Role Discrepancy is It a Common Problem Among Nurses | Nursing | Validity (Statistics)

N U R SI N G A N D H E A L T H C A R E M A N A G E M E N T A N D P O L I C Y

Role discrepancy: is it a common problem among nurses?
Miyuki Takase
BN MN PhD RN

Assistant Professor, School of Health Science, Tottori University, Tottori, Japan

Phillip Maude

BScN MN PhD RN

Senior Lecturer, School of Nursing, The University of Melbourne, Carlton, Victoria, Australia

Elizabeth Manias

BPharms MPharms MN PhD RN

Associate Professor, School of Nursing, The University of Melbourne, Carlton, Victoria, Australia

Accepted for publication 20 February 2006

Correspondence: Miyuki Takase, School of Health Science, Tottori University, 86 Nishi-Machi, Yonago-Shi, Tottori 683-8503, Japan. E-mail: m.takase@pgrad.unimelb.edu.au

TAKASE M., MAUDE P. & MANIAS E. (2006)

Journal of Advanced Nursing

54(6), 751–759 Role discrepancy: is it a common problem among nurses? Aim. This paper reports a study of nurses’ perceptions of the differences between ideal and actual nursing roles, how these perceptions differ according to length of experience and the factors that might contribute to these perceived differences. Background. The literature suggests that nurses tend to experience role discrepancy or a mismatch between their ideal and actual roles. Although it has been assumed that experienced nurses perceive less role discrepancy than inexperienced nurses, either because the former adjust themselves to their actual practice or because they have the expertise to improve their practice, this assumption has not been tested. Methods. A survey design was used and the data were collected in 2003. Selected items from the Jefferson Survey of Attitudes Toward Physician–Nurse Inventory and the Staff Nurse Role Conception Inventory were administered to 216 Registered Nurses in Victoria, Australia to measure their perceptions of ideal and actual nursing roles. Data were analysed using a t-test and regression analysis. Results. Nurses with more clinical experience rated their ideal and actual nursing roles more positively than those with less experience. However, the results showed that both groups of nurses experienced the same degree of role discrepancy. Both groups perceived strong role discrepancy in the areas of organizational decisionmaking and provision of patient education. Experienced nurses also perceived moderate role discrepancy in developing nursing care plans and in the freedom to initiate referrals. Conclusions. Role discrepancy cannot be resolved by having more clinical experience. While clinical experience enhances nurses’ conceptions of their ideal roles, it can also lead to role discrepancy if there are organizational barriers that prevent nurses from engaging in their ideal roles. It is important to find a way whereby nurses can actualize their ideal views of practice in the current healthcare environment. Keywords: Jefferson Survey of Attitudes Toward Physician–Nurse Inventory, nursing roles, reality shock, Registered Nurses, Staff Nurse Role Conception Inventory, survey

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Introduction
Many nursing graduates face reality shock caused by differences between their expectations and the reality of their clinical practice (Kramer 1974). One cause of reality shock is role discrepancy, which refers to the incongruence between their ideal roles and the roles they actually engage in at work. Role discrepancy occurs because the roles that new graduates were taught in schools to adopt as their professional responsibilities, are often difficult to actualize in the workplace – due to undue workloads, organizational policies focusing on cost containment and conflict with other healthcare professionals at work. Role discrepancy is a serious problem as it could contribute to nurses’ intentions to leave their jobs (Takase et al. in press). Unfortunately, the experience of role discrepancy is not unique to newly graduated nurses. Literature suggests that it is a common phenomenon experienced by nurses in general (Bourgeois 1991, Blegen et al. 1993, Takase et al. 2005). However, a question arises as to whether or not nurses with more experience share the same degree of role discrepancy with less experienced nurses. Investigating such a research question enables nursing managers and organizations to develop strategies to reduce the role discrepancy and to retain both junior and experienced nurses.

Background
Few studies have investigated the discrepancy between ideal and actual nursing roles perceived by nurses and how these perceptions differ depending on the length of their clinical experience. The effect of clinical experience on nurses’ perceptions of role discrepancy is unknown. Nevertheless, it is plausible to assume that a long tenure could help to mitigate such a burdensome experience. Organizational literature suggests that individuals are negotiating agents who strive to achieve adjustment to their work environment during the course of their employment (Dawis & Lofquist 1984). The forms of negotiation used by individuals include: adjusting themselves to the environment; changing the environment in a way that corresponds to their occupational needs; and leaving their work to look for a more suitable environment (Dawis & Lofquist 1984, Walsh & Holland 1992, Dawis 2000). It is these negotiating nature and skills of human beings that may differentiate the extent of role discrepancy felt between experienced and less experienced nurses. Despite a lack of empirical evidence as to the effect of clinical experience on nurses’ perceptions of role discrepancy, the nursing literature appears to support the assumption that nurses with more experience could achieve a better congru752

ence in their roles than less experienced nurses. The literature also suggests that this congruence could be achieved in the following two ways. The first way of achieving role congruence is to adjust an individual’s role preferences to their existing or available roles. In other words, this type of congruence could occur as a result of nurses abandoning some of their role preferences in accordance with the degree of their actual involvement. For example, a lack of opportunities for nurses to participate in clinical decision-making has been reported (Coombs & Ersser 2004), and this lack of opportunities may motivate nurses to detract from the role of decision-making to achieve role adjustment. Indeed, Joseph (1985) found that more experienced nurses declined to engage in decision-making compared with less experienced nurses because they learned that challenging the decisions of physicians could lead to tensions. Blegen et al. (1993) also reported that nurses with 1–5 years experience desired independence in patient care and advocacy, while nurses with more than 15 years of experience and aged over 50 years preferred to leave to, or share, decisions with others such as doctors. The second way of nurses achieving adjustment is to change their work environment in accordance with their professional preferences. This type of adjustment is more preferable compared with the previous way of nurses withdrawing from their professional roles. Nurses’ capacity to change their environment could be developed as a result of long-term professional development. Nurses go through various stages of professional development as a result of a positive clinical experience and socialization with professional role models and colleagues (Fitzpatrick et al. 1996). More experienced nurses, hence, may have more opportunities to assimilate skills, knowledge and values necessary for their work compared with less experienced nurses, which could elevate their expectations toward their roles. Nurses with a long tenure are also likely to have more power to change their environment in accordance with their role preferences due to a long-earned recognition for their work and organizational and negotiating skills acquired. In fact, a comparative, correlational study undertaken by Wynd (2003) reported that experienced nurses tended to have more autonomy in their practice and showed a stronger orientation to their nursing service than less experienced nurses. A review of literature indicates that experience can enable nurses to learn how to adjust their environment (Joseph 1985, Blegen et al. 1993, Wynd 2003). However, a lack of empirical evidence, coupled with the mixed implications as to how such an adjustment can be achieved, could inhibit the use of measures to facilitate the professional development of both inexperienced and experienced nurses. Thus, it is

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important to examine the degree of role discrepancy perceived by nurses with different lengths of clinical experience and to explore what factors may contribute to their perceptions of ideal–actual role discrepancy.

The study
Aims and hypotheses
The aims of the study were to answer the following research questions: • How do nurses with different lengths of clinical experience perceive their ideal and actual nursing roles? • How do nurses with different lengths of clinical experience perceive the discrepancy between their ideal and actual roles? The hypotheses tested were: • Nurses with less clinical experience perceive their ideal and actual roles differently from those with more clinical experience. • Nurses with less clinical experience perceive the discrepancy between their ideal and actual roles differently from those with more clinical experience.

Design
A survey design was adopted and the data were collected in 2003.

nursing roles. The latter comprised 10 items, which were categorized into two factors. The first factor consisted of eight items measuring perceptions of the use of nursing skills (e.g. participation in clinical and organizational decisionmaking, providing patient education and providing emotional support). The second factor consisted of two items assessing delegation of basic nursing care to ancillary personnel (i.e. assisting patients’ daily activities and hygiene measures). These items were selected from the Jefferson Survey of Attitudes Toward Physician–Nurse Inventory (Hojat et al. 1999) and the Staff Nurse Role Conception Inventory (Taunton & Otteman 1986). Minor rewording of the original items was done in accordance with the purpose of the study. These items were rated using a six-point Likert scale, with a high score indicating strong desire to engage in various nursing roles and a perception that these roles were adopted in actual practice. The questionnaires were distributed to the hospital and university samples. For the hospital samples, the survey packages were distributed by nurse unit managers at our request. Completed questionnaires were returned by replypaid envelops. For the university sample, we distributed questionnaires to students in classrooms. Some students completed the questionnaires within the classrooms and returned them directly to us. Others completed them at home and returned them using reply-paid envelopes.

Validity and reliability
Three methods were used to establish the validity of the instrument. First, a panel review was conducted by six nursing experts, who evaluated the relevance of each question in the instrument according to the study’s purposes. The Index of Content Validity (Waltz et al. 1984) was used in this review to calculate the level of agreement among the experts. Second, the instrument was pilot-tested with 16 postregistration students. Their feedback was used to refine the wording of the questions and the design of the questionnaire. Finally, factor analysis was conducted to establish the construct validity of the instrument. The results of this are reported below. Reliability was evaluated using Cronbach’s alpha. We identified a reliability of 0Æ62 for the instrument measuring nurses’ perceptions of their overall ideal roles. A reliability of 0Æ77 was identified for the instrument measuring the overall actual roles.

Participants
This study is part of a larger project that investigated various aspects of ideal–actual nursing practices and their impact on nurses’ work behaviour. The original sample consisted of 346 Registered Nurses from two teaching hospitals and a university in Victoria, Australia. Of this sample, 216 nurses were included in the current study and classified into two groups. One group consisted of those with £4 years of clinical experience (n ¼ 108). The other group consisted of nurses with ‡13 years of experience (n ¼ 108). These experience categories were chosen because the findings by Blegen et al. (1993) suggest that 10 years of clinical experience may allow nurses to adjust to the environment by changing their conceptions of ideal roles. These categories were also chosen to retain appropriate sample sizes for statistical analysis.

Data collection
The questionnaire contained demographic questions and measures of nurses’ perceptions of both their ideal and actual

Ethical considerations
Approval was obtained from all participating institutions. The questionnaires were accompanied by information sheets
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explaining the study purposes and procedures. The anonymity and voluntary nature of participation were also emphasized. Consent to participate was assumed by return of a questionnaire.

Data analysis
Independent t-tests were used to compare perceptions of ideal nursing roles between less and more experienced nurses and to compare their perceptions of actual nursing roles. Next, the differences between the ideal and actual nursing roles perceived by these two groups were examined by a paired ttest. Finally, a two-step hierarchical regression analysis was conducted to examine if the degrees of role discrepancy perceived by less and more experienced nurses differed. In the first step of the regression analysis, the scores for nurses’ perceptions of their ideal roles were regressed on the scores for actual nursing roles, demographic variables, group membership and the interaction terms between demographic variables and group membership. In the second step, the interaction term for actual nursing role scores and group membership was entered into regression analysis. The aim of the first step was to control the main effects of demographic variables, group membership and perceived actual roles on nurses’ perception of their ideal roles. The aim of the second step was to see if length of clinical experience moderated the difference between ideal and actual nursing roles (see Cohen et al. 2003).

Results
The response rate in the original study (n ¼ 346) was 36Æ7%. Of the 216 nurses in the study, 92Æ6% were female. The mean age of participants was 34Æ5 years (26Æ6 years for the less experienced group and 43Æ3 years for the more experienced group). The majority of participants (60Æ2%) worked more than 35 hours per week and held clinical positions (90Æ7%). Approximately, half had bachelor’s degrees, followed by 25% having higher degrees and 20% having nursing

diplomas. In addition, 41Æ2% of the participants were studying at universities for bachelor’s degrees or postgraduate qualifications. Up to 1994, nursing diplomas were offered under the previous nursing educational scheme in Australia, and required 3 years of hospital-based training leading to registration. However, the diploma course no longer exists, as the bachelor degree has become the minimum qualification required for registration. As for areas of practice, participants came from 16 clinical areas. Of 216 nurses, 23Æ6% were from surgical wards and 22Æ2% from either intensive care units or emergency departments. Nurses from each of the following wards, medical, mental health, paediatric, palliative care and cardiac wards, represented 6–8% of the sample respectively. The remainder, such as those from orthopaedics, gerontology, rehabilitation and oncology, comprised a small portion of the study participants. As shown in Table 1, nurses with ‡13 years of clinical experience had statistically significantly more desire to use their nursing skills and to engage in task delegation practice than those with £4 years of experience. Table 1 also shows that those with ‡13 years of clinical experience tended to perceive themselves using more nursing skills and engaging in task delegation to a greater extent than those with less experience. In particular, experienced nurses had statistically significantly more opportunities to delegate basic nursing care to others than their less experienced counterparts. As for the discrepancy between ideal and actual nursing roles, the results of a paired t-test suggest that both groups rated their ideal roles in the use of nursing skills and task delegation practice statistically significantly higher than their actual roles. Both groups also perceived a greater role discrepancy in the use of nursing skills (t ¼ 12Æ72, P < 0Æ01, for nurses with £4 years of experience; t ¼ 11Æ66, P < 0Æ01 for nurses with ‡13 years of experience) than task delegation (t ¼ 3Æ78, P < 0Æ01, for nurses with £4 years of experience; t ¼ 3Æ54, P < 0Æ01 for nurses with ‡13 years of experience). These results indicate that both groups experienced role discrepancy.

Table 1 Comparison of ideal and actual nursing roles between less and more experienced nurses Ideal roles Variables and factors Overall Factor I: the use of skills Factor II: task delegation £4 years 4Æ86 (0Æ53) 4Æ99 (0Æ56) 4Æ32 (1Æ26) ‡13 years 5Æ13 (0Æ54) 5Æ24 (0Æ54) 4Æ73 (1Æ20) t-value 3Æ78** 3Æ24** 2Æ46* Actual roles £4 years 3Æ96 (0Æ70) 4Æ02 (0Æ74) 3Æ75 (1Æ57) ‡13 years 4Æ23 (0Æ86) 4Æ22 (0Æ92) 4Æ24 (1Æ51) t-value 2Æ45* 1Æ81 2Æ31*

Values are given as mean (SD ). As to the t-values at the factor level, significance was controlled by the sequential Bonferroni procedure. *P < 0Æ05; **P < 0Æ01. n ¼ 216. 754 Ó 2006 The Authors. Journal compilation Ó 2006 Blackwell Publishing Ltd

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Figures 1 and 2 illustrate the role discrepancies perceived by less and more experienced nurses respectively. The first eight items from the left describe the use of nursing skills and the next two items describe task delegation practices. As shown in Figure 1, nurses with £4 years of experience tended to perceive greater discrepancies in providing patient education and decision-making on work and support policies. In particular, a large gap was observed between their desire to participate in decision-making on work policy and their perception of the actual opportunity for participation. As for the remainder of nursing roles, their ideal and actual roles show more congruence, although the

scores for ideal roles were higher than those for actual roles. With reference to the discrepancy between ideal and actual nursing roles perceived by more experienced nurses, Figure 2 shows that they also perceived ideal–actual role discrepancies in providing patient education and organizational decisionmaking, in particular in relation to decision-making to support policy. Unlike those with £4 years of experience, however, nurses with ‡13 years of clinical experience tended to perceive more fluctuations in other areas of the relationships between their ideal and actual roles. For instance, while experienced nurses tended to perceive moderate
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correspondences in the provision of emotional support to patients and task delegation practice, they experienced mild role discrepancies in developing patient care plans and in the freedom to initiate referrals. Although there were some differences in perceptions of the ideal–actual role discrepancy between less and more experienced nurses, the results of the hierarchical regression analysis suggest that these differences are not statistically significant. The coefficients on the interaction terms between actual role scores and group membership in the second step of the analysis were nearly zero (i.e. 0Æ00 for the use of nursing skills and 0Æ03 for task delegation practice, P > 0Æ05 for both coefficients). In other words, length of clinical experience did not moderate the difference between perceived ideal and actual nursing roles.

Discussion
A cautious interpretation of the findings is prudent. One of the reasons for such caution is the limited generalizability of the findings. Our participants were nurses employed in one of two hospitals and students undertaking a postgraduate course at a university. The university students were recruited to enhance the representativeness of the sample, as these students worked in a variety of clinical settings. However, the fact that the university students comprised 36Æ1% of the sample indicates that highly educated nurses may be overrepresented in the sample. This possible over-representation could cause heterogeneity of the sample compared with the entire Australian nursing population, thus reducing the generalizability of the findings. Also contributing to a limited generalizability of the study findings is the low response rate. As already mentioned, these data are part of a larger study investigating various aspects of ideal–actual nursing practices and their impact on nurses’ work behaviour. To capture a range of factors in nursing practice, a large number of questions were included in the questionnaire, and this may have discouraged many nurses from participating. To give more accurate pictures of the role discrepancy perceived by nurses and to develop sensitive measures to reduce such an unpleasant work experience, replication of the study with a more representative sample is required. Another weakness of the study arises from the relatively low reliability of the instrument that measured nurses’ conception of their ideal roles. Corwin’s Role Conception Scale is an alternative instrument for measuring nurses’ perceptions of their roles, but this also suffers from low reliability and validity (Merritt 1997, Taylor et al. 2001). Therefore, development of a more reliable instrument is necessary.
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Despite these limitations, the present study gives insight into how both less and more experienced nurses perceive role discrepancy. Both had positive conceptions of their ideal roles and the latter were rated higher than their perceptions of actual roles. Positive conceptions of ideal roles may be fostered through the professionalization of nursing. In particular, the move of nursing education into universities has played a major role in Australia. It has been over 10 years since all nursing education programmes were transferred to tertiary institutions in Australia. The educational transfer means that all less experienced nurses have been exposed to theoretical ideas about nursing as a profession. Such theoretical components include education for professional decision-making, leadership, ethics and evidence-based practice. The transfer of nursing education also established postregistration nursing courses which allow former hospital-based diplomate nurses to obtain a bachelor’s degree and pursue postgraduate studies. These educational changes may have increased nurses’ professional self-concepts and sense of responsibility. However, moving nursing towards being an academic profession has been said to have created a distance between nursing education and clinical practice (Walsh & Jones 2005). As a result, nurses may experience disharmony between roles they were inspired to assume during education and those they perform in actual practice. Such disharmony is influenced by organizational factors such as cost-containment policies, heavy workloads and a hierarchical relationship between doctors and nurses. Nevertheless, fostering a positive conception of ideal roles is crucial in nursing practice. A recent study suggests that embracing ideal roles of their own contributes to better nursing performance, as their idealism could serve as a guide for their professional practice (Takase et al. in press). In this regard, nursing education is considered essential to deliver a high standard of care. On the other hand, it leaves tasks for educational institutions to deal with role discrepancy. One possible solution is to work collaboratively with healthcare institutions to ensure that what is taught in universities is congruent with what nurses do in actual practice. Another possible solution is to equip students with skills to promote their practice in a way that corresponds to their ideal roles. As for the comparison between less experienced and experienced nurses, our results show that experienced nurses tend to have more positive conceptions of their ideal roles than less experienced nurses. These results contradict the findings of previous studies, which indicate a gradual decline of experienced nurses’ intentions to engage in some of their roles, such as decision-making (Joseph 1985, Blegen et al. 1993). On the other hand, our results support the positive

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effect of professional socialization on the development of nurses’ ideal role conceptions. Longer clinical experience allows nurses to have more time and opportunities to engage in professional socialization. Socializing with clinical role models and assimilating their conceptions of professional nursing roles is one form of professional socialization (Fitzpatrick et al. 1996) and this could enhance nurses’ views of their ideal roles. Another form of professional socialization occurs through tertiary education, as has been discussed above. In particular, approximately 40% of the experienced nurses in this study had already completed postgraduate courses. Thus, exposure to tertiary education may have also contributed to experienced nurses’ embracing more positive views of their ideal roles than their less experienced counterparts. The results show that experienced nurses also perceive themselves as engaging in more of their anticipated clinical roles than less experienced nurses. This level of engagement may be because experienced nurses have more clinical and time-management skills for providing a range of nursing services to patients as a result of a long-term professional development than less experienced nurses. More experienced nurses also tend to earn more recognition and seniority in the workplace, which makes it easier for them to delegate tasks to ancillary personnel than it is for less experienced nurses. Although experienced nurses tended to develop their conceptions of ideal roles more positively and engage in more of these roles than less experienced nurses, it is surprising to note that both groups of nurses experienced the same degree of role discrepancy. One of the reasons could be the adaptability of new graduates. The literature suggests that graduate nurses experience stages of adjustment to their work during the first year of professional life (Kelly 1998, Delaney 2003). A swift adjustment is necessary for graduate nurses to reduce the experience of reality shock, which could be a considerable burden to them. If this early adjustment process were evident in first year nurses in our sample, grouping nurses with £4 years of clinical experience and comparing their perceptions of role discrepancy with their experienced nurses would be inappropriate. The true effect of reality shock that might have been experienced by newly graduated nurses could be obscured in the process of data aggregation involving nurses with 1–4 years of experience. Thus, the adoption of a research design that is more sensitive to the adaptive process of new graduates might have identified differences in perceptions of role discrepancy between less and more experienced nurses. Another reason why both groups of nurses experienced the same degree of role discrepancy might be that experienced

nurses also suffer from reality shock or its chronic form – called the theory–practice gap. As has been mentioned, many participants were educated at university and some were also completing or had completed further education. While experienced nurses continuously engage in professional development and enhance their professionalism, they may perceive that their actual practice does not correspond to such developments. Perhaps a heavy workload and other organizational factors (including cost-containment hospital policies and a hierarchical relationship between doctors and nurses) may be contributing to prevent experienced nurses from achieving their ideal practice. In other words, experienced nurses may be facing difficulties applying their acquired knowledge and skills due to lack of organizational support. An environment that does not reinforce nurses’ professional development could cause a serious problem by inducing chronic experience of role discrepancy and might lead to many leaving their jobs to look for more self-fulfilling work (Takase et al. in press). Our findings suggest that organizations and administrators need to understand nurses’ professional needs and be more responsive to their professional development. When perceptions of the ideal–actual role discrepancy were compared between more and less experienced nurses, there were some similarities as well as differences. Both groups of nurses reported that they experienced role discrepancy in the areas of organizational decision-making and provision of patient education. A study by Blegen et al. (1993) also showed nurses’ experience of role discrepancy in unit policy decision-making. Thus, a lack of participation in organizational decision-making, as opposed to what is desired, might occur in the workplace and this problem should be resolved by appropriate measures (see Drenkard 2001, Thyer 2003). As for the provision of patient education, it is uncertain why nurses perceived more discrepancy in this compared with other clinical roles, such as providing emotional support. One possible explanation could be that the heavy workload commonly experienced by nurses (Hegney et al. 2003, Khowaja et al. 2005) forces them to prioritize roles relating to patient comfort and treatment and to downgrade patient education. Unlike less experienced nurses, those with ‡13 years of experience reported moderate role discrepancy in developing nursing care plans and in the freedom to initiate referrals. It appears that experienced nurses seek more autonomy in their clinical practice, which results in perceiving more role discrepancy in these areas compared with less experienced nurses. These results suggest that the areas of role discrepancy perceived by nurses may differ as they go through the various stages of professional development and additional
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What is already known about this topic
• Many new nursing graduates face reality shock when they begin clinical practice. • Years of clinical experience allow nurses to adjust to their actual roles.

Acknowledgements
The authors thank the University of Melbourne for providing a Melbourne Research Scholarship to support the conduct of this study. The authors also thank the statistical consulting centre at the University of Melbourne for their statistical advice.

What this paper adds
• Both experienced and less experienced nurses perceive role discrepancy. • There are similarities and differences in how lesser and more experienced nurses perceive role discrepancy. • It is important to acknowledge how nurses with different clinical experience perceive their nursing roles so as to retain both young and experienced nurses.

Author contributions
MT was responsible for the study conception and design and drafting of the manuscript. MT and PM performed the data collection and data analysis. MT provided statistical expertise. EM made critical revisions to the paper. PM and EM supervised the study.

References
measures to reduce role discrepancy may be required for more experienced nurses.
Blegen M.A., Goode C., Johnson M., Maas M., Chen L. & Moorhead S. (1993) Preferences for decision-making autonomy. IMAGE: Journal of Nursing Scholarship 25(4), 339–344. Bourgeois A.M. (1991) A Study of Ideal and Actual Professional Role Conceptions of Nurse Administrators/Managers and Staff Nurses. Unpublished doctoral dissertation. Bourgeois, University of Massachusetts, MA; Merritt, University of South Florida, Florida. Abstract retrieved 22 May 2002 from Ovid database. Buchan J. & Calman L. (2004) The Global Shortage of Registered Nurses: An Overview of Issues and Actions. International Council of Nurses. Retrieved from http://www.icn.ch/global/shortage.pdf/ on 12 November 2005. Cohen J., Cohen P., West S.G. & Aiken L.A. (2003) Applied Multiple Regression/Correlation Analysis for the Behavioural Sciences, 3rd edn. Lawrence Erlbaum Associates Publishers, Hillsdale, NJ. Coombs M. & Ersser S.J. (2004) Medical hegemony in decisionmaking: a barrier to interdisciplinary working in intensive care? Journal of Advanced Nursing 46(3), 245–252. Dawis R.V. (2000) The person–environment tradition in counselling psychology. In Person–Environment Psychology and Mental Health: Assessments and Intervention (Martin W.E. Jr & SwartzKulstad J.L., eds), Lawrence Erlbaum Associates, Publishers, Mahwah, NJ, pp. 91–111. Dawis R.V. & Lofquist L.H. (1984) A Psychological Theory of Work Adjustment. University of Minnesota Press, Minneapolis, MN. Delaney C. (2003) Walking a fine line: graduate nurses’ transition experiences during orientation. Journal of Nursing Education 42(10), 437–443. Drenkard K.N. (2001) Creating a future worth experiencing. Journal of Nursing Administration 31(7/8), 364–376. Fitzpatrick J.M., While A.E. & Roberts J.D. (1996) Key influences on the professional socialisation and practice of students undertaking different pre-registration nurse educations programmes in the United Kingdom. International Journal of Nursing Studies 33(5), 506–518.

Conclusion
Role discrepancy may contribute to nurses’ intentions to leave their jobs (Takase et al. in press). In Australia, as well as other countries (including the United Kingdom and United States of America), the shortage of nurses is an issue affecting a number of healthcare organizations and communities (Buchan & Calman 2004). Reducing role discrepancies perceived by both less and more experienced nurses could mitigate the current nursing shortage. In this regard, our findings provide vital information about the nature of role discrepancy perceived by nurses with different amounts of clinical experience and the areas of role discrepancy to be resolved. They also highlight issues that need to be addressed in future studies. One of these is how quickly graduate nurses can adapt to actual clinical practice to reduce the experience of reality shock and what types of strategies they use. Another issue is the ways in which educational institutions could effectively assist nurses to deal with role discrepancy. The last, yet most fundamental, issue is why role discrepancy occurs in nursing practice. Using a quantitative approach, we have illustrated the degree and areas of role discrepancy commonly experienced by nurses working in a variety of healthcare settings. We have also given some explanations for the causes of role discrepancy. However, such explanations need to be scrutinized using more sensitive research approaches. Qualitative research designs, incorporating emancipatory or critical modes of inquiry, would facilitate this line of the investigation and compliment the findings of the present study.
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Nursing and healthcare management and policy Hegney D., Plank A. & Parkerm V. (2003) Nursing workloads: the results of a study of Queensland nurses. Journal of Nursing Management 11, 307–314. Hojat M., Fields S.K., Veloski J.J., Griffiths M., Cohen M.J.M. & Plumb J.D. (1999) Psychometric properties of an attitude scale measuring physician–nurse collaboration. Evaluation & The Health Professions 22(2), 208–220. Joseph D.H. (1985) Sex-role stereotype, self-concept, education and experience: do they influence decision-making? International Journal of Nursing Studies 22(1), 21–32. Kelly B. (1998) Preserving moral integrity: a follow-up study with new graduate nurses. Journal of Advanced Nursing 28(5), 1134–1145. Khowaja K., Merchant R.J. & Hirani D. (2005) Registered nurses perception of work satisfaction at a Tertiary Care University Hospital. Journal of Nursing Management 13, 32–39. Kramer M. (1974) Reality Shock: Why Nurses Leave Nursing. C.V. Mosby, St Louis, MO. Merritt J.T. (1997) An investigation of the validity of Corwin’s nursing role conception scale. Unpublished doctoral dissertation. Abstract retrieved 19 March 2002 from Ovid database. Takase M., Maude P. & Manias E. (2005) Comparison between nurses’ professional needs and their perceptions of their job. Australian Journal of Advanced Nursing 23(2), 28–33.

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