Shifting Paradigms: The Development of Nursing Identity in Foreign Educated Physicians Retrained as Nurses Practicing in the United States

Written by Liwliwa Reyes Villagomeza

doi: hhttps://doi.org/10.13178/jnparr.2019.09.02.0907

Abstract

Background: A unique breed of nurses for the US market is emerging —Transprofessional Physician-Registered Nurses (TP-RNs). They are foreign-educated physicians (FEPs) who have retrained as nurses and are now practicing in the United States (US). Shifting from a discipline traditionally viewed as more prestigious than nursing, development of their nursing identity is fundamental in their transition to nursing practice.

Objective: The purpose of this study was to generate a theory that can explain the devel-opment of nursing identity in TP-RNs. 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.

Methods: This is a qualitative study using grounded theory methodology. IRB approval was obtained from the University of South Florida. Twelve TP-RNs were interviewed. Transcribed interviews were imported to ATLAS.ti. Text data were analyzed by constant comparison. Concept formation, development, modification, and integration were accomplished through different levels of coding and through theorizing. Methods were employed to ensure trustworthiness of findings.

Results: 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 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.

Conclusions: 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 TP-RNs. This theory named Theory of Transprofessionalism is conceptualized as having five phases: (a) disengagement, (b) discouragement, (c) enlightenment, (d) encouragement, and (e) engagement. These phases correspond to the five stages of the substantive theory.

Keywords: nursing identity, foreign educated physicians, grounded theory, TP-RNs, theory of transprofessionalism