education
Role modelling and students’
professional development
Ian Felstead
T
eaching and learning in health and social care involve
a dual relationship, conducted between two people,
with the majority of learning acquired informally via
role modelling (Charters, 2000).The term ‘role model’
is commonly used in various occupational fields and walks of
life. It is often described as a person who exemplifies behaviour
or a social role for others to emulate (Price and Price, 2009).
A role model is also defined as someone who sets a positive
example and whose attitudes and values are assimilated by
learners (Perry, 2009).
When considering professional socialisation, defined as
acquiring the values, attitudes, knowledge and skills of a
professional group (Roberts, 2008), it is reasonable to question
whether role models are expected to establish and demonstrate
the accepted norms of conduct and behaviour, not just how
to do the job; patients expect to be cared for by nurses who
are not only competent but also behave professionally.
The Nursing and Midwifery Council (NMC) standards for
preregistration nursing education stipulate that professional
values must underpin education as well as practice (NMC,
2010a). It also states that the public should be confident that
new nurses will act with professionalism and integrity, and
that care will be provided in a compassionate, respectful way.
It is therefore imperative that students are educated to develop
the professional qualities necessary not only to enhance the
quality of care but also to meet patient expectations. Adult
nursing students are exposed to many people during training,
so the influences on the development of their professionalism
can be varied and complex.
This article explores the concept of role modelling in
relation to professional development, with particular reference
to preregistration adult nursing education. The intention is to
stimulate debate around issues such as role model identity
and role modelling strategies, with links to teaching and the
curriculum. It is hoped that nurse educators and practice staff
will also become more aware of their status as role models.
Role model identity
Students will have a perception of what they expect a nurse
to do and how a nurse should behave when they start their
Ian Felstead is Senior Lecturer/Pathway Director (Adult Nursing),
Department of Nursing and Applied Clinical Studies, Faculty of Health
and Social Care, Canterbury Christ Church University, Kent
Accepted for publication: January 2013
British Journal of Nursing, 2013, Vol 22, No 4
Abstract
Patients expect to be cared for by nurses who are not only competent
but also behave professionally, so students must be educated to develop
professional qualities. The Nursing and Midwifery Council stipulates
that professional values must underpin education as well as practice
(NMC, 2010a). Much has been written on the qualities of an effective
role model and the potential barriers to becoming one. This article
focuses on preregistration adult nursing education and role modelling,
with a slant towards the development of professionalism, as opposed
to skills competence. Attention is paid to the identity of students’ role
models and strategies for role modelling linked to teaching and the
curriculum. Practice and academic staff have an equal stake in nurse
education; for them to be seen equally as role models, there has to be
a partnership approach to that education. Both practice and academic
staff are able to exemplify behaviours and attitudes that directly
influence the development of professionalism. This article is intended
to stimulate discussion within and between nurse educators and
practice-based staff about the impact their role modelling has on the
development of adult nursing students’ professional practice.
Key words: Role model ■ Students ■ Preregistration education
■ Professionalism
programme. This may influence who they choose as a role
model and influence their professional development. The
primary individuals students meet are the academic staff at the
university, practitioners in practice placements and peers across
the theoretical and practical aspects of the course (Figure 1).
Practice staff
Much of the literature around role modelling by practice staff
is associated with skills development and clinical competence,
as opposed to the development of professionalism. Many
definitions of role modelling in the healthcare professions
equate effective role models with senior staff (Perry, 2009).
Lewis and Robinson (2003) found in their study of student
radiographers that the top nominations for workplace role
models were staff in chief positions and believed this related
to senior staff being ‘prominent demonstrators of clinical skills
and professional conduct’.
There is, however, an issue regarding whether these staff
have the capacity to model behaviour for all students (Perry,
2009), given their small number and large remit. This creates
the potential for a dissemination approach, whereby senior
staff role model to junior staff who then facilitate students’
development (Figure 2). This would ensure that professional
223
Senior staff
Junior staff
Nursing student
Figure 2. Role modelling continuum
Practice
staff
Student
Academic
staff
Fellow
students
from a variety of sources, such as nurses with whom the
student has worked. The student’s self-evaluation can also be
used. This could be expanded to include feedback from peers
and patients. A potential benefit is that students may feel
more confident to develop professional attributes not seen in
their assessor but in others, in the knowledge that they will
be assessed following feedback from these people. On the
downside, using this method of feedback to inform assessment
may generate conflicting opinions, making it difficult for the
assessor to determine whose feedback is accurate.
Much of the literature on role modelling in nursing concerns
learning in the practice environment. This potentially has a
negative impact on the 50% theory:50% practice nature of
preregistration programmes as regulated by the NMC. The
fact that many authors focus on the idea that the ideal setting
for students to learn nursing is the practice environment may
do a disservice to their academic colleagues who, through a
partnership approach, are responsible for half of the students’
education and development as professionals.
Academic staff
Figure 1. The main people students meet
behaviours are passed on from senior staff.
All preregistration students should be allocated a mentor
when on a practice placement (NMC, 2010a). The mentor’s
role is to facilitate students’ development within the practice
environment and assess their competence (NMC, 2008).
However, role modelling practice and professional behaviours
while judging/assessing a student create a potential conflict.
Often students want to fit in, so will not challenge their
mentor if they see behaviour that conflicts with their sense
of professionalism, instead choosing to emulate it. A positional
hierarchy in practice influences the effect of role modelling.
Bandura (1977) asserts that how much the observer learns
from an experience depends on the incentive and motivation
to learn. Students may view the process as ‘my mentor is
assessing me, so I should follow their example and do as they
do’. This is despite possibly having to emulate behaviours that
might be contrary to their beliefs or sense of professionalism.
Students are taught that nurses should challenge practice and
that they should begin to develop these critical skills during
academic studies and clinical placements. However, if they
see themselves as ‘the student’, they are unlikely, unless of a
particularly assertive nature, to question what they see.
Attempts to minimise this paradox using a 360° feedback
process are already in place in many areas. This is where
feedback comes from an individual’s immediate work circle,
as opposed to the traditional top-down appraisal (Chartered
Institute of Personnel and Development, 2012). To shift the
responsibility for assessing the student away from a single
mentor—as well as affording the opportunity to gain better
information on skills and performance—feedback is collated
224
Initially, student nurses’ role models are academic staff (Pfeil,
1997) but, as they progress towards registration, the focus
moves to nurses working in practice. This does not hold true
with the notion that students enter the programme with
a fixed idea of what nursing is and what they aspire to be
(Chow and Suen, 2001), which would lead them to view
nurses in practice as very different from university staff.
Role theory suggests individuals perceive their identity
in relation to groups with whom they identify closely in
terms of roles (Illingworth, 2006). This means students may
not think of academic staff as role models, as they may not
be seen as nurses. This is despite the NMC requirement for
all academic staff to engage in practice (NMC, 2008; 2010a),
which students may not be aware of. Certainly, difficulties
arise when academic staff are viewed as being distant from
the practice of nursing, particularly in terms of credibility.
With the move of nurse education away from schools of
nursing into higher education, the responsibility for clinical
supervision fell to mentors working in practice (Chow and
Suen, 2001). It is conceivable that separating the theoretical
and practical aspects between clinical settings and universities
has perpetuated the idea that academics are not role models
for students because of their perceived distance from nursing.
Lown (2007), however, states that the ability to act as a role
model to students stems from the responsibility to teach a
programme with academic and practical components. This
depends on how much practical component is taught in the
university by academic staff. When clinical skills are taught in
the academic setting, this could encourage students to view
academic staff as clinically credible, particularly if this is the
students’ only experience of nursing practice.
However, while role play of clinical scenarios in an academic
setting enables academic staff to exemplify desired behaviours,
much of this is aligned to the development of psychomotor
British Journal of Nursing, 2013, Vol 22, No 4
education
skills. Expanding this to include role play of professional
behaviours could enhance the credibility of academic staff,
provided that these behaviours are replicated during practice
learning opportunities. Furthermore, the development of
more practice educator or lecturer-practitioner posts could
help integrate theory and practice, and improve the credibility
of academic staff. Lecturers have difficulty in being seen as
clinically credible by some students if they are not engaged in
what students see as ‘real’ nursing. This is particularly relevant
when nursing is compared with medical training, where the
vast majority of tutors are practising doctors.
Ottewill (2001) examined undergraduate business education
to establish the role of tutors in higher education. He found
tutors hold a position that allows strategic modelling of
the attributes expected of graduates by employers. There
was a focus on professionalism in its widest sense and the
ability to ‘fit into the work culture’. Whether this holds
true for nursing education is questionable, given academics’
limited engagement with practice discussed above. There
is also the consideration that working in a practice setting
exposes students to situations that cannot be replicated in a
classroom (Pfeil, 1997), which inhibits some of the students’
occupational experiences. What also needs to be considered
is that when students become immersed in a culture, they
may replicate all practices that they witness, good and bad.
The need to feel as though they fit in with the team and
get on with their mentor/supervisor potentially limits their
ability to discern what is unacceptable and report this via the
university’s raising and escalating concerns processes. This is
particularly relevant if the role model is the practitioner who
will be assessing them.
Teacher education, on the other hand, is unique in that
educators not only teach their students about teaching but
also, through their own teaching, model the role of the
teacher (Lunenberg et al, 2007). The authors make a direct
comparison with medical education, stating that doctors
who teach medicine do not serve as role models, as they
do not ‘treat’ their students. When we align this to nursing
education, it is then we identify that academic staff teach
about nursing practice but do not role model the actual
practice of nursing. Practice-based nurses, on the other
hand, are able to role model the practice of nursing but their
teaching role in relation to the theoretical underpinnings of
practice is less. This perhaps automatically leads to practice
staff being viewed as role models by nursing students but to
the potential detriment of the theory behind the practice.
The nurses’ role is, however, an amalgam of education and
professional socialisation in the practice setting (Illingworth,
2006) and therefore both practice and academic staff should
be seen as role models.
Student role models
Charters (2000) maintains that much of his nursing socialisation
and behaviour was not learnt at his school of nursing but by
observing others in practice. His role models were the thirdyear students and staff nurses he worked with during training.
He does, however, state that he ‘watched and copied’ them,
which rather diminishes the concept of building one’s own
professional identity and role. After all, the aim is not to create
British Journal of Nursing, 2013, Vol 22, No 4
‘clones’ but to stimulate a desire on the part of students to
become role models in their own right (Ottewill, 2001).
In a study examining the role of fellow students in practice
learning, seniority influenced who students chose as role
models (Roberts, 2008). As well as practice skills development,
there was an overwhelming sense of ‘learning the ropes’ from
fellow students; however, there is a disparity here, as the
length of time in an area appeared to be more important
than seniority when related to professional socialisation.
Roberts (2008) found that elements of socialisation are not
‘taught’ by mentors, as it is expected students will just ‘know’
the cultural rules of the qualified staff. It is here that new
students will pick up cues from fellow students to help them
integrate into the team. This leads to the conclusion that a
buddy system may be effective in integrating new students
into the practice environment. Certainly, fellow students
can act as role models in regard to socialisation. The NMC
essential skills clusters extends this to stipulate that, at entry
to the register, newly qualified graduate nurses must be able
to act as an effective role model in decision-making, taking
action and supporting others (NMC, 2010b). These skills
must therefore be developed and demonstrated during their
educational programme.
Multiple exposures
There is much debate regarding the influence of multiple
exposures. This concerns whether students take examples
from many people to build their professional identity or if
there is an element of singular association. It is during their
programme of study that students gain an insight into nursing
then progress to a deeper understanding of it. Bandura (1977)
maintains that reinforcement influences whether certain
behaviour is adopted but this causes problems when students are
exposed to differing practices or behaviours in similar practice
situations. The nature of an adult nursing preregistration
programme with the multitude of competencies that students
are required to achieve and the requirements set out in the EU
Directive 2005/36/EC, regarding the variety of instruction
required for adult nursing students, necessitates frequent
moves between practice settings, which limits reinforcement
from one person.Within other fields of practice, the influence
of role modelling on student development is affected by
placement patterns. The provision of a ‘base placement’ that
the student returns to on a regular basis during training (for
example, in children’s nursing) or the allocation of particular
clients (for example, in learning disability nursing) will have a
different, and presumably positive, impact. The primary focus
here, however, is on the education of adult nursing students
and how different placements provide different role models,
and these students need to be able to identify aspects relevant
to their development.
Students should be encouraged to work with a variety of
people and observe their approaches, abilities and conduct, to
enable them to develop their own professional practice. This
is supported by Bandura (1977), who indicates that learners
develop skills and behaviour patterns from their experience,
as opposed to a single modelled behaviour. It therefore
seems feasible that students will home in on the elements of
professionalism that fit their notion of a nurse and develop
225
their practice accordingly, and these could be from anyone
they come into contact with. Donaldson and Carter (2005)
concur, stating that observers rarely pattern their behaviour
after a single source, preferring to adopt different aspects
and characteristics from a variety of models. This introduces
the concept of collaborative working and whether a team
approach can influence a person’s professional development.
When relating this to the issue of students following
their primary mentor’s example, given that mentors assess
competence, it can be seen that there is a benefit in students
being exposed to several role models. This, however, needs to
be guided by the theory of professional practice, to enable
students to differentiate between the reality of practice and
what would be considered as the gold standard. Students may
see behaviours and conduct that, while commonplace, are
not ideal. Theoretical input concerning best practice through
reflection, for example, could allow students to explore these
differences and become more discerning.
Role modelling strategies
Role modelling is often implicitly taught by example, with
students unconsciously modelling nurses’ practice. Cruess et
al (2008) maintain that as human beings we model ourselves
consciously and unconsciously on individuals we trust and
respect and aspire to be like.
Embodying a role—or just playing it
It is argued that role modelling should be explicit and is
only effective when well planned and conducted with clarity
(Price and Price, 2009). Specific role modelling sessions
where issues can be switched ‘on and off ’ when the session
starts and ends have been suggested. Pang and Wong (1998)
say that model emulation should be a structured activity to
ensure that behaviours indicative of professional nursing are
brought to the students’ attention.
Cruess et al (2008) state that awareness of being a role model
Key points
n
Adult nursing students are educated to develop professional qualities
to ensure they not only provide high-quality care but also meet patient
expectations.
n
A top-down approach from senior practice staff to student nurses should be
used to disseminate professional practice.
n
A 360° feedback process could move the responsibility for assessing a
student away from a single mentor. This would enable students to build
professional practice from a variety of sources, instead of feeling they should
emulate the behaviour of their assessor.
n
Nursing combines education and professional socialisation in practice, so both
practice and academic staff should be seen as role models.
n
Adult nursing students should not be taught to play a role but learn how to
embody the nurse’s role and be professional in all they say and do.
n
Students should be encouraged to learn from a variety of academic and
practice staff, guided by theory, to develop their own professionalism.
226
can improve the process and Wright and Carrese (2002)
identified that physicians consciously think about being
role models while interacting with students. This concept is,
however, contentious. Awareness and planned activity give
the impression of something false, and could influence role
modelling behaviour. It could be argued that the student is
not seeing an honest reflection of the practitioners’ attributes
if they are aware they are being watched. Kenny et al (2003)
said professionals were ‘embodying’ not ‘playing’ a role.
Making role modelling conscious, for example where the
role model is modelling a particular behaviour, gives the
impression of showing the learner how to play a role. If a
role model embodies role, just carrying out that role should
demonstrate behaviours that the learner should emulate.
Prior warning
There is an element of whether learners should be advised
in advance that they will be expected to model teachers’
behaviour. Bandura (1977) maintains that prior knowledge
increases the attention of the observer.This is advantageous in
motor skill development. When considering professionalism
in respect of conduct, behaviour and attitude, this should
be implicitly modelled through all interactions. Students
should observe the conduct of a professional without prior
discussion of what to observe; this is sometimes referred to as
‘silent’ modelling. However, given that an interaction could
have a number of interpretations, the role model’s values and
justification must be clear to the learner. This is an argument
for structured role modelling in that, without a defined
learning opportunity, the student may learn but not have the
opportunity to interpret the situation fully (Charters, 2000).
An opportunity to reflect and discuss the intricacies of the
experience at the end of a day would go some way to address
this issue.
Role modelling is a very powerful educational tool that
can be used to teach the ‘real world’ of nursing. Can this be
true if role modelling sessions are planned? Nursing work is
often unscheduled and learning in the practice setting is often
spontaneous in response to patient requirements (Charters,
2000). Learning how to react in those unscheduled times is
vital and not necessarily something that can be recreated.This,
again, would appear to be more role play than role modelling.
Role modelling and the curriculum
The moral sense of nursing cannot be taught but can be
caught (Pang and Wong, 1998). There is a general sense in
the literature that role modelling is a basic component of
the educational process (Ettinger, 1991). Students learn by
following the example of their educators. Those educators,
who are afforded respect by nature of their authority, are able
to influence the development of students’ skills, competence
and professionalism. The intricacies of professionalism are not
necessarily outwardly discussed and debated but exemplified
through the educators’ behaviours, actions and attitudes. The
downside to this is that when someone in authority displays
negative behaviours, these could be considered as acceptable
professional responses and emulated by the learner. This in
turn becomes a reflection of the profession that forms the
students’ view (Ettinger, 1991).
British Journal of Nursing, 2013, Vol 22, No 4
education
In their study of physician role models, Wright and Carrese
(2002) maintain that these people foster professional values
in trainees—specifically attitude, behaviour and ethics—and
exemplify a ‘standard of excellence’ that learners should
imitate. Illingworth (2006) agrees and makes the distinction
that while competence is an important aspect of the role
and is enhanced through professional development, role
modelling is also important for changing attitudes.
The contextual elements of curricula are well documented
in the literature. The formal, informal and hidden curricula
have a varying impact on role modelling (Cruess et al,
2008). The formal preregistration curriculum is set by the
NMC education standards and competencies (NMC, 2010a).
Learning within this sphere appears to be heavily influenced
by the enthusiasm and commitment to learning and teaching
by tutors. This has been evidenced by student evaluation
where statements such as ‘the tutor was motivated and
enthusiastic, making us want to learn’ are relatively common.
The informal curriculum is arguably most aligned to
role modelling and, more specifically, the development of
professionalism. It is highly interpersonal and very powerful
(Cruess et al, 2008). The informal curriculum concerns
the elements of a role that can be observed but are not
explicitly defined, such as behaviour, attitude, values and
communication, so is closely linked to attitudes in the
delivery of the formal curriculum.
Organisational and/or cultural influences lead to the
hidden curriculum, which is often defined as unintentional
learning. An example of this is where work pressures in
practice areas limit the time available for staff to spend with
students (Hopkins, 2000, cited in Pellatt, 2006). This could
lead to compromised supervision of students, as this may be
rushed. Despite this, the most appropriate way for students
to learn what it means to be professional is to see this in
action. The didactic nature of teaching in universities makes
it difficult for students to see professionalism and expectations
in a meaningful way (Ettinger, 1991). This is not to negate
the vital aspects of learning that take place in academic
settings, such as graduate skills, critical thinking and research
awareness (Perry, 2009).
Within universities, the way that business is done has
much influence. Tutors set expectations of work patterns and
behaviour that will potentially influence the development of
the students’ professionalism. A culture of starting work early
and finishing late and answering emails in the evenings and at
weekends, for example, serves to demonstrate that this is how
a professional is expected to deliver services, when these may
be unrealistic expectations. Lown (2007) says that the primary
objective of the staff in her faculty is to develop behaviours
that reflect the highest professional standards. Academics
often find it difficult to teach professional behaviours, but it
is maintained that it is their actual behaviours that teach more
to students by way of role modelling.
Conclusions
This article hopefully provides some food for thought around
role modelling and how it may or may not influence the
development of professionalism in nursing students. The
intention is that the ideas presented will stimulate discussion
British Journal of Nursing, 2013, Vol 22, No 4
within and between academic and practice-based staff, raising
awareness of role modelling and its influence.
Several people influence the development of professionalism
in student nurses. Recommendations include:
■■ Guidance by academic staff, by way of theoretical input,
should be provided to steer students in the right direction
and encourage them to draw on elements from several
people to build their own professional identity.
■■ To remove the incentive to simply follow what their
mentor does, a 360° feedback process should be introduced
by practice staff, if this is not already in place.
■■ A buddy system should be considered to assist students’
integration into the practice setting and allowing them to
concentrate on developing their professional role.
Further debate is needed on whether role-modelling
should be a conscious activity where the student is told
in advance that they will be expected to follow someone’s
example, as there are strong arguments to support and reject
this approach. This contentious issue has the potential to
form the basis for a research study examining the outcomes
of conscious versus unconscious modelling. Further research
could also be conducted to examine the influence of varying
practice learning experiences across the nursing fields on the
BJN
development of professionalism.
Conflict of interest: none
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