'They're not doing too much are they?' How the socialization of registered nurses perpetuates status differences with certified nursing assistants: A qualitative study.

Background: Limited knowledge exists about how the socialization of vocationally trained registered nurses both at school and during internships in the community of practice influences their perception of, and working relationship with certified nursing assistants.

Objectives: This paper studies, first, how registered nurse students internalize the perceptions and discourses about certified nursing assistants conveyed by teachers, mentors and other students during their socialization at school and in the community of practice. Second, it examines how this socialization forms student's perception of, and actual working relationship with certified nursing assistants.

Design: Qualitative descriptive and exploratory study using an interpretative framework.

Methods: Individual in-depth interviews were conducted with 15 registered nurse students that were in their third or fourth year of training.

Results: The findings reveal that at school the division of tasks and working relationship between registered nurse students and certified nursing assistants was very rarely discussed explicitly. However, teachers and students implicitly and explicitly conveyed that certified nursing assistants have lower status, describing the latter's role as inferior and as assisting to the role of registered nurses. During internships in the community of practice, some students initially adjust this perception when directly working with certified nursing assistants, who generally are their mentor in the first years of training, consider certified nursing assistants as equal and highlight the interdependence of the two occupational groups. Yet, further in their training, registered nurse students start to relate more to graduated registered nurses and reproduce the dominant perception and discourse that certified nursing assistants are inferior and supposed to support registered nurses, thereby perpetuating pervasive status differences and inequality.

Conclusion: Findings will assist nurse educators both in training centers and in the community of practice to understand how education can be used to end pervasive status differences and foster mutual respect and equity between different designations in nursing.