Participants in this study shared their experiences of educational discrimination. During data analysis, three themes and 10 subcategories appeared. The extracted themes and classes focus on the reasons that are caused nursing students to feel discrimination, which is described below (Table 1).
The extracted themes and classes focus on the reasons that are caused nursing students to feel discrimination
Inappropriate role of nursing professors (or instructors)
Discriminatory behavior by nursing professors (or educators)
Lack of sufficient self-confidence in nursing professors and its transfer to the student
The educator role in motivating or eliminating motivation
Inequality in supervising and implementation of rules among students of different disciplines
Differences in compliance with laws and regulations
Nurses are being strictly monitored
Lack of nursing professional independence
Lack of nursing authority
Lack of supportive organizations for nurses
Lack of proper social status of nursing in society
The high authority and power of physicians over other disciplines
Theme 1: inappropriate role of nursing professors (or instructors)
1.1 discriminatory behavior by nursing professors (or instructors)
In this regard, many students considered the reason for the feeling of discrimination is the behavior of their professors with students who are all on the same level in terms of seniority (both in the field of teaching theory and in the field of clinical education in the hospital). Regarding this theme expressed one of the participants:
“At the beginning of the classes, after entering to the nursing faculty, the professor said: You had a very bad last year and you were not successful at all, and it made you come to a field (nursing) that is not a good job for your future at all …". Because one of his own children is studying medicine. (Participant number two).
Some students believed that the behavior of professors in the theoretical and clinical classes was different and sometimes even contradictory. For example, a student said, "it is written in nursing textbooks that a nurse should first, have a strong relationship with the patient so that he or she is comfortable. So, the lessons and rules give us that authority. but I personally went up to one of the patients and greeted him warmly. Then the professor came and said why did you become intimate with the patient? ... Go very formally, ask questions and come back ...." (Participant number two)
1.2 Lack of sufficient self-confidence in nursing professors and its transfer to the student
Many students believed that their instructors do not have enough self-confidence and authority in the internship environments and show weakness in the face of medical students and their professors, which cause others to dare to discriminate between nursing students and other disciplines. In this regard, a student said:
" If a fellowship comes in the patient’s room with their students, our instructors tell us -in front of the medical students- to go out and we will come back later. They tell us not to argue, the room is for them (medical students).
Another student said:” It is upsetting that if while we’re using a classroom and medical students also want to use the room, they have the authority to make us leave the class, and our instructor is not so confident to not let this happen! “(Participant number seven).
1.3 The educator role in motivating or eliminating motivation
Students stated that instructors have an important role in motivating students and make them to work and study more enthusiastically, but unfortunately in many cases they are being compared with medical students and this causes them to lose motivation and self-confidence to continue their education and feel ashamed of being a nurse.
In this regard, a student said: "We were in the second semester … Our professor told us, what field would you like to learn more about? Ask me some questions about it. Some students said that we would like to know more about pharmacology, so that if a doctor ordered a medication, and we thought that the medication interfered with another or it was not appropriate, we could mention it to them or we would like to be so good to know what is good for the patient now and to do it ... The instructor said: you never can do that... (Participant seven).
In addition, another student said, "One of the professors said: each of you who does not like nursing has to go and study medicine. I think medicine is much better!' (Participant five)
Theme 2: Strict rules
2.1 inequality in supervising and implementation of rules among students of different disciplines
Violation of the rules by medical students and failure to deal with them, lack of supervision of medical students, excessive supervision of nursing students, failure to comply with the rules in the field of medicine, etc. were cited by many students as a source of discrimination. For example, a student described his experience of discrimination in this regard: "There is no rule for medical students. There may be rules, but there is no supervision on them. They go to the hospital anyway they want. Sometimes they do not even wear a uniform"(participant five).
2.2. Differences in compliance with laws and regulations
The participating students believed that the level of compliance with university rules and regulations and the clinical environment of hospitals were not the same simply because the disciplines were different. A student considered the extent of compliance with hospital rules and regulations not only in their dressing code, but also in the hospital's clinical regulations and communication with the patient, saying: "For example, a medical student can talk to patients in any way they want and they have the right to treat the patient as they wish, but if nursing student greet warmly with patients, they will face punishments from their staff and trainers" (participant two).
2.3 Nurses are being strictly monitored
The students stated that so many rules and regulations for nurses and nursing students have been defined in detail and that non-observance of them has bad consequences that it seems that this group is under a microscope! One student described his experience as "from the very beginning there are certain rules for nursing that do not exist for any other field. For example, the length of the uniform should be that inches below the knee or be so loose; pants should not be jeans at all; the fabric of the pants should be either black or blue, etc.… Everybody can understand from the student's appearance what field they are, nursing or medical?! "(Participant two).
Another student said, "Doctors are not strict at all, and that in itself is discrimination" (participant six).
Theme 3: Lack of nursing professional independence
3.1 Lack of authority
Doctors' interference in nurses' affairs and nurses' non-objection, being dependent on the doctor, reducing the quality of nursing care due to the nurse's unquestioning obedience to the doctors, etc., were all points that students mentioned and will eventually lead to feelings of discrimination.
One student said: "if nurses object to the doctors, in many cases, it has very bad consequences for them, so look, we do whatever they say... and whatever the doctor orders, we do... and what does this mean? It means that the genius of the nurse goes blind "(participant seven).
3.2 lack of supportive organizations for nurses
The students said that another factor that causes nursing to lack a proper professional independence and as a result suffer a lot of discrimination from others, are their lack of support for each other.
In this regard, it can be attributed to factors such as the feeling of futility of nursing liability insurance, lack of defense support for the nurse, consider a low worth of the nurse's work even in the nursing system, different behavior of even nursing staff with nursing students in front of medical students, not appreciating the work of nursing students, etc.
A student complained about the behavior of nursing staff towards nursing students, saying, "Even nursing staff do not respect us, they don’t consider us as their future coworkers" (participant four).
3.3 Lack of proper social status of nursing in society
Students consider that one of the things that causes discrimination is the lack of a proper social position for nursing in society and the view of all people. Regarding the role of the media in creating a negative attitude towards the nursing profession, one student said: "In TV movies, nurses are always changing sheets, or saying yes to doctors’ orders...! Or even in the novels I read the doctor is always in a superior position, but the nurse always is insulted! these things change the people’s attitudes towards nursing”.
The same student commented about the negative attitude of people in the community, including patients, towards nurses: "It means that when you tell patients that I am a nursing student, they will not answer you anymore ... but if a doctor comes, everyone will respect them" (Participation Nine).
3.4 The high authority and power of physicians over other disciplines
Another factor that has reduced the authority and professional independence of nurses is the high authority of medical practitioners in the Iranian society, which has led to a sense of superiority over other disciplines. A student said: “I heard it myself that a nursing supervisor objected to an intern medical student. But what happened eventually?... The nursing supervisor went to the head of the hospital and apologized" (Participant seven).
Or another student said: "A nurse in the hospital cannot show genius and creativity in any way; even if it is true, the head nurse or the supervisor says: how dare you to interfere in the treatment of the patient?" (Participant 15). " But in other countries, multidisciplinary teams are gathered including a nurse and decide for the treatment of a patient”,", he added "Such things will not happen in our society (Iran) for another thousand years! Because there is only a medical commission and they do not consider the nurse, even if she has a lot of knowledge" (participant seven)