with lecturers. Seven (7) students from adult, child and mental health nursing were interviewed multiple times over the three years of their nursing programme. FIGURE 1 presents an overview of the research process. The analysis suggested that participants drew upon a number of interpretative repertoires and memes. These led to the identification of discursive threads, which were proposed as entangled within discursive knots, serving to position students and lecturers within a dynamic process of professional discourse development. The theoretical perspectives of Foucault, Goffman, Bourdieu and Harre informed the interpretation of the talk. Initially, students were positioned in a place of high surveillance through authoritative language used by lecturers. This position informed the discursive know of 'separation' which serves to maintain student nurses as 'different' and ‘special’, and to distance them from other university students. Clinical practice experience was seen as influencing students’ talk when back in University, emphasising differences. The discursive knot of 'maintaining quality and credibility' questions the 'real' place of nursing and the credibility of lecturers, and brings about a positioning of students that influences agency. The final discursive know of 'permission' is located in the talk of lecturers and final-year student nurses only. This knot illustrates students adopting the discourses of the registered nurse, including the surveillance talk used by lecturers to first-year students. This suggests that final-year students 'become' enforcers and protectors of 'difference'. This study highlights the intricacies and complexities of the 'professionalism discourses' woven into the talk of lecturers and nursing students, and their spread via both the overt and hidden curricula. Indeed, the adoption of the 'permission' discourse by third-year students suggests the perpetuation of a discourse via a socialisation process. The discursive 'knots' seem to function to instill, maintain and perpetuate wider discourses. The 'separation' and 'permission' knots may be viewed as serving to 'other' to maintain the 'specialness' of the profession, while the 'maintaining quality and credibility' knot may indicate tensions related to academic and clinical professional sub-groups and sites of knowledge development.

As part of a high quality nursing student experience within Higher Education there is a need to access the voice of the student. By listening to the students, greater clarity and understanding from the students' perspective is proposed. The focus of this research is within the first year of an undergraduate nursing programme. This thesis gives insight into the experiences and perceptions of undergraduate nursing students' transition into Higher Education and professional transformation, within the first year of a three year proframme. In addition, the research sought to illuminate the participants' personal learning journeys and experiences. There is a dearth of literature addressing various aspects of the first year student experience and minimal literature which represents the student voice. The first year experience is a complex and multifaceted area of study. This complexity is related to the Higher Education organisational processes that are required to enable the student to succeed and the amount of personal investment by each student who enters programmes of learning within a university setting. It has been identified that the first year is the most critical to ensuring that students engage with programmes of learning and achieve both academically and professionally (Trotter and Roberts 2006). To develop insight into the learner's journey a theoretical framework is constructed from within an interpretive paradigm. Hermeneutic phenomenology was selected as a suitable methodology for this research, informed by the work of Max van Manen (1990). The use of hermeneutic phenomenology enable the exploration of participants' experiences. The participants in this research were representative of a typical nursing cohort's profile and, therefore, provided the ideal means of investigating the student nurse experience within the first year. Ten student nurses volunteered to participate in this research and data was collected over a period of one year by use of repeated semi-structured interviews and collection of critical incidents using digital voice recorders. Data was analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Findings from this research identify that the students have developed skills to survive but there was considerable variation in the student experience which impacted on their motivaton and behaviour. A key finding was the ability of students to develop their own skills of coping to deal with the demands of academic life and those of the practice settings. The skills of self-reliance and self efficacy are evident in the findings and are explored in relation to professional transformation.